The Shift from Training to Employment: Managing Initial Career Contracts

For more than thirty years, I have advocated for physicians, and each year I remain astonished by the perspective of numerous budding doctors as they step into their inaugural attending positions. These individuals, among the most clinically adept globally, frequently underestimate their value despite entering a marketplace marked by a significant physician deficit. One might expect that such skilled professionals would confidently negotiate advantageous conditions, yet many shy away from requesting even typical terms—be it the average signing bonus, guaranteed pay, or constrained call obligations. A commonly heard sentiment among them is the apprehension of forfeiting the job offer.

This mindset evokes images of an exaggerated scenario—a long line of doctors waiting at an employer’s entrance, where the employer sternly warns them to appreciate the opportunity. Nevertheless, this depiction strays far from the truth. The physician shortage is urgent and escalating; employers are driven, often having struggled for years to fill vacancies. Yet, young doctors, weighed down by significant educational debt, frequently voice worries stirred by recruiters who assert that the “standard contract” is non-negotiable—a claim that may ring true from the recruiter’s viewpoint but does not encompass the entire reality.

Typically, while recruiters may lack the power to amend agreements, the organization’s legal or departmental leaders can accommodate sensible adjustments. Just because a contract is standard doesn’t imply it’s unmodifiable for everyone: physicians who attain the attending designation have triumphed through fierce competition at every stage of their training. However, this competitive mindset requires adjustment once an offer is extended. At that moment, the physician becomes the coveted asset. Employers have poured substantial resources into selecting a candidate, forgoing revenue-generating patient consultations during the selection phase, and they are unlikely to risk their preferred choice over standard contract terms.

In light of this situation, it’s crucial for newly minted physicians to stand up for themselves, realizing that contract negotiation is not a continuation of former competition but instead securing equitable terms in a role for which they are already chosen. The reluctance to seek modifications is a prevalent error; the essential task is not to stay competitive but to guarantee the employment agreement mirrors both their worth and dedication to the role.

I have observed that when young doctors provide legal input, most employers react favorably—they perceive this as a robust indication of interest in the role. Additionally, when negotiating for private practices in the past, practice owners often expressed satisfaction at seeing prospective associates engage legal counsel, viewing it as a sign of commitment and involvement with their forthcoming career transition.

To summarize, as they embark on their initial attending position, young physicians must shift from perceiving themselves as competitors to understanding their value as desirable hires. Secure a fair contract with an employer who has already selected you, ensuring that the conditions are advantageous and reflect the substantial financial and personal investment that becoming a physician requires.

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Dennis Hursh, a knowledgeable attorney with over 40 years of expertise, operates Physician Agreements Health Law, focusing on the evaluation of physician employment contracts. His published work and presentations serve as invaluable resources for doctors striving to adeptly navigate the legal intricacies of employment arrangements.