12 Strategies to Improve Your Job Negotiating Skills

Koushik Shaw, MD


August 09, 2019

Editor's Note: This article was adapted and updated from the Physician Business Academy course "Finding the Right Physician Job" by Koushik Shaw, MD. Additional reporting by Gail G. Weiss.

Negotiating your employment contract can be nerve-racking. Once you sign the contract, there's no going back. "The most intimidating thing I had to do during my residency and fellowship training had nothing to do with patient care. It was negotiating my first employment contract," a physician wrote in a blog[1] for the American Academy of Family Physicians.

The best way to deal with your contract is to take a serious, balanced approach. Read it carefully, and have a healthcare attorney read it too. If you find problems, ask for reasonable changes.

According to Steve McMahan, president of the national healthcare staffing firm CompHealth, "Common things to negotiate are salary, sign-on bonuses, and restrictive covenants. The point here is to keep it to limited changes. If you create an endless back and forth, the employer may see you as too much trouble and pull the offer."

Will Employers Negotiate?

The size of the facility may limit how much an employer can negotiate. As McMahan notes, "Large healthcare institutions may be less likely to agree to changes if they think it sets a precedent they don't want to follow."

Some large organizations insist on standard contracts and refuse to change even a comma. Smaller practices may be more accommodating, but if they're in a highly competitive market—such as a large metro area, where they can expect plenty of other candidates to apply for the job—they often stick to their guns.

"People often think of such places as Boston or Los Angeles as having high salaries to go along with the high cost of living," McMahan says. "However, healthcare is different from most other fields in that you often see big disconnects between cost of living and wages. For example, because of demand, hospitals in Boston are likely to pay physicians less than that same physician would make in a small town in the Midwest with a 30% lower cost of living."

The main reason that contracts are signed without changes is that many physicians don't want to go through the bargaining process. You can keep the stress to a minimum by familiarizing yourself with the process and planning ahead.

Prepare for Successful Negotiations

1. Screen out problem employers. This is the time to listen to your gut. Does the employer seem fair, and does the job seem stable? If not, reject the job offer and move on to a new prospect.

2. Have an advocate in the organization. One reason to establish rapport with the people who interview you is to turn them into your advocates. Then, when management is weighing your requests for contract changes, your internal advocates will urge the administrators to at least partially accommodate you.

3. Bring up unusual requests early on. For example, tell people during the interview stage that you prefer a 4-day workweek. If they agree, get it in writing. Oral assurances mean nothing.

4. Hire an attorney. Don't try to review the contract on your own. Attorneys with expertise in physician contracts can zero in on potential pitfalls that might never have occurred to you. Also, they usually know reasonable salary levels, how to negotiate changes, and which provisions can—and cannot—be revised. Jonna D. Eimer, a physician contract attorney in Chicago, states, "You might not always obtain the changes you want, but your attorney should ensure that you understand what you are signing and there are no surprises in the contract."

Hiring an Attorney: 3 Critical Questions

When should I hire an attorney? Do this early in your job search. A contract offer could come up unexpectedly, and you need to be ready.


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