I recently completed a 5 year, surgical subspecialty residency and am now a hospital-employed attending. After a fairly long search process for my post-residency position, I landed on the opportunity that I wanted to pursue towards the end of my PGY4 year. I had my dream job picked out, and after a final round of interviews, had my new contract in hand. What next? I looked over my contract and saw ample vacation time, reasonable call coverage, a monthly residency stipend and signing bonus, as well as a yearly salary that dwarfed my current resident pay. I wanted to sign it right away and start to prepare for the next phase of my life, but I knew from previous senior residents that I should take the time to have a lawyer look over my contract.

Process of Finding A Contract Lawyer

The first thing I did was to speak with my mentor at my residency program. She was currently hospital-employed at an academic institution, but had worked in private practice for a number of years. I asked her to review my contract and see if there were any glaring issues or omissions. The main thing that she pointed out was the lack of guarantees for equipment or personnel support. Her advice to me was that this may be the only chance I get to guarantee certain purchases from my institution. It is a lot harder to ask for a brand new medical device 2 or 3 years into a contract rather than at the outset. My future employer and I had discussed building out several service lines, but the contract did not stipulate that they need to purchase the necessary equipment or provide support in clinic and the OR. I made a list of the main things that I would need and made sure to include it when proposing a counter offer.

The next step I took was to speak with several of my previous senior residents regarding the specific names of contract lawyers that they had used. I found a number of lists online, but many of these seemed to be paid advertisements, so I was unsure about their legitimacy. I heard the same name a few times and decided to reach out to Contract Diagnostics (and no, this is not sponsored by Contract Diagnostics). They offered straightforward packages with flat pricing and were very responsive. I found their pricing to be reasonable and completed an initial consultation with them (I would suggest reaching out to several companies to compare pricing, but I immediately liked the agent assigned to my case and decided to move forward with them). Upon signing my contract, with the contract lawyers, I paid just over $200 upfront and $101 per month for the next 5 months, totalling $710. This was for their ‘Advanced’ package. 

Physician Contract Review Process

Contract Diagnostics provided a written review of my contract within several days, covering everything from Duties of Employer and Employee to Compensation, Benefits and Termination. They highlighted items considered to be standard as well as potential gray areas that needed more clarification. An example of this would be a clause that stated I would receive a bonus per APP supervised, but did not stipulate whether the hiring of an APP would require my approval. They also provided a comprehensive Compensation Data Report based on my specialty. This included average pay for my Region, State, First Year Physicians and Established Physicians, as well as percentiles for Call Coverage Compensation. This was based on their own internal data, and they included several anecdotal comparisons based on the exact terms of my contract and employment. 

Following the written review, I was given several days to review on my own and we scheduled a virtual meeting to discuss further. I left the meeting with some of the following questions to ask my future employer:

• What resources will be available for the future service lines that we plan to build out?
• Could they increase my signing bonus and resident stipend (and how is it taxed)?
• Would they guarantee that no other newly hired physician would have a higher RVU rate than me, or if so, will they increase my contract to match?
• Is there a cap on the number of days that I would need to cover unattached call?
• Are there protections in place if new locations or outreach clinics are added to my coverage?

These were just some of the questions that needed to be answered before I signed my contract, but the process really helped me think through a number of potential scenarios that I had not originally considered. Contract Diagnostics did offer a package that would allow them to negotiate the contract on my behalf, but given that I was not asking for any major changes, I decided to do it myself.

After the review meeting, they followed up with another written summary of our conversation, as well as several other resources surrounding Benefits and Compensation Q&A’s. I felt that I was ready to make my counter offer, and prepared my updated contract.

Negotiating My Physician Contract

I set up a phone call with the leadership team at the hospital and had my notes prepared based on my initial contract review. I started with the straightforward pieces of the contract, mostly pertaining to compensation. They seemed amenable to what I was asking for, and I was told they would review and respond within a few days. We then moved on to the other questions that I had surrounding my contract. I was given assurances on my call coverage and we discussed the resources and equipment that would be made available to me. As they were unable to guarantee specific makes/models of certain pieces of equipment without first contacting the associated companies and discussing with the Finance department, we agreed to include language that would detail the types of equipment and support that I needed, but left with the understanding that I should be provided with everything I need given their necessity in clinic or the OR. 

After our meeting, they presented me with a new version of the contract. I again had my mentor look over the new version and felt satisfied that my demands had been met. They increased the total amount of my resident stipend as well as the signing bonus (which was broken into 2 payments – part at signing and part once I was credentialed at the hospital), and made clear my duties involving call coverage and expansion of service lines. 

Signing My Final Contract

To give some context to the type of contract that I ultimately signed:

• 3 year contract
• 2 year guaranteed base salary with opportunities for small production based bonuses
• Resident stipend (I signed over well over a year before my start date) and signing bonus
• 3rd year uncapped RVU based compensation model with base salary equal to 75% of 2nd year RVU production

Things I Would Have Done Differently

Overall, I am very happy with the result of my contract and have no plans to change my employment any time soon. But there are several things I would have done differently, knowing then what I know now.

1. I should have been more expansive in my demands for certain equipment. I operate in both an outpatient center and in the main hospital OR, and while most of my equipment lives in my clinic or the outpatient center, the hospital did not initially purchase extra sets of equipment for the main OR, often causing issues during weekend call coverage or unscheduled cases. As predicted by my mentor, it has become increasingly difficult to procure new equipment as my employment has continued.
2. In the final version of my contract, the RVU rate was slightly lowered due to updates from the CMS (who sets rates nationally). These rates are non-negotiable, but I did not take into account the trend of decreasing RVU rates. What I had predicted as the full salary for my 3rd year of employment may end up being less based upon lower RVU rates. It is possible I could have asked for more of a sliding scale compensation model. I am not unhappy with the base salary + RVU model that I signed, but likely the number of RVU’s needed to meet certain nationwide percentiles for my specialty will have increased by year 3.
3. Related to this, I should have asked for more data regarding typical RVU values for certain CPT codes. As a resident, we are all generally aware of billing and the RVU model, but rarely get to see behind the curtain and get the chance to fully understand how each of our attendings is compensated. I might have asked them to provide an example of a typical day in clinic or the number of RVU’s associated with some of the more common surgical cases I perform. In speaking with my mentor, I was assured that the total number of RVU’s quoted in their benchmarking data was accurate, but I did not have a great sense of exactly how much work it would require to meet those demands until I actually started.

Hopefully this helps provide a glimpse into the actual process of negotiating your own physician contract for your first job out of residency. Of course every institution, specialty, and location will have its own unique things to consider, but I have found that this level of detail is rarely shared with current residents. You should absolutely confer with your mentors and former senior residents to get recommendations and pick their brains, but I would highly recommend hiring a contract lawyer as well. While there is some upfront cost associated with it, I found that the benefits far outweighed the cost.