Negotiating your first post-residency job contract

By Jules Murtha | Fact-checked by Barbara Bekiesz
Published April 20, 2022

Key Takeaways

  • In addition to salary, new physicians can consider a workplace’s  location and culture—as well as their skill set and future goals—when securing that first job.

  • When you negotiate your first contract, ask for more than you want—then you’ll have room to give up less-important conditions and preserve what really matters.

  • Remember: Keep your worth in mind when negotiating. There are not enough physicians to cover increasing demand.

If you could design your first contract, what would it look like? What schedule, income, and benefits would you want? These are important questions to consider at this stage, since you do have a say—even as a young doctor.

Many doctors may not be well-versed in negotiating contracts, as noted in a article.[] There are, however, some basic guidelines for first-timers to help them sweeten the deal.

New doctors must consider their wants, worth, and negotiation strategies.

Factors to consider in a first-time job

You made it through the transformative journey of medical school, followed by residency. Now, you’re looking to nail down your first physician gig. As you explore opportunities, there are a few factors (aside from income) to contemplate.

Work culture

According to an article published by, the culture of the healthcare facility plays a big role in your overall job satisfaction.[]

For example, upon starting a full-time contract, you may find that the expectation is for you to work far beyond the hours you bargained for. Meanwhile, at a different full-time hospital gig, you could work the minimum hours and no one would bat an eye.

How the hospital navigates and prioritizes quality of care, wait times, and overall patient experience is also part of the institution's culture.

Location and use of skills

The second factor to consider is where you want to work. Some physicians immediately return to their hometown after residency, even though many suburban or rural hospitals don’t have a need for their advanced skill sets like hospitals in other areas do. 

Being close to family is comforting. But you might find that routinely handling only common cases could cause your skills to atrophy.

Future goals

Finally, question whether this job will bring you closer to your long-term work goals. You may want to focus on a first job that has built-in career development resources such as clinical mentoring, operational leadership opportunities, and funding for advanced degrees.

You may choose to work in a facility that allows you to utilize the full breadth and depth of your skills.

What do you want, and how do you get it?

You’ve explored some options; now consider the best routes.

The AMA published an article detailing the results of a 2019 survey completed by final-year residents.[] It prompted them to talk about their priorities when entering the workforce.

Among the top responses were time flexibility, compensation, and a salaried position with a production bonus. If these responses resonate for you, there are a few important next steps.

Physicians can confirm their time commitment in an employment contract, which is common among new doctors. Once you have it in writing, all parties should have a clear understanding of your schedule—whether you work 9–5 or other hours, on weekends, and so on.

Adequate compensation, on the other hand, comes from knowing your worth. There currently aren’t enough doctors to satisfy needs across the US, which gives you a leg up in negotiations.

Don’t settle for less.

Securing a salaried position with a production bonus also hinges on your ability to understand what “production” really means. There should be a clear correlation between what you make and how much clinical care you provide.

Taking charge in contract negotiations

You know what you want and why you deserve it.

How do you negotiate to get it? The AMA published an article explaining a few negotiation strategies provided by Wes Cleveland, AMA senior attorney.[] They include:

  • Ask for more than what you want. If you can’t live without three or four conditions, have seven or eight. You’ll usually lose at least one “want” in negotiations. If you’re prepared to let go of several less-important things, you can protect what really matters.

  • Know your potential employer. You’ll impress your future boss if you come to the table with thorough knowledge about the health status and characteristics of the facility’s patients, staff profiles, and the facility’s competition. This will show that you care about the job, want it, and will be great to work with.

  • Don’t make (or accept) the first offer. Making the first offer, more often than not, puts you at a disadvantage. If you can, let the employer make it. Because there is a physician shortage, you probably shouldn’t accept their first offer.  If they want you, they’ll fight for you. Perhaps you know an expert (such as an attorney) to advise you on when to accept or decline an offer.

What this means for you

As a new doctor, you may not yet know how to negotiate job offers. Thankfully, there are several strategies to score the best-possible deal. Think about where you want to establish a practice, as well as your preferred work culture. Consider how your skills meet the position’s needs, and whether the job brings you closer to your goals. Finally, when negotiating, always ask for more than what you actually want—and remember your worth in a system that desperately needs professionals with your expertise.

Related: Post-residency job interviews: Plan and dress for success
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