CV prep

Navigating employment contracts

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By understanding potential contract issues, you increase the likelihood of a productive, happy work life

If you’re like most physicians, you have high hopes for a great first job or fabulous next position. But what could be your Achilles heel? You needn’t look any further than physician employment contracts to see what could undermine your immediate or even future status with a new employer. There are plenty of negotiating pitfalls and agreement glitches that can prevent you from tying a bow around a deal that looks good and is good for you.

As Maria Mora Pinzon, M.D., MS, preventive medicine physician/scientist with the Madison-based University of Wisconsin School of Medicine and Public Health, notes: “Everybody needs to see the contract and negotiating process not as a burden but as an opportunity to see if the place that they’re looking at — either as a future partner or employee — is the right place for them, their career and even their family.”

So, how do you avoid the kind of snafus or missteps that can turn a promising situation into a not-so- satisfying career move?

Obviously, there are many nuances to consider, but if you’re intent on averting an unfavorable contract — in favor of a favorable agreement— the first step is to be comfortable with negotiating your future. That means being realistic yet assertive. Standing your ground is a definite plus, especially since employment contracts aren’t always fair or what you’d like them to be. But due diligence is the critical linchpin, particularly if you want to avoid revisiting the deal.

“…Handing a 90 percent redlined version from your lawyer to your potential employer is just not a real crowd-pleaser,” says Rade Vukmir, M.D., JD. Be clear about the changes that are most important.

Preparation is key

So where do you begin? For starters, your success negotiating any employment agreement may very well depend on the size and structure of the organization you’re targeting as well as your CV. Obviously, the more years you have under your professional belt as well as the various skills you bring with you, the better your chances of getting HR to see things your way.

Conversely, if you’re new to the profession, you may find yourself lacking enough bargaining chips to get exactly what you want — or to make any substantive changes. In either case, you need to review the particulars. “Regardless of where they are in their careers, we at least want to make sure that they’re aware of what the agreement says, even if they don’t have a lot of leverage to change it,” says Kathryn Hickner, jd, partner with Cleveland, Ohio’s Brennan, Manna & Diamond.


Keep in mind that most physician employee contracts for large health systems are standard agreements with boilerplate language. If you’re joining such a network or a major corporate-based multi-specialty practice, you’ll likely be signing the same contract offered to hundreds, if not thousands, of physicians. Granted, the organization must adjust to be competitive. But if the people recruiting you have thought carefully about the contract—and have fairness as a goal—they’ll be equally cautious about altering anything substantial. In other words, you may be able get changes at the margins, but you won’t be able to overhaul their work. As Rade Vukmir, m.d., jd, American College of Emergency Physicians spokesperson, notes: “I think the first misunderstanding that occurs is that they’re completely negotiable. They typically are not.”

If you’re targeting smaller, independent private practices, you may have greater sway with the terms because the hiring partners have more flexibility too.

What’s more, if you’re targeting such a practice in a rural or other underserved area that desperately needs your skills and services, you’ve likely upped your odds of successfully negotiating those provisions most important to you. “You have to know your environment,” says Vukmir, who is also a Pittsburgh-based critical care medicine specialist, in terms of making any demands. “What is the competition? Are there more people than jobs or more jobs than people? That sort of tells you how it might work out.”

” You can’t have the perfect be the envy of the good. You have to decide what areas you care the most about and stand for those things,” advises Phillip Eskew, D.O., JD.


Since you’re the primary stakeholder in your future, you never want to consider a contract without establishing your priorities first. For starters, what is your ideal job and what do you need to maximize it? What might the responsibilities look like—and what do you need to make it work? A piece of technology? A physician assistant? A decent call schedule?

Once you have those clarified, be sure to round out the picture with other items that could shape your work-life and future. Is it a leadership role? Support to do research or earn an MBA? Maybe it’s just time for a life outside your day job? Whatever makes you tick, be clear about those particulars, especially since they have ramifications for your agreement.

If you’ve identified any activity that will enhance your career or even the practice, make sure it’s addressed. In a similar vein, Roberta Gebhard, d.o., believes that anything reasonable is on the table.

In fact, as past president of the American Medical Women’s Association and Founder of its Gender Equity Task Force, she encourages outside-the-box thinking not just in fashioning your job wish list, but also advocating for a life outside the office. “You just need to figure out what’s the most important thing in your life,” Gebhard says, “and make the contract reflect it.”

Speak up for your priorities

Throughout every step, you want to be hands-on. Since you know better than anyone else what will work for you, you’re the person who should also negotiate for you. Having your attorney speak on your behalf sends the wrong message when you’re trying to make a good first impression.

Whatever the case, when the offer finally comes your way, read it, list your questions, and re-read it. Above all, make sure that those must-haves you’ve prioritized are not only included but that the language matches the conversation. If, for instance, you were told that you’ll have a nurse practitioner, you want to make sure that the position is detailed and protected by your agreement, especially if there are future organizational changes. “If that’s important for you,” Pinzon says, “it needs to be put in the contract. Otherwise, you might not be successful.”

In fact, if longevity and a happy work life at this place is your goal, don’t be afraid to say, “I don’t think this accurately describes what we talked about or what we agreed to.” Hopefully, you’ve tapped an organization willing to take a second look. “If something important to you doesn’t appear in the contract, you may need to sit on your hands until it does,” says Philip Eskew D.D., JD, MBA, family medicine physician and founder of Direct Primary Care Frontier.

Then again, if you hold out until everything goes your way, you might wear out your welcome before you sign the agreement. Gebhard, for instance, recalls losing one college opportunity by trying to parlay a full-time offer into a part-time gig. The organization wasn’t moved when she proposed including her nurse practitioner as part of the package so that she could keep her office elsewhere open. Instead, she lost the position. “I was pushing a little bit too far,” she says.

Whatever the case, your first goal is to turn your preferences into the right position.

Be strategic

Whatever contract or offer you’re considering, make sure that you’re strategic in how you approach your future bosses. It doesn’t sit well with recruiters or hiring teams when physicians pit employers against each other over agreements. You may feel like a savvy entrepreneur trying to cut the best deal, but it’s better to focus on the one offer that reflects your must-haves. “You could be wasting a lot of people’s time, so you want to know what you want and what you’re willing to give up,” says Kim t. Collins, mba, cmsr, director of provider recruitment and onboarding at Community Health Systems.

When it comes to those contract changes that you’re flirting with, be equally upfront and savvy in your interactions.


Asking for pie-in-the-sky changes can raise just as many flags about your personality and approach as being wishy-washy, experts say. You don’t want to be known for either. You’ll be a more attractive candidate if you go to bat for a few must-haves than if you’re handing over a lengthy wish list that doesn’t have a shot.


Experts agree that the quickest way to kill goodwill and a great opportunity is to keep coming back piecemeal. Keep in mind that just as you have priorities, organizations have standard checklists too. That includes how far they will or will not go vis-à-vis those negotiable and non-negotiable items.


If you believe strongly in what you need and want, of course give at least your best shot. But be prepared that not everyone will be on your page immediately—or perhaps ever.

Stop, look, listen

You may or may not be successful in securing what you’ve fashioned in your mind. But the organization’s response will tell you enough about the environment that you’ll either stay or look elsewhere. Hickner, for instance, recalls reviewing the contract of one recent fellowship graduate who seemed to have just what a rural entity wanted. But when she and her client requested a handful of reasonable modifications, the response was “‘We don’t ever change these provisions.’ That was it. They weren’t willing to negotiate or even discuss them,” she says. “My client didn’t have a lot of leverage, but it still was a red flag about the culture of the organization. He decided not to take the position.”

Your contract not only states the obvious, but also may reveal just how the leadership operates.

Says Pinzon: “The contract should really speak to you and what you want. If it doesn’t work for you, you need to ask, ‘Is this the organization I want to join?’”

Final thoughts

As to any final words of wisdom, keep in mind that even under good circumstances, things can go awry. Ideally, you’re entering a harmonious, mutually productive, long-term alliance. Yet divorces can occur in employment relationships just like they do in marriages, despite the best of intentions of both parties. You may have no evidence initially that things are going to go south in the future. But by understanding the contract process, you’re taking a critical first step in avoiding such a break-up. What’s more, if you play your negotiating cards wisely, you’ll achieve your mission — without being sidelined by missteps.


Chris Hinz

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