After ten grueling years of training to become a physician, you can finally see the light at the end of the tunnel. You may be receiving countless emails that advertise amazing starting salaries, sign-on bonuses, and/or loan repayments that almost seem too good to be true. Dozens of calls are coming in on a weekly basis from recruiters who want to help you find your dream job, and the prospect of quadrupling your income has certainly caught your attention.

Enjoy this time; you deserve it! But it is equally important to proceed with caution. You do not want to get caught up in all the excitement with blinders on. Those blinders could have you wandering into a field filled with negotiation landmines as you attempt to secure your first opportunity out of residency.

You are well prepared for your medical career, but are you equally prepared for all that comes with negotiating your first contract? Do you know how to negotiate a contract? Have you considered the possibility that you could ruin your chances of landing that perfect job in the contract negotiations process? Many have learned that lesson the hard way, but you don’t have to!

View the video below to see how this physician fell prey to illusions of grandeur and misinformation:

Compensation is certainly one factor you must consider when determining which opportunity is best for you, but is not the only consideration, and for some, this may not be the most important. Your colleague may accept an opportunity with a significantly higher starting salary, but you may determine that you would not thrive in the same type of community or practice. Ultimately, you must consider the factors that are most important to you and make the best decision for you.

In my career, I’ve negotiated some $600 million dollars of physician compensation packages, and I understand the importance physicians place on starting salaries. But you cannot overlook how you will maintain or increase your income once your guaranteed salary expires. Many physicians receive a two year guaranteed salary, and after those two years expire, their income is based on their productivity.

I’ve seen too many physicians purchase homes and cars; then create a lifestyle based on their initial guaranteed salary. Those who are unable to sustain that level of income can feel under-valued and may seek to find the next guaranteed salary. Some physicians work for 6 or 7 different employers over 10 to 12 years. Suffice it to say, you do not want to find yourself in that situation.

To avoid this pattern, I recommend placing as much focus on the big picture in your negotiations as you do your initial salary. You have to consider what it will take to maintain or increase your income over time. Here are a few questions that will point you in the right direction:

• Can you walk me through the compensation structure?
• Is there a productivity formula? If so, how does it work?
• If I perform well, what is the income potential for year 1? Year 2?  Year 3?
• Do you anticipate acquiring any new systems that will impact and improve patient care?
• Describe the process and formula you use in transitioning from a guaranteed salary to productivity compensation.
• How have other physicians adapted to the change after two years?
• How many patients will I need to see to earn $xxx per year?
• Per month?
• Per week?
• Per day?
• What is the current waiting period for a new patient to see a physician?
• How busy will I be from day one?
• Is the hospital going to help market my practice? If so, can you walk me through what the marketing plan looks like?
• What are my responsibilities to build a successful practice here, and are there any bonuses if I exceed my milestones?

Todd Skertich is managing partner, Arlington Healthcare and founder, Adventures in Medicine and Physician Career Planning. He is the author of The Art of Physician Negotiation and can be reached on Twitter @adventuresinmed.

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