As an early career physician, transitioning from residency or fellowship into attendinghood, or even just contemplating a job change, can feel both exciting and overwhelming. There’s the thrill of stepping into your first “real” job, finally earning a salary that reflects the years you’ve invested. But alongside that excitement often comes anxiety: About finding the right fit, navigating unfamiliar systems, and negotiating a contract you may not fully understand.

Amid all the new responsibilities, your first job contract might seem like just another task to check off the list. But in reality, it’s one of the most important documents of your career. It will shape your compensation, your workload, your autonomy, and most importantly, your well-being.

Some residents and fellows receive formal preparation for reviewing and negotiating contracts, but far more do not. The result? Many physicians enter the workforce unprepared to advocate for themselves. To illustrate this, let’s look at two very different first-job experiences.

Dr. Cynthia Chen-Joea:

When I signed my first attending contract, I didn’t know what I didn’t know.

I was just so grateful to have gotten the job of my dreams—the highest paying faculty job I was offered. I thought it was decent pay, great hours with flexibility, and I was so excited to work with others who shared my same passion for teaching residents. Like many physicians, I truly believed that medicine was a calling, not a career. I wasn’t supposed to care too much about the money or fine print. After all, I had just spent over a decade in training—wasn’t this the reward?

I thought I knew enough about negotiation to ask all the questions I was supposed to ask, which was more than many of my colleagues.

But what I didn’t know and realize was something I wouldn’t find out until more than half a decade later.

I didn’t realize my worth.

I didn’t realize my value to the program and the institution.

And I didn’t realize that I had no idea how to negotiate.

It cost me clarity, leverage, and peace of mind.

Dr. Peter Baum:

I was known for going above and beyond for my patients, to the point that self-sacrifice led me to experience burnout during residency.

When I got my first offer, I was excited by a job prospect that seemed in alignment with my values, that would also allow me to prioritize my well-being. When the salary offered was lower than what I was hoping for and expecting, I sought guidance from a mentor on how to handle the situation and try my hand at negotiating.

After a few back and forths, I was able to negotiate a salary that was in alignment with the local employment market values, and importantly with my financial needs as an early career attending just starting a family living in a high cost of living area.

Eventually, my family and I needed to move a few times due to my wife’s career needs and job trajectory. The skills that I had learned in that first negotiation set me up for success in my subsequent physician employment contract negotiations, and I made sure to advocate for my value in them.

Together, in our work as physician coaches, we’ve worked with countless doctors who feel stuck, burned out, and disillusioned—but often, their frustration traces back to the very contract they signed on day one.

That’s why we strongly believe this:

Learning how to negotiate your contract is one of the most important career skills you can develop as a physician.

And no—it’s not just for the “business-savvy” ones.

Why physicians hesitate to negotiate

Most physicians are never taught how to negotiate. We’re trained to save lives, make diagnoses, chart endlessly, and survive on three hours of sleep. But ask us to advocate for ourselves—to review a non-compete clause or question our base salary? Cue the martyrdom and imposter syndrome.

Many of us were raised in systems—medical and otherwise—that rewarded obedience and punished assertiveness. We’ve been conditioned to follow the rules, not question them. And when we do speak up, we are often reprimanded or second-guess ourselves.

Am I being too difficult? Too demanding? What if they rescind the offer? Is this what they think I’m worth?

Add to that a culture that often praises self-sacrifice and frames medicine as a calling rather than a career, and you’ve got a recipe for shame, silence, and missed opportunities.

But here’s the truth: Negotiating doesn’t make you greedy. It makes you informed. It’s not about being adversarial—it’s about creating clarity and alignment. A strong contract not only protects you, but it also ensures that you can show up fully for your patients without constantly running on empty. This means that you’re not rushing from one patient to the next, mentally calculating how many more charts you’ll need to finish after-hours. It means you’re not silently stewing over inequities in pay or feeling trapped in a toxic work environment with no clear exit. It means you have protected time to rest, reflect, and recharge—so that when you’re in the room with a patient, you’re actually present, not distracted or depleted. It also means that your values and your work are in alignment.

When your contract reflects what matters to you—whether that’s time with your family, room to teach or lead, or the ability to grow outside of your clinical role—you’re more likely to feel grounded, focused, and fulfilled.

When you advocate for yourself, you’re not just investing in your career—you’re investing in the quality of care you provide. And that benefits everyone.

Negotiation is part of building that sustainable life in medicine. It’s a skill—one that can be learned—and it’s one of the most empowering tools we have to reclaim agency in this changing health care system we have today.

What’s at stake

Your first contract shapes everything from your earning potential to your work-life balance. It can dictate:

• How many patients you’re expected to see per day
• How much protected time you have for administrative or academic work
• How much notice you need to give before leaving
• Whether you can moonlight, teach, or build other income streams
• Whether you’re stuck within a non-compete zone if you leave
• Whether your employer may own your creative and intellectual pursuits

It’s not just about salary. It’s about freedom, boundaries, and long-term alignment of you with your values.

Three things to consider before you sign

You’re allowed to ask questions. A contract is not a directive—it’s a dialogue. Too often, physicians treat contracts as non-negotiable, when in reality, they are simply a starting point for discussion. If anything in your contract feels unclear, vague, or overly restrictive, ask for clarification.

For example, if your contract states you’re expected to “work evenings as needed,” what does that actually mean? Once a week? Once a month? And who decides what’s “needed”? Asking these kinds of questions early on can help prevent resentment and burnout later.

It’s also completely fair to ask for time to review the contract before signing. Don’t let the pressure of a fast timeline or verbal reassurances push you into rushing. A respectful employer will understand your need to be thoughtful about your decision. Remember: Asking questions is not being difficult—it’s being deliberate.

Negotiation isn’t just about money. Yes, salary matters. But in medicine, burnout often doesn’t come from the paycheck—it comes from feeling overwhelmed, undervalued, and overextended. That’s why a holistic view of the contract is essential.

When reviewing your offer, ask yourself:

• Is the call schedule sustainable?
• Are you expected to chart on weekends or during personal time?
• Do you receive adequate CME funds and time off to actually use them?
• What kind of administrative support will you have? (Will you have an individual or shared MA? A scribe?)
• Is there tail coverage for malpractice insurance if you leave?
• Will you have the ability to moonlight, teach, or pursue creative or advocacy work on the side?

A contract that offers flexibility, respect for your time, and alignment with your interests often provides far more long-term value than one that simply offers a slightly higher base salary.

Negotiate not just for your wallet—but for your well-being, your energy, and your passion for the work.

Get a second set of eyes. You don’t know what you don’t know—and that’s OK. Even the most confident, high-achieving physicians can miss important clauses or fail to spot language that could lock them into restrictive or even exploitative agreements.

Having a second set of eyes—ideally someone with experience in physician contracts—can help you identify red flags in non-compete or termination clauses, clarify vague productivity expectations, assess the fairness of compensation relative to local or national benchmarks, and advocate for adjustments that better reflect your role, goals, and value.

Think of it like getting a second opinion on a complex diagnosis. You wouldn’t treat yourself without consulting someone else—you shouldn’t accept a contract without doing the same. You’ve trained too long, worked too hard, and given too much of yourself to simply hope everything works out. Protect your peace, your power, and your future by making sure someone with experience reviews the fine print.

You deserve to thrive, not just survive.

Contract negotiation isn’t just about protecting your paycheck—it’s about protecting your purpose. It’s about making sure the life you’ve worked so hard to build is one you can actually sustain. When we don’t ask questions, when we settle for “good enough,” when we sign contracts that don’t reflect our needs—we slowly chip away at the joy and meaning we once found in medicine. And the cost isn’t just personal. It ripples outward—to our patients, our families, and the future of our profession.

You deserve more than just survival. You deserve a career that supports your values, your voice, and your vision for your life.

So read every word. Ask every question. Get the support you need. Advocate for yourself—because no one else will do it for you. And because doing so isn’t selfish—it’s one of the most responsible, impactful things you can ever do as a physician.

Cynthia Chen-Joea and Peter Baum are family physicians.