I have been representing physicians for over 30 years, and I am still amazed by the attitude of most young physicians going into their first attending position. These are smart, accomplished, fully qualified physicians who have received some of the best clinical training in the world. And yet, many of these highly trained individuals in a field with massive shortages seem reluctant to acknowledge even the slightest modicum of self-worth.

Bear in mind that these are some of the most clinically qualified physicians in the world. There is a massive physician shortage in this country, which is projected to worsen over the next few years. If ever there was a “seller’s market” for physicians, now is the time. And yet, when I am reviewing contracts for young physicians I am continually asked if we should really be asking for the median signing bonus, or the median guaranteed compensation, or some limit on call coverage. “I really don’t want to lose this job” is constantly repeated.

When I hear this, I envision a miles-long line of qualified physicians lined up outside the door of the future employer. “You’re lucky to even get a job” the stern but benevolent employer intones. In this fantasy world, of course the newly minted physician would be crazy to ask for anything. The thing is, I have just described a fantasy world.

Back in the real world, however, things are a bit different. The physician shortage is very real. I have recently reviewed contracts where the employer had been attempting to fill the position for more than three years. The term “motivated buyer” comes to mind.

I completely understand the concern of these young physicians. After decades of school, they have massive debt, and they are eager to apply all the knowledge and skills they have been accumulating. Many times, the recruiter has solemnly informed them that they are being given the “standard contract,” and the recruiter can’t change anything. This is probably true, as far as it goes. Most likely every physician is given this contract, and it is quite possible that the recruiter personally does not have the authority to change anything.

However, even if the recruiter does not have the ability to change the agreement, almost certainly the legal department and the department head have the authority to do so. And the fact that every physician is given this contract does not mean that every physician has signed that contract.

Physicians do not get to the position where they are ready to become an attending unless they are extremely competitive. They have competed through college, medical school, residency, and perhaps a fellowship or two. A competitive nature has proven to be very helpful in getting them to where they are. However, young physicians don’t seem to realize that when an employer has made a job offer, the competition is over.

Once a job offer has been made, the physician is now the prize. The employer has invested significant time and money in making its choice. Physicians have reviewed the CV and interviewed the physician when they could have been seeing patients (and billing for the employer). There may have been other candidates, but the employer has chosen the one it deems best.

Given this dynamic, physicians should be willing to push for a reasonable contract. Instead, I often must urge my clients to simply pass along the letter I have written asking for changes. Many times, I need to assure them that the employer will not react negatively because the physician cared enough about the position to invest in an attorney. In fact, in the past, when I was representing private practices, the owner was often pleased to see that a candidate had retained an attorney. This is usually (quite rightly) viewed as a strong indication of interest in this position.

To summarize, the biggest mistake young physicians make in their first employment agreement is to attempt to be “competitive” after they have won the competition. The employer has made its choice; now it’s up to the physician to obtain a reasonable contract from the employer that has already decided that they are the one the employer wants.

Dennis Hursh is a veteran attorney with over 40 years of experience in health law. He is founder, Physician Agreements Health Law, which offers a fixed fee review of physician employment agreements to protect physicians in one of the biggest transactions of their careers. He can also be found on YouTube and LinkedIn.

Dennis is a frequent lecturer on physician contracts to residency and fellowship programs and has spoken at events sponsored by numerous health systems and physician organizations, including the American Osteopathic Association, the White Coat Investor, the American College of Rheumatology, the American Health Law Association, and the American Podiatry Association.

Dennis has authored several published articles on physician contractual matters on forums such as KevinMD and Medscape. He is also the author of The Final Hurdle – A Physician’s Guide to Negotiating a Fair Employment Agreement, which is considered the go-to resource on physician contract negotiation.