Contract negotiation, compensation models, and employment decisions.
14 articles in contracts & compensation
Signing bonuses are withheld at 22% while attendings often face 32–35% marginal rates, and most clawback clauses demand the gross amount back. The math, the traps, and the pro-rata fix.
Practice ownership trades an income floor for an income ceiling. This is the honest version of that trade — buy-in math, ancillary revenue, the management tax, and when staying W2 wins.
Some contract terms are negotiable annoyances. Others are structural traps that can cost $100,000 or more. Here are the red flags that justify walking away, with the dollar consequence of each spelled out.
The worst realistic outcome of a professional ask is "no," yet most physicians never ask. What is genuinely negotiable in a physician contract, what is not, and plain-language scripts for each conversation.
Medical director pay is constrained by fair-market-value rules, not just negotiation. Here is how stipends and hourly rates are structured, what documentation hospitals require, and how to evaluate whether an offer is fair.
Employed and independent physicians get paid in structurally different ways. Here is the honest math on both models, including a worked five-year comparison with every assumption stated.
The academic salary discount is real — and so is six-figure PSLF forgiveness, double retirement deferral space, and protected time. Here is how to compare the two paths on total financial terms, not just base salary.
Physician non-competes are governed by state law, not the failed federal ban. Typical terms, the states with physician-specific limits, and the negotiation moves that actually change outcomes.
Lookback periods, threshold resets, payer-mix exposure, and termination clauses quietly reshape what a productivity bonus pays. Here are the seven terms to negotiate, each with a worked dollar example.
Convert any call offer into an effective hourly rate, compare it against your base hourly rate, and spot the uncompensated call hiding inside "professional duties" clauses before you sign.
A $135/hour locum rate is not a $135/hour raise. Self-employment tax, self-funded benefits, unpaid time off, and PSLF non-qualification all come out of that number. Here is the honest math, both directions.
Tail coverage typically costs 1.5 to 2 times your annual malpractice premium, and employer-drafted contracts often make you pay it. What claims-made coverage means and the exact language to negotiate.
Most employed physicians are paid on wRVUs but few have modeled their own formula. The mechanics of base-plus-productivity comp, a worked example, and the benchmark math that reveals a five-figure gap.
Your first attending contract governs hundreds of thousands of dollars a year, yet most physicians sign without a framework for reading it. Here is every major section, what it means, and where the money hides.