5 things to keep in mind when negotiating your first employment agreement:

1) Always Negotiate: An institution’s or practice’s goal is always to attract the best talent with the leanest economic and professional package possible.  Failure to negotiate for those personal, professional, and economic items important to you and your family will likely have negative long term implications on your time in the role. 

It is better to “ask in a highly professional manner” and be told no than to not have asked at all out of fear of losing the chemistry.  If you ask sound business questions in a professional manner and you lose the opportunity, then you have overestimated the chemistry that existed in the first place.

2) No Experts Needed: You do not have to be a sophisticated negotiator to address the questions you have about your agreement with a chief, a chair, and/or a practice’s partners.  The key is in your willingness to set the appropriate expectations upfront.  The large majority of graduating residents and fellows have received inadequate business of medicine and career education prior to completing their medical training.  It is unlikely that a graduating surgeon or specialist will also graduate a master knowledgeable negotiator.  This does not have to be a disadvantage!  A successful expectation-setting conversation might go something like this:

Physician: “I am not sure about your training program, but we received very little in the way of business and career education.  Was it that way when you were in training?”

Practice: “Absolutely.  Most of us have learned the business side of medicine via on the job training and have made a lot of mistakes in the process”

Physician: “I am glad to know it is not just me because understanding the ins and outs of these employment agreements has been a bit overwhelming.  I have some questions about my contract and I wanted to make sure you were OK with me discussing them with you?  (Pause for affirmative response)  With my current lack of business savvy, I am concerned about not offending you or your colleagues but do know that the conversation will be educational for me and will help me feel more confident about the opportunity.  (In a jovial manner, say:) You promise not to get offended by my questions?

Alter the above to fit your style but do not fail to set expectations.  Admitting your current knowledge level and experience at this point is not seen as a sign of weakness and puts you and the practice or institutional representative on the same team.  Conversely, trying to pass oneself off as a sophisticated negotiator will surely create a competitive environment and a greater likelihood that conversations will damage the established chemistry.

3) Go Live Or Risk Going Viral:  Emails or faxes containing your lengthy requests and concerns about your agreement are not advised.   As suggested above, it is better to visit live via phone or face-to-face.  Live conversations allow you to read your counterpart and maintain a sense of positive direction by reading tone and/or body language.  The conversation is also an excellent educational opportunity.  You should prioritize you wish list as there is no guarantee of making it through the entire list.  The danger of avoiding conversation and sending your requests via email is you loose your ability to manage the conversation.  If item #4 on your list creates a sense of irritation with the chair or partner, then you have no ability to withdraw or manage the remaining twenty requests.  Images of you being difficult and demanding can be easily created and can become viral and may negatively impact the teams perception of you as a future member.

4) The Amazing Invisible Ink: The conversations suggested in #3 above will yield many thoughts and dreams and promises on the part of the practice or university.  Work hours and locations, compensation and bonuses, partnership or tenure, research support and marketing support will all be discussed.  You must make every effort to convert the promises and discussions into the written word of an employment agreement.  Once you sign, you can count on healthcare reform, endowment depletion, further resident hour reductions, and the tightening of outside funding sources to step into the mix and challenge the institution’s or practices abilities to keep their commitments.  Historical experience would say it has been hard for many to keep the commitments put in writing let alone those made on a verbal promise or a handshake.  I believe there is always a real interest in keeping promises made but the environmental pressures present at the time may not allow it to be so.  Having all terms in writing may not ensure you all that was promised but it will provide you some protection in proving a breach should the need arise.  I would hate for you to trust in the promises of people only to find out that the invisible ink of well-intended promises has simply disappeared.

5) Legal Expertise:  Remember that there are two parts to a contract negotiation: 1) Negotiating the deal, and 2) Determining if the deal negotiated is legal and is effectively embodied  in the language of your employment agreement.  Negotiating your deal can be done by yourself or a business consultant, accountant, or attorney with appropriate knowledge and skill sets.  It is imperative that you select wisely for this step as the process and interactions will have long lasting impressions about you as physician and potential partner or professor.  Selection of an offensive and/or caustic personality for negotiation purposes could be detrimental.  Once the deal terms are negotiated, a contract attorney is the only person who can tell you if what you negotiated is legal and if what you negotiated is embodied in the agreement.  The costs for legal review of a typical employment agreement with both written and verbal feedback by and attorney should not exceed $500.

About the Author:

Wesley D. Millican, MBA, CEO and Physician Talent Officer of CareerPhysician Advisors, LP, and CareerPhysician, LLC, provides comprehensive talent solutions for academic children’s hospitals, colleges of medicine and academic medical centers across the nation. He possesses a longstanding passion for career development of all young physicians and serves as a go to career resource for training program directors and their residents and fellows. In continuing his commitment to the “future of medicine”, Mr. Millican speaks nationally at residency and fellowship programs. His Launch Your Career® Series is a proven resource for today’s residents and fellows and has served as a go to resource for program directors over the last 15 years.