How to Negotiate a Fair Employment Agreement

By November 2, 2018 No Comments

As a new board-certified physician, you have beaten the odds to gain admission into a selective medical school, studied for hours in the library to score well on the USMLE step examinations, matched with a residency program to further your training, and you have finally received that employment offer from the healthcare employer of your choice! As exciting as this moment is, after devoting yourself to medicine for nearly a decade, the next decision you make could greatly influence the next phase of your career. The item of utmost importance at this stage is this: the employment agreement.

The vast majority of early-career physicians have yet to negotiate a fair employment agreement, as their medical school and residency programs likely offered a standard compensation package to everyone in the program. However, once you become a practicing physician, employment agreements can differ to a great degree. How can you be certain that you are being fairly compensated for your hours worked? How do you determine how shifts are assigned to you? What about overtime and call time? Benefits? Each of these items is important to discuss with your future head of department and human resources before you sign a contract and agree to begin a career at a new institution. The following will discuss key considerations and best practices for new physicians to consider as they negotiate fair employment agreements with potential future employers.employment

It is important to first understand that employment agreements (also known colloquially as “offers” in the working world), will vary from workplace to workplace. There are distinct differences between employment agreements made with academic medical centers, private hospitals, private practices, and solo clinics. When deciding on a future home institution, it would be beneficial to conduct preliminary research using public information sources such as or Despite these more nuanced considerations, there are certain factors that are critical for the physician to discuss prior to employment at any workplace.

1.Mutually-agreed upon, set hours[1].

As an anesthesiologist, it is crucial that you discuss the specific hours you will be working prior to setting foot in the hospital or practice. The surgeries are long, and there may be additional clinical responsibilities alongside your scheduled shifts. You should therefore be clear on exactly when you are expected to be working, and how soon you will be notified in advance of each shift.

2. Compensation — hourly or a salary?[2]

This section of the employment agreement is somewhat self-explanatory. Will you be compensated on a salaried or hourly basis? The answer will usually depend on the institution. If you are working for an academic medical center, for example, the departmental head may prefer physicians to be salaried so they can also commit to academic responsibilities during the work week. However, in a typical hospital or private practice, hours may be tracked more rigorously, and you may be compensated only for the hours that you’ve worked (e.g. getting paid on an hourly basis that can change depending on call and overtime).

3.Protection for medical malpractice[3]

In the modern world of medicine where there is always the potential for a lawsuit, anesthesiologists are at risk to be held liable without proper legal protections. While hospitals should implement every possible measure to ensure safe, high-quality surgeries, mistakes do still happen in the OR. Your future employer should provide you with a contingency plan in the event of medical malpractice. Possible protections include insurance plans, dedicated employer funds to be used for potential law suits, or an in-house legal team focused on medical malpractice.

To our newly minted physician — congratulations! You are embarking on an enriching and fulfilling career. Before you charge forth into the world of medicine, be sure to take a moment to carefully consider and negotiate your employment agreement. By doing so, you can help ensure that you have the proper supports, protections, and benefits at your disposal to succeed as a healthcare practitioner!


[1]Kraft, J. “The Final Hurdle: A Physician’s Guide to Negotiating a Fair Employment Agreement”. Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. Aug 2017.

[2] Oliver, E. “10 statistics on anesthesiologist compensation, benefits.” Becker’s ASC Review. April 2018.

[3]Tan, SY. “Medical Malpractice: Understanding the Law, Managing the Risk”. Hackensack, New Jersey, World Scientific Publishing Company, 2006.