Signing a contract is a big deal. Yes, everything will work out, and nothing is set in stone, but this legal document can take a major financial and emotional toll on your life. Through residency and fellowship, we have no say in pay, vacation, maternity policies, anything, so this moment is long awaited for all of us, but don’t let the “I have finally arrived” glee cloud your judgement.
Medical training, in many ways, protects us from reality. After you graduate from training, things become real, fast. Work-life balance, children, financial planning, loan repayment, marriage, coping with others’ bottom lines - these are life skills normal people gradually grow into in their mid-twenties to early thirties. For us, these years are spent in a bubble of medical training where street smarts are belittled and idealism is touted. As soon as we are finally “done,” we are thrown into a world where priorities are completely upside down from our normal.
Looking at that first contract, it is easy to think, nothing could be as bad as training, when the fact is, it can. In fact it can be much worse because others prey on the naivete of new grads. I have seen far too many of my friends sign contracts that take advantage of them. Everybody has their own bottom line and for most businesses, even in medicine, it is dollars.
As a physician, you are valuable. A salary four or more times what you were making in training feels great when you see it on paper, but remember, this is not training anymore - your first job does not have an end date like training did, and nobody would offer you a salary they do not expect you to earn above. This in my opinion is actually fine, if a practice is set up for you to walk into with patients ready to be seen, it is fair for them to make money off of your work; however, ask questions to glean whether they are truly set up for you to thrive.
The goal of a contract is to protect both parties. Unilateral contracts that protect the interests of one side are bad contracts. Unwillingness to negotiate a unilateral contract raises a major red flag about the culture of a business.
Like I mentioned before, a physician is valuable, so a business should support a well-trained, hard working doctor. Support enables us to maximize our productivity, build a company’s brand, to draw business. When you are planning for a new job, plan to show up, work hard, make the company look good, treat patients and employees well, help the business grow everyday, be a team player, say yes to doing favors for your seniors - plan to be more than amazing. If you are planning to be lazy, then you have nothing to negotiate for.
In order to be amazing, you need support. I don’t mean you expect ten weeks of paid vacation or a Ferrari as a signing bonus, but things like maternity leave, vacation, time and space for lactation, non-competition, termination notice - things that deeply affect your family’s life - should all be on the table for open discussion. If not, do not be afraid to walk away.
An attorney in the past year told me that the most valuable person to talk before signing a contract is a physician who has left the company you are planning to sign with. They may not be completely forthcoming for a variety of reasons, but I still think this is great advice. People in the business are motivated to mold the truth to get you to sign that dotted line.
Also, do not assume that your attorney knows more than you do. I learned recently from lawyer friends that when attorneys say things like, “this is typical” or “standard,” it is attorney speak for “I’m too lazy to truly advocate for you.” Press them - that is what you are paying them for. Remember, nobody will understand what you value more than you - make sure they know what you need and are willing to go to bat for you.
And moms, moms-to-be, and anyone who is considering being a mom: please start talking about maternity leave and lactation when discussing contracts. Even the AMA recommends this, but we still are not. Do it for our babies. So many of us are afraid of bringing this up because we fear what the perception will be, and this perpetuates the problem. If you do not ask for maternity leave or space and time for breast pumping, you are not even giving your employer a chance to do the right thing.
Be sharp, be persistent, be strong and be willing to give some, but not everything.
Arti Thangudu, MD is an endocrinologist and a 2018–2019 Doximity Author. She specializes in Endocrinology, Diabetes, and Metabolism and is a mom of two beautiful kiddos under three! She has started her own lifestyle and preventative medicine clinic called Complete Medicine in San Antonio. She has also contributed to Medscape and KevinMD. Outside of work, Dr. Thangudu enjoys traveling, cooking, and spending time with her husband and two children.
