How to Negotiate Your First Attending Contract

Your first attending contract is one of the most important financial documents you will ever sign. Here is what to negotiate and how to do it.

Why Most Physicians Undersell Themselves at Contract Time

Medical training does not prepare you to negotiate employment contracts. After years of accepting what you are given - program assignments, call schedules, rotation sites - the instinct to accept the first offer feels normal. But an attending contract is not a residency match. It is a business negotiation between two parties, and the terms you accept on day one follow you for years. Base salary, productivity bonuses, non-compete clauses, and call obligations are all negotiable to varying degrees, and most employers expect a counter.

The leverage you have at the moment of an offer is the highest it will ever be in that employment relationship. Once you sign and start, your negotiating position weakens. Use the window between offer and signature to ask for everything that matters - not just salary.

Understand the Compensation Structure Before Negotiating Anything

Attending physician compensation comes in several forms and the mix matters as much as the headline number. Base salary is the guaranteed floor. Productivity bonuses are typically tied to wRVUs - work relative value units - which measure clinical output. Quality bonuses may be tied to patient satisfaction scores, outcomes metrics, or documentation compliance. Sign-on bonuses are common and often partially or fully repayable if you leave within one to three years.

Before negotiating, request the wRVU threshold at which productivity bonuses kick in and the conversion rate - dollars per wRVU above that threshold. Ask what the median wRVU production was for physicians in that same role over the past two years. If the threshold is set above median production for the role, the bonus is effectively theoretical. A high base salary with an unachievable bonus structure may be worth less than a lower base with a realistic productivity upside.

Use MGMA data as your benchmark. The Medical Group Management Association publishes annual compensation data by specialty, region, and practice setting. Your base salary and total compensation should be benchmarked against MGMA median and 75th percentile figures for your specialty before you counter anything.

The Non-Compete Clause - Read It Carefully

Non-compete clauses restrict where you can practice if you leave the employer. A typical physician non-compete might prohibit you from practicing within 15 to 25 miles of any practice location for one to two years after departure. In a dense urban market, that radius can effectively eliminate your ability to stay in the city. In a rural area, it may cover an entire region.

Negotiate the geographic radius down and the duration down. Push for carve-outs that allow you to continue seeing existing patients. Ask whether the non-compete is waived if the employer terminates your contract without cause - this is a reasonable ask and some employers will agree to it. If the non-compete is non-negotiable, factor it into your decision about whether to accept the offer at all. A restrictive non-compete in a specialty with limited local opportunities is a meaningful financial constraint that affects your options for years.

Other Terms Worth Negotiating

Beyond salary and non-compete, several other contract terms have real financial value. Malpractice tail coverage - who pays for it if you leave - can cost $30,000 to $80,000 depending on specialty. If the contract requires you to purchase tail on departure, negotiate for the employer to cover it after a certain tenure, or ask for it to be covered regardless. CME allowance and paid CME days, licensing and DEA renewal fees, and relocation assistance are all standard asks that most employers have budgeted for.

If you are joining an academic practice, clarify whether protected research or teaching time is guaranteed in writing or merely informal. Time commitments that are not in the contract tend to expand over time without additional compensation. Get the specifics of your schedule, call obligations, and any administrative duties documented before you sign. Verbal assurances during recruitment are not enforceable once you are employed.