As Pope’s Essay on Man declares, “Hope springs eternal” for residents completing their training.

However, in approaching our first actual job in medical practice, and the contract that comes with it, we have to both hope for the best and prepare for the worst.

This is perhaps the first time many of us will examine a professional contract, and it is a process that requires a lot of deliberation, effort, and vigilance.

Understand the Author

As you contemplate your contract, it is critically important to understand the organization that has authored it. Each practice will approach the drafting of a contract, and the subsequent negotiation, differently. Large health systems are more likely to have a standard contract for all employed physicians, and are less likely to be flexible on key terms. Some have even been known to have a single page contract, and the remaining details are left to the bylaws, which are completely inflexible. Smaller practices may approach the contract and negotiation in a completely different way, and are likely to be far more flexible in considering requests for changes.

Your impression of the recruiting process and the practice’s approach in drafting and negotiating the contract offers critical insight into the organization as a whole. Do they seem to take the process of recruiting talent seriously? Are they transparent in responding to requests for additional information about the contract, or about the practice as a whole? They should be willing to share aspects of the financial records, information about the financial performance of similar young physicians in the group, and other aspects of the practice’s operations. There should not be any red flags that deviate dramatically from industry standards, and the practice should seriously consider a candidate’s requests.

A final key aspect to getting to know the author of the contract is to develop relationships with members of group, particularly among your peer group. This often includes a younger physician in the group that you might have met along the way. This advocate can provide valuable insight about the organization, and his or her experience in negotiating terms of the contract.

Hire an Attorney

This is always a sensitive subject for physicians, mostly due to our relative inexperience working with attorneys in general. However, involving an attorney is not necessarily an adversarial move. Instead, consider the involvement of an attorney as an insurance policy to make sure you identify and avoid an red flags or pitfalls in the contract, and that you understand clearly what you are committing to from a legal perspective. Keep in mind, the practice absolutely involved an attorney in the drafting of the contract, so why wouldn’t you involve your own representation in understanding and signing it?

A person signing a contract

It is critical to involve an attorney early in the process. You can source an attorney in a variety of ways. The best approach is find someone recommended by coresidents, cofellows, colleagues or mentors. Oftentimes, specialty societies may provide information regarding hiring a contract lawyer. Most attorneys that you find will work in a local law practice; however, there are national companies that offer contract review services. These may not provide a true attorney, but instead a professional who is experienced in the review of medical contracts. Physician Contract Review and Contract Diagnostics are two examples. These companies tend to be less expensive. They would argue they are as capable in reviewing contracts and identifying red flags and opportunities for negotiation. Regardless of the approach, make sure to identify representation early, and communicate clearly your goals and the role you want them to play, including advising you during your interactions with the practice and mediating the relationship between you and the practice directly.

Letter of Intent

A letter of intent has become more common in medicine. This is the preliminary step to signing the final contract. It outlines the most important terms of the contract, and formalizes the relationship between you and your potential employer. Take this document seriously. It will codify the basic structure of your employment agreement, and it can be used against you if you later express concern over aspects of the deal you may have previously agreed to. In that same vein, use the letter of intent to begin a conversation about the most important issues to you, and in the best case, to agree to terms on these issues. This will allow you to identify potential employers that perhaps don’t meet the criteria mentioned above: transparency and fairness. If you and your potential employer are too far apart on key terms to reach a reasonable agreement, it is better to move on before the letter of intent is signed.


Navigating your first employment contract as a graduating resident or fellow can be daunting task, as it may be the first time you have encountered such a contract in a setting where negotiation is possible. It is important to be vigilant, disciplined, and thorough in this process.

It is also important to understand that attorneys drafted this document, and in all likelihood you will require your own attorney to properly examine the document, understand its implications, and advocate for changes when necessary.

Take Home Points

  1. Understand the organization who has offered you this employment agreement. Use the process as an opportunity to assess its culture, whether you want to work there. Develop relationships with young members of the group to assist you in the process.
  2. Hire a professional to assist you in the examination and negotiation of the employment agreement.
  3. Take a letter of intent seriously. Use it as an opportunity to open the door to negotiation of your most important issues.
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