How doctors can negotiate a better employment contract

Signing an employment contract with a hospital or health system is one of the most consequential decisions a physician will make, yet many doctors enter negotiations with little training on what to look for. Medical school and residency rarely cover contract law, leaving physicians to navigate compensation structures, restrictive covenants, and termination clauses largely on their own — often while facing pressure to sign quickly.

In this interview, Sarah Nosal, MD, president of the AAFP, walks through the key provisions physicians should scrutinize before signing, from base salary and bonus structures to non-compete terms. The conversation also addresses a common misconception: that a contract offered by a hospital or health system is non-negotiable. In reality, employment agreements are adjusted and edited regularly, particularly in a market shaped by staffing shortages and physician burnout.

The stakes extend beyond the paycheck. Negotiating hospital contracts before signing is vital. Physicians need to look at all the contract terms around compensation, termination clauses and what happens if a hospital later says it can't sustain the deal it agreed to are all worth close attention. For physicians weighing a job offer — whether it's their first contract out of residency or a renegotiation after years of practice — understanding these terms in advance can mean the difference between a sustainable career move and one they come to regret.