How to negotiate your first physician contract

Cover your tail—literally and financially

When I launched my solo practice, I loved the autonomy, caring for my patients and community. But with independence comes responsibility. If you’re self-employed or working as a contractor, no one is setting aside money for your taxes or retirement. That’s on you.

Benefits matter. Even if your spouse’s insurance covers your family, you need to understand the full benefits package. Ask about:

• Health and life insurance
• Retirement contributions
• Paid time off
• CME and other benefits
• Malpractice tail coverage

Tail insurance is critical. Patients can file claims long after you’ve moved on. Make sure your contract spells out who’s responsible for that coverage, because you likely will change jobs.

Know the details of non-competes

I truly loved my work, but after 10 years in solo private practice my life shifted. Although it broke my heart to close my practice, with growing family needs and leadership roles, I transitioned to urgent care. It was a strategic move—more flexibility, more alignment with my values and the ability to do things that mattered.

This is where ikigai comes in, the Japanese concept of purpose at the intersection of what you love, what you’re good at, what the world needs and what you can be paid for. It’s your passion, vocation, mission and profession. It’s the reason why you get out of bed every morning.  

From there, I moved into leadership and administrative roles, changing employers during a nearly eight-year span, from director of quality and performance, director of health care strategy, regional medical director, to national director. I am now back in urgent care, as well as continuing to educate physicians on how to optimize population health, understand alternative payment methodologies and ensure practice success.

Each time, I have considered my ikigai and adjusted as needed, growing in leadership and advocacy, which now includes state and international roles.

But how does ikigai work when it comes to contracts? What else should you consider? I advise physicians to beware and understand non-compete clauses. If your contract has one, know its implications. You need to know not only how long it lasts, but how vast is its reach. If your employer has dozens of locations and the clause restricts you from practicing within 10 miles of any facility, you might have to leave your city—or even your state—to find work.

Before signing, ask yourself: Does this contract support the physician—and the person— you want to be? It’s important to also consider the call schedule and panel size expectations.

Network, network, network

Your network is a compass. Let connections from medical school, residency, your state chapter or other organizations guide your understanding of the position or job you are seeking. Talk and engage with people who live in that community and, more specifically, work for that organization.

• What is the work culture?
• How easy is it to get privileges if you want to do obstetrics or procedures?
• What is the town like?
• Are there good schools for your kids?
• Does the employer offer a sign-on bonus and/or pay relocation costs? 
• Are there employee stock options?
• What is the cost of living?
• What is the going rate for a family physician, specifically in your area of interest, whether that be outpatient, hospitalist, urgent care, academia, or something else?
• What are the opportunities for growth, leadership and advocacy?
• Are there physicians you know working for that organization, and do they seem genuinely content and fulfilled in their work? 
• Do they have AI scribes? What resources do they provide to minimize administrative burden?
• Will you need to oversee nonphysician clinicians or other members of the health care team? Will you be reimbursed for this work?

Know your worth

It is critical to know how much it costs to live in a community, and how much you’re going to get paid.

Compensation, however, isn’t just about numbers—it’s also about value and the value you bring as a family physician. Using your network can help you understand how much you can expect to be paid in a community or area. If your network is still growing or doesn’t yet include the geographic area that interests you, the AAFP can help.

The Family Medicine Career Benchmark Dashboard is a powerful tool based on survey data submitted by family doctors. It provides data on compensation and job satisfaction that you can filter by state, practice setting, race, gender, experience and more. 

In the end, you have to ask yourself if an opportunity aligns with your priorities. Does the role support the type of physician you want to be and the life you want to live? 

Flexibility, career development and work-life balance were essential negotiation points for me. Understand what matters most to you, and don’t be afraid to ask for it.

Kim Yu, MD, FAAFP, is a family medicine leader who has practiced and worked in numerous settings—hospital-owned clinic, solo private practice, urgent care, a federally qualified health center and administration—while filling leadership roles for her employers as well as state, national and international family medicine organizations. She is co-chair of the AAFP Foundation’s Emerging Leader Institute, president-elect of the California AFP, and member-at-large for WONCA’s Executive Committee.