Transition from Resident to Attending

Red flags, must-haves for young doctors in contract negotiations

Timothy M. Smith , Contributing News Writer

For young physicians transitioning to practice or moving on to the next stage in their early career, interviewing for jobs might seem like a new frontier, but it’s a lot more like medicine than they might think. Just as physicians are trained to ask patients sometimes awkward or uncomfortable questions to elicit the information they need to make a diagnosis or treatment plan, so too should doctors feel confident in asking hard questions of prospective employers and keep an eye out for potential trouble spots. 

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An AMA STEPS Forward™ toolkit explores how to evaluate a practice environment to match your priorities. It also provides breakdowns of the pros and cons of various practice settings and the steps to take to decide where to practice.

“Interviewing and negotiating contracts are really big windows into your relationship with a practice,” said AMA member Brandi Ring, MD, associate medical director of obstetrics and gynecology at the Center for Children and Women Southwest, in Houston.

“The biggest red flag is if you're really uncomfortable during the negotiation process—if you’re arguing and not feeling respected and not feeling valued,” Dr. Ring said. “That’s not going to get better once you sign the contract.”

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But a healthy relationship also depends on concrete details, including things as fundamental as work schedules and staffing.

“I’ve always felt a red flag was when an employer failed to commit to something around hours, time, responsibilities,” said AMA member Michael Hanak, MD, associate chief medical officer of population health at Rush University Medical Center, in Chicago. "If everything is only discussed in general terms, what do they think your Monday's going to look like when you start working? Are you on 12 hours a day or eight hours a day? You need to know these things.”

You should also look for details on call responsibilities and time off, both noted.

“As a resident, you’re probably tired of being on call,” Dr. Hanak said. “You might enter a practice where they give you a beautiful new office in a beautiful new building and tell you you’re the face of their new operation. But that might also mean that until you bring more people on, you’ll be the only one on call. You definitely want to know what support mechanisms are set up around you.”

Listen to or read highlights from this great “AMA Making the Rounds” podcast episode for tips on what to consider before you begin the contracting process.

Additionally, the AMA Transition to Practice series has guidance and resources on deciding where to practice, negotiating an employment contract, managing work-life balance, and other essential tips about starting in practice.

Fortunately, there are professionals who can help you navigate contracts and even interviews.

“You should absolutely have a lawyer. They can find conflicts of interest and other inconsistencies, but they can also speak the language. They can help you understand how a contract will impact you if decide to leave in four or five years,” Dr. Ring said. “The most important part of your contract is how you get out of it.”

Which might lead young physicians to wonder how long their contracts ought to run.

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“When you’re starting off, you want nothing more than two years,” Dr. Hanak said, adding that having an attorney—he found one through his state medical society, and he recommends going that route—helps facilitate a fleshing out of the pain points in a contract.

“You will usually do better by handling negotiations yourself,” he said. “But if there’s some change you want made to the contract, you can always say, ‘It's weird to me, but my attorney said I should ask about this.’”

Learn more about the AMA Young Physicians Section, which gives voice to and advocates for issues that affect physicians under 40 or within the first eight years of professional practice after their training as residents and fellows.