Don't Get Wowed by That First Offer

2026-01-29

Essential advice for residents and fellows transitioning to practice: understand your value, negotiate wisely, and consider using a healthcare recruiter to navigate the complex employment landscape.

Insights from Dr. Alisha Reiss, MD, and expert career guidance for physicians transitioning from residency to practice.

In residency, you are obligated to do the majority of your rotations at one facility, and while some programs have a few months when you get to go somewhere else, you will usually see only a very limited number of practice models. Plus, if you are interviewing for a job to stay on where you are doing your residency program, you have to be careful who you ask for advice about interviewing with people in other settings.

Dr. Reiss was able to get answers to many of her questions from colleagues in the organized medicine community, including the AMA Resident and Fellow Section, but she knows not all residents will have as many connections.

WHY USING A HEALTHCARE RECRUITER IS YOUR BEST OPTION

Navigating the transition from residency or fellowship to your first attending position can be overwhelming. Working with an experienced healthcare recruiter offers significant advantages that many new physicians overlook:

Expert Market Knowledge: Recruiters understand compensation benchmarks, market trends, and what employers are truly offering across different regions and practice settings.

Negotiation Support: A skilled recruiter advocates on your behalf, helping you negotiate salary, benefits, signing bonuses, and contract terms without the awkwardness of negotiating directly.

Streamlined Process: From initial job search to contract signing, recruiters handle the logistics, saving you valuable time during your busy residency or fellowship.

Finding the Right Fit: Beyond salary, recruiters help match you with opportunities that align with your career goals, lifestyle preferences, and values.

1. YOU ARE FREED UP TO FOCUS ON PATIENT CARE

The biggest difference between employment and private practice is how much of the business of medicine you want to be involved in.

I do not have to worry about many of the nuances of day-to-day business management, Dr. Reiss said, adding that her training did not cover running a business. In fact, that was more intimidating to me than doing major surgical operations.

But this is not purely a benefit. I do not sit in on many meetings about costs, and I do not worry about hiring and firing staff, which is a pro and a con. If you have staff you do not love, you also do not have the ability to replace them if you are not their direct employer.

As an employee, you may have more limited earning potential, but you will also have more limited exposure to financial losses. You are going to have more of a set income. Through the COVID-19 pandemic, for example, I was probably more protected than many of my private practice colleagues.

2. COMPENSATION CAN VARY WIDELY

The reason for this comes down to the business model you are working in.

A private practice model of compensation is definitely different from the employed model, Dr. Reiss said. They get paid based on what they collect, so time management is very important to maximizing your profit. In an employed model, I get paid for working.

Her contract is set up so that she gets a base pay and a bonus for productivity, then separate compensation for call. But some other employment contracts might provide no pay at all for call, or no bonus, or some threshold for reaching base pay.

When you look at employment contracts, they are as variable as anything else you can do in medicine.

3. YOU GET FLEXIBILITY TO PURSUE OTHER INTERESTS

I had the impression during residency that being an employed physician would mean having a lot of structure to your day, for example, having a report time and a dismissal time, but that has definitely not been the case for me. I have a lot of autonomy over my schedule.

This extra time can make a difference in avoiding burnout and achieving your other life goals.

In reviewing contracts, I realized I could remain involved in the AMA and other organizations in the employed setting, whereas in a private practice setting, I felt any time I took off was going to have to come out of my earnings.

4. YOUR CONTRACT CAN DETERMINE YOUR SUCCESS

Just as physicians are not trained in the business of medicine, they are untrained in reviewing employment contracts. So do not try to do that on your own. Hire a lawyer who specializes in physician employment.

I got mine by asking around. My husband was working at an orthopaedic office at the time and had some connections there. You will realize it is a small world when you start asking around about this.

5. KNOW YOUR VALUE

Once you get to the offer stage, it pays literally to be patient.

There is a wow factor when you first see a compensation number because you are leaping from a resident salary to an attending salary. So even if you see a number that is not your fair-market value, you may still be in awe of that number because it is significantly different from your resident compensation.

Do not fall prey to this and blindly take the first offer.

Going into it, you need to know what you are worth given your specialty, your demographic area and the practice setting. If somebody comes to you with a lowball offer, you can either respond with data or politely decline and move on if it is not something you can negotiate.

6. THINK CREATIVELY ABOUT COMPENSATION

Some employers have terms that are set in stone and apply to everyone. That is where I encourage residents to be creative about getting the things they want. For example, you can negotiate in a signing bonus, loan payments or moving expenses.

Of course, this means knowing what is important to you. Dr. Reiss recommended making a list:

If PTO or time away is critically important, know the minimum you are willing to settle for and also what is your ideal. Is CME something you need your employer to pay for? Can you negotiate in some of your association dues or recertification dues?

Too many people often get caught up strictly on that base-pay piece. You should also factor in duties if you are asked to be a medical director or to supervise nonphysician providers.

7. TERMS SHOULD ACCOUNT FOR LIFE POSSIBILITIES

The one thing that jumps to mind that I did not get negotiated into my contract, despite going through all the advice I did, was maternity leave.

I had what I felt was great paid time off, and the call parameters felt very fair, but I did not plan for how that would look once I took maternity leave. Luckily, I had an employer that worked with me and did not force me to make up call. But they could have.

8. CONTRACT NEGOTIATION IS NOT A ONE-SHOT DEAL

Be patient once you get a draft contract from the employer.

I went through it with my lawyer, and we talked about what we liked and did not like, what I wanted here and there, and then we sent them back revisions. Then they sent some changes back, but not all of them, and that is when I asked my lawyer to handle the next round or two. So, it was a two to three round process.

As a new grad, I felt guilty like I was asking for too much and I should just settle for whatever they offered. Fortunately, I had a strong lawyer who encouraged me to work for what I wanted. He told me the worst they can say is no.

If you ask for something that is really important to you and they deny it, that is probably a red flag that it is not a good fit for you.

9. BE CAREFUL WHEN DISCUSSING JOB OFFERS

My last bit of advice to anyone going through this process of looking at employers, jobs, and contracts is this: Do not stretch the truth about an offer you have received. Medicine is a small world.

Somebody is always going to be asking about you in a back-door route while you are going through this process, so do not ever lead anyone astray. Be honest and you will come out good on the other side.

READY TO NAVIGATE YOUR CAREER TRANSITION?

At Generation Health Search, our experienced healthcare recruiters specialize in helping physicians like you find the perfect opportunity. We will help you:

- Identify positions that match your goals and lifestyle - Understand fair market compensation for your specialty and region - Navigate contract negotiations with confidence - Streamline the entire job search process

Source: American Medical Association