Negotiating Your First Consultant Contract

After 10-15 years of rigorous medical training, exams, and fellowships, you are finally transitioning from "Trainee" to "Consultant" (or Attending). You are an expert in orthopaedic surgery. But you are likely a novice in contract law and negotiation.

This mismatch—high clinical value, low business acumen—makes new surgeons prime targets for unfavorable contracts. The first contract you sign sets the financial and lifestyle baseline for your early career. A bad contract can cost you millions of dollars over a decade and lead to burnout.

This guide provides the strategic framework for negotiation. (For the technical definitions of contract clauses, see our companion article: Variables Beyond Salary).

Visual Element: A "Leverage Seesaw" graphic. On one side: "Surgeon Value" (Specialized skills, Training pedigree, Willingness to take call). On the other: "Hospital Needs" (Trauma coverage, Backlog clearance, Prestige). The goal is to balance or tip the seesaw.

The Psychology of Negotiation

1. You Have Leverage

You might feel lucky just to get a job offer. Stop that thinking. Recruitment is expensive.

• Scarcity: Orthopaedic surgeons are hard to find.
• Revenue: You generate massive downstream revenue for a hospital (imaging, PT, OR fees, implants). You are a revenue center, not a cost center.
• BATNA: Best Alternative To a Negotiated Agreement. If you have another offer (or are willing to keep looking), you have power.

2. They Expect You to Negotiate

Hospitals and practice groups almost always leave "room" in the initial offer. If you accept the first offer, you are leaving money (or time) on the table. Negotiating is professional; accepting blindly is naive.

3. It's Not Just About Money

Salary is important, but lifestyle clauses often matter more for longevity.

• Block Time: Guaranteed OR access is vital.
• Call Frequency: "1 in 3" vs "1 in 6" is a life-changing difference.
• Support: PA/NP support, scribe, dedicated admin time.

Strategic Points of Negotiation

1. The "Ramp-Up" Period

It takes time to build a practice.

• Ask: A guaranteed salary for the first 2 years (Income Guarantee).
• Why: This protects you while you network, market yourself, and build referral streams. Avoid pure "eat what you kill" (production only) models in Year 1 unless you are stepping into a retiring surgeon's full practice.

2. Block Time and OR Access

You are a surgeon. You need to operate.

• The Trap: Being hired to clear clinic backlog but given no OR time.
• Ask: "Guaranteed Block Time" (e.g., 2 days/week) for the first year.
• Metric: Ask how block time utilization is calculated and when it can be taken away.

3. The Non-Compete (Restrictive Covenant)

This is the "Golden Handcuffs" clause.

• The Danger: A 50-mile radius for 2 years. If you leave, you have to move your family and kids to a new city.
• Negotiate:
  • Reduce Radius: 5-10 miles (or just the specific hospital, not the network).
  • Reduce Time: 1 year.
  • "Buy-Out": A clause allowing you to pay a fee to void the non-compete.

4. Call Obligations

"Equitable share of call" is dangerous language.

• Ask: Define "Equitable." Does the 60-year-old senior partner take trauma call? If not, "Equitable" might mean you take all the holidays.
• Cap it: "Maximum of 5 nights per month."
• Paid Call: Is excess call paid?

The "Signing Bonus" vs "Retention Loan"

Be careful with upfront cash.

• Signing Bonus: Usually paid upon signing. Taxable.
• Relocation Allowance: For moving expenses.
• Student Loan Repayment: Often paid directly to lender.
• The Catch: These are often "Forgivable Loans." You must stay for X years (usually 2-3). If you leave early, you must pay it back with interest.

Red Flags During Negotiation

1. "We'll sort that out later": If it's not in the contract, it doesn't exist. "Verbal promises are worth the paper they are written on."
2. "This is our standard contract": There is no such thing. Every contract can be amended. An addendum can be added.
3. High Turnover: If the last 3 partners left within 2 years, the contract (or the culture) is toxic.
4. Vague Bonus Metrics: "Discretionary bonus based on citizenship." This means "We pay you if we feel like it." Demand objective metrics (wRVUs, collections).

The "Tail Coverage" Trap

Malpractice insurance is expensive.

• Claims-Made Policy: Only covers claims made while you are employed.
• Tail Coverage: Covers claims made after you leave for events during employment.
• Cost: 1.5x - 2x your annual premium (e.g., $50k - $100k).
• Strategy: Negotiate for the employer to pay the tail if you leave, or at least split it 50/50.

Conclusion: Hire a Lawyer

Do not review your own contract. You are not a lawyer.

• Hire a Healthcare Attorney: Specifically one who knows physician contracts.
• Cost: $500 - $1,500.
• ROI: Potentially saving you $100,000+ or a lawsuit.

Remember, a contract is the beginning of a relationship. Negotiating fairly and firmly sets the tone that you are a professional who respects their own value.

#ContractNegotiation #SurgeonLife #CareerAdvice #MedicalLaw #PrivatePractice #HospitalEmployment #RVU #NonCompete #OrthoVellum