Blog Viewer

9 Steps to Smart Contract Negotiation


Before starting your new role as an anesthesiologist, there's one last hurdle: employment contract negotiation. By John Rose, DO

As a newly minted anesthesiologist at the end of years of arduous medical training, the anticipation of your first attending paycheck can be exciting. However, before starting your new role, there's one last hurdle: employment contract negotiation. Here are nine steps to navigating this process so you can begin your career on the right foot.

1. Know your worth (research and self-assessment).

Before you even start the negotiation process, it's essential to understand your value in the job market. Fortunately, it is an opportune time to enter the field. Starting salaries have been consistently rising for general anesthesiologists over the past few years, with average earnings up over 7% from last year alone. However, many factors can affect your future salary. Geographic location, fellowship training, and call incentive can greatly impact compensation. Assess your own qualifications, considering your residency, fellowship, and any additional certifications you might hold. Having a clear picture of your worth will give you a strong foundation for negotiation.

2. Understand the offer completely.

Take your time to thoroughly review the employment contract. It is also may be prudent to have a lawyer review it, so that you clearly understand what you are signing up for. Understanding any non-compete clauses, malpractice insurance coverage, and the overall benefits package is vital before signing. Keep in mind that many potential employers offer a lot on interview day, but unless it is in writing it may be difficult to enforce after your hired. Make sure your salary, benefits, working hours, call duties, and performance expectations are all clearly laid out in the contract. Don't hesitate to ask for clarification on any points that seem unclear or ambiguous.

3. Prioritize what’s important to you.

Focus on negotiating the most critical aspects of the contract that will significantly impact your career and quality of life. There are many ways to practice anesthesia. For example, if salary is what you value most, it may mean taking on a larger call burden or putting in longer hours. If you are looking for a no call position, it may come with a smaller salary or less control over your case variety. You should have a clear idea of what you are looking for when it comes to salary, benefits (healthcare, retirement, disability), vacation time, call schedule, and work-life balance. Be prepared to discuss these points in detail and express your preferences clearly.

4. Be proactive about malpractice insurance.

Malpractice insurance is an essential component of your practice as an anesthesiologist. Ensure that the contract specifies the details of coverage, limits, and who will pay for it. Typically, most employers will cover your malpractice insurance. However, in many practices your coverage ends when you leave the job, and the employer’s policy will not protect you against claims that are brought against you after you leave. Knowing if your employer includes a policy (known as tail insurance) to cover those claims specifically is crucial. If there are any discrepancies or uncertainties, seek legal advice to ensure you are adequately protected.

5. Negotiate non-compete and restrictive covenants.

Non-compete clauses can impact your future career opportunities. Many employment contracts will include a non-compete clause, meaning that if you leave the job, you may not be able to work in the surrounding geographic location for a predefined period. While many employers don’t enforce these clauses for anesthesiologists, it is important to understand that it is within their legal write to do so if you have signed such a clause. Review the non-compete terms carefully, and if they are overly restrictive, consider negotiating for something more reasonable. You'll want to ensure you have the freedom to pursue new opportunities if they arise.

6. Practice effective communication.

Approach negotiations with professionalism and confidence. Anesthesiology is a closer-knit community than you might think and burning a bridge with one employer can follow you while you interview at different practices. Be prepared to explain why certain terms are important to you while being open to compromises that benefit both parties. It is important to maintain a positive tone and remain respectful throughout the negotiation process.

7. Don't rush the process.

Employment contract negotiations take time, and it's crucial not to rush through the process out of eagerness to start your new role. If an employer is rushing you to sign a contract you aren’t comfortable with, you should proceed with caution. Ideally your potential employer will encourage you to look at other opportunities before signing, or at the very least be open to giving you time to have a lawyer review your contract. Take the necessary time to negotiate terms that align with your career goals and values.

8. Secure promises in writing.

Any verbal agreements or promises made during the negotiation should be included in the final contract. This includes call responsibilities, protected research time, maternity/paternity benefits, or any other element that is important to you. This ensures that both parties are on the same page and helps prevent misunderstandings down the line.

9. Trust your instincts.

An important adage to remember is that you cannot put a price in loving your job. Remember that your employment contract is a reflection of your potential employer's commitment to your well-being and professional growth. If something feels off or raises concerns during negotiations, trust your instincts and consider whether the role is the right fit for you.

Embarking on a career as an anesthesiologist is a momentous occasion. By approaching employment contract negotiations with knowledge, confidence, and the guidance of legal experts, you're setting the stage for a successful and fulfilling journey in the world of healthcare. Your skills are in demand, and it's up to you to ensure that your employment terms reflect your true worth and aspirations.


John C. Rose, DO, received his undergraduate education at Denison University, a Master’s degree in Immunology at the University of Aberdeen, and his medical education at Nova Southeastern University. After completing his graduate medical training at Mount Sinai Morningside-West hospitals, he stayed on as an Assistant Professor and as an Associate Program Director for the residency. He serves as the site director for Oncological Anesthesia and Minimally Invasive Vascular Anesthesia. His areas of academic interests include trauma anesthesia and resident education.

The ASA Committee on Young Physicians is pleased to present this monthly article series on personal finance. These articles are not written by hedge fund managers or real estate tycoons but by practicing physicians. Some have business degrees and some do not – but every contributor is an anesthesiologist who has some guidance to offer the rising generation of attending physicians. It is not the intention of the committee to offer definitive financial advice, but rather some pearls of wisdom to consider while developing a personal fiscal plan. 

ASA Community Blog is published as a benefit for ASA members. The views expressed on this blog are those of the individual contributing writers only and do not necessarily represent the opinions of ASA.