Here's a secret most physicians don't realize: the first offer is almost never the best offer.
Hospitals and practice groups expect negotiation. They build wiggle room into their initial offers. Yet most physicians—especially those coming out of training—accept the first number they see.
That's a costly mistake.
Why Physicians Don't Negotiate (And Why They Should)
After years of training, you're finally getting a "real" salary. It feels like a lot. You don't want to seem greedy or jeopardize the offer.
But consider this:
- A $30,000 increase in your starting salary compounds over your career
- Over 25 years, that's $750,000+ in additional earnings (not counting raises)
- Most employers expect to negotiate and won't rescind offers for asking
The bottom line: Not negotiating is leaving money on the table. Every time.
Before the Negotiation: Do Your Research
Know Your Market Value
Before any negotiation, you need data:
- MGMA Data - The gold standard for physician compensation benchmarks
- AMGA Compensation Survey - Another reliable source
- Doximity Compensation Report - Free and specialty-specific
- Glassdoor/Indeed - Take with a grain of salt, but useful for ranges
Look at:
- 25th, 50th, 75th, and 90th percentile for your specialty
- Geographic adjustments (NYC pays different than rural Iowa)
- Experience level adjustments
- Academic vs. private practice differences
Know What You Bring
Identify your unique value:
- Subspecialty training or certifications
- Bilingual abilities (huge in some markets)
- Research or teaching experience
- Leadership experience
- Existing patient panel (if applicable)
The Negotiation Framework
Step 1: Let Them Name the First Number
Never share your salary expectations first. When asked, deflect:
"I'm focused on finding the right fit. I'm confident we can agree on fair compensation if this is the right opportunity."
Once they make an offer, you have an anchor to negotiate from.
Step 2: Express Enthusiasm, Then Pause
"Thank you for the offer. I'm excited about this opportunity. I'd like a few days to review the details before we discuss further."
Never negotiate in the moment. Take at least 48-72 hours to:
- Review the full compensation package
- Compare to market data
- Identify your priorities
Step 3: Negotiate the Full Package
Compensation isn't just base salary. Consider:
| Component | Negotiable? | Typical Range | |-----------|-------------|---------------| | Base Salary | Yes | $20K-$100K+ | | Signing Bonus | Yes | $10K-$100K | | Relocation | Yes | $10K-$30K | | Loan Repayment | Sometimes | $20K-$200K | | CME Allowance | Yes | $3K-$10K | | PTO Days | Yes | 3-10 additional days | | Start Date | Yes | Flexibility | | Call Reduction | Sometimes | Fewer call days | | Partnership Track | Sometimes | Earlier eligibility | | Non-Compete | Yes | Shorter/narrower | | Tail Coverage | Yes | Employer-paid |
Step 4: The Counteroffer Script
"Thank you again for the offer. I'm very interested in joining [Organization]. Based on my research of market compensation for [specialty] physicians with my qualifications in [region], and considering [specific value you bring], I was hoping we could discuss a base salary of [your target number]."
Key principles:
- Be specific with numbers
- Cite data, not feelings
- Emphasize your value
- Stay positive and professional
Step 5: Negotiate Beyond Base Salary
If they can't move on base salary:
"I understand base salary is constrained. Could we explore a signing bonus to bridge the gap?"
Or:
"What about additional CME funds / PTO days / earlier partnership eligibility?"
Often, non-salary items come from different budgets and are easier to approve.
What If They Say No?
If It's Still a Good Offer
Accept graciously. You asked, they said no, that's okay. You haven't damaged the relationship.
If It's Below Market
"I appreciate you considering my request. Unfortunately, at [offered amount], I wouldn't be able to accept. If circumstances change, I'd love to revisit this conversation."
Be prepared to walk away. Sometimes they'll come back. Sometimes they won't. But accepting a below-market offer breeds resentment.
Common Negotiation Mistakes
- Negotiating too early - Wait until you have a written offer
- Accepting immediately - Even if it's perfect, take time to review
- Making ultimatums - Stay collaborative, not adversarial
- Focusing only on salary - Total compensation matters more
- Not getting it in writing - Verbal promises evaporate
Special Situations
New Graduates
You have less leverage, but you still have some:
- Subspecialty training
- Research publications
- Board scores
- Any unique skills
Start modest but still negotiate. Even $10-15K matters over a career.
Mid-Career Moves
You have more leverage:
- Proven track record
- Existing patient relationships
- Established reputation
- Competitive offers
Don't be afraid to ask for what you're worth.
Academic Positions
Academic salaries are often "set" but:
- Startup funds are negotiable
- Protected research time is negotiable
- Lab space is negotiable
- Title/rank may have flexibility
Key Takeaways
- Always negotiate - It's expected
- Do your research - Know your market value
- Negotiate the full package - Not just base salary
- Stay professional - Collaborative, not adversarial
- Get it in writing - Verbal promises don't count
The 30 minutes you spend negotiating could be worth hundreds of thousands of dollars over your career. It's the highest-ROI activity you'll ever do.
Want more physician career resources? Browse our job listings or check out our contract red flags guide.