Negotiating Physician Work Obligations: Why Clarity is Power

One of the most common surprises our clients experience in physician employment contracts is the disconnect between what was promised in interviews and what shows up in the employer’s first-draft employment agreement. At our firm, we help physicians spot these mismatches early and use that insight to guide targeted negotiation, particularly around work obligations.

This blog breaks down why your work obligations section is one of the most important and often negotiable parts of your employment agreement.

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The Contract Often Tells a Different Story

Too often, we see major discrepancies between the key interview promises that make you excited about the position, vs. what the contract says. Almost all physician contracts have what’s called an “Entire Agreement” clause that says any promises made during the interview process are unenforceable. This sounds wild, but check your contract, and it’s almost always there.

Let’s look at a few common examples:

• Work Location: You were told you’d only work at a single site, and I bet it had the best equipment, fully staffed, the most convenient location, and the freshest paint. But the contract allows for assignment to five different sites or says your location can change unilaterally by the employer based on the employer’s needs. This is one of the most common negotiation requests in the firm.
• Work Hours: You were told the job is “32 clinical hours and 8 administrative hours.” The contract simply says, “40 hours per week,” with no breakdown, or “at least 32 clinical hours, which may be adjusted based on employer need,” which may not be a ceiling at all. If you’re picking a job over another because of lower clinical work hours, it’s important to make sure you’re getting what you expect!
• Call Schedule: You were told, “Call is never worse than Q5.” But the contract says, “Call is at the sole discretion of the employer.” That’s a big gap, and expanding call duties is a common reason that physicians already in employment agreements call us for assistance in renegotiations and exits.
• NP/PA Supervision: In primary care, many employers want to make physicians do this for free for multiple non-physician practitioners. In some surgical specialties, it may be a practice advantage to have NPs or PAs assigned to you as you build your practice. We have negotiated this both ways, including the removal of this requirement for a psychiatrist or a pediatrician, but including language of expected reasonable staffing levels for a surgeon. Uncompensated duties or understaffed practice can have a big impact on whether your work obligations match your total compensation package.
• Scope: If you’re picking a position because it comes with a specific scope of practice, it can be super helpful to clarify this in the contract. We have seen employers unilaterally expand the scope against the physician’s wishes when there is a business need. Having clarity in the contract can help you push back.

None of these details are “minor.” They dictate your quality of life.

How to Negotiate Work Obligations

When discrepancies arise, here are some terms you might consider negotiating:

• Primary Location Language: We recently worked with a hospitalist negotiating an employment contract with a staffing company that had multiple hospital contracts in that geographic area. The interview process was solely at Hospital A, but the contract included five different locations, and no clarity around which one he would be at. During our negotiations, they admitted that they wanted flexibility to schedule some shifts at another site (likely because it was the hardest to staff). We pushed back, and eventually landed on a request that at least 80 to 90 percent of your work occur at a single named location, with any change requiring mutual agreement. The employer obliged, which helped significantly reduce the exposure here.
• Defined Clinical Hours: A primary care physician client expected 32 clinical and 8 admin hours based on the interview process. The client asked for that language to be included clearly. The employer obliged. Three years later, the employer had lost a few primary care physicians and wanted to unilaterally expand it to 38 and 2, believing that they had the legal right to do this under their ‘standard’ contract. However, our client circled back with us, and we examined our prior negotiations and final contract, which included the 32 and 8 language. She was the only physician who had this language in the contract, giving her a leg up in further discussions and allowing her the right to say no. 
• Call Schedule Stability: We worked with an OBGYN who was joining a private practice group with 8 others, creating an expectation of Q9 call. We inquired about this in the contract because it said, “Call shall be determined in the employer’s sole discretion.” We negotiated for a cap that allowed some flexibility, asking for ‘evenly’ distributed call and a cap at Q6. While they agreed to the ‘evenly’ language, they did not agree to the call cap. However, they offered to pay for call greater than Q6. While that was less ideal, it at least created a financial advantage if the unexpected occurred.
• NP/PA Supervision: We worked with a psychiatrist who was considering an employment opportunity with a large system. The responsibilities around NP/PA supervision were vague, and the interview process suggested this was not applied uniformly and was uncompensated. We negotiated for a change, but the employer was clear that they would not budge, and the psychiatrist must be prepared to accept an expanding supervision expectation at any time. This psychiatrist had another opportunity a couple of months later, and we negotiated the same thing – and they agreed. While she was bummed about the first opportunity, the negotiation process led to clarity on a key issue, and she made the right decision.
• We also worked with a dermatologist who was evaluating an opportunity with an independent physician-owned practice that was mostly cosmetics. We negotiated for two dedicated MAs for her clinic, and the employer obliged. We also negotiated for access to a bonus structure for NPs in the clinic she would be spearheading, and they added a modest compensation structure that increased her compensation if the NPs in her practice location were profitable.
• Scope: We have worked with multiple OBGYNs with Complex Family Planning fellowship training. They are often hired on to build a clinical practice primarily focused on contraception and abortion care. Many employers don’t have this already set up in their practice, but are hiring to fill this critical need. However, this is rarely included in the contract, and it often reads as if the physician will be an OBGYN generalist. It’s super helpful to build something into the contract that explains the goals and expectations of your clinical practice – and particularly in OBGYN- and a clause that speaks to prorated reduction in general OBGYN call when your practice shifts toward your subspecialty.

Some employers may resist and suggest that all ‘operational’ issues are external to the contract. Flexibility is valuable to them. However, they also insist that their exit strategy clauses (noncompetes, termination rights) must be locked into the contract. This mismatch is unfair for physicians, and you deserve an opportunity to advocate for yourself and obtain the clarity you need to proceed with confidence. Your mentors and attendings may suggest this is futile, and this is ‘just the way it’s done’. Please push past that defeatist mentality. It’s not working for physicians and leading to moral injury and burnout. You deserve better.

Remember, your goal is clarity, not rigidity. You’re not just asking for an easier job. You’re trying to avoid surprises that can disrupt your life, undermine your expectations, and disrupt your career aspirations.

Why This Matters

Work obligations are more than logistics. They form the foundation of how you’ll spend your time, how your performance will be evaluated, and how sustainable the job will feel.

Contracts are not just about compensation. They are about control, predictability, and fairness. And in most physician contracts, work obligations are one of the most “fuzzy” sections, unless you bring clarity to them. Employers often expect questions about your contract. While they are not inclined to voluntarily tell you what they may or may not negotiate, it’s important for you to do your homework and ask the important questions.

Don’t rely on verbal promises. If something matters to your day-to-day life, it needs to be clarified in the contract. The employer may not intentionally mislead you, but misunderstandings happen, and their future business needs and plans may change. And unfortunately, what’s written is what governs.

Work with a physician contract lawyer before you sign. We can help you identify gaps, ask the right questions, and negotiate terms that create clarity from day one. Visit www.michaeljohnsonlegal.com for more contract tips, or reach out to schedule a full-scope evaluation and negotiation plan.

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