Show me the Money

Tips for negotiating your first salary after residency

Know your worth. Ask for what you want. And know when to walk away.


Whether you’re working with a recruiter or doing a job search on your own, negotiating the salary for your first job after residency can be a daunting task. The DO spoke with physicians and a recruiter who provided insights about the negotiating process as well as tips on having this discussion.

Determining how negotiable a given position is

The negotiability of your desired job’s pay will depend on several factors, says Jamie Thomas, executive vice president at The Medicus Firm, a physician staffing company in Dallas.

“If you decide to go into a smaller practice, you may have more room to negotiate and you may have a wider scope of practice. In a lot of large systems, things cannot be negotiated as much,” he says.

Your specialty will also make a huge difference, he notes.

“If primary care is your specialty, you may have more flexibility to negotiate because there is a shortage of primary care physicians,” he says.

It’s also a good idea to consider what skills your employer is looking for and whether you bring those to the table. For instance, perhaps you speak Spanish and your prospective patient population includes Spanish speakers.

Employers are looking for a match, Thomas says. “They’re asking themselves, ‘How does this candidate’s skill set help the group overall?’ There are certain skill sets that will help grow a practice and those that will not. That’s all a part of the screening process.”

While an employer’s budget will certainly influence an offer, a candidate’s perceived ability to perform is also a top consideration in the selection process, Thomas says.

“It’s more about potential than salary,” he says. “They want to make sure that the incoming physician has the aptitude to meet that potential.”

When to negotiate

Knowing when to bring up the money factor is also an important part of negotiating. That discussion should come after several other factors outside of salary have been considered and after an offer has been made, says Monique Gary, DO, a general surgeon and medical director who recently led an AOA webinar on contract negotiations.

“The time is right [to negotiate] once you’ve evaluated the other key aspects of the job, the scope of practice, location, culture, work environment, the relationship of physicians with c-suite executives and the happiness of the physicians, among other factors,” says Dr. Gary. “Once you deem those things are a good fit, then it’s time to discuss salary.”

How to negotiate

Once you’ve received an offer, if you’d like to see if the employer will negotiate further, Dr. Gary suggests saying ‘Thank you for this initial starting point. I’d like to inquire about the following aspects of this offer.’

“Be prepared with data to substantiate any [salary] requests,” she says.

Family physician William Tan, DO, recommends that job seekers use aggregate data on physician salaries. “I don’t think the average medical student or resident really knows about this available data,” he says.

Dr. Tan suggests reviewing the physician salary data provided by the Medical Group Management Association (MGMA) and AMGA. “You have to pay for this data and it’s not cheap,” he adds. “I believe many physician recruiting firms refer to this data when counseling candidates.”

A free resource that can be useful is Medscape’s Physician Compensation Report, Dr. Tan says.

After residency, Dr. Tan joined a small practice that had an affiliation with a large hospital. He negotiated for a first-year guarantee based on the average family medicine salaries in the area. And then asked for more.

“I pressed hard for an above-average salary based on the prior relationship the hospital system had with my now-partner. Based on his revenue generation for them, the hope was that I would eventually bring in those numbers,” he says.

Knowing your worth and value will help when you’re assessing an offer, Dr. Gary says.

“Employers should want you as much as you want them,” she says. “If the offer doesn’t fit your needs and long-term goals, Learn to say ‘thank you,’ and be willing to gracefully walk away.”

Beyond salary

True job satisfaction, experts say, goes well beyond money. Salary is just the beginning.

“Salary doesn’t guarantee happiness,” says Dr. Gary. “The number one mistake physicians make is focusing on salary above all else.”

As a recruiter, Thomas has helped hundreds of physicians to find their first job. “I always encourage new residents to look at a few things outside of salary,” he says. “Other areas to consider are the type of community you’re going into, large or small, city or rural, hospital or clinic. For some physicians, family and quality of life are more important than money.”

Your second job and beyond

Career experts agree that your first job will likely not be your last. If you’re looking for the next job, Dr. Gary says, “Spend some time in introspection about your last position. Ask yourself, ‘What would I do differently?’ Then, clarify your goals for your new position. Read the fine print on any contract. How you get out of a contract is just as important as how you enter it.”

Additionally, Dr. Gary suggests working with a professional consultant or career coach to better learn the language of negotiation. “The investment can make the difference between a life you want and one that keeps you trapped in a situation you may not have fully understood,” she says.

For more information:

For details on current job openings and career resources, visit the AOA Career Center.

If you’re interested in independent contractor positions, you may find this article to be helpful.

Find more tips on landing your first job after residency in this article.

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