The 5-Minute Doctor Guide to Pay & Negotiation

Many of you will be negotiating offers or contracts over the next few months.

New attending jobs. Renewals. Partnership discussions. Productivity resets.

So I wanted to share a simple framework that helps physicians position themselves before they ever start negotiating. Because most doctors approach this process backwards.

They start with:

“What does my specialty usually pay?”

That’s the wrong question.

The better question is:

“Where does this offer sit relative to the real distribution in my specialty?”

That difference matters far more than most physicians realize.

Why Salary Data Actually Matters

Most doctors negotiate in the dark.

We rely on:

recruiter anecdotes
internet averages
what a senior resident “heard once”

The problem is that averages hide the range.

And negotiation without understanding the range is just guessing.

What you actually need is context — enough information to understand whether you’re starting near the bottom, middle, or top of what’s normal for your specialty.

That context can come from several places:

talking directly to colleagues about what they’re seeing
tools like Marit Health that show salary distributions, job postings, and real-world offers
MGMA data – which most employers use. This typically costs a few hundred $, but PPS subscribers who are clinicians can get the benchmarks for their specialty for free on Marit
contract review firms who specialize in helping physicians negotiate stronger offers

No single source is perfect. But negotiating without any of them is a mistake.

One Pattern the Data Keeps Showing (With an Important Caveat)

Across specialties, one trend shows up repeatedly at the top of compensation ranges:

Ownership and alignment matter more than anything else.

Physicians who are:

self-employed
on a real partnership track
paid on collections or productivity
owners in ASCs or ancillary services
part of transparent, equal-share models

consistently appear in the highest income brackets.

You can even see it in the tax paperwork. K-1 income shows up far more often among high earners than pure W-2 income.

Important caveat: Not every specialty has access to these levers. In some fields, ownership simply isn’t realistic, and chasing it would be a distraction rather than a solution.

The point isn’t that everyone should pursue ownership. It’s that you should understand which levers actually exist for you — and which don’t.

How to Negotiate for Alignment (When It’s Available)

You don’t usually walk into a negotiation and say, “I want equity.”

You start by asking better questions.

For example:

“Is there a partnership or equity path here, and is it written down?”
“What does compensation look like once someone is fully ramped?”
“Who benefits financially when volume increases?”
“Do physicians see the economics of the practice?”

If the answers are vague, the ceiling usually is too.

If ownership isn’t possible now, you’re listening for whether it’s:

clearly defined later, or
quietly never coming

Both are useful information.

In specialties where ownership isn’t on the table, alignment often shows up instead through:

transparent productivity formulas
paid leadership or administrative roles
clear rules for how extra work is compensated

The First Tactical Step (After Ownership & Alignment): Place Yourself in the Distribution

Once you understand what levers exist, the first tactical move to approaching a negotiation is simple:

pull real specialty-level compensation data
understand where your offer sits relative to peers
stop thinking in terms of “good salary” or “bad salary” and instead, think in terms of positioning.

If you’re already near the top of the distribution, your strategy looks very different than if you’re near the bottom.

Same specialty. Different moves.

What to Negotiate Once You Know Where You Stand

Once you understand your positioning, negotiations stop being emotional and start being practical.

If the offer is near the bottom of the range

Your leverage is structural.

You should be asking:

“How does this number change over time?”
“What moves compensation meaningfully here?”
“What do higher earners in this group do differently?”

You’re not asking for a raise. You’re identifying whether the job has a ceiling baked in.

If the offer is near the middle

Your leverage is clarity.

This is where you negotiate:

how productivity is calculated
how extra work is paid
what renegotiation actually looks like in practice

Small changes here compound quickly.

If the offer is near the top

Your leverage is protection.

You focus on:

contract length
non-compete scope
exit flexibility if life changes

At this stage, preserving optionality matters more than squeezing dollars.

In my case, my offer and salary were above average, which for my skill set and what I bring is appropriate (a biased opinion if there ever was one!) That’s why the primary focus of my negotiations was creating a good time frame to renegotiate (I like 3 years) and eliminating my non-compete clause, which I was able to do completely. I also focused on altering language to make sure I could pursue non clinical side gigs, which is obviously very important to me.