The Limiting Beliefs Holding Doctors Back from Negotiating - and How to Overcome Them
For new doctors fresh out of residency or fellowship, negotiating the first contract can feel like a moral test rather than a milestone.
“I don’t want to come off as pushy or greedy.”
“I’m on a visa - I can’t really negotiate.”
“I heard someone tried negotiating, and the offer got pulled.”
“It’s a decent offer. I don’t want to lose a job over something small.”
These aren’t fringe concerns. They’re common, deeply held beliefs voiced by residents, fellows, and new attendings across all specialties - and they are quietly shaping careers in ways that are costly and avoidable.
How Training Teaches Doctors to Avoid Negotiation
Training rewards compliance, endurance, and deference to hierarchy. After talking to many fellows and new attendings, I’ve found that by the end of training, many new graduates have internalized at least one of three mindsets:
- Accepting power asymmetry without pushback. Trainees never got to negotiate job terms or compensation before. Authority always flowed downward, and questioning terms now feels like overstepping.
- Financial worth at the expense of moral “worth.” Altruism gets equated with self-sacrifice, and financial self-advocacy gets subconsciously coded as selfish. Asking for fair pay can subconsciously feel like betraying a professional value.
- Entrenched scarcity thinking. Years of competitive selection reinforce the belief that opportunities are rare and fragile– even as national data shows persistent physician shortages in many specialties and regions.
The Most Common Negotiation Myths
“I'll seem greedy if I negotiate. It’s already a decent offer.”
Negotiation can get mischaracterized as a character flaw rather than a professional skill. In reality, negotiation is a routine and expected process. According to physician contract attorneys, most employers expect - and budget for - negotiation. Not engaging doesn’t make you more virtuous; it simply leaves leverage on the table.
“This is a standard contract.”
Don’t let terms like “standard agreement” lead you to believe there is no room for negotiation. A first draft labeled “standard” doesn’t mean you can’t request modifications. Even large hospital systems that won’t change their benefits package can still offer concessions in schedules, CME funds, and signing bonuses when asked. There’s nearly always something negotiable, and the vast majority of employers will make reasonable changes if asked.
“I’m on a visa. I can’t really negotiate.”
Visa status does increase vulnerability, but it doesn’t eliminate agency. Immigration attorneys and contract lawyers routinely negotiate on behalf of visa-holding doctors, particularly around termination clauses, contract length, legal fee coverage, call burden, and compensation structures. The risk isn’t in negotiating; it’s in signing terms that don’t adequately support you.
A Canadian alum admitted, “I felt so brand new and not confident; I had a visa to worry about and was just trying to get any job I could. They said this was a ‘standard position’ so I didn’t realize I could even negotiate it.” After asking for a consideration and explaining his circumstances, he was surprised that the department offered him a larger moving bonus and more schedule flexibility.
“I heard that [some bad outcome] happened when someone negotiated.”
Medicine trades heavily in anecdotes. While they make for memorable cautionary tales, the vast majority of physicians consistently secure a range of benefits, from call restructuring to base pay and sign-on bonus boosts, when negotiating. More importantly, an employer who rescinds an offer in response to reasonable asks can reveal a culture that would have surfaced later at a far greater cost.
“Don’t lose a job over asking for this.”
Just landing a job, at the expense of poor contract terms, proves costly down the road. Terms leading to excess call, vague productivity metrics, and restrictive noncompetes are among the leading drivers of early burnout and job turnover, which already affects 1 in 5 physicians within the first few years of practice.
Says another alum, “I heard this phrase too, and I think it’s pretty bad advice. You won’t lose your job offer by just asking for an extra two weeks of vacation. If you even did, that says a lot more about them.” She negotiated a later start date easily.
Reframing the question turns “Is this clause worth losing a job over?” into “What will this clause cost me if I stay?” Burnout, resentment, and exit costs dwarf the short-term discomfort of negotiating.
Why the First Contract Matters More Than You Think
It’s about trajectory.
- Your first contract sets your baseline. Compensation growth often builds on your starting salary. MGMA data shows five-figure annual differences in physician pay in the same specialty and region - variation that compounds over time. A weaker starting position can echo through raises, bonuses, and partnership tracks for years.
- Negotiating builds your professional self-trust. Advocating for yourself early on teaches yourself that you are worthy, valuable, and have agency in your career. That belief generalizes, and compounds – those who learn to negotiate early often find it easier to set boundaries, navigate conflict, and step into leadership later.
- The precedent you set promotes downstream fairness. Every undernegotiated contract quietly reinforces suppressed benchmarks for the next hire. One doctor negotiating well expands the reference range for the colleagues and peers behind her. Negotiating fairly helps normalize appropriate pay and working conditions for those who follow, and it’s an opportunity to shape the future of the field as a whole.
The Takeaway
Negotiating your first contract doesn’t make you difficult or demanding. It’s the norm, and it’s a hallmark of those who can name their value, ask good questions, and advocate for the work conditions they worked so hard for. It’s about working together to reach an agreement that’s sustainable, fair, and explicit.
The stories we tell ourselves matter. Make sure yours is one of self-worth and self-trust.
Kelley Yuan, MD is a resident physician at Stanford Health Care who loves where health meets design, venture, and trust. You can reach her on LinkedIn.
