A few years back I took a locums assignment at a hospital running a 1:7 nursing ratio. It was an absolute grind. Medication administration was delayed, nurses were exhausted, and discharges took much longer. It reminded me how much staffing levels affect the quality of care, and how often the people making those decisions are far removed from the floor.
In today’s newsletter:
Microsoft expands more into healthcare with AI
Know what to do when facing a new work contract
Find your average specialty salary in your region
Locums contracts and the MSA
What I’m Reading
Washington is finally paying attention to physician burnout. The Senate held a hearing this month titled "The Doctor Is Out: How Washington's Rules Drove Physicians Out of Medicine," where witnesses testified that prior authorization and administrative overload are the primary drivers pushing physicians out of the workforce.
Big Tech is coming for your hospital. Microsoft is aggressively expanding into healthcare through AI scribing tools, Epic integrations, and patient-facing products. For physicians, this means the technology driving your daily workflow is increasingly being built by companies whose primary expertise is technology, not patient care. Time will tell if this ends up being a good or bad thing.
The Contract I Signed Without Reading
Fresh out of residency, I did what most new attendings do. I got a full time job offer and felt relieved.
I didn't negotiate my salary. I didn't negotiate my relocation bonus. I didn't ask meaningful questions about my call schedule, bonus structure, or tail coverage. There was a non-compete buried in the contract. I knew about it, asked if it was negotiable, was told no, and believed them.
As it turned out, I got lucky as the job was a great one. But luck isn't a contract strategy, and most physicians I know are still signing the same way I did. Not because they're careless, but because nobody ever taught us this part of the job.
So here's what I wish I'd known:
Salary
Your initial offer is rarely the best one. MGMA, the industry's standard compensation database, publishes compensation benchmarks by specialty and region. If you don't know what physicians like you are earning in your market, you're negotiating blind.
Relocation bonus
Most practices have funds allocated for this. If it's not in your offer, ask. Even if you're staying in the same city where you trained, those funds are often still available. This can often be negotiated.
The non-compete
This is the clause that can quietly limit your options for years after you leave. The radius and timeframe are often negotiable even when the clause itself isn't. Many contracts also include a buyout option that lets you exit early for a fee. For hospitalists and other specialties without long-term patient relationships, non-competes are hard to justify, which is an argument worth making.
Call schedule
Vague language here is a trap. Phrases like "on call as needed" sound reasonable until the group shrinks and you're covering far more than you anticipated. Get the maximum call frequency defined in writing.
Bonus structure
Understand exactly what triggers your bonus and what can disqualify you from receiving it. Discretionary bonus language, where the employer has broad latitude to withhold payment, is a red flag worth flagging before you sign.
Tail coverage
If your malpractice policy is claims-made, you'll need tail coverage when you leave, which can cost tens of thousands of dollars out of pocket. This protects you from any delayed claims made once you’ve left a job.
Bonus: Make sure you also have your contract reviewed by a lawyer who specialized in physician job contracts. It is definitely worth the money that can save you a huge headache down the road.
The Practical Win: Look Up Your Pay Range
🚀 Before your next contract renewal, look up what physicians in your specialty and region are actually earning.
MGMA publishes the compensation benchmarks most hospitals use when making offers, but the full database is behind a paywall.
A site called Marit lets verified clinicians access MGMA's 2025 data for free by anonymously sharing their own salary. Knowing the number before you negotiate is the simplest thing you can do to advocate for yourself.
The Locums Corner
Before you ever talk hourly rates, you’ll be handed a Master Services Agreement (MSA) by a locums agency. Don’t just immediately sign this. The MSA is the permanent legal "umbrella" that covers every shift you’ll ever work for that agency.
The three non-negotiables to look out for:
The non-compete: Agencies try to "own" your relationship with a hospital for 12–24 months after you leave. Make sure this only applies to the specific facility where you worked, not every hospital in the agency’s entire national database.
Tail malpractice coverage: If they use claims-based insurance, the MSA should explicitly state the agency pays for the tail. If it’s vague, you’re looking at a very high bill for malpractice protection years after the gig ends. If they refuse to pay for the tail, ask if they will change the policy to occurrence based.
The 30 day exit: You’re a 1099 contractor, not a W2 employee. Ensure there’s a mutual termination clause that lets you walk away with 30 days' notice if the facility turns out to be a disaster.
The Bottom Line: If the language looks one-sided, it probably is. As with W2 contract offers, it’s worth getting a physician contract attorney to take a look at the MSA before you sign it if you aren’t sure.
What’s coming in the next few issues:
More details about locums contracts
How good is real estate as a side gig?
Healthtech advising and how to find roles
What would you like covered in future issues? Reply to this email and let me know!