What Your Recruiter Won't Tell You About Your Rate

I read and saw multiple red flags in it. I outlined them and sent him back an email with my concerns and requested changes.

His response? He told me he has never had that many ‘complaints’ about their contract.

I didn’t hear back from him again.

The golden rule is to never sign anything without you reading it.

In today’s newsletter:

Match Day 2026 just dropped and it's the biggest one ever

The 2026 Main Residency Match broke records again. Over 44,000 positions offered, more than 53,000 applicants. But positions filled by non-U.S. citizen international medical graduates dropped this year. The $100,000 H-1B visa filing fee imposed by the Trump administration is a big reason why.

Private equity is back in physician practices, but playing a different game

According to Bain's 2026 Global Healthcare PE Report, the old "buy everything and roll it up" playbook has cooled.

If you read my earlier issue on locums pay rates, you know the first step is understanding your market value. But knowing the number is step one. Getting it is step two. Here are six moves I've learned:

1. Rate floor

Recruiters will ask what you want before they tell you about the gig. They keep this number in mind when they find more assignments for you. It's a qualifying question for their database. Know your floor rate and then add 10-20$ per hour on top of that when asking.

2. Know the bill rate

Agencies typically mark up your rate by 30-50% when they bill the hospital (usually they have two separate contracts). So if you're getting $180/hr, the hospital might be paying the agency $250-$270. That spread is their margin. You don't need the exact number, but understanding that it exists changes how you negotiate.

3. Use competing offers

Even if you're not seriously considering them. "I have another facility offering $X" is simple and it often works. Agencies and hospitals both respond to competition. If you only have one option on the table, you don’t have as much leverage. Keep in mind that some agencies are owned by the same parent company.

4. Negotiate the stuff that isn't the rate

Travel stipends. Housing allowances. Guaranteed hours or minimum shift commitments. Cancellation penalties. Licensure reimbursement. Don’t get caught paying out of pocket for a lot of extra expenses. Some of this is standard but occasionally the facility may not cover a big expense.

5. Position yourself as high value

Flexibility is currency. If you can work nights, weekends, holidays, or commit to high volume, say so. Facilities would rather credential one physician who's going to average 14+ shifts a month than juggle three who commit to just a handful each.

6. Know what ‘presenting you’ means

Make sure you’re ok with them sending your CV to the facility and explicitly ask if ‘presenting’ you to a facility locks you into their non-compete for that place. This can lock you out of a place for two years if you aren’t careful before you even do a shift there.

Do NOT sign a master service agreement (sometimes called service agreement) without reading it first. This is the agreement between yourself and the recruiting agency. Most agencies will send this to you and expect you to sign this quickly (because most physicians do without reading it). Look at details for:

What’s coming in the next few issues:

What would you like covered in future issues? Reply to this email and let me know!