Behind Closed Doors: How Doctors Negotiate Side Hustle Contracts

The way most physicians “negotiate” side hustle contracts is weak, naive, and exactly how companies want you to behave. Let me show you how the game actually works behind closed doors.

You think you’re asking for too much.
They think they’re getting you for a discount.

The Quiet Reality Of Physician Side Hustle Contracts

I’ve sat in meetings where non-clinical executives laughed—literally laughed—about how little pushback they get from doctors on side gigs.

“I love hiring physicians,” one VP at a telehealth startup told us. “They’ll argue with you about antibiotic choices, but hand them a contract and they just sign.”

That’s the dynamic you’re walking into.

You’re usually talking about things like:

• Telemedicine moonlighting
• Expert witness work
• Chart review / utilization management
• Medical writing / content creation
• Start-up advisory / medical director roles
• Speaking, consulting, CME, industry boards

The pattern is the same: they dangle “easy money” or “flexible work,” you’re tired, it seems straightforward, and you’re told, “This is our standard contract.”

“Standard contract” roughly translates to: “Maximum protection for us, minimum leverage for you.”

The physicians who win this game know three things:

1. What’s actually negotiable (and it’s a lot more than rate).
2. How these companies internally value you.
3. The subtle clauses that will screw you later if you ignore them.

Let’s go through how this actually plays out.

Common Side Hustles Physicians Negotiate

Category	Value
Telemed	80
Expert Witness	35
Chart Review	45
Consulting	30
Speaking	25

How Companies Really Set Your Initial Offer

No one is sitting in a room saying, “What’s a fair deal for Dr. Smith?”

They’re thinking in spreadsheets and risk.

Here’s how the internal discussion sounds at a telemed or consulting company:

• “What’s the minimum we can pay and still fill our roster?”
• “What are competitors paying? Can we undercut that and get volume?”
• “Can we structure this as independent contractor so we avoid benefits and malpractice?”
• “How do we cap our downside if they underperform or bail?”

They start from their risk and their margins, not from your value.

A medical director role pitched as “$2,000/month for a few hours of calls” might be sitting in a budget line as “$48,000 for risk mitigation and regulatory credibility.” They are comparing that to the cost of a lawsuit, a compliance fine, or not qualifying for some accreditation.

If you think you’re negotiating an “extra side gig,” and they think they’re buying regulatory cover, you’re coming in way too cheap.

This is why seasoned physicians ask questions that newer ones never do:

• “How are you planning to use my name, image, and credentials?”
• “Where does this role sit in your risk/compliance strategy?”
• “What problem are you solving by hiring a physician instead of a cheaper clinician?”

The answer tells you how hard you can push. If you’re a checkbox they need for legal or marketing reasons, you’ve got leverage and probably don’t realize it.

The Levers You Should Actually Be Negotiating

Most doctors obsess over one thing: hourly rate. That’s amateur hour. Rate matters, but insiders negotiate the whole deal: rate, risk, flexibility, and future upside.

Let me walk you through what seasoned physicians actually mark up with a red pen.

1. Rate – But In Context Of Real Time

Telemed example. They offer:

• $80/hour
• 3–4 patients per hour
• No-show time unpaid

You’re thinking “80/hour, decent.” What they’re thinking is “variable effective rate.” Because your time isn’t just patient-facing.

Your true time:

• Pre-shift tech issues
• Mandatory trainings
• EMR inbox / messages
• On-call availability windows

This is why experienced docs will counter with something like:

• A minimum shift stipend regardless of volume
• Separate compensation for mandatory trainings or meetings
• Clear policy on unpaid inbox time (or a per-message rate)

And yes, they ask for it. Out loud. And often they get at least part of it.

2. Term and Termination – The Trap You Ignore

Here’s where I see doctors get burned constantly.

Most contracts will say something like:

• Term: 1 year, auto-renew
• Termination: Either party may terminate with 30 days’ written notice
• Cause: Immediate termination for “unprofessional conduct,” “clinical concerns,” or failure to meet metrics

Looks harmless. It isn’t.

Behind the scenes, these vague “cause” clauses are how they dump you immediately if:

• You start pushing back on unsafe volume
• You become vocal about quality concerns
• They find someone cheaper in another state

Savvy physicians do this:

• Clarify that “cause” must be tied to specific, defined behaviors or objective findings
• Add a cure period: “Company will provide written notice and 10–15 days to cure any alleged deficiency before termination for cause.”
• Preserve the ability to terminate without cause on your end with reasonable notice (30 days is fine; 60–90 is ridiculous for side work)

If they refuse all of that, you just learned what they really think about you: replaceable commodity.

3. Malpractice and Indemnity – The Landmine

Executives care deeply about indemnity language. Most physicians skim it.

This is the part that says who pays if something goes wrong.

Common tricks:

• They provide malpractice, but the contract says you’ll indemnify them for claims “arising from your services.”
• They sneak in language where you agree to cover their attorney’s fees.
• They classify you as an independent contractor but try to push institutional risk onto you.

Behind closed doors, legal counsel will explicitly tell them: “See if we can get the physicians to carry more of the exposure. Many won’t notice.”

Your response:

• If they provide malpractice, you limit your indemnity to your own proven negligence, not their systems failures or business decisions.
• You remove any language that makes you responsible for their corporate misconduct or regulatory violations.
• You confirm in writing who is named on the policy, the limits, and whether tail coverage is included.

Good lawyers obsess over these paragraphs. You should too. This is the difference between “annoying lawsuit” and “career-ending, house-on-the-line problem.”

4. Non-Competes and “Moonlighting Handcuffs”

Side hustle contracts love overreaching non-competes and non-solicits.

I’ve seen clauses that say a telemed side gig prevents you from doing any telemedicine in your specialty in the entire United States for one to two years after you leave.

Internally, they know much of this is unenforceable. But they also know you don’t want the headache of a legal fight, and your hospital employer won’t touch it, so you’ll back down.

You don’t sign that.

Reasonable constraints, sure:

• No directly competing with their specific product in the same niche, in the exact same state, for 6–12 months.
  Unreasonable:
• Blocking broad categories of practice or entire modalities (all telemed, all expert witness, all consulting).

You push to:

• Narrow geography
• Narrow scope of services
• Shorten duration
• Explicit carve-outs for existing commitments and future clinical practice

Insider move: ask them to add a clause that non-compete doesn’t apply if they terminate you without cause. You’d be surprised how often that flies when legal is lazy or they’re in a rush to onboard.

5. IP, Content, and Your Name

This is where medical writing, speaking, and startup advisory gigs quietly rob you.

You create a slide deck for their CME. You write white papers. You help design clinical protocols. Their in-house counsel is writing IP clauses like:

“All work product, ideas, inventions, and derivative materials related to the services shall be the sole property of Company…”

Translation: Anything you touch, even if based on your prior work, belongs to them forever.

Behind the scenes, they use that language to:

• Repurpose your content into online courses
• Re-sell your protocols or tools to other clients
• Lock you out of using your own frameworks elsewhere because they “own” them

You negotiate:

• Narrow definition of “work product” (only what you create on their time for their project)
• Explicit carve-out that your pre-existing materials, methods, and know-how remain fully yours
• A non-exclusive license for them to use your content, not complete ownership, if the fee is modest

If they want full ownership of high-value IP, you charge accordingly. Five-figure range, not a $500 honorarium.

Clause Type	Rookie Accepts	Insider Pushes For
Termination	30 days / vague cause	Clear cause + cure period
Malpractice	“We cover you” only	Tail + limited indemnity
Non-compete	Broad, long, national	Narrow, short, carve-outs
IP Ownership	“All work is ours”	Limited license / carve-outs
Compensation	Flat hourly	Stipend + volume/time clarity

Where Leverage Really Comes From (It’s Not Just Your CV)

You don’t get good contracts because you’re a good person or a good doctor. You get them because you’re hard to replace for what they need at that moment.

Executives and project managers think in three currencies:

• Risk
• Speed
• Optics

If you’re helping on a project with a looming regulatory deadline, or you’re the only board-certified subspecialist in their target state, or they need your academic title for credibility, your leverage goes way up.

Insider reality:

• They often have grant timelines, investor expectations, or payer contracts that require a certain number or type of physicians.
• They are frequently late securing those physicians.
• By the time they’re talking to you, there’s an internal clock ticking you never see.

You learn to ask calibrated questions:

• “What timeline are you under for this project?”
• “Are there state-specific or credential-specific requirements for this role?”
• “Are there other physicians already contracted, or am I among the first?”

You’re not being nosy; you’re gauging leverage.

If they’re in a rush or you’re filling a rare niche, the right move is not “Sure, whatever you’re offering.” It’s “Given the urgency and scope, this is below market for the level of risk and expertise you’re asking for. Here’s what would make this workable.”

Delivered calmly. No apology in your voice.

Side Hustle Contract Negotiation Flow

Step	Description
Step 1	Offer Received
Step 2	Assess Role Value
Step 3	Push Broadly on Terms
Step 4	Target Key Clauses Only
Step 5	Negotiate Rate, Risk, IP
Step 6	Sign with Documentation
Step 7	Walk or Ask for Revisions
Step 8	High Leverage?
Step 9	Deal Acceptable?

How The Negotiation Actually Sounds On The Phone

Most doctors imagine negotiation as an adversarial showdown. That’s not how it works for side hustles.

It sounds more like this.

They send a contract. You review. You schedule a 20–30 minute call with whoever owns the physician relationship (often a “Medical Director of Something,” sometimes operations or HR).

You say something like:

“I had a chance to go through the agreement. Overall, I like the work and I think it’s a good fit. There are a few sections I’d want to tweak so this is sustainable on my end. Mind if I walk through them?”

You just told them you’re leaning yes, if they help you fix a few issues. That keeps them engaged instead of defensive.

Then you hit:

1. Termination cause + cure
2. Malpractice / indemnity
3. Non-compete scope
4. Compensation structure (not just rate)
5. IP / usage of your name and image

You do not send a 2-page counter-draft written like a hostile lawyer. You talk like a professional, then confirm key items by email.

Behind closed doors, they have to decide:
“Is it worth making these concessions to get Dr. X, or do we go back to the market?”

When you’re reasonable, concise, and clear on your boundaries, they often say yes to more than you think—because filling these roles is a pain for them.

Outcomes When Physicians Ask vs. Don’t Ask

Category	Value
Got 1+ Terms Improved	65
No Change	35

I’ve watched this play out dozens of times: physician asks for 5 things, company gives 3, both sides sign. Physician who never asked? Signs the original.

Same role. Same work. Different income and risk profile for years.

Red Flags That Mean “Walk Away Quietly”

Not every side hustle is worth salvaging. There are contracts where the right move is to close the PDF and never respond.

The patterns:

• They refuse to put anything about malpractice in writing, or say “We’ll sort that out later.”
• Non-compete is massive and they won’t narrow it at all.
• They insist on owning all your ideas/content even if the pay is trivial.
• They want you to “sign quickly so we can get you scheduled”—pressure and rush.
• Every question you ask is treated as disloyalty instead of professionalism.

Behind doors, these organizations are thinking short-term. They’re often undercapitalized, overpromising to investors, and planning to churn through physicians.

Do not tie your name or license to people who won’t even have an honest conversation about risk and fairness.

You’re not burning bridges by walking. You’re avoiding being the physician they try to drag under with them when the ship sinks.

The Future: Side Hustles Are Professionalizing—Fast

Here’s the part most physicians haven’t caught up to: side hustles are becoming formalized economic structures. Not casual “extra work.”

Telehealth is big business. Expert networks, legal consulting, digital health startups—this is structured money. With legal teams, investor expectations, and scale.

On their side of the table, the playbook is getting more sophisticated. Template contracts. Coordinated non-competes. Carefully engineered compensation models that look generous until you understand their margins.

On your side, you have three options:

1. Keep treating side hustles like casual gigs and keep getting the weakest deals.
2. Refuse to engage and miss out on what will become a major economic pillar for physicians.
3. Get smart about the business and legal side, and step into these roles as a professional, not a desperate moonlighter.

The physicians who do #3 are already stacking:

• Multiple carefully-structured contracts
• 1099 income with tax advantages
• Equity and advisory roles in early-stage companies
• A diversified career that isn’t hostage to one employer

And they’re very, very intentional about each contract they sign. Because they understand one bad agreement can block three great future opportunities.

FAQ: What Doctors Quietly Ask About Side Hustle Contracts

1. Do I really need a lawyer for every side gig contract?
Not for every single one. But for your first few, or anything that touches significant risk (telemed, medical director, startup advisory, anything with broad IP language or equity), a good healthcare lawyer is worth it. Here’s what insiders actually do: they pay a lawyer once to mark up a few representative contracts, learn what to look for, then handle simple ones themselves using that playbook. You do not need full custom legal work for a $1,000 speaking gig. You absolutely should get help if someone wants your name on a medical director line, equity in lieu of cash, or any kind of broad non-compete.

2. Will asking for changes make them rescind the offer?
Almost never, if you’re reasonable. I’ve seen maybe one rescinded offer in a decade, and that was a physician trying to renegotiate the entire business model. Most companies expect some back-and-forth from serious professionals. If they yank the offer because you asked for a cure period and clearer malpractice language, you just discovered they were a terrible long-term partner. That’s a win, not a loss. The key is tone: collaborative, concise, not adversarial.

3. What’s the single most important clause to focus on if I can’t afford a lawyer and don’t want to fight over everything?
If you only pick one: termination and non-compete. Those two determine whether this contract can blow up your life. You want: the ability to leave with 30 days’ notice, clear and narrow “cause” language, and non-competes that are sharply limited in geography, scope, and duration—with explicit carve-outs for your main clinical work and existing or future independent projects. If those two areas are clean, the rest of the contract might be mediocre but usually survivable.

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Key points to walk away with:

1. Side hustle contracts are designed to favor the company by default; your job is to rebalance risk, not just chase rate.
2. You have more leverage than you think when you understand how they’re using your license, name, and expertise.
3. Calm, specific negotiation of 4–5 clauses—termination, malpractice/indemnity, non-compete, compensation structure, IP—will quietly separate you from 90% of physicians who just sign and hope.