Physician Contract Negotiation for Med-Peds: A Complete Guide

Why Contract Negotiation Matters for Med-Peds Physicians

Medicine-Pediatrics (Med-Peds) physicians sit at a unique intersection of adult and pediatric care, often juggling inpatient and outpatient responsibilities across age groups. That same versatility also creates complexity when you transition from residency to your first attending job—and nowhere is that more evident than in your first employment contract.

Whether you’re approaching the medicine pediatrics match, preparing to graduate, or already in practice looking for a new position, understanding physician contract negotiation is as essential as understanding clinical guidelines. A poorly negotiated contract can lock you into:

• Unmanageable call schedules
• Unsafe patient volumes
• Restrictive non-compete clauses
• Lower compensation than peers
• Limited flexibility for your dual-boarded career path

A well-negotiated agreement, on the other hand, can support:

• Sustainable work–life balance
• Fair and transparent compensation
• Protected time for teaching, research, or program leadership
• A long-term Med-Peds career that uses your full skill set

This guide walks through what every Med-Peds physician should know about employment contract review, attending salary negotiation, and long-term career protection.

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Understanding the Med-Peds Employment Landscape

Before you negotiate, you need to understand where Med-Peds fits in the market. Your leverage—and what you should ask for—depends heavily on the practice context.

Common Practice Models for Med-Peds

Med-Peds physicians can work in:

1. Academic medical centers

   • Mixed practice: adult wards, pediatric wards, Med-Peds continuity clinics
   • Roles in residency education, Med-Peds program leadership, QI, and research
   • Often lower base salary but greater job security, benefits, and academic promotion pathways

2. Hospital-employed multispecialty groups

   • Adult IM clinic + pediatric clinic or fully integrated Med-Peds clinic
   • Possible inpatient work (adult, peds, or both) and newborn nursery coverage
   • Typically RVU-based or hybrid compensation models

3. Private practice (single- or multi-specialty)

   • May be marketed as family practice equivalent, but skill set is distinct
   • Often higher earning potential, but more variability in schedule and coverage
   • Ownership or partnership track possibilities

4. Non-traditional roles

   • Hospitalist (adult, pediatric, or combined Med-Peds hospitalist services)
   • Urgent care, telemedicine, complex care clinics, transition clinics
   • Public health or administrative leadership roles leveraging dual training

Each setting values your skills differently. Before entering an offer conversation, clarify:

• Will you practice both adult and pediatric medicine?
• What percentage of time for each (e.g., 60% adult / 40% peds)?
• Will you do inpatient, outpatient, or both?
• Any special niches (e.g., NICU follow-up, complex care, transitional care)?

Your contract should reflect your actual role, not a generic “internal medicine” or “pediatrics” template that ignores your combined training.

Market Data and Benchmarks

For meaningful attending salary negotiation, you need data:

• Compensation surveys: MGMA, AAMC (for academic roles), AMGA, state medical society data.
• Specialty nuance: Many surveys don’t list “Med-Peds” separately. You may need to look at:
  • General internal medicine
  • General pediatrics
  • Hospital medicine (adult and pediatric) if large inpatient component

As a Med-Peds attending, you can leverage this by:

• Requesting they benchmark each component of your work (e.g., adult clinic, pediatric clinic, hospitalist coverage) rather than averaging down to the lowest rate.
• Asking how your salary compares to both the internal medicine and pediatrics colleagues doing similar work within the same system.

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Core Components of a Med-Peds Physician Contract

Every physician contract negotiation conversation should be grounded in a clear understanding of what’s in the document itself. Below are the major sections you’ll almost always encounter, with Med-Peds-specific considerations and practical advice.

1. Position Description and Duties

This section defines what you’re actually being hired to do.

Key elements:

• Clinical sites: outpatient clinics, inpatient units, nursery, urgent care
• Adult vs pediatric time split
• Call responsibilities (adult, peds, both; in-house vs home call)
• Teaching, research, or administrative expectations

Med-Peds tip: Ensure the contract (or a clearly referenced schedule/appendix) specifies:

• Percentage of clinical time in adult vs pediatric medicine
• Proportion of inpatient vs outpatient work
• Any leadership roles (e.g., Med-Peds clinic director, associate PD) and associated protected time

Example language to seek:
“Physician will practice a combination of adult internal medicine (approximately 0.5 FTE) and pediatric medicine (approximately 0.5 FTE), with adjustments to be mutually agreed upon in writing.”

Vague descriptions like “physician will work as assigned by the department” give the employer broad flexibility and reduce your leverage if your role shifts in ways you don’t want.

2. Compensation Structure

Compensation is more than just a base salary. It often includes:

• Base salary (guaranteed)
• Productivity incentives (e.g., RVUs)
• Quality or value-based bonuses
• Signing bonus
• Relocation allowance
• Loan repayment or retention bonuses

Base Salary

Ask:

• How does your base salary compare with the 25th, 50th, and 75th percentile for internal medicine and pediatrics physicians in similar settings?
• Is the base salary guaranteed, and for how long (e.g., 1–3 years)?

Negotiation angle:
If they’re paying you at the pediatric rate while expecting adult-level productivity and call, you can reasonably ask for a blended or higher rate.

RVU and Productivity Incentives

If your contract includes RVU-based compensation:

• What’s the RVU target, and how was it calculated?
• What rate is paid per RVU above target?
• Are adult and pediatric RVUs valued differently in your system?
• How are non-RVU activities compensated (teaching, admin, QI, complex care visits)?

For Med-Peds, this can be tricky: pediatric visit RVUs often run lower than adult visits. If you’re heavily weighted toward pediatrics, your earning potential may be limited by the compensation formula.

Actionable step: Ask for historical data:

• Average RVUs generated by similar Med-Peds or generalists in the group
• Expected patient panel size and template (e.g., 20–24 patients/day)

If the RVU target is normalized to high-volume, adult-only internists, but you’re doing complex pediatric transitions or split practice, you should negotiate for:

• Lower RVU targets
• Additional protected time or a higher base
• Separate benchmarks for adult and pediatric panels

Bonuses and Incentives

The contract may include:

• Quality bonuses: HEDIS metrics, patient satisfaction, vaccination rates, readmission rates
• Citizenship bonuses: committee participation, admin work, leadership roles
• Signing / retention bonuses: often tied to a commitment period or repayment obligations

Clarify:

• Exact metrics and how they’re measured
• The proportion of your total compensation that depends on these bonuses
• Any clawback provisions if you leave early

3. Schedule, Call, and Workload

Workload is where many Med-Peds physicians underestimate contract impact.

Key details to pin down:

• Clinical sessions per week (e.g., 8 half-day clinics vs 10)
• Inpatient weeks per year (adult, peds, or both)
• Call frequency, type, and compensation (if any)
• Holidays and weekend coverage expectations

Med-Peds-specific issues:

• You may get pulled into both adult and pediatric call pools.
• You may cover complex pediatric patients on adult floors (or vice versa) without clarity on workload or compensation.
• Academic roles often have invisible labor: resident supervision, sign-outs, ad hoc consults.

Negotiation example:
“If I am expected to participate in both the adult and pediatric call rotations, I’d like to see either:

1. Reduced clinical FTE to offset call burden, or
2. Additional call stipends and a maximum call frequency defined in the contract.”

Don’t accept vague verbal assurances about “reasonable call” without written parameters.

4. Benefits and Non-Salary Compensation

Benefits often add substantial value to your total package:

• Health, dental, and vision insurance
• Retirement contributions (401(k), 403(b), pension)
• Disability and life insurance
• CME funds and days
• Licensing, DEA, society dues
• Malpractice (with tail coverage considerations—see below)
• Parental leave and family benefits

For Med-Peds physicians, consider:

• Is there CME support for both internal medicine and pediatrics professional activities (e.g., dual board maintenance fees, two major conferences)?
• Will they cover memberships for both ACP and AAP (or other relevant societies)?

You can often negotiate higher CME funds, additional professional dues, or better parental leave, especially in academic or hospital-employed settings.

5. Malpractice Coverage and Tail Insurance

Malpractice terms are critical and often underappreciated by new attendings.

Key points:

• Is coverage occurrence-based or claims-made?
• Who pays for tail coverage if you leave?
• Does the policy explicitly cover your full Med-Peds scope (adult and pediatric care, procedures, inpatient/outpatient)?

Risk point: Claims-made coverage requires tail insurance when you leave the job. Tail can cost 150–250% of the annual premium—often tens of thousands of dollars.

Negotiation strategy:

• Ask the employer to pay tail if they terminate you without cause or if your departure is due to relocation of your spouse, family needs, or practice closure.
• At minimum, clarify cost estimates and consider negotiating a forgiveness schedule (e.g., tail fully covered if you stay 3–5 years).

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Legal Clauses That Deserve Extra Scrutiny

Beyond compensation and schedule, several legal provisions can profoundly affect your freedom and future options.

1. Term and Termination

The contract should specify:

• Length of the agreement (often 1–3 years, sometimes auto-renewing)
• Conditions for termination with cause (e.g., loss of license, misconduct)
• Ability to terminate without cause (by either party)

Focus on:

• Required notice period for without-cause termination (common: 60–180 days)
• Whether the employer can change your primary site or role during that notice period

Practical Med-Peds concern:
If you’re deeply embedded in a specialized Med-Peds role (e.g., transition clinic, Med-Peds hospitalist), sudden reassignment to a generic adult clinic across town may not align with your training or goals. Try to include language about mutual agreement for major role changes.

2. Non-Compete and Restrictive Covenants

Non-compete clauses can limit where you can practice after leaving:

• Geographic radius (e.g., 10–25 miles)
• Duration (commonly 1–2 years)
• Scope (outpatient only? hospital-based? both?)

For Med-Peds physicians, restrictions can be especially problematic:

• Your dual skill set may be in short supply in a region; moving may be the only option.
• A non-compete can effectively force you to leave a community where you care for patients across generations.

Negotiation strategies:

• Ask to:
  • Narrow the radius or duration
  • Limit the non-compete to specific practice sites
  • Exclude academic, telemedicine, or hospitalist positions
  • Remove restrictions if the employer terminates you without cause

In some states, physician non-competes are restricted or unenforceable; still, having it removed or softened in writing reduces risk and future legal headaches.

3. Duties Outside the Written Role

Watch for broad or vague duty clauses:

• “Other duties as assigned by the employer”
• “Physician agrees to work at any site owned by employer”

These can lead to “scope creep”—for example:

• Being reassigned from a Med-Peds role to a primarily adult or pediatric role you didn’t want
• Being regularly rotated to distant satellite clinics without adequate compensation

Ask for:

• A requirement of mutual consent for changes in primary site or major scope alterations
• Clarification on maximum travel distance and expectations for satellite coverage

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Strategy: How to Approach Physician Contract Negotiation as a Med-Peds Doctor

Knowing the components is only half the battle—you also need a strategic approach to negotiation tailored to Med-Peds.

Step 1: Clarify Your Priorities

Before you see any contract, know what matters most to you. Common priority areas for Med-Peds physicians:

• Practicing both adult and pediatric medicine vs focusing on one
• Degree of inpatient responsibility and call
• Academic vs community practice
• Geographic and family considerations
• Leadership, teaching, or program-building opportunities

Rank your top 3–5 priorities. This will guide where you push hardest during negotiations.

Step 2: Do Your Homework

Prepare by gathering:

• Local and national salary benchmarks for internal medicine and pediatrics
• Information about call schedules and workloads at comparable institutions
• Feedback from recent Med-Peds graduates in similar regions
• Details on how Med-Peds is integrated into the institution’s structure (Is there a Med-Peds Division? How many Med-Peds attendings?)

Use this to frame your asks logically:

“I see that general internists in this region typically make X and general pediatricians make Y. Given that this role expects 50% adult and 50% pediatric care, I’d like to discuss a blended rate closer to…”

Step 3: Normalize Negotiation

Many residents feel uncomfortable negotiating, especially if they see the employer as a prestigious academic center or dominant health system. Remember:

• Negotiation is expected and professional, not adversarial.
• The medicine pediatrics match process is competitive precisely because your skills are valuable; your post-residency role is, too.
• Most employers leave room in their initial offer for adjustments.

Professional phrasing you can use:

• “I’m very excited about this role and think it’s a strong fit. I do have some questions about the contract and a few areas I’d like to discuss before I can comfortably sign.”
• “Could we explore some adjustments to better reflect the combined adult and pediatric responsibilities of this position?”

Step 4: Involve an Expert for Employment Contract Review

Given the complexity of physician contract negotiation, it’s wise to:

• Hire a healthcare contract attorney or a physician contract review service.
• Choose someone familiar with your state’s laws and, ideally, with Med-Peds or dual-specialty roles.
• Have them review:
  • Non-compete and restrictive covenants
  • Termination clauses
  • Malpractice and tail coverage
  • Compensation structure and any ambiguous language

Think of this as an investment; a few hundred to a couple thousand dollars upfront can prevent losses of tens of thousands over time.

Step 5: Negotiate the Package, Not Just Salary

Don’t get stuck on a single number. You might face institutional limits on base pay, but still have leverage on:

• Signing bonus size and payout schedule
• Relocation assistance
• CME funds and days
• Protected time for Med-Peds leadership or teaching
• Flexible scheduling, telehealth options, or part-time FTE arrangements
• Call compensation or frequency caps
• Loan repayment or retention bonuses

For a Med-Peds physician, protected time to build a Med-Peds clinic, complex care or transition program, or residency curriculum can be as valuable as a small salary bump—especially if it supports your long-term career trajectory.

Step 6: Get All Agreements in Writing

Verbal promises don’t protect you later. If the recruiter or department chair says:

• “We’ll definitely keep your mix at 50/50 adult and peds.”
• “You’ll rarely have to cover both adult and pediatric call in the same month.”
• “You’ll have 0.2 FTE protected for the Med-Peds clinic.”

Ask for those assurances to be reflected in the contract or an attached, signed addendum. Polite way to phrase it:

“Would you be comfortable adding that understanding to the written agreement so we’re all on the same page moving forward?”

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Transitioning from Residency: Med-Peds-Specific Scenarios and Examples

To make this more concrete, here are a few scenarios commonly faced by Med-Peds graduates and how negotiation can change the outcome.

Scenario 1: “You’re Just an Internist Here”

You match into Med-Peds, finish residency, and are offered a job at your training hospital. The contract lists your specialty as “Internal Medicine” only, with adult-only clinic and no pediatric responsibilities.

Potential issues:

• You may gradually lose pediatric skills and board eligibility if you’re not practicing pediatrics.
• You’re being paid at an internal medicine rate but losing half of your training’s value.

Negotiation approach:

• Clarify your desire to maintain a dual practice and board certification.
• Ask about options for:
  • A blended Med-Peds continuity clinic
  • Periodic pediatric inpatient or urgent care shifts
  • Aligning your title and role to “Medicine-Pediatrics” rather than IM only

If the employer is unwilling to support any pediatric practice long-term, this may not be the right fit for a Med-Peds-trained physician.

Scenario 2: Double Call Burden, Single Compensation

You’re offered a hospital-employed job with:

• Adult inpatient weeks
• Pediatric inpatient weeks
• Combined call for both services

But compensation is benchmarked solely to adult hospitalists, with no mention of additional pay for pediatric call.

Negotiation approach:

• Request a transparent breakdown of how they value:
  • Adult weeks
  • Pediatric weeks
  • Call for each service
• Propose:
  • Call stipends for pediatric call
  • Reduced number of total weeks if you’re covering both pools
  • A higher base reflective of your versatility and expanded responsibilities

You can point out that they would otherwise need to hire two specialists (one IM, one peds) to cover what you’re doing as a single Med-Peds physician.

Scenario 3: Building a Med-Peds Clinic or Transition Program

You’re joining a system that wants to grow Med-Peds services, including transition-of-care clinics for adolescents with chronic childhood-onset diseases.

Negotiation opportunities:

• Protected FTE for program development and coordination (e.g., 0.1–0.2 FTE)
• Start-up support: nursing, social work, care coordination staff
• Academic title and promotion path if affiliated with a medical school
• Defined metrics for success and potential for additional support as the program grows

These details should not remain informal; get them in writing as part of your offer or a formal letter of understanding.

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FAQs: Med-Peds Physician Contract Negotiation

1. When should I start thinking about contracts during residency?

Begin seriously exploring options in your PGY-3 year (or PGY-4 in Med-Peds if taking a chief year or fellowship). For many, the timeline looks like:

• Late PGY-3 / early PGY-4: clarify goals (academic vs community, inpatient vs outpatient mix)
• 9–12 months before graduation: start interviewing; discuss role structure
• 6–9 months before graduation: request offers and draft contracts
• 3–6 months before graduation: complete employment contract review and negotiation, sign final agreement

Don’t wait until the last minute—rushed decisions erode your ability to negotiate thoughtfully.

2. Do I really need an attorney for employment contract review?

While not legally required, a healthcare contract attorney or experienced physician contract reviewer is highly recommended. They can:

• Interpret complex legal clauses (non-compete, termination, malpractice)
• Identify red flags you might miss
• Suggest specific language changes
• Help you quantify the value of compensation and benefits

Given the long-term financial and professional consequences, it’s usually a worthwhile investment, especially for your first attending contract.

3. How do I negotiate without seeming “difficult” as a new graduate?

Professionalism and clarity are key. Focus on:

• Expressing enthusiasm for the role
• Framing your asks in terms of fairness, alignment with your training, and long-term retention
• Prioritizing a few high-impact issues rather than nitpicking every clause
• Using data (market benchmarks, workload comparisons) rather than emotion alone

Most employers expect some back-and-forth. Reasonable, well-supported requests signal that you’re thoughtful and plan to build a stable practice.

4. What’s different about Med-Peds contract negotiation compared to single-board specialties?

The main differences:

• You must clarify whether you’ll practice both adult and pediatric medicine, and in what proportions.
• Compensation and RVU structures may not fully reflect your dual role unless you actively negotiate for it.
• Call and inpatient responsibilities can span both populations, increasing workload without automatic increases in pay.
• Your long-term maintenance of competence and board certification in both specialties depends on your scope of practice—your contract and role must support that.

Keeping your distinct Med-Peds identity central in negotiations will help ensure your contract reflects your full value—not just half of it.

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Thoughtful, well-informed physician contract negotiation is one of the most important professional skills you’ll use as a Med-Peds physician. By approaching each employment contract review with clarity about your priorities, realistic market knowledge, and a willingness to advocate for your dual-specialty expertise, you can build a sustainable, rewarding career that benefits you, your patients, and your future colleagues.