Mastering Physician Contract Negotiation in Pediatrics-Psychiatry: A Guide

Understanding the Unique Landscape of Pediatrics-Psychiatry Contracts

Pediatrics-Psychiatry is a small, highly specialized niche—particularly for those coming from a peds psych residency or a triple board program (Pediatrics / General Psychiatry / Child & Adolescent Psychiatry). That rarity is your leverage.

Whether you’re finalizing your first post-residency position or renegotiating as a mid-career attending, physician contract negotiation in this space is not just about your attending salary negotiation. It’s about protecting your clinical scope, your time, and your long-term growth in an emerging, in-demand field.

Before you start:

• Know your training path: Employers may not fully understand what a triple board or peds psych residency graduate can do. You may need to educate them.
• Know your value: You are qualified to work across pediatrics, psychiatry, and child & adolescent psychiatry—this is rare and billable.
• Know your goals: Are you aiming for mostly outpatient child psychiatry? Integrated pediatric mental health? Inpatient consults? Policy and program development? Your contract must match your goals.

Use this guide as a roadmap for employment contract review, negotiation strategy, and specialty-specific pitfalls to avoid.

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Key Contract Elements Every Peds-Psych Physician Must Understand

Even before you argue for a number, make sure you understand what you’re signing. The most sophisticated attending salary negotiation will not save you from a poorly structured job. Below are the foundational elements you should review in every employment contract.

1. Job Description and Scope of Practice

For pediatrics-psychiatry and triple board physicians, the position description is often vague—sometimes deliberately, sometimes because the employer doesn’t fully understand your skill set.

Look for clarity on:

• Clinical mix

  • Percent pediatrics vs psychiatry vs child & adolescent psychiatry
  • Outpatient vs inpatient vs consult-liaison vs integrated primary care
  • Administrative/leadership/program development time—protected or not?

• Age range

  • Children only?
  • Transition-age youth?
  • Will you be pressured to see adults because of “psychiatry need”?

• Settings

  • Hospital-based clinic, community mental health, FQHC, academic medical center, private group, or hybrid?
  • Telehealth expectations (especially for psych services)

Actionable negotiation tips:

• Insist that the job description be attached as an exhibit to your contract.
• If you are being hired partly to “build a program,” negotiate:
  • Protected admin FTE (e.g., 0.1–0.2 FTE)
  • Clear milestones and support (therapists, care coordinators, nursing, etc.)
• Add language that any substantial change in duties requires mutual written consent, not unilateral employer decision.

2. Workload, RVUs, and Productivity Expectations

Triple board and peds psych physicians often get trapped in productivity models built for either pure pediatrics or pure psychiatry—which don’t fit well when you do both.

Clarify:

• Clinical hours vs admin hours

  • Typical full-time definitions: 36 clinical hours + 4 admin hours, or 32/8, etc.
  • How many patient-facing hours are truly expected?

• Patient volume

  • Pediatrics clinic: Is the expectation 20–25 patients/day?
  • Psych clinic: Is the expectation 10–14 psychiatry patients/day?
  • Combined model: Are they trying to get you to do both at full speed?

• Visit lengths

  • Child psych intakes often need 60–90 minutes.
  • Follow-ups commonly 20–30 minutes.
  • Pediatric visits: 15–30 minutes depending on type.

• Productivity metrics

  • Are you on base salary only?
  • Base + RVU bonus?
  • Pure RVU or collections-based?

Peds-psych–specific pitfalls:

• Unrealistic expectation to “fill the pediatric panel” and “handle all psych” with the same FTE.
• Being treated as a full pediatrician and a full child psychiatrist in call and productivity metrics.

Negotiation strategies:

• Request that productivity expectations explicitly reflect your mixed practice model:
  • Example: “Average of 10–12 psychiatry visits/day or 14–16 pediatric visits/day, with proportional expectations when mixed.”
• Ask for a ramp-up period (6–12 months) with lower productivity targets while your panel builds.
• Avoid purely collections-based models early in your career; they often under-reward the complexity of peds psych care.

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3. Compensation Structure and Attending Salary Negotiation

Physician contract negotiation often starts with salary, but for pediatrics-psychiatry, you should first understand how that salary is defined and what benchmarks are being used.

Key components:

• Base salary

  • Is it guaranteed? For how long (1–3 years)?
  • What are the conditions for changing it or renewing it?

• Incentive/bonus pay

  • RVU-based: What is the conversion factor ($ per RVU)?
  • Quality metrics: Are they reasonable and within your control?
  • Other incentives: Behavioral health integration, program development, supervision of trainees.

• Sign-on bonus and relocation

  • Paid up front vs over time.
  • Clawback terms if you leave early.

Benchmarking Your Value

Triple board and peds psych residency grads may not fit neatly in standard salary surveys. Employers might underpay by using pediatrician benchmarks instead of psychiatry/child psychiatry benchmarks.

Ask outright:

• Which benchmark data are you using? (e.g., MGMA, AAMC, AMGA)
• Which category and percentile? (Child & Adolescent Psychiatry? Pediatrics? General Psychiatry?)

Best practice:

• Push for compensation closer to child & adolescent psychiatry benchmarks, not general pediatrics.
• If your role includes inpatient consults, call, or difficult-to-recruit services (e.g., eating disorders, autism clinics), you have further leverage.

Tangible negotiation moves:

• Ask for:
  • Higher base salary in exchange for a more moderate RVU target, or
  • Higher bonus potential if expectations are high but you’re confident in demand.
• Consider trading:
  • Slightly lower base salary for better schedule flexibility or protected academic time if that matters more to you.
• When an offer is low:
  • Present competing offers or national data.
  • Emphasize your ability to cover both pediatric and psychiatric needs—a significant recruitment advantage.

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4. Non-Compete, Moonlighting, and Intellectual Property

Non-clinical terms can have just as much impact on your future as salary.

Non-Compete (Restrictive Covenant)

Non-competes can be especially problematic in pediatrics-psychiatry because there are relatively few employers providing integrated care—leaving you with few alternatives nearby.

Evaluate:

• Geographic radius: 5 miles vs 30 miles makes a huge difference.
• Duration: 6 months vs 2 years.
• Scope of practice: Does it cover “any medical practice,” “any psychiatry,” “any pediatrics,” or your full combined scope?

Negotiation tips:

• Aim to:
  • Narrow the radius (e.g., from 25 miles to 10 miles).
  • Shorten duration (e.g., from 24 months to 12 months).
  • Limit scope (e.g., only outpatient child psychiatry, not all medicine).
• Ask for no non-compete in academic or public-sector roles, where they are increasingly uncommon.
• If they won’t remove it, seek exceptions:
  • Academic teaching roles
  • Telepsychiatry from home (if allowed by law and contract)
  • Work for certain safety-net or public institutions

Moonlighting and Outside Activities

Because peds psych physicians are in demand, moonlighting can be lucrative and professionally rich (e.g., inpatient weekend coverage, tele-psych, pediatric consults).

Check for:

• Moonlighting clause: Are you prohibited, or can you work elsewhere with permission?
• Conflicts of interest: Are there restrictions on consulting, expert witness work, or speaking?

Negotiate:

• Clear language allowing outside clinical work as long as:
  • It doesn’t interfere with your primary job.
  • It’s outside of your employer’s defined market or service area.
• Permission for telehealth work in other states if not directly competing.

Intellectual Property (IP)

If you are building novel integrated care models, educational programs, or digital tools, IP may matter.

• Academic centers often have broad IP claims.
• Private groups may claim ownership of any work created “in the scope of employment.”

Ask for clarification if you plan to:

• Develop curricula
• Build digital tools / apps
• Create written or video content for broader audiences

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Special Considerations for Triple Board and Peds Psych Residency Graduates

Your training path directly shapes what you can negotiate for—and how you should frame your value.

1. Educating Employers About Your Skill Set

Many administrators have never worked with a triple board physician or a peds psych residency graduate. They may not understand:

• That you can:
  • Provide full-scope pediatrics and full-scope child psychiatry.
  • Serve as a bridge between pediatrics, psychiatry, and systems of care.
  • Lead or design integrated behavioral health programs.

Use this to your advantage:

• Prepare a 1-page summary of your training and capabilities.
• During discussions, emphasize:
  • You reduce the need to hire multiple separate specialists.
  • You improve care coordination and continuity.
  • Your presence can support referrals, reputation, and patient retention.

This framing supports stronger salary and protected time negotiations.

2. Protecting Against “Scope Creep”

A common risk for peds psych physicians: as soon as colleagues recognize your breadth, you become the default for everything even vaguely related to mental health or complex pediatrics.

Signs of scope creep:

• You’re asked to do all psychiatric consults regardless of age or complexity.
• You become the de facto behavioral health lead with no protected time.
• Your schedule is filled with emergency add-ons that disrupt continuity.

Contract strategies:

• Request explicit limits:
  • Maximum number of inpatient consults/day unless additional compensation is triggered.
  • Defined FTE for each service line (e.g., 0.6 child psych outpatient, 0.3 pediatrics, 0.1 admin).
• Build in review points:
  • Formal workload review at 6 and 12 months with an adjustment clause if scope expands.
• Add a clause specifying that new major responsibilities require:
  • Mutual written agreement
  • Revisiting compensation and FTE allocation

3. Academic vs Community vs Hybrid Roles

Your negotiation strategy shifts depending on setting.

Academic centers:

• Often offer:
  • Lower base salary
  • More stability, benefits, and prestige
  • Teaching and research opportunities
• For peds psych, academic centers may value you as:
  • Program director or associate director for integrated care
  • Key faculty for triple board or combined programs
• Negotiate:
  • Protected time for teaching and scholarly work
  • Clear academic promotion expectations
  • Seed support for developing integrated programs

Community or hospital-employed roles:

• Often higher salaries but fewer formal academic opportunities.
• Negotiate:
  • Reasonable productivity expectations
  • Adequate support staff (therapists, case managers, MA/RN support)
  • Protection from unsafe workloads, especially in high-need mental health settings

Hybrid positions (academic appointment + community practice):

• Clarify in writing:
  • Who is your primary employer?
  • How is your time divided and paid?
  • Who evaluates you and decides on renewal?

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Step-by-Step Strategy for Effective Physician Contract Negotiation

A systematic approach can turn a stressful process into a controlled, strategic one.

Step 1: Gather Data and Define Your Priorities

Before you discuss numbers:

• Research compensation:

  • Talk to recent peds psych or triple board grads.
  • Use national survey data (MGMA, AAMC, specialty society reports).
  • Consider geographic differentials and cost of living.

• Define non-negotiables vs negotiables:

  • Non-negotiables: clinic mix, location, family needs, ethical boundaries.
  • Negotiables: salary band, signing bonus, schedule details, title.

Create a short list of Top 5 priorities, such as:

1. Predominantly child & adolescent psychiatry outpatient.
2. Max 1 in 6 call with appropriate backup.
3. Protected 0.1–0.2 FTE for program development.
4. Competitive salary based on child psychiatry benchmarks.
5. Reasonable non-compete or none at all.

Step 2: Get a Professional Employment Contract Review

Even if you’re comfortable reading contracts, a lawyer experienced in physician contract negotiation is invaluable. Look specifically for someone who:

• Has healthcare and physician employment experience.
• Ideally has seen contracts for psychiatrists and pediatricians.
• Understands typical issues in non-compete, malpractice, and compensation.

What they can help you with:

• Identifying red-flag clauses (e.g., broad unilateral termination rights).
• Interpreting confusing compensation formulas.
• Strategizing negotiation points and alternative language.

Think of this as an investment in your first several years of practice—it often pays for itself quickly in improved terms.

Step 3: Sequence the Negotiation

Timing and framing matter.

1. Express genuine interest first.
   • Make clear you like the role and mission.
2. Ask for the full draft contract early.
   • Avoid verbal-only promises; everything important should be written.
3. Review privately with your advisor/attorney.
4. Return with an organized list:
   • Group into:
     • Must-change items
     • Strongly desired items
     • “Nice to have” items

During conversations:

• Use collaborative language:
  “I’m excited about the role. To make this sustainable long term, I’d like to adjust a few areas.”
• Lead with safety and sustainability:
  • Workload expectations
  • Support staff
  • Call structure

Step 4: Leverage Your Unique Value as a Peds-Psych Physician

Your rarity is a negotiating asset:

• Emphasize:
  • Recruitment difficulty for both child psychiatry and pediatrics.
  • The system’s need for integrated behavioral health solutions.
  • Your ability to fill multiple roles (clinical, educational, programmatic).

Concrete talking points:

• “The market rate for child and adolescent psychiatrists in this region is X–Y. Given that I can also cover pediatrics and integrated care, I believe a compensation package at or above that range is reasonable.”
• “If you’re looking for me to build an integrated program, I will need protected time and support—otherwise we risk burnout and turnover, which is costly to the system.”

Step 5: Negotiate Beyond Salary

If salary movement seems limited, shift to:

• Schedule flexibility (4-day workweek, partial remote days).
• Additional CME funds and professional development.
• Support for certifications (e.g., in psychotherapy, leadership, quality improvement).
• More favorable call schedule or additional compensation for call.
• Better termination terms (longer notice, severance if terminated without cause).

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Common Red Flags and How to Address Them

Here are frequent issues that come up in employment contracts for pediatrics-psychiatry physicians and how to approach them.

1. Vague Language About Duties

Red flag examples:

• “Other duties as assigned.”
• “Physician will provide services as needed in pediatrics and psychiatry.”

Why it’s risky:

• Enables unbounded scope creep.
• Makes it hard to argue that expectations are unreasonable later.

How to fix:

• Insert more specific language:
  • “Primary duties will include outpatient child and adolescent psychiatry (approx. 0.7 FTE) and pediatric primary care (approx. 0.2 FTE), with 0.1 FTE administrative/program development. Any significant change in these allocations requires mutual written agreement.”
• Keep “other duties” but narrow it:
  • “Other duties reasonably related to the above, consistent with the physician’s training and experience.”

2. Uncapped Workload or Call

Red flag examples:

• No maximum number of patients/clinic day.
• “Call as needed” with no limits.
• No mention of backup or coverage structure.

How to fix:

• Define:
  • Maximum average daily patient load.
  • Expected call frequency (e.g., 1 in 6) and what “call” entails.
• Seek additional pay if call load is heavy.
• For inpatient settings, clarify:
  • Weekend rounding expectations
  • Holiday coverage rotation

3. Broad Non-Compete that Covers Both Pediatrics and Psychiatry

Red flag:

• Non-compete that bars you from practicing any medicine or psychiatry within a large geographic area.

Why it’s uniquely harmful to peds psych physicians:

• Few employers in your niche may exist locally; this can effectively force relocation.
• You might want to stay in the region and switch to a different emphasis (e.g., mostly child psych or mostly pediatrics).

How to fix:

• Narrow scope to:
  • “Child and adolescent psychiatry outpatient within X miles” or
  • “Pediatric primary care within Y miles.”
• If the employer refuses:
  • Ask at minimum to exclude telehealth to out-of-state patients.
  • Try to shorten duration and radius.

4. Unilateral Changes to Compensation

Red flag:

• Language allowing the employer to change your salary, bonus plan, or expectations at any time without your consent.

This creates significant instability.

How to fix:

• Insert language requiring:
  • Written notice and mutual agreement for material compensation changes.
  • Or, if they insist on some flexibility, at least:
    • Advance written notice (e.g., 90–180 days).
    • Clear upper and lower bounds on potential changes.

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Frequently Asked Questions (FAQ)

1. When should I start talking about contract terms during my job search?

After you’ve had an initial interview and both sides have expressed mutual interest, you can request a draft contract or at least a term sheet. You don’t need to wait until the very end to see formal terms. In fact, for peds psych roles, earlier clarity about job mix (peds vs psych) and expectations is crucial and can save you from progressing too far with an ill-fitting position.

2. Are academic positions for pediatrics-psychiatry physicians always lower paid?

Academic roles often have lower base salaries than private or community jobs, but they can offer non-financial benefits: academic titles, research opportunities, teaching, program leadership roles, and greater schedule predictability. In pediatrics-psychiatry, academic centers may especially value your ability to train residents and medical students, help develop integrated care programs, and support triple board or combined tracks. That said, you should still negotiate firmly, particularly for protected time and clear promotion criteria.

3. How much can I realistically negotiate as a new graduate?

You likely have more power than you think, especially in peds psych. Many areas have serious child psychiatry and pediatric mental health shortages. As a triple board or peds psych residency graduate, you bring rare training. While you may not get every change you request, you can often negotiate improvements in salary, bonus structure, workload, call schedule, and non-compete terms. A thoughtful, data-backed and collaborative approach typically yields multiple concessions.

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

It’s strongly recommended. Physician employment contracts are complex, and the implications for your career, finances, and geographic flexibility are significant. A lawyer experienced with physician contract negotiation can identify red flags you might miss, suggest language that protects you, and help you prioritize what to push for. This is particularly important when clauses affect non-compete, malpractice coverage, termination, or complex compensation models. For most physicians, the cost of legal review is quickly offset by better contract terms and avoidance of future problems.

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Thoughtful, informed negotiation is a professional responsibility, not a luxury. As a pediatrics-psychiatry physician—especially with peds psych residency or triple board training—you hold a uniquely valuable skill set. With careful employment contract review, strategic attending salary negotiation, and attention to both financial and non-financial terms, you can build a career that is sustainable, impactful, and aligned with the reasons you entered this specialty in the first place.