You’ve survived the sleepless nights, mastered your surgical skills, and made it through more years of training than you care to count. Now comes the offer you’ve been waiting for: your first real job! It’s tempting to zero in on the salary. After all, you’ve earned it, and let’s face it, the student loan bills are real. But how do you know if your job offer is actually a good one?
Take it from those who’ve been there: The biggest threats to your long-term happiness often hide in the fine print. From restrictive non-competes to vague partnership paths and unrealistic productivity benchmarks, this month’s column breaks down what really matters in a first contract.
Recognizing Hidden Pitfalls
While a competitive salary matters, it’s far from the only thing that makes a job worth taking. Other contract terms can significantly impact your long-term satisfaction—and your ability to grow in your role. Be on the lookout for the following:
• Noncompete Clauses: These restrictions can limit your ability to practice within a certain geographic area after leaving a position. Employers use them to protect their patient base, but they can backfire on you—especially if you’ve put down roots in a community you don’t want to leave. Understanding the scope, duration, and enforceability of a non-compete clause is essential before you sign.
• Ambiguous Partnership Tracks: Vague or undefined terms can leave you working toward a future that may never materialize. Contracts should clearly outline partnership timelines, expectations, and evaluation criteria. Otherwise, you may invest valuable years without a clear path forward.
• Unrealistic Productivity Expectations: Transitioning from training to independent practice comes with a steep learning curve. Even seasoned physicians can struggle if benchmarks are mismatched with available support. Is there enough patient volume, staff support, or infrastructure to actually meet the goals they’ve set for you? If not, you’re set up to fail.
• Undefined Responsibilities: Contracts should spell out your day-to-day duties—not just in the clinic or OR, but in any teaching, research, or administrative roles. Without clear definitions, don’t be surprised if you’re suddenly in charge of staff scheduling, equipment maintenance, or reviewing profit and loss sheets you’ve never seen before.
Securing a Contract That Works for You
Effective negotiation isn’t about being difficult—it’s about knowing what you want and making sure your contract reflects that.
• Reflect on Your Values: Before entering negotiations, identify what matters most to you. Whether that’s work-life balance, subspecialty focus, mentorship, or location stability, your contract should align with your values and goals, not just your short-term needs.
• Consult an Expert: Run your contract by a health care attorney or, at minimum, a trusted mentor who’s seen a few of these. A second set of eyes can catch what you might miss and help protect your long-term interests.
• Advocate for Yourself: Don’t be afraid to ask for what you need to succeed—whether it’s a personal scribe, protected OR time, specific vacation dates, or something else. As the saying goes, the squeaky wheel gets the grease. The worst they can do is say no.
Conclusion
Landing your first attending job is a huge milestone, but don’t let a big salary blind you to the fine print. By evaluating job offers with a long-term lens, identifying hidden red flags, and negotiating confidently, you can avoid common missteps that derail early careers. Protect your future and set yourself up for real, lasting success. OM
Want to go deeper? For tips and real stories from young ophthalmologists who’ve been in your shoes, tune in to the “Negotiations” episode of the Real World Ophthalmology podcast. Find it on Spotify, Apple Podcasts, and Castbox.
