Behind The White Coat - Real Talk For Physician Spouses
Being married to medicine comes with challenges—long hours, relocations, and feeling like you’re navigating it all alone. That’s where this podcast comes in.
I’m sharing the things I wish someone had told me—how to survive medical training, juggle parenting, manage finances, and actually build a life you love. We’ll cover everything from making friends in a new city to understanding insurance, finding childcare, and staying connected as a couple.
Some episodes will be just me, sharing real stories and lessons learned. Other times, I’ll bring on expert guests—financial advisors, physician spouses, and those who’ve been through it all—to offer practical advice.
Most of all, this is a place for community. A space where you can feel understood, supported, and even laugh along the way. Because being married to medicine doesn’t mean doing it alone.
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Behind The White Coat - Real Talk For Physician Spouses
#12| Navigating Physician Contracts: Legal Insights for New Doctors
Michael Johnson, founder of Michael Johnson Legal, shares essential insights about physician employment contracts and reveals why these agreements are typically more aggressive than those in other industries.
• Understanding physician contracts is critical for career autonomy and financial well-being
• The majority of clients are physicians entering their first employment agreement after training
• Best practice is to start job search 9-18 months before completing training
• Get educated on compensation structures before interviews - most physicians are paid on volume, not just base salary
• Typical compensation ranges from 40-45% of net collections or varying work RVU rates depending on specialty and location
• Non-compete clauses remain enforceable in most states and can force physician relocation
• The "non-negotiable contract" myth: most employers will make reasonable adjustments when approached professionally
• Legal representation typically costs $1,000-$2,000 - a small fraction of the contract's value
• Two most concerning contract terms: inability to terminate without cause and restrictive non-compete clauses
• Educational resources available at michaeljohnsonlegal.com and through the Instagram account @physiciancontracts
Check out our educational course - nine hours of CME-eligible content at physiciancontracts.com that can help you prepare for this important career transition.
Hey guys, welcome to today's episode, excited to have you here and even more excited to introduce my guest. He is somebody that I feel like my husband and I could have benefited from when we were new out of training, not only from an educational standpoint, but just a great sounding board for advice, things to look for, pitfalls to potentially avoid. And so, without further ado, I would love to introduce you to Michael Johnson. He is Michael Johnson Legal, which is a law firm that primarily represents individual physicians and often first contract physicians as they evaluate and navigate through their contracts. He helps physicians transitioning between employment, buying and selling practices and disputes concerning physician contracts and all things in between. Michael, thank you for joining us.
Speaker 2:Thank you so much. I'm excited to be here and have a discussion about this. Thank you.
Speaker 1:Yeah, I am excited. Michael and I met thanks to Instagram. I feel like there's the pros and cons to social media, but I'm definitely grateful that it allowed us to cross paths and I think you've got a lot of great advice that I think a lot of the listeners will be able to take and apply to what they're currently going through. So, Michael, give us a little bit of a backstory to you, your family and how you got into this physician contract business.
Speaker 2:Yeah, very good. So it starts in New Orleans. That's where I went to law school, where my wife went to medical school and residency. She's outpatient adult psychiatry but we met really at the very end of medical school for her. We were both swiping right at the right time. We were able to connect. We spent residency together in New Orleans and around 2018, 2019, she started looking at her first opportunities.
Speaker 2:First physician employment agreements and I'll tell you this wasn't the area that I was practicing in at the time. But, looking at these for the first time, they are wild. They are much more aggressive than any employment agreements in any other industries. I had some background in construction, engineering, architect, those types of employment agreements and these are much, much rougher than those. So I started looking around what resources are out there, what educational opportunities are out there for lawyers and or physicians to learn about this? It really wasn't much out there. So we did what we had, what we could with her contracts, kind of learned through that process, and then I started helping some of her contracts, kind of learn through that process and then I started helping some of her classmates, some of her upper levels, and it kind of started snowballing from there.
Speaker 2:In August of 2019, I started a solo practice Michael Johnson Legal with the goal of building out a practice that could close this gap, help individual physicians get thoughtful legal advice as they navigate all the different contracts between them and their work, and it's been a really fun process. So fast forward. Six years later, we have represented thousands of physicians navigating basically every specialty across the country. We're four lawyers now kind of sprinkled across the country. It's a really fun practice area because we get to connect with individual physicians, really talk about how these contract terms really affect your life, your ability to control your career, your autonomy, and offer kind of beyond the words on the page, advice on what's important and what's not and how to navigate these deals. So that's what we do. We got a couple of little kids as well that keep us busy, so a lot going on.
Speaker 1:I'm sure. Well, I love this and I find it so interesting because until we met on social media, I didn't even know it was a thing in all honesty, and I feel like obviously there's a huge need. You were just talking about the thousands that you have helped, so, for the listeners, give us an idea of the type of physician that you help. I know you said individuals, but are those individuals that own a private practice? Are they those that are joining a private practice or a larger institution? Who are the people that you typically service?
Speaker 2:Yeah, the majority of our clients are folks coming out of training first contract and about 80% of those, maybe more, are going into an employment agreement of some kind, either with a large hospital system or being employed by a private practice, maybe going into an academic setting. At this point very, very few are starting a private practice right out of training. It's certainly possible, it's not impossible, but the common trend right now is employment. So that is the majority of our clients. And then we'll help a lot of attendings that are transitioning between jobs, trying to renegotiate often renegotiate compensation when they're early to mid-career. We'll also help folks buying and selling practices. That's a smaller portion of our practice and only in a handful of states, but we'll help folks navigate their employment contracts in all specialties and across the country.
Speaker 1:So what does this look like? So, let's say, because I have a huge majority of residents that are coming in as first-time residents from all over different states, but at what point do they get their contract, look over the contract and then what does that process look like? Then coming to you and being like, hey, michael, this is my first time seeing this contract, what do I do and how does that process look?
Speaker 2:Yeah, very good. Best practice here is to prepare earlier than that. Okay, my starting advice is to start interview process 18 to 9 months out. Give yourself plenty of time. If you're looking for a job, 2, 3 to 9 months out, Give yourself plenty of time. If you're looking for a job 2, 3, 4 months out. Even the credentialing process it's going to be hard for you to be able to start on time, and not having income right after you finish training can be really rough. So start 18 to 9 months out and then get educated on what physician contracts mean. So we have a course that I created, Mastering Physician Contracts at physiciancontractscom nine hours of CME-eligible education. Often your academic residency fellowship programs don't have this, which is a real bummer right, it is.
Speaker 2:I think there's a high need yeah we do a lot of residency and fellowship presentations. Happy to do something for your program, if you're listening, but get educated on some of the basics and then I highly recommend setting an initial consult as you're starting interviewing or during the interview process with someone like us and make sure you understand at a minimum the basics of compensation. We do this consult service in the firm One hour. We pull the macro-level comp data and we talk about the norms that you should expect based on your specialty, your practice setting and your geographic region, and then, fourth, how volume plays into this. A lot of residents and fellows want to see a starting base salary that is super high, but the vast majority of physicians are actually paid on volume. It's more of like a commission-based type job. So being educated on what are the typical volume-based compensation models For example, in Durham it's common to be paid 40% to 45% of your net collections, whereas if you are an adult outpatient psychiatrist, like my wife, you need to understand how work RVUs work and how much you're paid per work RVU that is really the main driver of your comp. So you might see something from in the 50s and maybe a low, maybe academic, maybe more urban space to maybe even something in the 80s in a more rural hospital-employed type model compensation per work, rvu. So being educated on what actually matters in comp and what doesn't is a really good place to start.
Speaker 2:Some employers will hit you with like how much you want to make during the interview process and you need to be prepared for that, and if you're not, then you could kind of undershoot yourself or maybe make a little bit of missteps. So first step is education before you start interviewing. As you start interviewing, a comp consult in our firm or someone else that does this regularly is a really good place. Next step you'll probably get an offer letter before you get a contract. Not always, but you need to sit down with your lawyer, go through that offer letter and see if there's something that you need to consider negotiating. Okay, this is more of like high level stuff. What are the basics of the comp plan? What are the key work obligation issues that you need to clarify before moving forward? Okay, that's usually the offer letter type stuff. So you know, for example, for us we have prioritized opportunities that have offered a partial tele option. Okay, some sort of reduced work week, so a four day week or a three day week with kind of longer days. We got a couple of kids, so having that flexibility is really really nice for us. So there might be a handful of things that you want to negotiate at the offer letter stage, but then after that we look at the contract.
Speaker 2:Okay, we write out a detailed report about what the contract says, how to get in and out of them, what does comp mean? We go through that with you in detail on Zoom meetings. Really make sure you understand what you have, and then we guide the negotiations all the way through. Having a lawyer on your side, someone that does this regularly from the interview process until you sign or walk away, is really best practice. You're going to avoid missteps. You're going to avoid maybe negotiating something that doesn't really matter. You're going to avoid more of the tricky parts, the tripwires that can come up in this process. So, yeah, that's my best advice.
Speaker 1:No, I love that.
Speaker 1:And for me I just assumed, right out of training there's this natural hierarchy and we just got what we got, that I didn't realize you actually could negotiate those things, being down here and just out of training.
Speaker 1:But I guess I was wrong in thinking that what comes to mind for me, which I'm sure a lot of the listeners, and it's a little bit of a loaded question. So, forgive me, but fresh out of training we don't have a lot of money right, and so trying to figure out, gosh, how do I pay for this, how do I pay these legal fees? Because I think there's this preconceived notion that attorneys are super expensive and if you're fresh out of training, not having much, is there different ways that this process could work as far as how they pay you payment plans, I mean whatever, and you don't have to get into the nitty gritty with it. But I have a feeling a lot of them are thinking that want to hire you or have your services. But I mean, I remember coming fresh out of training we didn't have anything and nor did we feel like we could negotiate anything.
Speaker 2:Yeah. So a couple of important points. If you and I highly recommend you get a lawyer that does this regularly and helps you all the way through this process, If you're getting a lawyer that's going to do that, you're almost certainly going to spend between $1,000 and $2,000. Okay, If you're looking at multiple contracts or it's kind of an extended process, it could be more than that. Obviously, if you're buying a practice, it's going to be much more than that, but about $1,000 to $2,000 is what you should expect.
Speaker 2:The vast majority of folks that do this type of work will offer payment plans, so a 12-month payment plan. You also will often have a signing bonus, something that will pay you within the first 30 to 60 days after you sign pay. You're thinking about risk, reward and investment. The vast majority of physicians will make more than a million dollars in the first five years Dealing with seven-figure deals here, and they on the employer's side are very, very well-versed. They're very experienced in negotiating these things and to have someone on your side that's going to cost you $1,000 to $2,000 to avoid catastrophe here is a really, really good investment. And I'll say also, a lot of employers will tell you that the contract is non-negotiable. You're almost certainly going to hear this, but I have hundreds, if not thousands, of files in my law firm that show otherwise, that they'll say it's not negotiable and then we will negotiate important things and they'll agree to reasonable changes in the contract. Sometimes they don't go as far as you want, but they often start with no and then consider the things that you're asking for and then consider the things that you're asking for Also, for the vast majority of physicians, if you start early and consider more than one opportunity, interview at more than one place, you'll probably have more than one offer and understand, at a minimum understanding the differences between those two.
Speaker 2:You know how do they differ on top. How do they differ on my ability to leave Things like non-compete? How do they differ on top? How do they differ on my ability to leave Things like non-compete? How do they differ on defining my work obligations, call schedule, work location, days of the week, hours of the week. Understanding these key differences can be really, really important to making an informed choice.
Speaker 2:So if you're thinking, oh, this is all for naught because they won't change anything, that's not really the right approach. The right approach is to make sure you have clarity, you understand the pros and cons of the deal or deals that you're looking at. You're making an informed choice and then you're negotiating for the things that are most impactful for you, and a lot of them will consider reasonable adjustments, meaningful adjustments, and that really shouldn't be a barrier. We'll see some outliers, like we had one where we got another quarter of a million dollars in the first two years. That happens on occasion. Okay, that is not the norm, but there are a lot that it's more like okay.
Speaker 2:At the end of this process, I now know very clearly how I'm going to be compensated, what I'm required to do in this position and then, if it doesn't work out, how painful is it going to be to leave Position. Contracts are very difficult to get out of. You've got non-competes. You've got rough termination rights. You might have to pay malpractice tail expenses. Rough termination rights you might have to pay malpractice tail expenses. You have to pay back signing bonuses or lose out on bonus structures during a transition. It can be very, very expensive. So at a minimum, you deserve clarity.
Speaker 1:Yeah, no, I agree because, speaking for myself, a lot of the legal terms are hard to understand, so I think it's nice having somebody there on your side being able to read through the fine print and put it in terms that I personally would understand.
Speaker 2:Yeah, a lot of times these are written in old middle English, whereas in heretofores. I think a lot of employers would do better if they just wrote it in plain English. But I agree the lawyers they just don't. So it makes a lot of sense to make sure you understand what you have. And, looking at these for the first time, it's really difficult to get there. But lawyers were trained on this. We're trained negotiators, we're experienced in navigating these deals and we can help clarify.
Speaker 1:And well worth that $1,000, $2,000 to have peace of mind, to understand everything that you are going to be signing and negotiating, whether it's like you talked about your income or what it looks like to actually leave the practice, potentially maybe vacation, maternity, paternity leave, like all of those things right.
Speaker 2:Very good. Yeah, exactly, there's a lot of nuances, a lot of details that you need to clarify. Also, you might have a contract and you might think, okay, I've read this and I think I understand what's in there, but you might not know what's not in there and should be, so it's difficult to make sure you have it all without appropriate guidance.
Speaker 1:But yeah, yeah, no, I love that. So what is the scariest physician contract term that a physician should be on the lookout for?
Speaker 2:So I'll modify that question with a couple typical lawyers, right. So one is a term clause that doesn't allow you, the physician, to terminate without cause for about two, three years or more. I've had some really rough issues in the firm with folks that signed up for a job realized a year in that this is not for me. Maybe I picked the wrong practice setting. Maybe this practice is a bummer. Maybe I need to move. Maybe I picked the wrong practice setting. Maybe this practice is a bummer. Maybe I need to move. Maybe my family's unhappy. There's a lot of things that can happen. In this first year or two You're probably going to know something pretty substantial about whether this job is a long-term good fit. Probably within the first six months to a year, some contracts maybe about 10% to 20% of contracts will have an initial lockout period where the physician literally does not have the legal right to leave. A lot of residents and fellows have dealt with something pretty close to that in training. Like you technically change training locations, but very, very difficult, you probably don't want to do that in the next step. So I'd say scariest piece number one is do you have the legal right to leave whenever you want? Usually it's like a 90 to 180 day advance notice provision, which I'm typically fine with. But making sure you have that right. I literally looked at one this morning that said five years, no legal right to leave. Oh gosh, like whew, that can be really really rough. I've had to consider litigation around a clause like this and I'll tell you, it is nasty and some employers will hold your feet to the fire. This can be a seven figure damages problem if you catch the wrong thing. So one is termination Okay. Number two is the non-compete and or the non-solicit clause. That means you have to leave town if this job ends for any reason.
Speaker 2:A little background on non-competes. There was an effort by the Federal Trade Commission to make them unenforceable for all physicians across the country. Those efforts have failed. We still have enforceable non-competes and it really just depends on the state. There's about eight or nine states that don't allow physician non-competes, but the vast majority do. There's about eight or nine states that don't allow physician non-competes, but the vast majority do. Whatever is in your contract, you have to be prepared for that to be enforced against you in full, to the letter. You might approach this saying a two-year restriction for 30 or 40 miles. That is so wild there's no way that is enforceable but it is and the vast majority of other employers won't hire you if you have a non-compete that prevents you from taking that job. They probably have the same non-compete in their contract. So they're not super interested in helping physicians violate these things. So making sure you understand that very clearly.
Speaker 2:This actually goes into the decision on whether to buy a house immediately or rent for a year when you move to a new place. Because if you have a, you have to leave town non-compete. And you look at that bubble you say, okay, if this job doesn't work out, we have to pack up and move. And doing that with only six months or a year of equity in your home that can be very difficult. Okay now if you have a much more reasonable non-compete and there are other opportunities outside of that bubble like, you're just not going to have to move. You know for us my wife's outpatient adult psychiatry there's plenty of tele options that she could take at any time for a year or two to wait out a non-compete or just do that. So in some specialties this isn't as big of a deal, but in some it is. So watch out for that you have to leave town non-compete. That would be my two biggest ones.
Speaker 1:Oh, interesting, yeah, yeah, I would never have even thought about that. So, as I said earlier that we met on social media, instagram and I know that is like your biggest platform, where you post a lot of your information, a lot of your content, and you had mentioned earlier about some educational courses that you offer. Will you tell the listeners a little bit more about those educational things that you offer, whether on your website or, if it's a live Instagram, what does that look like?
Speaker 2:Yeah. So education is a big one for us. At its core, our mission as a firm is to change the balance of power in medicine, put it back in the hands of physicians as best we can. So, on the educational side, we have an Instagram profile at physician contracts. Okay, we're very obvious, but we post pretty much every day some tips, something that physicians need to be aware of, so I'd love to follow there. It's a good thing to just occasionally scroll.
Speaker 1:Yeah, great information there.
Speaker 2:Thank you, just being aware of what's going on. Check out our website too, michaeljohnsonlegalcom, and check out our blog section. So, for example, we have a long, detailed blog about hospital employed compensation models, about net collections based models and how they differ. You know how to negotiate academic contracts. We try to, you know, create, produce a lot of, you know, background information, something to get you caught up, get you, you know, a bit of a reference point on some of these main issues. You know non-compete, sexist strategies, so check that out. We also have an educational course nine hours of watching and listening to me and reading about physician contracts at CME Eligible, and that's at physiciancontractscom.
Speaker 2:I tried to build that in a way where this is the education that you need to do. Spend a weekend, grab your spouse, have them join in as well, but just do it over a weekend before you start interviewing. So you know what's going on. You're going to go into these conversations about jobs, about contracts, about comp with more confidence, with some background information. And those are really the three main ones.
Speaker 2:Also, if you have a residency or fellowship program that has space in their didactics, we do virtual didactics we come join for an hour talk about physician contracts, we often dive into the particular specialty that we're talking about, some of the nuances that might be different for ortho versus psych, versus neurology versus trauma surgeons. There's some nuances based on specialties that are really important. So we can do that as well. But I'd say this regardless of how much education you get, it's still really, really important to get an experienced lawyer on your side as you're navigating these, because doing it once or twice is just not going to be enough to be completely fluent in this new language of physician contracts. So we highly recommend that.
Speaker 1:Yeah, great, thank you. So I always end with two questions that I ask every guest. So the first one is what advice would you give your younger self?
Speaker 2:Yeah, so relax, chill out, play a little bit more golf from time to time, it's going to be okay. I think that as lawyers we're kind of like physicians we often dive in completely into the thing that we do and maybe ignore some other important aspects of life. So maybe chill out. I would tell myself. Keep swiping around on Bumble because your wife's going to be there.
Speaker 1:I love that. That's great. That's great, all right. And then the second question is if your life was a reality TV show, what would the title be? Goodness, chaos with Kids, I guess life was a reality TV show.
Speaker 2:what would the title be? Goodness Chaos with kids. I guess I think that's kind of where we're at in our life now. So, you know my wife's five. I was almost six years out of training. We've got a almost six-year-old and almost four-year-old in the house. I did the last day of 3K today.
Speaker 2:So almost geared up, but there's a lot of moving parts early in your career and navigating this kind of sea change. A lot of folks they might have kids during medical school or during residency, but they often wait towards the end of residency or early career and that can have a massive impact on your priorities, on your time, on just how you want to live your life. So I'd highly encourage you to make sure you understand how your contract works, for flexibility, for changes, for potential, pivot in your priorities. You know, if you told me 10 years ago that I would have my own practice working from home and you know be doing this you'd be like whoa, that's not exactly what I expected, but you know there's a lot of changes coming, so keep that in mind.
Speaker 1:I love that. That's my biggest thing is the seasons of life, right. I feel like what we need here, or what we think we need here, progressively changes and we've got to kind of adapt and pivot with that. So I love that. And, michael, thank you for being here today. I think you shared a ton of stuff that is going to be super helpful for our listeners, and if they do want to ask questions or reach out to you, can they just send you a DM on Instagram? Yeah, that's a great way to they just send you a DM on Instagram.
Speaker 2:Yeah, that's a great way to connect At Physician Contracts on Instagram. Send a DM. Sometimes I'll take the really good questions and just do a reel about it. I won't put you out there, okay, I won't say any names. Relax, stay anonymous. Don't worry, you'll stay anonymous, it's okay. But if you have any questions, send them there and we'll try to get them answered. Also, you're welcome to connect on the website. It's easy to book an initial consult with us on our website, michaeljohnsonlegalcom. I encourage you to just be prepared for this next step in your life. You put so much time and energy and sacrifice into getting to this point. Let's make sure this next pivot, this next transition, is done right and we can help you navigate that.
Speaker 1:Yeah, no. Thank you again for being here and for those of you listening, if this was something that you related to, please leave us a review or send questions or pass it on to another physician spouse that you feel would benefit from this information, and until next time. Thanks so much for tuning in. Thank you, bye. That's a wrap on this episode of Behind the White Coat. I hope today's conversation left you feeling more understood and supported, and if you enjoyed this episode, I would love for you to subscribe, leave a review or share it with another physician spouse. Your support helps more of us to connect. Keep in mind this podcast is for you, so let's keep this conversation going. Dm me on Instagram at Amanda Barron Realtor, with your thoughts, topic ideas, questions or even guest suggestions. I would really love to hear from you. Thanks for spending part of your day with me and remember you are never in this alone. See you next time.