A Primer in Contract Negotiation for Young Spine Surgeons (or, in Simple Words, How to avoid being Cheated on)
You have completed your neurosurgery residency, passed your written board and are now finishing your scoliosis and complex spine surgery fellowship. You have already interviewed with several groups and interesting proposals have arisen. Today, a contract from one of the groups arrived in your mailbox. It contains no less than 30 pages, with plenty of archaic formal terms such as “hitherto”, “henceforth” and “whereof” which, honestly, do little to make things more clear to you. You are so busy to read every single clause and besides that the proposed annual salary seems reasonable and you liked the place. Therefore you just jump straight to the last page, sign, date and mail it back, look-ing forward to the dream life of a highly skilled spine surgeon dealing with complex pa-thologies.
However, a few years later, things do not look so bright anymore. You realize that the overhead of the practice employing you accounts for more than 50% of what you bill. As your six-figure salary puts you in the higher bracket of income tax, the U.S. Treasury takes almost another 50% of the remaining. State incomes and property taxes come as a bonus to make you even more miserable. Your call schedule is very busy and now that the family is growing you would like to devote some precious time to them. You think about leaving the practice and joining another group across town about which you heard good things. Before, any impassined decision, you decide, just in case, to read again (now carefully) the contract you signed a few years ago, just to realize that the agreed-upon terms are not exactly in your favor. You have agreed upon a “non-competing clause” which prevents you from working in a 20 miles radius from your cur-rent practice location. You check on GoogleMaps and such a carefully chosen number simply covers every single hospital in town. At this point, the option is either staying in your current exploitative practice or trying to convince your spouse, who is probably busier than you are managing three little ones who joined the family in the past few years, that it is your best common interest to pack everything, leave the friends and meaningful relationships you have just established in the local community to, once again, face, a brave new world. By the time you give your resignation notice, you realize that the billing practices of your employer and their convoluted math was far from ko-sher. You think about vindicating your rights and seek legal counsel. Only to discover that, again, in your initial contract, you have agreed upon an arbitration clause which prevents you form seeking legal remedies in court, while demanding any dispute to be resolved in arbitration. You hear that the arbitration provider selected by your employer (lo and behold) is quite “business-friendly”, perhaps something related to the fact that your employer is the one who regularly pays the arbitration fees and, as expected, no well-respected private resolution entity willfully disregard the interests of their long-term, faithful client, a classic proverbial goose of the golden eggs.
Such a short nightmare, which hopefully, none of the SpineLine readers has ever experienced highlights some key aspects of contract law which may pass unbeknown to healthcare practitioners. A few simple things to remember when evaluating a contract are: “every word matters”; the drafter of the contract has an inherent advantage over you because of their experience and available legal counsel; now innocuous and apparently inapplicable clauses may one day cost you dearly and, more than anything, if you have that intuitive feeling that something is not fair, you better pay attention because it is probably true. Remember, you are a valuable asset! You can negotiate your terms and, based on your excellent academic qualifications and training, there will be plenty of po-tential parties interested in your specialized services. Don’t be afraid to request it your way, to demand a compromise or, if everything fails, to simply say “Thank you very much but I believe it won’t work for me”. Worst than being unemployed for a few addi-tional months is to be stuck in a poor employment for years, bound by legal commit-ments which you yourself in a glimpse of poor judgement and anxiety promptly agreed in order to finally start your carreer. Be patient and meticulous, read carefully and, if necessary, spend a few hundred dollars seeking legal advice. Remember that where and under which conditions you will work is one of the most important decisions of your life, the culmination of years of hard labor, and, therefore, deserves the due diligence. I promise you it will ultimately pay out. Advice from someone who has been through some of the aforementioned hardships but who now has the privilege of providing some guidance so that the bright and young generation may avoid the same mistakes. As Otto von Bismark, the mastermind of 19th century German unification once stated “Only a fool learns f from his own mistakes. The wise man learns from the mistakes of others’. I hope my own mistakes help you to prosper without having to repeat them. My best wishes, success and remember to study well (as you have always done) for this unique task. 
1. Menger R, Esfahani DR, Heary R, Ziu M, Mazzola CA, LeFever D, Origitano T, Barnes T, Cozzens J, Taylor S. Contract Negotiation for Neurosurgeons: A Practical Guide. Neurosurgery. 2020 Sep 15;87(4):614-619. doi: 10.1093/neuros/nyaa042. PMID: 32310279.