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In this continuing episode, host David Mandell sits down with Ethan Nkana, JD, MBA, founder of Rocky Mountain Physician Agency and his client, Dr. Erica Mathieu, Chief Medical Officer at Primary Health Solutions.  Here, in part two of this two-episode interview, David begins the discussion with Erica, looking at her situation as a case study – first discovering what her frustrations were with her then-present job, how she found Ethan to help her, and their process of renegotiating her employment contract over the ensuing months. They focus on key success factors, such as leverage through other job offers and the timing of negotiations.


(Video Available May 16, 2024)



  1. The Importance of Leveraging Expertise when Navigating Physician Contract Negotiations

    Erica Mathieu makes it clear that she could not have done it alone.  “I knew my contract was up in about a year and I said, there’s got to be a way to negotiate this. I’ve got to find somebody to help me do this because like I said, I’m from a blue collar town. I don’t come from some long medical legacy. I don’t know how to do this. And I’m okay with not knowing that it’s time for someone else’s expertise.”Ethan Nkana highlighted the importance of timing in renegotiation processes, “For experienced attendings, renegotiate now. There’s no reason to wait because exactly what Dr. Mathieu said is what I used to do on that side is I would just slow play you. Oh hey Dr. Smith, we’re writing budget season, give it six months. Well hey Dr. Smith, we’re in capital planning season. Give it three months. I’ll just slow play you. And then it comes down to that thirty-day window she talked about where you’ve got to sign a contract, review it, and then make a move.”

  2. Ethan’s Role Went Way Beyond Negotiating

    Ethan explained how his role involves helping physicians find and vet opportunities, making him an invaluable asset in the negotiation process. “Because I know that negotiating a one-on-one with a hospital or a practice rarely, rarely, rarely goes well. I am not going to waste my time or infinitely more important my doctor’s time by going in and asking for a raise without leverage.” Much of the work is done before approaching the existing or targeted employer.Dr. Mathieu concurred, affirming the value of the assistance she received, “I felt like working with Ethan was a very… It’s similar to having a big brother or big sister when you’re the younger sibling going on a date when someone says, well, they sent me a rose. And you’re like, so what? He should have sent you a dozen roses for what? This is. What’s the appropriate thing to expect?”

  3. Negotiating for Better Contracts Can Improve Job Satisfaction and Work-life Balance

    The speakers emphasized the impact of contract negotiations on job satisfaction and work-life balance. Erica shared how Ethan’s assistance in negotiating her contract resulted in improved balance and satisfaction in her work.Erica described how her previous contract led to a lack of work-life balance, “I couldn’t do that because it kept me from making the amounts of RVUs that I needed. And if I took the day off, even though it was a PTO day, it still put a zero in that encounters column. In essence, it was losing thousands of dollars on my paycheck and really just the structure disincentivized you really utilizing your PTO.”


  • It’s important to understand your value as a provider and how to market it to potential employers.
  • Having a competing offer is crucial to successful negotiations.
  • Timing is important in contract negotiations. Starting the process early gives you leverage and prevents you from being forced into a situation you’re not happy with.
  • The process of contract negotiation goes beyond just negotiation; it can involve helping the client find and vet opportunities.
  • Contract negotiation can be a nerve-wracking process, but having someone experienced in the field can provide much-needed support and guidance.


  • Guest, Ethan Nkana, JD, MBA, Bio
  • Guest, Dr. Erica Matthieu, Bio
  • Host, David B. Mandell, Bio