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Listen or watch this episode as 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. In part one of this two-episode interview, David begins the discussion with Ethan, covering his background in law and as a hospital administrator, where he used to negotiate physician employment contracts from the employer side. He explains his agency’s approach to contract negotiations in representing doctors and the common misconceptions physicians believe which hold them back in getting better deals.


(Video Available May 2, 2024)

Erica adds to the conversation the physician perspective, commenting that many doctors have a mindset that believes the employer’s statement that contract terms are non-negotiable, when, in fact, this is not true.

As this initial part of the conversation concludes, Ethan also emphasizes the crucial success factor of having other quality offer(s) on the table when negotiating your next contract.


  1. The Significance of a Physician Agent
    The primary reason for doctors to need an agent is to ensure they get the best deal out of their contract. Unlike professional athletes who hire agents when they go pro, physicians are often left on their own to negotiate their contracts. Ethan Nkana, founder of Rocky Mountain Physician Agency, emphasizes the importance of aligning the agent’s incentive with the doctor’s compensation. “Our focus is on helping make doctors more money. And if we cannot do that, we don’t get paid,” he states.
    Nkana also explains how his agency’s approach differs from that of a traditional healthcare attorney. Instead of charging by the hour, they focus on maximizing the doctor’s compensation, aligning their incentives with the success of the doctor. “There’s no question about like, “Hey, is Ethan motivated to spend five hours reviewing a contract?” No, I’m motivated to help you make as much money as possible,” he says.
    Negotiating a physician contract involves a lot of nuances. Nkana advises physicians to prioritize what’s important to them and to negotiate with people who have the power and influence to make decisions. “If you’re going to negotiate, don’t do it with the recruiter. Don’t do it with the first person you got a phone call from. Do it with the people who have the power and influence in the organization to make that change,” he suggests.
  2. The Mindset of Doctors in Contract Negotiation
    Doctors often find contract negotiation daunting, especially those fresh out of training. Dr. Erica Mathieu agrees with Nkana’s observation about the conditioning of doctors to do exactly as they’re told. She notes that it’s a shock for doctors to come out of that mindset and start asserting what they want in their practice and what they deserve.
    Dr. Mathieu provides insights into the mindset of doctors, especially those early in their careers. “When you’re a medical student, you’re paying to work in essence. You are not being paid to do the work,” she says. This mindset often carries into their professional career, where they feel hesitant to negotiate their contracts.
    Mathieu also shares her agreement with Nkana’s approach of prioritizing what’s important to the doctor in contract negotiations. “What matters most to my doctor?” Nkana asks. “The levers that I pull are different, but the language is all the same, the context is the same, and the players are all the same, just sitting in different context.”
  3. The Leverage in Contract Negotiation
    Having multiple job offers gives doctors leverage in contract negotiations. Nkana advises doctors to get multiple offers that they would be willing to accept to confidently push back on negotiations. “I encourage doctors to do, and Dr. Mathieu did this in her experience as an attending, is get multiple job offers that you’d be willing to accept,” he says.
    While Nkana acknowledges that their success rate is lower when the doctor has one offer, he emphasizes that the key to having leverage is the ability to walk away from the offer with an equally satisfying option.
    Nkana also notes that there are different nuances depending on whether the doctor is negotiating with a large institution, joining a private practice, or moving across at a partnership level. He emphasizes that what matters most is what’s important to the doctor. “The levers that I pull are different, but the language is all the same, the context is the same, and the players are all the same, just sitting in different context.” he says.


  • Doctors, especially those early in their careers, often feel they have little to no room for negotiation in their contracts, which is not the case.
  • Having an agent to represent doctors in contract negotiations can be beneficial as they can help maximize the doctor’s compensation.
  • The mindset of doctors being conditioned to follow orders and not negotiate can be detrimental when it comes to contract negotiations.
  • Having multiple job offers provides doctors with leverage in contract negotiations.
  • The negotiation process and priorities can differ greatly depending on whether the doctor is joining a private practice or a large hospital/health system.


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