"I just want this settled" is one of the most expensive feelings you can bring to a negotiation.
Because of when the decision happens. The biggest financial commitment of a physician's career gets made in the last months of training, on top of a job that already takes everything, against a deadline someone else set. Exhaustion doesn't make anyone less intelligent. It makes them want it to be over.
I understood this from the inside. For twenty years I was the person on the other side of that table.
When a physician takes a first offer they aren't thrilled about, or signs a contract they haven't really read, or lets a hard clause slide, it is almost never because they're naive or bad at negotiating. It's because they're tired. The particular kind of tired you get at the end of a very long decade.
Why it matters: The process is very good at capitalizing on that, whether or not anyone designed it that way. The timing isn't an accident of your life. It's the structure, and the structure quietly favors the side that isn't running on fumes.
Not in some calm, well-rested stretch set aside for careful thinking. It happens in the last months of residency or fellowship, while you're working brutal hours, trying to graduate, maybe moving a family, running on a sleep debt you've been carrying for years.
Into that, someone hands you forty pages and a date.
That's the more dangerous problem. "I just want this settled" is the feeling that makes a second option sound like more work instead of more leverage. It makes reading the call clause carefully feel like effort you can't spare tonight. It quietly turns "take it or leave it" into "fine," not because the offer is good but because the alternative is more of this, and more of this feels unbearable when you have nothing left.
The people across the table don't have to be cynical to benefit. Mostly they aren't cynical at all. They're simply rested, doing the thing they do every day, while you're stepping out of your zone of expertise into theirs, worn out, wanting only to stop. That gap does most of the work by itself.
This is the part that always got me. Worn out, you drift toward the job that asks the least additional thought of you, which is almost always the one already in front of you. You wave off the small doubts about the call or the culture as things you're too tired to look into tonight.
Those doubts were data. They were the beginning of the questions you should have asked, and exhaustion relabeled them as tomorrow's problem. By tomorrow you've signed.
I watched this happen more times than I can count. A physician signs in a post-call haze, reads maybe half of it, and figures the details can be sorted out later. Later never comes, because the details were the contract, and the version of them who could have negotiated it was asleep. Nobody outsmarted them. They were just done, and being done is a state this process will reliably catch you in.
You spent years being tired for other people. For patients, for programs, for everyone who needed you.
It would be a bad trade to let that same exhaustion, right at the finish line, quietly hand back the leverage you earned the whole way here. The other side is counting on you being too worn out to look up. The most valuable thing you can do is prove them wrong for about two weeks.
One to two weeks is normal and rarely questioned, and that assumes an attorney is reading it, which one should be. If you need longer because you're waiting on another process, say so plainly rather than stalling. Most employers would rather know than guess.
Sometimes, usually when a start date is tied to a credentialing window or a budget cycle that genuinely closes. Ask which it is. A real constraint has a reason attached and the person can name it. A manufactured one gets vague when you ask why that date.
Earlier than most people do, and mid-training rather than in the final six months. The point isn't to sign sooner. It's to do the slow parts, working out what you want and learning what the market pays, while you still have the capacity to think, so the tired version of you is only making the last decision rather than all of them.
You don't need to frame it that way. "I want to give this the attention it deserves, so I'll come back to you Thursday" does the same work and sounds like diligence, which it is. An employer who can't accommodate that has answered a question you hadn't asked yet.
This is general information, not legal advice. Contract terms and their enforceability vary by state. Have an attorney review your agreement before you sign it.