Medicine's landscape is ever changing. The working model in which an orthopaedic surgeon operates is no exception. These models can be very confusing for the orthopaedic surgeon who has little training in the area of business, but especially to the young orthopaedic surgeon who has focused their efforts nearly 100% on medical training over many years. This article examines some of the issues that might not be obvious to the physician who is trying to decide between hospital employment and private practice or some combination thereof. Also, there are several discussion points and questions raised for the physician contract negotiator when examining an employment contract. Finally, introduced are some advocacy steps that we, as orthopaedic surgeons, should consider to continue to improve medicine and our work environments.