After years of medical school, residency, and sometimes fellowship, getting an attending job offer can feel like reaching the finish line. Many physicians are tired, busy, and ready to start working, so they skim the agreement and sign it quickly. The problem is that a physician employment contract controls much more than your starting salary. It decides how your pay is calculated, what happens if you want to leave, where you can work next, and who pays certain insurance costs after you go.
Before you sign, it helps to know which sections deserve a closer look. Many doctors choose to have an attending physician contract lawyer review the agreement, since an attorney who works with physician contracts can spot terms that look standard but carry real costs. Below are the main legal issues worth reviewing, whether you are taking your first attending role, renewing a contract, or comparing two offers.
Compensation Terms and How Productivity Pay Works
Many attending contracts tie part of your pay to productivity, usually measured in work relative value units, or wRVUs. Your pay may depend on a base salary, a rate paid per wRVU, a production threshold, and a bonus formula. These pieces work together, so a high rate per wRVU does not help much if the threshold is set at a level you are unlikely to reach.
It is also smart to check how long any guaranteed salary lasts. Some contracts promise a fixed income for the first year or two and then switch fully to productivity pay. If the patient volume at that practice is low, your income could drop once the guarantee ends. Comparing your offer to national compensation data for your specialty can show whether the numbers are fair or need to be negotiated.
Noncompete Clauses and Where You Can Practice Next
A noncompete clause limits where and when you can practice after you leave a job. It usually sets a distance, such as 10 or 20 miles from your clinic or hospital, and a time period, such as one or two years. The same distance can mean very different things depending on location. In a large city, it might cover only a few neighborhoods. In a rural area, it might cover every hospital you could reasonably work at.
Whether a noncompete can be enforced depends heavily on the laws where you practice. Some places void most noncompete agreements, while others have passed laws that limit or ban them for doctors. A federal rule that would have banned most noncompetes nationwide never took effect, and the Federal Trade Commission’s noncompete rule page explains its current status. Some contracts also include a buyout option that lets you pay a set amount to be released from the restriction, which can be worth negotiating before you sign.
Malpractice Insurance and Tail Coverage
Your contract should explain what type of malpractice insurance you have. With a claims-made policy, you are covered only while the policy is active. If you leave the job, you may need tail coverage to protect you from claims filed later about care you gave while you worked there. Tail coverage can cost thousands of dollars, and often more in higher-risk specialties.
The key question is who pays for it. Some employers cover the tail in every situation, some cover it only if they end the contract, and some leave the full cost to the physician. This is a common point of negotiation, so it should never be left vague.
Termination Clauses and Notice Periods
Most contracts include a without-cause termination clause, which lets either side end the agreement without giving a reason. The notice period is often between 90 and 180 days. Short notice periods can create real instability, especially when combined with a strict noncompete, because you could lose your job and also be blocked from working nearby.
You should also read the “for cause” section closely. Some contracts use broad language that gives the employer room to fire a physician for reasons that are not clearly defined. Clear definitions, a chance to fix a problem before termination, and fair notice terms all protect you if the job does not work out.
Duties, Call Schedules, and Workload
A contract should describe what your job actually involves. Look for details about clinic hours, the number of shifts, call coverage, work at more than one location, and administrative tasks. Vague phrases such as “duties as assigned by the employer” can allow your workload to grow over time without any change in pay.
If you are expected to take extra call or cover extra sites, the contract should say whether you will be paid more for that work. It is much easier to set these terms before you start than to argue about them after a schedule has already become routine.
Signing Bonuses, Relocation Money, and Repayment Rules
Signing bonuses, relocation payments, and student loan help can make an offer look very attractive. However, these benefits often come with repayment rules. If you leave before a certain date, you may have to pay back the full amount, even if you stayed for most of the required time.
Check whether repayment is prorated based on how long you worked and whether you must repay the money if the employer ends the contract without cause. These details can turn a generous bonus into a financial burden if the job changes or the practice is sold.
Frequently Asked Questions
When should an attending physician have a contract reviewed?
The best time is before you sign a new offer or a renewal. A review also makes sense when your workload grows, your pay has stayed flat for several years, or you are comparing more than one offer and want to see the real differences between them.
Can I negotiate a contract that the employer says is non-negotiable?
Often, yes. Many employers will consider specific, reasonable requests that are backed by market data, especially for pay structure, tail coverage, noncompete terms, and notice periods. A clear, well-supported request gives the employer something concrete to respond to.
Is every physician noncompete enforceable?
No. Enforceability depends on the laws where you practice, the exact wording of the clause, and any rules that apply specifically to health care workers. A clause that holds up in one place may be void in another.
Read the Fine Print Before You Commit
An employment agreement shapes your income, your schedule, and your freedom to move on in the future. Taking the time to review compensation terms, noncompete language, tail coverage, termination rules, and repayment clauses can save you from costly surprises later. When something in the contract is unclear, getting answers before you sign is far easier than trying to fix a problem after the agreement is already in effect.
