Physician Contract Glossary

If a practice's value depends on ancillary revenue, understand whether you share in it and how the ownership is structured for compliance. Ancillary income is real upside, but only if the Stark and Anti-Kickback structure holds up.

If your arrangement relies on a safe harbor, confirm it meets every required element, because partial compliance offers no protection. This is health-law attorney territory, not something to take on faith from a recruiter.

Be wary of any compensation that rewards you for referrals or for steering patients to a particular facility. Arrangements like that can implicate the Anti-Kickback Statute, and the penalties are criminal, so legal review is worth it.

Notice whether arbitration is mandatory and binding, who selects the arbitrator, and who pays the cost. A clause that lets the employer pick the arbitrator or saddles you with the fees tilts the field before any dispute begins.

If your pay is production-based, understand how patients are assigned and whether you control your panel. Being handed low-volume or low-reimbursement assignments can cap your income regardless of how the formula reads.

Find the non-renewal notice deadline and put it on your calendar the day you sign. An evergreen clause renews on the old terms, so it can also be your moment to renegotiate compensation if you act in time.

Get the exact threshold and the exact rate in writing, and ask what the average physician in the group actually earns against it. A threshold set above what the practice's patient volume can realistically support is a base salary dressed up as an incentive.

Read what the contract defines as a breach and confirm there is a cure period before consequences attach. Watch for one-sided language that makes your obligations breaches but treats the employer's failures as nothing.

Read the buy-sell before you buy in, paying special attention to how a departing owner is valued and paid. A favorable buy-in paired with a punishing buy-out formula can trap your capital in the practice.

If a buyout exists, scrutinize how the amount is calculated, because a buyout priced at a punishing multiple of salary is a non-compete in disguise. If none exists, negotiate one, especially in states that do not mandate it.

Review which pre-tax options the plan offers and the annual limits, then use them, because pre-tax benefit dollars are a quiet raise. Read the plan document rather than relying on a one-line summary.

Get the call frequency and structure in writing, including what happens if a partner leaves and the rotation tightens. Unlimited or as-needed call language can quietly turn into a schedule that consumes your life.

If your coverage is claims-made, the tail question is unavoidable. Settle in writing who pays the tail premium when you leave, because that one line can be worth one and a half to two times your annual premium.

Confirm both the dollar amount and the paid days, and whether unused allowance rolls over. A CME budget with no protected time off means using vacation days to meet your own licensing requirements.

Resist pledging personal collateral or signing a personal guarantee for a recruitment advance where you can. If collateral is unavoidable, understand exactly what is at risk and under what conditions the lender can claim it.

Ask who controls billing and what the group's net collections rate has been. You are betting your income on a back office you do not run, so find out how good it is before you sign.

Align your start date with the realistic end of credentialing. Starting before you can bill, or before your previous tail coverage ends, can cost you income or leave a malpractice gap.

If your recruitment package depends on a community need finding, confirm that documentation exists and is sound. A recruitment incentive built on a shaky need assessment can be challenged, and the fallout can reach your compensation.

Watch the scope and the survival period, and make sure the covenant does not silently bar you from normal practice. Confirm what you must return at departure so you are not later accused of retaining confidential material.

Read the penalties before you assume a restriction is unenforceable. Even a shaky non-compete can be expensive to fight, and liquidated damages or a fee-shifting clause can make a violation cost far more than the move was worth.

The biggest challenge is not any single clause, it is signing without knowing which clauses are negotiable. A directory, a contract education, and a contract attorney exist to close that gap before you sign.

Ask for every group-level document your contract incorporates by reference, including bylaws and policy manuals. You are agreeing to all of it, so read what governs the group, not just your individual terms.

Know your state's rule and negotiate the radius, the duration, and a buyout. A non-compete measured from every practice location the employer owns can fence you out of an entire metro area, not just your office.

Confirm credentialing is underway well before your start date and clarify who is responsible if it is delayed. Get in writing what you are paid if you cannot bill yet, so a slow credentialing process is not your financial problem.

Check how disability is defined and who determines it, and make sure the timeline gives your own disability coverage time to start. A definition the employer controls, with a short runway, can cut off income before your policy pays.

Read the vesting schedule and the forfeiture conditions before you count on a dollar of it. Ask whether the deferred amount is funded and protected, or just a line in an agreement.

Check whether employer coverage is own-occupation and whether it is portable if you leave. Group disability frequently is not, which is why many physicians carry their own individual policy on top of it.

Disclose fully and keep copies of everything you submit. An omission that surfaces during a credentialing audit or a malpractice claim can cost you the position and the coverage at the worst possible moment.

Find out whether the draw is recoverable or non-recoverable. A recoverable draw can turn your first year into a debt instead of a paycheck if your ramp is slower than projected.

Push for specifics: defined call frequency, named practice sites, and limits on duties outside your specialty. Open-ended language like as assigned by the employer hands the practice unlimited claim on your time.

Read this clause as carefully as the salary. The combination of an activated non-compete plus a tail premium you owe can be the most expensive paragraph in the entire contract.

Research who the employer actually is, including who owns them. A practice owned by private equity or a management services organization can change your day-to-day reality regardless of what the contract's clinical language promises.

This is the document the senior people in your program signed without reading. Read every clause, because the employer drafted it to protect the employer, and the terms are negotiable until you sign.

Before celebrating a partnership offer, confirm it is real equity with profit distributions and voting rights, not a senior salary with a label. Get the buy-in price, the valuation method, and the rights in writing.

Pin down exactly which overhead costs are deducted before your excess is figured. A practice can quietly load shared expenses into your overhead line and shrink the surplus you thought you were earning.

When you see this phrase in a contract, read it as tail coverage and apply the same scrutiny: confirm the cost and who is responsible. The formal name does not change that this is the expensive departure obligation.

Recognize that fair market value language is protecting the legality of your pay, not capping it arbitrarily. When buying into a practice, insist on an independent valuation rather than a number the sellers set themselves.

Recognize that many odd-looking contract provisions exist to satisfy federal law, not to shortchange you. When something touches referrals, ownership, or compensation tied to volume, that is the moment for health-law review.

Ask the practice to run the formula against last year's actual numbers for a physician in your role. Headline figures are marketing; the formula applied to real volume is the truth.

Add the value of the full benefits package when comparing offers, not just the salary. A lower salary with strong retirement matching, full malpractice and tail, and a real CME allowance can beat a higher number with thin benefits.

Tie the radius to the single location where you primarily practice, not to all employer sites. Confirm the mileage and what it realistically excludes by mapping it before you sign.

Check that the governing law matches the state where you will actually practice, and understand that state's stance on physician non-competes. A favorable-looking non-compete can become enforceable under a less protective state's law.

Treat every dollar of upfront assistance as a loan until the contract proves otherwise. Read the forgiveness timeline and know exactly what you would owe if you left in year two.

Confirm the effective date and the employer's premium share, especially for family coverage. Line up the start so there is no gap between your old coverage ending and the new plan beginning.

Look for language assigning outside income to the employer. If you plan to speak or consult, negotiate the right to keep your honoraria explicitly rather than assuming they are yours.

Treat the assistance agreement as a full contract in its own right, with its own clawback and service requirements. Read how it interacts with your employment terms, since leaving one can trigger obligations under the other.

Ask which policies are incorporated by reference, because a short contract can pull in a long employee handbook you are bound by but never saw. Get those documents before you sign.

The guarantee is a recruitment tool, not free money. Confirm the forgiveness schedule, the service-area requirement, and the tax treatment of forgiven amounts before you sign.

Look hard at any clause requiring you to indemnify the employer, and confirm your malpractice policy actually covers what you are agreeing to be responsible for. An uninsured indemnification obligation can put your personal finances on the line.

Calculate the real difference after self-employment tax, benefits you must buy, and malpractice you must carry. Also confirm the classification is legitimate, because misclassified contractors create tax and liability problems that land on you.

Notice any clause where you concede that a breach causes irreparable harm or waive your right to contest an injunction. That language is the employer building the case to shut you down quickly, and it is worth pushing back on.

If you create anything outside clinical care, content, inventions, side projects, carve it out explicitly. Broad IP assignment language can otherwise hand the employer ownership of work that has nothing to do with your day job.

For deferred compensation, confirm the arrangement complies with Section 409A, because violations create immediate tax and penalties for you, not the employer. An accountant reviewing the offer is worth the fee.

Push the duration to one year or less where you can, and check how your state's courts treat the length. A two-year clause over a wide area can force a temporary career change or a move.

Do not treat a letter agreement as informal. Read it with the same scrutiny as a full contract, and notice what is absent, because missing terms default to whatever the law or the employer's interpretation supplies.

Map the forgiveness schedule against your real plans. If there is any chance you leave before the term ends, calculate the unforgiven balance plus the tax bill now, not later.

Check the required venue and any shortened deadline to bring a claim. A distant forum and a tight filing window are subtle ways to make it impractical for you to enforce your own rights.

List every expense the contract makes mandatory and subtract them from the offer. A strong headline number with heavy mandatory expenditures can net out below a simpler salary elsewhere.

Identify which fronted costs you must reimburse and under what conditions. Pair this with the tail-insurance clause, since who pays the tail is the single most expensive reimbursement question in many contracts.

Get the parental leave terms in writing, including whether any of it is paid and how it affects production-based compensation. Silence in the contract means you are relying on default law and unwritten policy at the worst time to be guessing.

If you have service obligations, confirm the contract honors your federal reemployment rights and clarify whether leave is paid and how it affects production pay. Contract language cannot override USERRA, so flag anything that appears to try.

Make sure the definition of confidential information excludes your general skills, training, and publicly available knowledge. An overbroad NDA can be used to claim you took something you did not.

Clarify whether the clause bars active solicitation only, or also passive treatment of patients who find you on their own. A clause that bars even seeing patients who follow you voluntarily is far broader than a true non-solicitation.

Understand exactly what triggers your duty to report and the deadline, especially under a claims-made policy. Missing a reporting window can void coverage for a claim you would otherwise have been protected against.

Make the notice period mutual and long enough to land elsewhere, and check whether the employer can place you on leave during it. Being walked out on day one of a 90-day notice can mean 90 days without the income you were counting on.

If you are offered occurrence coverage, recognize the value: no tail liability when you leave. When comparing to a claims-made offer, factor the future tail cost into the comparison, not just the annual premium.

Insist on a written cure period, usually 15 to 30 days, for any curable breach. The absence of a cure clause means the employer can terminate for cause the moment they allege one, with no recourse for you.

Understand that in most employed contracts you set neither your fees nor own your collections. Know that going in, and weigh it against the income model offered.

Confirm you retain reasonable access to records for patients you treated, at minimum for malpractice defense. Losing all access to your own clinical documentation can leave you defenseless if a claim surfaces years later.

Confirm the exact legal entity employing you and look it up. If the employer is a thinly capitalized subsidiary or a staffing intermediary, the promises in the contract are only as solid as that entity.

If your pay is collections-based, confirm in writing that you are paid for collections received after departure on work you performed. Practices often keep that tail of revenue unless the contract says otherwise.

Ask for objective, written, measurable conditions and find out what happens if you miss them. Subjective performance standards judged solely by the employer give them a path to terminate or withhold bonus at will.

When changing jobs, compare buying tail from your old policy against getting prior acts coverage from the new one. If the new employer offers nose coverage, it can save you the tail premium entirely, so ask before you pay for tail.

Have a physician contract attorney review the agreement before you sign, every time. This is the single highest-return hour of professional help in the entire transition.

Confirm the policy type, the coverage limits, and who buys the tail at departure. The single most expensive surprise in many contracts is discovering you owe a tail premium worth twice your annual malpractice cost.

Find out the total days, the accrual and carryover rules, and whether unused PTO is paid out when you leave. Also check whether call coverage and CME eat into the same pool, which quietly shrinks your real time off.

Identify any community-benefit or charity-care obligations in your contract and how they interact with production-based pay. Unpaid required service can quietly lower your effective compensation if your pay is tied to billable volume.

Look for clauses letting the hospital adjust your compensation or claw back amounts to maintain regulatory compliance. These can quietly put your pay at the mercy of a later compliance determination.

Understand both the opportunity and the restriction here. The right to buy into ancillary ventures can be a major income source, while a clause barring outside investment can limit your wealth-building, and both must respect Stark and Anti-Kickback limits.

Check the clawback window and whether the amount is grossed up for taxes. A five-figure relocation package that you owe back if you leave in eighteen months is a retention chain, not a perk.

Add up every dollar subject to repayment and model what you would owe at each year of departure. The sum of all repayment provisions is the true cost of leaving early, and it is often larger than physicians expect.

Trace who is ultimately responsible for the obligations owed to you, not just the entity that signed. If the responsible party is thinly capitalized, the protections in your contract may be hard to collect on.

Narrow the restricted activities to your specialty and to in-person practice. Broad language that captures telehealth, locums, or any medical role can leave you unable to work even outside the geographic zone.

Map every retention mechanism and what each one costs you if you leave at year one, two, or three. The combined drag of vesting plus forgivable advances is the real exit cost, and it is easy to underestimate.

Read the match formula and the vesting schedule together. A strong match on a long vesting cliff can vanish if you leave early, so factor your realistic tenure into how much the plan is actually worth to you.

If the employer self-insures, get written confirmation of how departing physicians are covered for prior incidents. A self-insured plan with no tail equivalent can leave you exposed for past care once you leave.

If your pay depends on collections, ask who sets the fee schedule and how often it is updated against payer contracts. Fees frozen for years quietly erode collections-based income.

Determine whether sick leave is its own bank or part of combined PTO. A combined pool means every sick day is a vacation day you no longer have, which is worth weighing when comparing offers.

Negotiate the amount, but read the repayment clause first. Confirm the vesting date, whether repayment is prorated or full, and whether it is grossed up for the taxes you will owe on it.

Ask for the SPDs for any plan that matters to you before you sign, not after. The one-line benefit summary in a contract can gloss over vesting schedules and exclusions that the SPD spells out in full.

If your compensation or any ownership stake touches services you refer to, confirm the arrangement fits a Stark exception, ideally vetted by a health-law attorney. Stark violations carry heavy penalties and intent is no defense.

Understand which Stark exception your arrangement relies on. The protection only holds if every element of the exception is met, so the compensation terms in your contract are doing legal work, not just paying you.

If your salary is stated with no production upside, find out how the number was set and when it gets reviewed. A flat salary with no growth path can fall behind your value fast in a busy practice.

Who pays the tail is one of the most negotiable and most expensive terms in the contract. Get it in writing, and consider negotiating that the employer covers it, or that the tail obligation disappears if they terminate you without cause.

Calculate the likely tail premium for your specialty and state now, so the number is not a shock later. Then negotiate who pays it, because an unplanned five-figure tail bill at departure is one of the most common contract regrets.

Read the term together with the termination and renewal clauses, not in isolation. A multi-year term only protects you if your exit rights inside it are real.

Demand a narrow, specific, objective list of cause events and an opportunity to cure where the conduct is fixable. Catch-all phrases like conduct detrimental to the practice hand the employer a for-cause exit on demand.

Make sure the notice period is mutual and workable, and trace what a without-cause exit triggers: does the non-compete activate, who pays the tail. A short notice period favors whoever wants you gone fastest.

Look past the number of weeks to the practical ability to take them. Ask how coverage works when you are out and whether vacation is truly separate from sick leave and CME days, or all drawn from one pool.

Get both the threshold and the conversion factor in writing, and benchmark the rate against MGMA data for your specialty. A low conversion factor quietly caps your earnings no matter how hard you work.