The First Contract

Start twelve months out

Negotiation needs time, and so does a proper review. Request the full agreement, including exhibits and the compensation plan, not a summary. Engage a contract attorney who works with physicians for the legal terms and a planner for the financial ones; the fee is small against the value of a single clause. Prioritize three asks, because employers respond to focus. And get every change into the signed document. If it is not in writing, it is not in the contract.

The money terms

Understand exactly how you are paid. A guaranteed base for one or two years followed by productivity pay is common; if productivity is measured in work RVUs, know the conversion factor, the threshold at which bonus pay begins, how that threshold compares with realistic volumes for a new physician, and when the guarantee ends. Signing bonuses and relocation almost always carry a repayment clause if you leave early; negotiate the period, proration, and whether repayment applies if the employer terminates you without cause.

Benefits are worth tens of thousands a year and are often more negotiable than salary: the match formula and vesting, whether a 457(b) exists and which kind, CME, licensing and DEA fees, and health, disability, and life coverage.

The risk terms

Tail coverage: if malpractice is claims-made, someone pays for tail when you leave, and it can cost one and a half to two times the annual premium. Negotiate employer-paid tail, or at least employer-paid tail if you are terminated without cause or leave after a defined number of years. The non-compete: several states limit or prohibit them for physicians; where enforceable, negotiate radius, duration, and scope, and ask that it fall away on termination without cause. Termination: find the without-cause provision and its notice period, read the for-cause definitions for vagueness, and know what happens to bonuses and the non-compete under each.

The terms that are not about money

Call frequency and the right to change it, additional sites, and the ability to assign you elsewhere should all be specific; “as assigned” is a blank check. In private practice, ask for the partnership timeline, the buy-in and how it is calculated, and how many associates have made partner in the last five years. Ask who keeps moonlighting, expert-witness, and consulting income. And ask what happens to the contract, and the non-compete, if the employer is acquired.

PSLF and the employer

Employment by a for-profit group does not qualify for PSLF, even inside a nonprofit hospital, with an exception in states whose laws prevent hospitals from employing physicians directly, chiefly California and Texas. If PSLF is your path, confirm the employer’s status in writing before you sign, not after.