When it comes to evaluating a physician employment contract’s job requirements such as call coverage, outside duties and supervisory responsibilities, doctors may feel comfortable and well-prepared for the task. Experts say, though, that physicians—particularly those in early career or those seeking their first role after residency or fellowship training—may make assumptions at their own financial peril.
A report on physician salary data (email required) recently released by Resolve, a contract review and negotiation firm specializing in physician employment, takes a deep dive into some of the clauses that most frequently sneak up on physician job seekers.
The report’s data comes from more than 4,000 physician contracts reviewed by Resolve in all 50 states and in 116 specialties and subspecialties. The report outlines must-know trends nationally, as well as across regions, practice settings and more.
“While base compensation, bonuses and work schedules tend to dominate early contract discussions, several less visible terms continue to have an outsized long‑term impact on physicians,” the report says. “These clauses are often standardized across systems and may receive little attention during negotiations unless specifically flagged, yet they can meaningfully affect mobility, financial obligations and exit flexibility.”
Without careful review before accepting a job offer, those five parts of a physician contract—noncompete clauses, termination provisions, repayment obligations, malpractice coverage structure, and renewal and exit provisions—can wind up having an outsized impact on your compensation, job satisfaction and even your long-term career.
Many of these topics are “things that we [as physicians] are not very familiar with but that can really be detrimental to you if you don’t understand them, and if you don’t negotiate them on the front end,” said Ryan Mire, MD, MACP, a physician educator for Resolve, in a recent webinar on the topic.
Dr. Mire, an AMA member, is an internist in private practice in Tennessee.
The AMA has teamed up with Resolve to provide AMA members an exclusive discount on services that include custom contract review. Resolve offers personalized legal expertise to help physicians secure the best employment contract terms, no matter where they are in their careers. Ready to access your AMA-member Resolve discount? Learn more now.
Restricting your mobility
Physicians should pay careful attention to the parts of their employment contracts that mention covenants not to compete, also called restrictive covenants or noncompete clauses.
Noncompete clauses limit where, geographically speaking, and in what specialty, a physician may practice after departing a role. Resolve experts said physicians often assume that they will be prohibited from practicing for a year or two in a “modest radius” away from the location where they were employed.
Dr. Mire, however, gave the example of a contract that required a physician to practice at least 30 miles away after leaving a role.
“What you have to be very careful about is if this is a practice or hospital system that has multiple locations, it [the noncompete clause’s geographic location] is typically not just from the location where you're located, it’s going to be a 30-mile radius from all of their locations,” he said. “So, if they're spread across an entire metropolitan area, that may factor in where you can next get your job, and that 30-mile radius extends from the furthest site of their locations. Even though you may be in the heart of the city, if they have a location in a suburb, you’ll be 30 miles outside of that suburban area.”
Additionally, the legal rules about noncompete clauses vary from state to state. Without expert guidance, a physician may find they are effectively prevented from leaving the job after they sign on.
Learn more on evaluating practice environments to match your priorities with the AMA STEPS Forward® toolkit, “What to Look for in Your First or Next Practice.” It is enduring material and designated by the AMA for a maximum of 0.5 AMA PRA Category 1 Credit™. Read up on AMA CME accreditation.
Thinking ahead to departure
It can be uncomfortable for physicians looking for their first jobs after residency or fellowship to think about eventually leaving the role. But the way some employment contracts are set up in regards to termination can be imbalanced.
Physicians might believe that the termination restrictions will apply equally to employers and employees regarding when and under what circumstances they can part ways.
The truth is, though, that these are often not reciprocal. While physicians may need to provide longer notice periods, an employer might need to provide as little as 60 days’ notice for ending an employment contract. Additionally, vague definitions of “cause” can allow immediate exits for employers without giving physicians equal freedom, even in environments that are untenable.
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A bill on departure
Physician-employment contracts may come with compensation add-ons such as signing bonuses, relocation allowances and medical student loan repayments that would need to be repaid in certain circumstances.
Though a job-seeking physician might assume that repayment of these add-ons will be prorated based on the length of time that they are with the organization, that is not always the case. Some physician-employment contracts contain acceleration clauses that can require full repayment under certain termination situations.
In fact, says the Resolve report, there even have been instances “where physicians who left after organizational restructuring or role realignment still faced repayment demands because the triggering event did not fall under any protected exception in the agreement language.”
Physician job seekers also should explore the JAMA Career Center®, which presents physician career opportunities, news and information relevant to the full spectrum of medical practice. Search for physician jobs by specialty and location or browse all of the physician jobs by specialty.
More than surface protection
Seeing a clause in an employment contract that simply states “malpractice included,” physicians may assume that they will have no worries about medical professional liability insurance, which is often called medical malpractice or med-mal insurance.
The reality is far more complex. So-called “tail insurance,” which provides stopgap protection in physician job transitions—including the move from residency or fellowship training to practice—must accompany a certain type of coverage.
There are important differences between claims-made policies, which cover claims filed during the policy period, and occurrence policies, which cover claims related to events that took place during the policy period, no matter when the claim was filed. Without the right protections, physicians can be on the hook for five-figure insurance obligations, says the Resolve report.
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When timelines are tricky
Physician employment contracts can include automatic renewal clauses with short opt-out windows, compensation resets and restrictive notice delivery timelines.
You may feel you have plenty of time to reassess or prepare for different phases of your contract, but it’s all too easy to get locked into less favorable terms or prevented from renegotiating.
Ultimately, physicians looking for their first jobs out of training are dealing with an entirely different landscape, one for which they need to be prepared.
“When we went through the Match for residency, we were just on the passive end, hoping that a residency program chose us and matched us into the specialty that we wanted to do,” Dr. Mire said. “But now you're at a position where you can become more empowered to not only have the practice interview you, but also so you can do due diligence and interview the practice.”
Once you’re looking at employment contracts, it is time to seek expert guidance. And AMA members receive a 20% discount on all Resolve services. With Resolve, you get:
- Custom employment contract review.
- Access to experienced attorneys who can negotiate on your behalf.
- Real-time, comprehensive compensation data and benchmarks to help you understand your worth.
- An instant contract-review option, powered by Resolve’s attorney-trained AI model.
- Free tools such as a contract scorecard to give you a quick overview of where your contract stands.
Ready to access your AMA-member Resolve discount? Learn more now.
And if you’re seeking your first physician job after residency, get your cheat sheet now from the AMA.
