Physician contract review: a four-question checklist

Question one: the work

The contract defines the job: the clinical schedule in sessions or hours, call coverage and its frequency, the sites you can be assigned to and whether that list can grow without your consent, and any administrative, teaching or committee duties, compensated or absorbed.

For every duty, ask how much, how often, and who decides. "Reasonable call" sounds harmless, but an undefined term is a term nobody has agreed on yet, and its meaning gets worked out after you sign. Ask in writing, and get the answer in writing.

Question two: the money, totaled

Base salary is one line. Total package value puts everything of monetary worth into one sum: base salary, the realistic bonus (what clinicians there actually earn, not the theoretical maximum), the signing bonus spread across the years it commits you, the retirement match, employer-paid health, disability and malpractice premiums, the continuing education allowance, licensing fees, and paid time off valued at the daily rate.

Then subtract the obligations attached. Three do most of the work:

• Tail coverage: who pays when a claims-made malpractice policy ends.
• Clawbacks: signing and relocation money tied to a minimum service period. Ask what triggers repayment, whether it prorates, and whether it applies if the employer terminates without cause.
• Uncompensated call: when call is "as needed" and unpaid, the effective hourly rate drops with every page.

Question three: the exits

Every job ends, and contracts are written for that day. Scan the termination section for vague words, for asymmetry (the employer can terminate without cause and you can't, or your notice period is long and theirs is short), and for missing pieces: no severance, no cure period to fix an alleged problem before termination, no tail language, no bonus formula.

Then ask the questions that change your exposure if the job ends:

• What is the notice period, in both directions?
• Is there severance, and what triggers it?
• Does the employer credential you before your start date, and pay you during the credentialing window?
• What is the waiting period and the definition of disability on any employer disability coverage?

Question four: the restrictions

The non-compete is geometry: a radius around the practice site, running for a defined period. Evaluate three dimensions with qualified local healthcare counsel. Geography: is the radius measured from one primary site or from every affiliate in the system? Duration: how long does it run? Scope: which activities, such as academic positions, hospital employment or telemedicine, are excluded? Also ask how it operates if the employer terminates without cause, sells the practice or eliminates the position.

Enforceability is a matter of state law. The 2024 federal rule that would have banned most noncompetes never took effect: it was set aside in court, the Federal Trade Commission dropped its appeals in 2025, and the rule was removed from the regulations in February 2026. Read non-solicitation and confidentiality clauses with the same care.

How to negotiate a physician contract

Negotiation runs in three moves. Prepare: pull market data from compensation surveys such as those from the Medical Group Management Association, the American Medical Group Association and Medscape (industry survey data, not peer-reviewed research), list the specific value you bring above the median, and sort priorities into must-haves, nice-to-haves and willing-to-trade.

Ask: when the offer arrives, one useful bridge sentence is "Thank you. I'm very interested. Based on my research and qualifications, I was expecting a range of X to Y. Help me understand how we might bridge that gap." If base pay is firm, move to benefits, and ask for a scheduled compensation review at twelve months with defined criteria.

Protect: have the covenant reviewed by local counsel, get the tail question answered in writing, and make the bonus a written formula. If "at employer's discretion" appears near the bonus, that is an intention, not a bonus.

Get it reviewed, and take the time

A healthcare contract attorney licensed where the agreement is governed is the person qualified to review it. Fees vary by market and complexity. Ask for enough review time for your circumstances; how an employer responds to that request is itself information. Pressure to sign quickly is a flag that outranks the rest.

This checklist draws on Sessions 7, 8 and 4 of WealthRounds. Designated by the Postgraduate Institute for Medicine for a maximum of 8 AMA PRA Category 1 Credit(s)™, 8 nursing contact hours, or 8 AAPA Category 1 CME credits.