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Physician Contract Renegotiation Checklist

  • Jun 19
  • 6 min read

While a lot of physicians in our online communities for doctors put a lot of thought into how to negotiate the initial contract with their employer, they often miss the importance of contract renegotiations when it comes time to renew their contract. This is a great time to correct what you got wrong or overlooked the first time, as well as make adjustments based on new data and what has changed since you first signed the contract. Below, we give you a checklist of things to consider renegotiating when you renew your contract.


As always, contact a physician contract attorney to help give you advice specific to your situation.


Disclosure/Disclaimer: Our content is for generalized educational purposes.  While we try to ensure it is accurate and updated, we cannot guarantee it. We are not formal financial, legal, or tax professionals and do not provide individualized advice specific to your situation. You should consult these as appropriate and/or do your own due diligence before making decisions based on this page. To learn more, visit our disclaimers and disclosures.


Checklist for renegotiating a physician employment contract, including 9 items to cover


Why should I bother negotiating my physician contract?


We covered this in a lot more detail in our overview article about how to renegotiate your physician contract, but you should absolutely treat the renegotiation of your contract in the same way that you did the initiation contract negotiations. Your employer may have changed the terms of the contract, the work environment may have changed in some way, you may have realized certain terms were unfair, or the market may have evolved such that you have more leverage to ask for more compensation or other terms that are important to you. You have more leverage at this time than you do during a normal workday, so don’t pass up this opportunity to advocate for yourself and your worth.


Make sure you use a contract attorney to help you in the process! They will help you spot red flags, navigate what fair compensation is in today’s healthcare marketplace, and more. Even one change will likely pay off the investment in their services with dividends.


Related PSG resource:



Physician contract renegotiation checklist


Pro tip: Start by doing a line by line comparison of the new contract with your current contract to see what wording has changed. While they may seem like the essence is the same, know that any changes are likely intentional. Make sure that you think about why the employer's lawyers may have changed that wording, and how it could adversely affect you.


Then it's time to move on to deciding what you'd like to change.


Compensation structure


Things to renegotiate include:


  • Base salary

  • Productivity model structure as well as what you want it to be based on (examples: wRVUs, collections, panel size, shifts)

  • Bonus structure and metrics on which it’s based

  • Retention bonus - review recent physician retention bonus insights by specialty

  • Quality related incentives

  • Call compensation

  • Extra shift or overtime compensation

  • CME funds

  • Student loan repayments


Related PSG resource:




Productivity metrics


Building off of this, you may want to revisit terms related to productivity entirely now that you’ve had the benefit of data. Additionally, many hospital systems have been revising these in contracts - make sure that you check for any changes in wording, wRVU values, etc. These include:


  • How productivity is measured

  • How compensation is modeled on these metrics

  • Attribution rules for work done under you or alongside another colleague

  • Comparison to recent benchmarks with MGMA, AGMA, or other compensation data

  • Transparency in tracking metrics (ask for real time ability to track your metrics)

  • Review frequency to correct for issues

  • Appeal process for any metrics you may dispute or disagree with



Benefits packages or non-monetary compensation


There may be certain benefits you want, or that you may not have initially qualified for or thought to negotiate. These include:


  • Health insurance

  • Retirement plans

  • HSAs

  • Disability insurance

  • Malpractice insurance (claims made vs. occurrence, tail coverage)

  • CME days

  • Licensing/DEA fees

  • Professional society dues

  • PTO and sick leave

  • Parental leave



Partnership track, profit sharing, or equity options


If you qualify for (or want) ownership or profit sharing, this is the time to bring it up. You could negotiate partnership terms, the track to partnership, profit sharing agreements, or equity shares depending on the structure of your practice or employer. You may specifically want to bring up:


  • Timeline to partnership

  • Buy-in amount

  • Governance rights

  • Compensation after partnership

  • Exit valuation formula

  • Transparency into financials




Restrictive covenants or non-compete agreements


As these become increasingly monitored, you may have leverage to renegotiate the terms of an existing burdensome noncompete clause. You could negotiate it out altogether, or renegotiate:


  • Duration (cut it down if possible)

  • Geographic radius (reduce if possible)

  • Non-solicitation clauses

  • Moonlighting or side gig restrictions or exclusivity requirements

  • Waiving these if terminated without cause




Intellectual property, side gigs restrictions, or other outside activity conditions


Piggy-backing off of the last point, make sure that your time outside of work is your time to the extent possible, especially if you have any desire to have alternative income streams or side projects. This includes protective language regarding:


  • Ownership of content, research, or inventions

  • Side gigs related to your training as a physician, such as speaking engagements, consulting work, or expert witness work

  • Academic publishing rights

  • Non-medical side gigs

  • Moonlighting




Provisions of the termination clause


You should make sure that you are able to leave if you want, and that they can only terminate you under certain circumstances or after certain requirements have been met. These include:


  • Tail coverage obligations (who covers it?)

  • The notice period required for a without cause termination (extend this so that you have more stability)

  • Notice period required by you if you want to leave (make the term shorter for maximum flexibility)

  • What is cause for immediate termination

  • The period of time you have to cure an issue if there is an alleged breach

  • Terms for severance

  • Automatic renewal language or conditions

  • Ensure terms are fair and mutual rather than one sided towards the employer




Schedule and workload requirements


As hospitals and other employers encounter staffing issues and are asking you to do more with less resources, it’s important to make sure that you protect yourself in the case that the workload increases dramatically from the original expectations. Insert language about:


  • Number of clinical hours expected

  • Patient panel caps

  • Maximum call frequency (or negotiate extra pay past a certain frequency)

  • Weekend/holiday coverage expectations

  • Dedicated administrative time or support for tasks such as charting and documentation, tumor boards, prior auths, etc. - this could include AI scribes or more MAs or staff

  • Supervision requirements for NPs, PAs, or other members of the medical team

  • What happens if someone leaves

  • Obligations to staff other locations or do telemedicine




Better malpractice coverage


As the malpractice environment heats up in terms of elevated payouts, and there are more supervisory requirements or responsibilities, you may want to revisit the terms of the malpractice coverage provided, including: 


  • Claims-made vs occurrence coverage

  • Who covers the tail insurance, or credits towards the purchase of tail insurance now that you’ve been there for a while

  • Consent-to-settle clauses to protect yourself

  • Indemnification clauses

  • Coverage limits (ensure that these match the current environment in your state)




Conclusion


As you can see, there are lots of things to think about renegotiating when you revisit your physician contract when it’s up for renewal. You'll want to start by reviewing what they've changed, and thinking about how those changes may adversely affect you. After that, you'll want to start thinking about what you'd like to modify. Chances are, your responsibilities and expectations have changed over the years, and there’s likely some things that you’re unhappy with. This is your time to change it. 



Additional contract negotiation resources for physicians


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