{"id":123126,"date":"2025-08-06T08:26:10","date_gmt":"2025-08-06T08:26:10","guid":{"rendered":"https:\/\/www.europesays.com\/us\/123126\/"},"modified":"2025-08-06T08:26:10","modified_gmt":"2025-08-06T08:26:10","slug":"residents-and-their-first-contracts","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/123126\/","title":{"rendered":"Residents and Their First Contracts"},"content":{"rendered":"<p>Tung Giep, MD, was ready to hire the doctor sitting across from him.<\/p>\n<p>Giep\u2019s Texas-based private practice needed another neonatologist. The young doctor in front of him was qualified and clearly in need of a change. Just a year out of training, the physician was working double the days on call he\u2019d signed on for and with no overtime pay.<\/p>\n<p>\u201cHow much notice do you have to give your employer?\u201d Giep asked. The interviewee admitted he had no clue, and Giep knew that was a bad sign. The interviewee called later that week to say his contract required a 6-month notice. Giep told him that he was sorry to hear it; he couldn\u2019t wait that long.<\/p>\n<p>\u201cYoung doctors have no clue about what\u2019s out there, especially in the contract arena,\u201d Giep told Medscape Medical News. After years of training, debt, and low wages, new doctors are rightfully eager to sign on to their first jobs. But, unbeknownst to them, hospital contracts can be littered with unfavorable terms \u2014 noncompetes, vague assignments, lack of overtime or insurance \u2014 that cause major problems down the road.<\/p>\n<p>There are ways for new doctors to protect themselves and their future plans. But they can\u2019t go it alone. Experts agree: Legal help is nonnegotiable.<\/p>\n<p><strong>About Medscape Data<\/strong><\/p>\n<p>Medscape continually <a href=\"https:\/\/www.medscape.com\/index\/list_12363_0\" target=\"_blank\" rel=\"noopener\">surveys<\/a> physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, the Medscape <a href=\"https:\/\/www.medscape.com\/slideshow\/2025-compensation-overview-6018103\" target=\"_blank\" rel=\"noopener\">Physician Compensation Report 2025<\/a> found that<\/p>\n<ul>\n<li>Doctors reported seeing an average of 78 patients per week for primary care physicians and 71 for specialists.<\/li>\n<li>About 61% of physicians feel underpaid.<\/li>\n<li>Nearly two thirds of doctors qualified for an incentive bonus program with the average amount of $48,000 in 2024.<\/li>\n<\/ul>\n<p><strong>Bigger Than Benefits<\/strong><\/p>\n<p>\u201cThe overwhelming majority of physicians are employed now, which is different than what it was pre-COVID,\u201d said Elizabeth Snelson, Esq., attorney and president of the Legal Counsel for the Medical Staff, PLLC. A <a href=\"https:\/\/www.physiciansadvocacyinstitute.org\/PAI-Research\/Rural-Physician-Employment-and-Acquisition-Trends-2019-2024\" rel=\"nofollow noopener\" target=\"_blank\">2024 analysis<\/a> funded by the Physicians Advocacy Institute found that more than 77% of doctors are now employed by hospitals, health systems, or corporate entities.<\/p>\n<p>After decades of training, the transition to employee can be abrupt for doctors who are accustomed to the protective academic system, said Snelson, who also authored the <a href=\"https:\/\/www.ama-assn.org\/system\/files\/hospital-employment-contracts-guide.pdf?check_logged_in=1\" rel=\"nofollow noopener\" target=\"_blank\">American Medical Association\u2019s Physicians\u2019 Guide to Hospital Employment Contracts<\/a>. Hospitals are very different.<\/p>\n<p>\u201cThey are coming at it, in my experience, very trusting and very eager,\u201d Snelson said of new doctors. Residents and fellows are overworked and underpaid for so long, \u201cthey\u2019re often dazzled by the zeros in the offer\u2026they\u2019ve never had cash flow like this,\u201d she said.<\/p>\n<p>Worse, the money and benefits are not unimportant. Doctors have debt to repay and years of training to make up for. But there\u2019s more to consider, Snelson said. The same contracts that make it easy to start \u2014 with salaries and bonuses \u2014 can make it extremely hard to live or leave when you please.<\/p>\n<p>Subtle nuances can have big implications. No mention of tail insurance likely means the doctor is responsible for paying the huge premium whenever they decide to leave. \u201cAt least 7 days per month on call\u201d means the employer can ask you to juggle 21 days. And if you\u2019re a specialist, like a neonatologist, but your contract uses the word pediatrician, the employer could assign you to rounds as a pediatric hospitalist.<\/p>\n<p>And that\u2019s just a small taste.<\/p>\n<p>Here are a few of the common contract hurdles new doctors run into:<\/p>\n<ol>\n<li>No compensation for additional call time.<\/li>\n<li>Assigned to work outside their subspecialty or outside the hospital location they were hired to work at.<\/li>\n<li>Long termination notices requiring 6- or even 18-month advance notice.<\/li>\n<li>Payback clauses that require the doctor to repay signing and moving bonuses if they choose to leave the position within the first few years.<\/li>\n<li>The absence of tail insurance, meaning the doctor will be on the hook for tens of thousands of dollars for coverage if they decide to leave.<\/li>\n<li>Broad noncompete clauses that prevent doctors from working within a radius of any of their locations \u2014 not just the primary hospital.<\/li>\n<li>No protections if the hospital hires the doctor but privileges are delayed.<\/li>\n<\/ol>\n<p>\u201cA contract is like a prenuptial agreement; you want to make sure everything is thought of,\u201d according to Giep, author of the new book, \u201cThe Business of Medicine: The Definitive Guide to Help New Physicians Start Their Career on the Right Path and Avoid Costly Mistakes.\u201d<\/p>\n<p>Which is why, all experts agree, you need a specialized attorney to review your contract.<\/p>\n<p><strong>Everything Is Negotiable<\/strong><\/p>\n<p>I don\u2019t blame doctors for missing the problematic details in their contract, said Dennis Hursh, a healthcare employment attorney who specializes in physician contracts. \u201cIt\u2019s legalese, and they just don\u2019t see it,\u201d he said.<\/p>\n<p>In fact, most new hires are told their contract is standard and that it can\u2019t be changed. So, they likely skim over it and agree, trusting the system just as they did in training.<\/p>\n<p>Except not being able to change the contract is false. \u201cThe recruiter isn\u2019t lying; they can\u2019t change it,\u201d Hursh said. But someone can. In his experience negotiating over 4000 contracts, he\u2019s seen less than 12 cases where the employers refused changes.<\/p>\n<p>The contract you\u2019re offered \u201cmay be the one everyone is given, that\u2019s true,\u201d Hursh said, \u201cbut it\u2019s not the one everyone signs.\u201d<\/p>\n<p>The reality is that most new physicians don\u2019t know their contract was negotiable until they\u2019re on the job. They find out their colleagues signed different deals: fewer call hours or better provisions, Hursh said. That\u2019s why \u201cI see a lot of second contracts,\u201d he told Medscape Medical News.<\/p>\n<p><strong>Price of Freedom<\/strong><\/p>\n<p>It\u2019s not enough to have a family lawyer or attorney friend look over your contract, Giep said. \u201cYou wouldn\u2019t see a dermatologist for an ob\/gyn issue,\u201d he argued.<\/p>\n<p>Doctors need an attorney experienced in healthcare employment, specifically. And contrary to popular sentiment, that\u2019s not selfish, greedy, or combative.<\/p>\n<p>Doctors may worry that hiring a lawyer seems distrusting, \u201cas if that employer doesn\u2019t have a bank of lawyers behind them,\u201d Snelson said. An attorney wrote the contract you\u2019re considering. Hiring one of your own is basic professionalism; it shows you\u2019re taking the opportunity seriously, Hursh added.<\/p>\n<p>But it won\u2019t be free. Prices vary widely, but experts said you can expect to pay at least $1000 for a contract review. It\u2019s pricey amid an already expensive transition. But, consider it the price of protection, Snelson said. It\u2019s just a small piece of the big salary you\u2019re signing on for, and it can make a huge difference in your future quality of life. Even if you don\u2019t make huge changes, a healthcare attorney can help you understand what you\u2019re signing on for, she said.<\/p>\n<p>If you\u2019re hoping to leave a position in 2 years because of your spouse\u2019s job, your attorney can help you decipher what it will take to quit. Is the notice 120 days or 18 months? Will you owe back bonuses or be on the hook for expensive tail insurance?<\/p>\n<p>If you\u2019re in the city you hope to stay in, you want help understanding and minimizing the noncompete. What are your limitations if you leave? Are you prevented from working near your primary hospital, or does the noncompete include any building affiliated with the hospital? That could be tens or hundreds of miles.<\/p>\n<p>\u201cIt should be based on where the physician did most of their services,\u201d Hursh said. And some specialties, like anesthesiology, radiology, pathology, or emergency medicine, pose no risk of stealing patients. They shouldn\u2019t have noncompete clauses in their contracts at all, he added.<\/p>\n<p>And even if your first job is at a dream institution, you need legal help protecting your day-to-day. The contract should be specific about the work you\u2019re doing \u2014 neonatology not pediatrics, for example \u2014 and where you\u2019re doing it. There should be a clear compensation structure for any additional hours.<\/p>\n<p>The employer benefits when the contract uses vague language, Giep said. \u201cThe healthcare attorney you hire will help you tighten it up.\u201d<\/p>\n<p>And if you get the sense at any time that a future employer doesn\u2019t want your lawyer involved, \u201cthat\u2019s a red flag,\u201d Snelson said. Ask yourself, if \u201cthey want a lawyer but don\u2019t want me to have one \u2014 Do I want to work here?\u201d<\/p>\n<p>Donavyn Coffey is a Kentucky-based journalist reporting on healthcare, the environment, and anything that affects the way we eat. She has a master\u2019s degree from New York University\u2019s Arthur L. Carter Journalism Institute, New York City, and a master\u2019s in molecular nutrition from Aarhus University in Aarhus, Denmark. You can see more of her work in\u00a0WIRED,\u00a0Teen Vogue,\u00a0Scientific American, and elsewhere.<\/p>\n","protected":false},"excerpt":{"rendered":"Tung Giep, MD, was ready to hire the doctor sitting across from him. Giep\u2019s Texas-based private practice needed&hellip;\n","protected":false},"author":3,"featured_media":123127,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14],"tags":[64,2563,17342,76078,76077,13656,263,27091,3584,619,27090,27089,420,39563,76073,76075,76076,76074,27088,76070,76072,15516,68332,16931,76071,67,132,68],"class_list":{"0":"post-123126","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-jobs","8":"tag-business","9":"tag-career","10":"tag-compensation","11":"tag-compensation-report","12":"tag-early-career","13":"tag-earnings","14":"tag-employment","15":"tag-employment-contract","16":"tag-hospitals","17":"tag-income","18":"tag-job-contract","19":"tag-job-interview","20":"tag-jobs","21":"tag-junior-doctor","22":"tag-new-doctor","23":"tag-new-generation-of-physician","24":"tag-new-physician","25":"tag-next-generation-of-physician","26":"tag-profession","27":"tag-remuneration","28":"tag-residency","29":"tag-residents","30":"tag-revenue-and-practice-management-practice-management-revenue","31":"tag-salary","32":"tag-salary-negotiations","33":"tag-united-states","34":"tag-unitedstates","35":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/114980872839195303","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/123126","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=123126"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/123126\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/123127"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=123126"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=123126"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=123126"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}