How to Review a Physician Contract Step-by-Step

Physician employment contracts can span dozens of pages, and understanding each clause is vital for attendings to protect their career and finances. From compensation formulas to restrictive covenants, seemingly small details can have huge impacts on your job satisfaction and future opportunities. Below, we break down the key elements to focus on when reviewing a U.S. attending physician’s contract, common pitfalls to avoid, negotiation strategies, state-specific differences, benchmark compensation data, and real examples of successful renegotiations. Let’s dive in.

Key Legal and Financial Contract Terms to Understand

When examining a physician employment contract, pay close attention to the following legal and financial provisions:

• Compensation Structure (Salary, Bonuses, RVUs): Make sure the contract clearly details your base salary and any incentive compensation. If productivity bonuses are based on work Relative Value Units (wRVUs) or collections, the rate per RVU and thresholds should be spelled out in writing. For example, many contracts offer a base salary plus an RVU-based bonus; 66% of physician contracts now include a productivity bonus (often tied to RVUs), whereas only 16% tie bonuses to quality metrics. Understand if there’s a compensation cap – some employers impose salary caps at a percentile of national benchmarks (e.g. 75th–90th MGMA percentile) which can limit high earners. Also clarify any performance incentives like quality bonuses or profit-sharing. Signing bonuses should be documented, along with any claw-back terms (e.g. you might owe repayment if you leave within 1–3 years – indeed, the majority of contracts include clawback provisions for bonuses if you depart before a set period).
  

• Malpractice Insurance and Tail Coverage: Verify what type of malpractice coverage is provided (occurrence or claims-made) and who pays for tail insurance if you leave. Tail coverage can be very expensive (often tens of thousands of dollars), so a favorable contract might specify the employer covers tail or splits the cost, especially if termination is without cause. If the contract is silent, you could be responsible for purchasing tail coverage out-of-pocket to insure against future claims after you depart. Make sure the coverage limits meet state requirements and whether legal defense costs are covered in addition to policy limits. A red flag is a contract that makes the physician pay for tail in all cases – many attorneys advise negotiating that the employer covers tail if you’re terminated without cause.
  

• Restrictive Covenants (Non-Compete and Non-Solicit Clauses): Most physician contracts include a non-compete clause restricting where you can practice if you leave, and a non-solicitation clause preventing you from poaching patients or staff. Scrutinize the non-compete’s radius, duration, and scope. An overly broad non-compete (e.g. 60–80 mile radius for two years) can “completely uproot physicians’ lives,” potentially forcing you to relocate to find work. Ideally, the geographic limit should apply only to your primary practice site, not every facility of a large health system. Some lawyers suggest negotiating non-competes to only apply if you’re terminated for cause (so that leaving on good terms or without cause would not trigger it). Know your state’s stance on non-competes – a few states (like California) prohibit physician non-competes entirely, while others enforce them with restrictions (details in the state section below). Non-solicitation clauses should not be so overbroad that they impede patient choice; typically you just can’t actively solicit patients or staff for a period, but patients can follow you if they wish.
  

• Work Duties, Hours, and Call Schedule: Ensure the contract spells out your clinical duties and work schedule (clinic hours, inpatient rounds, etc.) and especially how call is handled. Vague language here can lead to burnout. Ideally, the contract should specify the expected work hours or patient load and state that call duties will be “equitably divided among all physicians” in the group. If you’re in a call-heavy specialty, consider negotiating a cap on call frequency (e.g. “no more than X nights of call per month”). This protects you if, say, senior partners start exempting themselves from call, which could otherwise dump an unmanageable call burden on you. Also check for any call pay or extra compensation for exceeding a certain number of call shifts.

Remember: if a contract doesn’t define your working conditions (hours, locations, call), ask for those details to be added – you don’t want unpleasant surprises like covering multiple sites or excessive nights without compensation.

• Benefits and Perks: A good contract will outline your benefit package or reference an attachment with benefits. This includes health, dental, vision insurance, retirement plans, paid time off (vacation and sick leave), and expense reimbursements for CME, licenses, or memberships. Signing bonuses, student loan repayment, and relocation allowances should be explicitly listed if promised. If anything was offered verbally (e.g. “we will cover moving expenses” or “a signing bonus of $20k”), ensure it’s written into the contract. Also check for smaller benefits like tail coverage (as discussed), disability insurance, and whether things like license fees or DEA registration are paid by employer. These can add significant value. Retirement contributions (401k match) are usually standard across employees by law, but confirm eligibility and vesting.
  

• Contract Term and Termination Clauses: Note the contract’s term (duration) and whether it auto-renews. Importantly, review the termination provisions. Most contracts allow termination “with cause” (for specified misconduct or breach) and “without cause” (no reason needed). Red flag: extremely lopsided notice periods – e.g. requiring you to give 180 days notice to leave while the employer can terminate you with 30 days notice. Negotiating a shorter notice or equal notice period is advisable for fairness. Also, if there’s a probationary period or initial term, understand if you are locked in or if either party can exit earlier. Severance is rare for without-cause termination in physician contracts, but see if any severance or tail coverage is provided if they let you go. Finally, watch for clauses about repayment obligations upon termination – for instance, if you leave before a certain time, you might have to repay signing bonuses or relocation expenses (clawbacks). Try to add language that if you’re terminated without cause, you won’t owe repayment of those incentives. Similarly, clarify what happens to earned bonus or RVU pay if you leave mid-contract – ideally, the contract should pay out any bonus you accrued up until termination rather than forfeiting it if you’re not employed on December 31.
  

By ensuring these elements are understood and fair, you’ll have a solid grasp of the contract’s core terms. If anything is missing or seems unusual, consider it a point for negotiation or legal review.

Common Pitfalls and Red Flags in Physician Contracts

Even seemingly standard contracts can contain pitfalls that catch physicians off guard. Here are some common contractual red flags to watch for, as identified by physician attorneys and real case studies:

• Overly Broad Non-Compete: As mentioned, non-compete clauses that are far-reaching in geography or time are a top red flag. Example: A clause barring practice within a 50+ mile radius of any clinic of a large system for two years could essentially ban you from working anywhere in the region. If you see a sweeping restriction (especially in states where it might not even be enforceable), that’s a sign to negotiate it down – e.g. limit the radius to a reasonable distance from your primary site, and ensure it doesn’t multiply for each office or extend beyond 1–2 years. Remember that outside a handful of states (California, etc.), most non-competes should be assumed enforceable unless negotiated otherwise. Tip: Ask if the non-compete can be waived if you’re let go without cause or if the employer pulls out of the area.
  

• Vague or Unspecific Job Duties: Beware contracts that say you’ll perform duties “as assigned” without defining your expected clinic hours, patient load, call rotation, or practice location. Vague language could allow the employer to increase your workload or assign you to distant satellite clinics. Red flag scenarios include unlimited call responsibility or no cap on work hours. For instance, if call isn’t specified, you could end up on call every other night. The contract should, at minimum, note that call will be shared equitably, and better yet set a maximum frequency. If a contract is silent on these workload details, don’t assume it will be “reasonable” – get it in writing.
  

• Unbalanced Termination and Notice: Check if the notice period for without-cause termination is fair. A one-sided notice requirement (e.g. you must give 120 days notice, but the employer can terminate you with 30 days notice) is a red flag. This could leave you stuck for months if you want to leave, or conversely, out of a job on short notice. Negotiate for symmetry (e.g. both parties 90 days) or at least a shorter physician notice. Also, see if there’s a probationary period during which the employer can let you go with minimal notice. While some variability is common, any drastic imbalance is problematic. Another pitfall: contracts that let the employer terminate “immediately” for broad, subjective reasons like “unprofessional behavior” – this could be misused. Request narrowing of cause definitions or a “cure period” to fix issues before termination.
  

• Clawbacks on Bonuses or Relocation: Many contracts include repayment obligations if you leave too soon – e.g. you must repay your signing bonus or relocation stipend if you don’t stay 2 or 3 years. This is common, but watch for harsh terms like requiring 100% payback even if you leave for reasons beyond your control. A red flag would be a clawback that applies even if the employer terminates you without cause. Best practice is to add that clawbacks won’t apply in an involuntary termination or will be prorated by length of service. Similarly, watch for training cost clawbacks or other unusual penalties. These clauses aren’t deal-breakers if fair, but many physicians overlook them until they try to leave and get a surprise bill.
  

• Malpractice Tail Liability: A very common overlooked item is who pays for tail malpractice coverage when the contract ends. If the contract doesn’t explicitly state the employer covers tail (or if it says physician is responsible), that’s a significant financial risk. This often catches physicians by surprise later. Case in point: One legal advisor noted that if a contract is terminated without cause by the employer, it’s only fair the employer should cover the tail premium – but not all contracts say so. An absence of tail provisions is a red flag; negotiate it upfront, because once you’ve resigned or been terminated, it’s too late and you could be on the hook for a five-figure insurance bill.
  

• “Competitive Compensation” Without Details: Some offer letters or contracts promise to pay “competitive salary consistent with benchmarks” but then don’t list a number or RVU rate. Lack of concrete details on compensation formula is a pitfall. Always insist the actual dollar amounts (base salary, bonus formula, any annual raises or recalculation methodology) be included in the written contract. If the contract references a productivity model, it should specify, for example, “$X per wRVU above a threshold of Y wRVUs quarterly” or similar. If you only have generalities, you have no guarantee of what you’ll earn or how it’s calculated.
  

• No Mention of Partnership Track (if relevant): If you’re joining a private practice or a group that talks about partnership, be aware that many employment contracts do not include partnership details unless you request them. It could be intentional or an oversight. If becoming a partner/shareholder is important to you, the contract (or a separate document) should outline the timeline and terms for partnership – e.g. eligible after 2 years, what the buy-in cost is, how it’s calculated, and basic rights as partner. A red flag is an employer dangling “partnership potential” verbally but offering no written specifics; this can lead to misunderstandings or even never materializing. Always ask for any partnership or future compensation arrangements to be clarified in writing during your contract review.
  

• No Provisions for Bonus Payout at Termination: As touched on above, another subtle pitfall is how bonuses or productivity pay are handled if you leave or the contract ends mid-cycle. Some contracts state that you must be employed on the last day of the year (or contract term) to receive any bonus – meaning if you resign effective December 1, you forfeit all the bonus you “earned” that year. Red flag: language like “no bonus will be paid if employment is terminated, regardless of performance.” It’s more fair if the contract says you’ll be paid pro rata for any productivity or incentive up to the termination date. If it doesn’t, consider negotiating that in, especially if a large portion of your compensation is bonus-based.
  

• Excessive Moonlighting Restrictions: Many physicians have side gigs or moonlighting shifts. Check if your contract restricts outside work. A reasonable clause might require you to get approval or ensure it doesn’t interfere with your primary job. A red flag would be a blanket prohibition on any outside medical work, especially if compensation is below market and you rely on extra work to supplement. If you anticipate moonlighting or consulting, negotiate a carve-out that it’s allowed with notice, as long as there’s no conflict of interest. Also ensure the contract doesn’t claim excessive rights over intellectual property if you do non-clinical side projects.
  

In summary, never assume a contract is boilerplate and non-negotiable. Onerous clauses (non-competes, vague duties, clawbacks, etc.) are more common than you’d think, but they can often be modified if you raise them. Having a lawyer or experienced mentor review the document can help spot these red flags that physicians often overlook. It’s far better to address them before signing than to live with unpleasant surprises later.

Practical Tips for Negotiating Physician Contracts

Negotiating a physician contract can feel uncomfortable for doctors, but remember: almost everything is negotiable, and employers expect some negotiation. Here are strategies and tips from physician-focused attorneys and experienced doctors on how to effectively negotiate your employment contract:

• Do Your Homework on Compensation: Knowledge is power when negotiating. Before talks, research benchmark salaries and RVU rates for your specialty, region, and practice setting. Sources like SalaryDr, or AMA surveys provide data on average pay. For instance, if you know the median salary for your specialty in your area is $300,000, you’ll recognize if an offer of $240,000 is low. One new attending, Dr. Sarah Thompson, gathered MGMA data for family physicians in her region and presented it to justify a higher salary. As a result, she negotiated 15% above the initial salary offer plus student loan repayment – all because she came prepared with facts. Use data to support asks for salary, signing bonus, and even benefits. It shows you’re informed and serious. However, temper your expectations with reality; if you’re entering academics or an underserved area, market rates might differ. The key is demonstrating with evidence that your request is fair market value.
  

• Prioritize What Matters Most: Identify your top priorities before negotiating. Is a higher base pay most important, or a lighter call schedule, or perhaps location flexibility? You likely won’t get every change you ask for, so focus on the issues that truly impact your life. For example, if you have young children, you might value a capped number of weekend calls more than an extra $5,000. Or if you’re joining a practice mainly for its location, you might prioritize securing a non-compete that doesn’t lock you out of that area if things go sour. One attorney advises that physicians often zero in on salary and forget to negotiate the “obligations” – like call, clinic hours, administrative duties. Those workload factors can greatly affect your day-to-day happiness. Tip: Make a short list (maybe 3–5 items) in order of importance. For many attendings, this might look like: 1) total compensation, 2) call/travel requirements, 3) tail coverage, 4) non-compete reasonableness, etc. Tackle the big-ticket items first in negotiations, but don’t neglect smaller points that matter to you.
  

• Everything (Within Reason) Is Negotiable: Aside from a few things like the 401(k) match (which is usually fixed by law for all employees), most contract terms can be negotiated. This includes base salary, bonuses, relocation, CME stipend, call pay, PTO, contract length, non-compete scope, academic time – you name it. Don’t be afraid to ask. Employers won’t rescind an offer just because you ask for reasonable modifications; the worst they’ll say is “no.” In fact, the AMA notes that cookie-cutter contracts are the norm, but many terms will be negotiated if physicians speak up. Even if a hospital says “this is our standard contract,” you can often still request changes to particularly unfair or important clauses. Attorneys advise: “any terms that aren’t favorable can – and should – be made more reasonable” in the final agreement. For example, if the initial non-compete is 35 miles, you might get them down to 15 miles, or get an extra week of vacation, or an increase in your signing bonus. Target explicit pain points: if a clause is clearly one-sided or ambiguous, definitely negotiate it.
  

• Leverage the Letter of Intent (LOI) Stage: If your recruitment process includes a non-binding LOI or offer letter before the full contract, use that opportunity to address major terms early. Seasoned lawyers suggest trying to see or negotiate the critical clauses (like non-compete, compensation structure) at the LOI stage. It’s psychologically easier for an employer to tweak terms before the full contract is drafted. For instance, you can say, “Before I sign the LOI, can we clarify that the non-compete would be no more than 10 miles?” or “I’d like the offer to reflect a $20k signing bonus and $10k relocation.” Getting agreement in principle on these items will make the final contract negotiation smoother.
  

• Get Help from Experts: Consider having a physician contract review attorney or a contract review service go over the agreement. They spot nuances we might miss and can suggest appropriate language changes. Many physicians also seek input from colleagues or mentors who have experience, especially in the same specialty or area. While an attorney focuses on legal aspects, a senior physician might point out practical issues (e.g., “This call clause is too open-ended” or “Ask for more CME money”). Some services pair you with both a lawyer and a financial advisor to check that your compensation is benchmarked fairly. Given that an attending contract can exceed 20 pages of dense legal text, investing in a professional review is wise. They’ll help rewrite clauses to be more favorable or clear. Pro tip: Use an attorney who specializes in physician contracts, not just any corporate lawyer, because healthcare contracts have unique nuances and Stark law considerations. Also, attorneys can often tell you what’s standard in your region (“This employer usually agrees to pay tail if asked,” etc.).
  

• Practice Collaborative Negotiation: Approach talks in a collegial, problem-solving tone rather than issuing ultimatums. Frame your requests in terms of mutual benefit or fairness. For example, instead of “I won’t sign unless you raise my pay,” try “Based on my research, the average in this region is higher – is there flexibility to improve the salary so it’s aligned with market? I want to ensure I’m fully committed and not distracted with financial concerns.” Emphasize you’re excited to join and that your asks will help you stay long-term. Many employers have some wiggle room, especially on one-time costs like signing bonuses or relocation (which they prefer to increase rather than base salary, since it doesn’t permanently raise your pay rate). If they can’t increase salary, they might increase a bonus or add perks. Be prepared with counter-offer proposals for each issue.
  

• Address Work-Life Factors Openly: Don’t shy away from negotiating work-life considerations such as schedule, call, and location, which are often as important as money. If you need a certain day off each week for childcare, bring it up. If heavy call is a dealbreaker, negotiate limits or ask about hiring solutions if call exceeds a threshold. One attorney said he “often has the most success” negotiating obligations rather than salary – e.g. specifying that you won’t be assigned to more than two hospitals, or that you get a medical assistant or NP to help if volume exceeds X. These can dramatically improve your quality of life. Also discuss any flexibility you need (like the ability to do 0.8 FTE or work from home for admin days) up front and write it in.
  

• Have a Strong BATNA (Plan B): Your best negotiating leverage is the ability and willingness to walk away if needed. If you have another job offer (or are confident you could get one), you’re negotiating from a position of strength. As one lawyer put it, “The best leverage in renegotiation is a viable alternative and the ability to issue a notice of termination”. Employers absolutely do not want to lose a recruited physician to a competitor, especially in today’s doctor shortage. If you receive a better offer elsewhere, you can (tactfully) use that information: e.g. “I have another opportunity offering X – if you could match that, I’d prefer to join your team.” Even if you don’t explicitly say you have other offers, mentally prepare to say NO. If a contract has too many red flags and the employer won’t budge, sometimes walking away is the right choice. Physicians who are too afraid to walk away may accept subpar terms and regret it later. Having an alternative (or at least convincing them you do) is your strongest card. And if you’re already employed and renegotiating, be sure you’re willing to leave if they can’t meet acceptable terms – otherwise, they hold all the cards. Always keep your exit options in mind in case negotiations stall.
  

• Get All Changes in Writing: After negotiating, the contract document must be updated to reflect every agreed change. Do not rely on verbal assurances like “Don’t worry, we never enforce that clause” or “We’ll work that out later.” If it’s important to you, it needs to be written into the contract (or an addendum). Until you sign the updated contract, nothing is final. So double-check the revised draft carefully. It’s common for things to be accidentally left out or for one word to change meaning. Ensure any blanks are filled (e.g. compensation numbers, start date, etc.), and that attachments referenced (benefits summary, etc.) are provided. A good practice is to attach an exhibit for anything complex (like a productivity formula or a schedule outline) to avoid ambiguity. Ultimately, a well-negotiated contract should clearly memorialize what both parties expect – leaving no “handshake deals” outside the written agreement.
  

Negotiation may seem daunting, but approach it as a necessary part of transitioning from training to practice. As the saying goes, “you don’t get what you deserve, you get what you negotiate.” By being informed, professional, and assertive, physicians can often improve their contracts in meaningful ways – whether it’s more pay, better work conditions, or simply peace of mind about contentious clauses.

Geographic Differences in Physician Contracts (CA, TX, FL, MN, NY)

Healthcare is a heavily regulated industry, and certain contract terms – especially non-compete clauses and other restrictions – can vary widely depending on state law. Attending physicians should be aware of how key states differ in what is or isn’t allowed in employment agreements. Below we highlight differences in California, Texas, Florida, Minnesota, and New York, five significant states often noted for their unique rules or market conditions:

• California (CA): California is known for essentially banning employee non-compete agreements. Under California law, any contract clause that prevents a physician (or any worker) from engaging in their profession after leaving is generally void, with very limited exceptions (like the sale of a practice). Bottom line: if you’re taking a job in CA, you should not see a post-termination non-compete in your contract – and if you do, it’s not enforceable by state law. California physicians have freedom to change jobs within the state without being locked out of their patient region. That said, CA contracts may still include confidentiality and patient non-solicitation clauses, which are allowed. Another California consideration: the state’s malpractice environment has a longstanding cap on pain-and-suffering damages (MICRA law), which might keep malpractice insurance premiums a bit more predictable – but as an employee you’ll typically have malpractice covered by the employer anyway. California also has strong labor laws (e.g. required meal breaks, etc.) though physicians often have exemptions. Still, if work hours or overtime pay rules apply, they should comply with CA law. Key takeaway: California is physician-friendly regarding post-employment competition, so contracts there focus more on performance expectations than on restricting future practice.
  

• Texas (TX): Texas allows physician non-competes, but it imposes some important pro-physician restrictions on them. Texas law (as of 2025) requires that any physician non-compete must: (1) allow a buyout option (the physician can pay a reasonable amount to get out of the non-compete), and recent legislation capped that buyout cost to no more than the physician’s annual salary; (2) be limited in time and geography – Texas now explicitly limits non-compete terms to no more than 1 year in duration and a 5-mile radius in most cases (a new 2025 update); and (3) include certain patient protections – for example, Texas non-competes must allow physicians to continue treating patients with acute illnesses and must provide access to medical records for continuity of care. Furthermore, Texas law says if a physician is terminated without cause, the non-compete is void by statute. This is huge: it means an employer can’t enforce the covenant if they let you go without cause. In practical terms, Texas contracts will include non-competes, but they should comply with these parameters. If you see a non-compete longer than 1 year or broader than 5 miles, that likely wouldn’t hold up under new law. Texas also tends to have generous compensation in rural areas (given need for talent) and many Texas offers include hefty signing bonuses or loan repayment, especially for primary care in underserved areas. Just remember those bonuses often come with the standard 2-3 year commitment (or payback) clauses.
  

• Florida (FL): Florida is known to enforce non-compete agreements in physician contracts, generally speaking. Florida statutes consider restrictive covenants valid if they protect a “legitimate business interest” and are reasonable in scope and duration. For physicians, non-competes of up to 2 years in duration are commonly considered reasonable in Florida, and typical geographic ranges might be 15–50 miles depending on population density. Unlike California or the new Minnesota law, Florida has no blanket prohibition on physician non-competes, so doctors in FL need to negotiate scope on a case-by-case basis. Courts in Florida will enforce a well-drafted non-compete, so pay attention to it. One thing to note: Florida’s commercial statute does not provide special escape clauses for physicians like Texas does; however, some health systems voluntarily may offer a buyout clause or exceptions if you’re terminated without cause – but that’s not guaranteed by law. Malpractice insurance is another Florida quirk: Florida physicians are required to have a certain level of coverage or other financial responsibility (or else post notices to patients) by state law. Ensure your contract addresses this – most Florida employers will provide the required malpractice coverage (often $250k per claim/$750k aggregate under Florida’s requirements). But if you’re independent or moonlighting, be mindful of that law. In Florida’s high-litigation environment, tail coverage is crucial; a claims-made policy’s tail can be very costly due to higher claim rates in FL, so negotiate tail coverage carefully. Also, Florida has no state income tax, which is a financial perk, but that doesn’t affect the contract terms per se except that sometimes salaries might be a bit lower relative to high-tax states due to cost-of-living differences. Bottom line: Florida physicians should focus on narrowing non-competes and ensuring malpractice obligations are covered, as these are often points of pain.
  

• Minnesota (MN): Minnesota recently became one of the few states to ban nearly all new non-compete agreements for employees. A law that took effect July 1, 2023, prohibits post-employment non-competes in Minnesota for most workers, including physicians. So if you sign an employment agreement in MN now, any clause saying you can’t practice after leaving would be unenforceable (and void as against state law). This is a major win for physicians’ mobility. However, note that the law doesn’t invalidate non-competes signed before July 2023, and it still allows non-solicitation agreements (you can’t steal patients or staff) and confidentiality agreements. Also, the ban doesn’t affect clauses related to not soliciting patients or not disclosing trade secrets, which many contracts will still include. Minnesota’s change aligns with a broader trend to remove barriers on clinicians, so expect MN employers to possibly not even include a non-compete now (whereas they routinely did before). Another regional point: Minnesota (and neighboring states) have many large integrated health systems, and as noted in contract tips, some have begun imposing compensation caps or more standardized contracts. If you’re a specialist in MN expecting to crank out RVUs, check if the contract has language capping your total comp at some percentile – that’s more of a trend with bigger organizations. Minnesota’s malpractice environment is moderate; ensure the contract covers malpractice (most hospital employers in MN self-insure or use occurrence policies, meaning tail might be less of an issue if occurrence-based coverage is used). Summary: Minnesota new contracts shouldn’t have non-competes now – if you see one, it’s likely not enforceable. Focus on other aspects like compensation structure and any new trends like compensation caps or value-based bonus components that large networks might include.
  

• New York (NY): New York historically has allowed physician non-competes if they are reasonable in scope and necessary to protect the employer’s interests. However, New York is on the cusp of big changes. In recent years (2023–2024), the NY state legislature has considered bills to sharply limit or ban non-competes for many employees, physicians included. As of late 2024, one proposed NY law would prohibit non-competes except for very high earners, and even those would be limited. Even without a full ban yet, New York courts already tend to require non-competes to be narrowly tailored – e.g. a non-compete shouldn’t make access to healthcare difficult for a community. Large healthcare employers in NY (especially in NYC) might refrain from aggressive non-competes because the market is concentrated and they know overly broad restrictions could be struck down or invite legal challenge. Interestingly, a 2024 article noted New York as one of the states that “have outlawed or substantially limited” physician non-competesg – this may reference specific cases or pending rules. Physicians taking jobs in NY should definitely review any non-compete and possibly seek legal advice, because the enforceability might change soon if a ban passes. Aside from non-competes, New York doesn’t have any unusual state-specific contract items for physicians – but note that in New York City especially, cost of living and competition may affect salaries (often slightly lower base salary but higher incentives or prestige of employer). If you’re negotiating in NY, you might leverage the uncertain legal climate to negotiate no non-compete (“Given the legal trends in NY, perhaps we omit the non-compete clause entirely?”). New York also has specific labor laws like for bonus payments (earned bonuses must be paid, etc.), so employers tend to be careful with wording. Malpractice: New York has high malpractice premiums in downstate/NYC – ensure the contract’s malpractice coverage is adequate (New York doesn’t cap damages like CA, so coverage of $1.3M per claim/$3.9M aggregate is common there). Make sure tail is addressed if claims-made policy is used. Summary: New York is in flux on non-competes – stay tuned to legal changes, but absolutely push back on any onerous restrictive covenant as the state’s public policy is moving against them.
  

Of course, every state has its nuances (for example, Delaware, North Dakota, and Colorado have also restricted physician non-competes recently, and others like Illinois and Tennessee have special rules for medical professionals). Always check your specific state’s laws or consult a lawyer who knows that locale. The above five states illustrate how dramatically different your contract restrictions can be. In short: know your state’s stance on non-competes and related issues. It can give you leverage in negotiations (“This clause might not even be enforceable under state law, can we adjust it?”) and ensure you don’t inadvertently agree to something that local law would void or, conversely, fail to protect yourself thinking “they won’t enforce this,” only to find out your state will. Stay informed on legislative changes in 2025 as the FTC and states continue to debate non-compete reforms.

Salary, RVU, and Bonus Benchmarks for 2025

To negotiate effectively and evaluate an offer, physicians need to know the going rates for compensation. Here we compile some benchmark data on physician salaries, productivity (RVUs), and bonuses as of 2024–2025. These figures give a frame of reference, though actual pay varies by specialty, region, and experience:

• Average Physician Compensation: The overall mean income for U.S. physicians in 2024 was around $374,000 (across all specialties), up ~2.9% from the prior year. Primary care physicians averaged lower (roughly $265,000–$275,000 for family/internal medicine starting salaries) while specialists averaged around $404,000. In 2025, the average starting salary offered to physicians was reported as $403,000 (this skewed higher due to specialists, and actually slightly down from the previous year’s $406k average start). Median figures from another source (SalaryDr) show a median of about $300,000 across specialties, with the 90th percentile around $800,000. By experience: new attendings in their first few years might earn in the $250K–$350K range in many fields, whereas senior physicians or those in highly paid specialties can make $500K+. Keep in mind certain procedure-heavy specialties consistently top the pay scales.
  

• Highest and Lowest Paying Specialties: Orthopedic surgeons are often at the top – e.g. median ortho compensation is about $795,000 (with upper ranges over $1 million). Other top earners include cardiology (median ~$550K), gastroenterology, radiology, plastic surgery, neurosurgery (often $700K+ for neurosurgery). On the lower end, pediatrics, endocrinology, family medicine, and public health tend to earn in the $200K–$250K range median. For example, general pediatricians might have a median around $220K, pediatric sub-specialists slightly higher or lower depending on scarcity. Family medicine median is about $250K. Internal medicine is around $280K median. Of course, these are medians – actual offers will differ by region (a rural FM in the Midwest might get $300K plus bonuses to attract them, whereas one in a desirable city might get $230K). Regional differences: The Midwest tends to offer the highest average salaries (around $385K average) to attract physicians to less populated areas, whereas East and West Coast urban areas might pay slightly less on average but offer other advantages. For instance, an internist might be offered $300K in rural Minnesota vs $240K in San Francisco for a similar role – market demand influences this.
  

• RVU Productivity Rates: Many contracts pay bonuses per wRVU once a threshold is hit, or even base compensation directly on wRVUs. Typical wRVU rates vary by specialty. Primary care often sees rates like $40–$60 per wRVU for production beyond a certain number of RVUs. Specialties that generate more revenue per RVU (like some surgical fields) may see higher conversion rates, e.g. $60–$80 per RVU. As an example, one survey found median compensation per RVU for internal medicine around $50, and for surgery in the $60s (this can change yearly and by source). It’s crucial to check salaryDr or other current benchmarks for your field – if your contract’s bonus offers, say, $30 per RVU in a specialty where the median is $50, that’s a red flag that the rate is too low. Also check the RVU threshold (if any) you must reach. If an offer is base salary plus bonus after 5,000 RVUs/year, see if that’s realistic by comparing to average RVUs produced in your specialty. Many physicians have been caught out by unreachable targets. In recent trends, RVU-based compensation remains the most common bonus structure (in 2023, 59% of physicians with bonuses had RVU-based bonuses). Even quality-focused organizations often still rely heavily on volume metrics for pay.
  

• Signing Bonuses: Signing bonuses have become standard in many physician contracts, especially for in-demand specialties or rural areas. According to industry recruiting reports, the average signing bonus for physicians in 2024 was about $31,000, and it jumped to around $38,000 in 2025. Most physicians across specialties reported bonuses in the mid-five-figures. Median bonuses are a bit lower – one analysis found a median of ~$20,000, with averages higher due to some very large bonuses in rural or high-need specialties. Surgical and procedural specialists often command larger sign-on bonuses (some orthopedic or cardiology recruits see $50K+ sign-on offers), whereas primary care might be $10K–$25K. Geography matters: for example, family physicians were seeing average signing bonuses of ~$47K in recent recruitment trends, as primary care is in high demand. Most contracts require you to pay back the bonus if you leave before 2–3 years, as noted earlier. Also, many places offer relocation allowances (commonly $10K–$15K for moving expenses) on top of sign-on, and sometimes loan repayment incentives (particularly in rural or underserved placements). Those can range widely but often $50K–$150K paid over some years for loan forgiveness. These incentives can and should be negotiated – if a base salary can’t move, you might get a few thousand more in sign-on or relocation.
  

• Incentive Bonuses (Productivity/Quality): Beyond signing bonuses, about 55–60% of physicians receive annual incentive bonuses tied to performance. For primary care, an average annual incentive bonus might be around $31K (as reported for 53% of primary care docs who got bonuses). For specialists, 57% got bonuses and the amounts are often higher. The average incentive bonus across all specialties in 2023 was roughly $37K. However, this varies drastically by specialty: e.g. Orthopedic surgeons had an average incentive bonus of $134K (the highest of any specialty), reflecting lucrative volume-based pay. Other sizable bonuses: Cardiology ~$88K, Radiology ~$80K, General Surgery ~$75K on average. In contrast, primary care fields like family medicine and pediatrics had more modest bonuses (around $30K). Specialties with procedure-based practices (and thus more billings or RVUs) typically see larger performance bonuses. What counts for bonuses? The vast majority are still based on productivity (RVUs or revenue) rather than quality. In fact, by 2025, only 16% of contracts used quality metrics in bonuses, while two-thirds used productivity metrics. A smaller portion use things like net collections (20%) or patient encounters (5%). This means if you are a high producer, the sky can be the limit if there are no caps – but watch out for those compensation cap clauses that some groups introduced (capping total comp at a certain percentile). Always clarify if any bonus is capped or if there’s a maximum.
  

• Benefits and Other Perks: Though not direct salary, benefits form part of your compensation. Typical employer physician benefits (health insurance, retirement contributions, CME, malpractice coverage, etc.) can add tens of thousands in value. For instance, a 5% 401k match on a $300K salary is $15K/year in retirement money. If an employer offers CME allowances (commonly $3K–$5K per year) or extra time off for CME, that’s a nice perk. Vacation for attendings usually ranges from 3 to 6 weeks paid, depending on the employer – academics might have more time off but slightly lower salary, while private practice might bundle PTO and expect more hours. Call pay: Some specialties like hospitalists or intensivists might have no call, whereas surgeons or OB/GYN might get additional pay for each call shift or each weekend. Call stipends vary wildly, from ~$100 per weeknight in some internal medicine groups to $2,000 for a weekend in some specialties. If your job has a heavy call burden, see if call pay is offered or can be negotiated (especially if others in your region get it).
  

Understanding these benchmarks can help you gauge if an offer is within a normal range or if something is way off. For example, if you’re offered $200K as a general internist in a Midwestern city where peers make $280K, that’s a sign to negotiate or question why. Conversely, if you’re offered well above the 90th percentile, be cautious – extremely high pay can sometimes come with strings attached (like unsustainable workload or eventual pay cuts). Always consider the full compensation package, not just salary: a slightly lower salary with full malpractice including tail, a generous pension, and no call might actually beat a higher salary job with no tail coverage and brutal hours. Use the data as a guide, but also factor in your own priorities and the non-monetary aspects of each opportunity.

Final Thought: Reviewing and negotiating an attending physician contract is not just a formality – it’s an essential career skill. A well-crafted contract protects you legally and financially, and ensures you can focus on patient care without lurking worries about unfair terms. Many physicians, in hindsight, wish they had paid closer attention to the details (the onerous non-compete, the unfunded tail insurance, the undefined call schedule) before signing. By using the insights above – knowing the key terms, avoiding pitfalls, leveraging data and expert help, and understanding your local laws and market – you’ll be better equipped to secure a contract that meets your needs and aligns with your goals. In 2025’s evolving healthcare landscape, physicians who take an active role in contract review and negotiation truly empower themselves and set the stage for a more satisfying and successful practice. Good luck, and don’t hesitate to seek out the resources and support to get the contract you deserve.

Sources: The information above is derived from physician contract attorneys, industry reports, and physician surveys, including the NEJM CareerCenter resources on contract pitfalls, the Physicians Thrive 2024 Compensation Report, a 2025 physician salary report, and real negotiation stories from Residency Advisor, among other cited references. These provide up-to-date insights into the issues attending physicians should prioritize when reviewing contracts.