Resident and Fellow Contract Review

A first attending agreement determines far more than starting salary. For a resident or fellow leaving training, the contract can set the clinical schedule, call burden, productivity formula, bonus timing, malpractice coverage, and rules for ending employment. A term that looks manageable during recruitment can become expensive later. If a signing bonus must be repaid after any early departure, for example, the physician may owe the full amount even when the position differs from what was described.

These agreements also control where the physician can work after leaving, who pays for tail coverage, and whether compensation continues while credentialing is pending. The main agreement is only part of the picture. An offer letter, compensation exhibit, employee handbook, malpractice policy, or bonus plan may supply definitions that change the financial result. If the documents conflict, the integration and amendment clauses determine which promise controls.

Resident and fellow contract review connects each clause to the question an early-career physician is actually asking: What will I earn, what am I required to do, what will it cost to leave, and where can I work next? Chelle Law reviews the agreement, incorporated documents, and applicable state-law issues so the physician can identify unclear terms and decide what to address before signing.

What the First Attending Agreement Controls

A physician employment contract usually separates the business terms among the main agreement, exhibits, policies, and compensation plans. Reading only the salary paragraph misses how those documents interact. A bonus can be described in the agreement but calculated under a separate plan that the employer reserves the right to change.

Salary, wRVUs, Bonuses, and Payment Timing

A base salary states the guaranteed amount, but the guarantee may last for only part of the initial term. Once productivity compensation begins, the contract needs to define the wRVU threshold, conversion factor, measurement period, reconciliation method, and treatment of wRVUs generated before termination. A physician cannot reliably forecast a bonus if the employer can change the conversion factor during the year or exclude certain services without a defined standard.

Quality, retention, and collections-based bonuses create different risks. A quality bonus depends on who selects the measures and whether the physician can access the data. A retention bonus may disappear if the physician is not employed on the payment date, even after completing the work period. Collections compensation may lag months behind the date of service, making the post-termination collections clause as important as the percentage itself. Our guide to physician RVU compensation explains the formula terms that deserve close attention.

Clinical Duties, FTE, Call, and Outside Work

The duties section needs to match the position described during recruitment. For an academic physician, the agreement may divide time among clinical care, teaching, research, and administration. If protected nonclinical time is omitted or can be reassigned unilaterally, the physician may still be held to a full clinical productivity target. Private-practice and hospital agreements may instead use clinic sessions, patient-contact hours, or site assignments to define workload.

Call language should answer who participates, how often coverage occurs, whether additional call is paid, and whether call counts toward productivity. A general obligation to take a “fair share” gives little information if the group can add physicians, lose physicians, or expand coverage locations. The same level of detail matters when reviewing physician call requirements.

Moonlighting and outside-work clauses can reach consulting, telemedicine, expert-witness work, teaching, and volunteer activities. If advance approval is required, the agreement needs a workable approval standard. The physician also needs to know whether outside income belongs to the employer and whether the employer’s malpractice policy covers the activity. Residents and fellows planning to continue outside clinical work can compare these terms with Chelle Law’s discussion of physician moonlighting restrictions.

Benefits, Leave, Credentialing, and the Start Date

Benefits can carry conditions that do not appear in the compensation paragraph. Retirement contributions may vest over time, student-loan assistance may require continued service, and relocation payments may become repayable after an early departure. Leave policies also need to be compared with productivity terms. If the wRVU threshold remains unchanged during parental leave or an extended medical absence, the physician can lose incentive compensation despite having approved leave.

Credentialing, licensing, and privileging can delay the start of clinical work. The contract needs to say whether employment and salary begin on a fixed date or only after every approval is complete. If compensation starts only after credentialing, the physician bears the financial risk of an administrative delay. If employment can be canceled because approval is not obtained by a deadline, the clause also needs to be compared with relocation expenses and any position the physician has already declined.

Financial and Career Risk When Employment Ends

Early-career physicians often focus on getting into the position. The exit provisions deserve equal attention because termination can activate several obligations at once. A single resignation may trigger bonus repayment, tail responsibility, a noncompete, and the loss of an unpaid productivity bonus.

Malpractice Coverage and Tail Responsibility

An occurrence policy generally covers a claim based on treatment rendered while the policy was active, even if the claim is made later. Claims-made coverage generally requires coverage to remain in place when the claim is made, which is why tail coverage can be necessary after the policy ends. The contract needs to identify the policy type rather than merely promise “malpractice insurance.”

The tail clause then assigns the cost. Some agreements require the physician to pay after any termination. Others shift responsibility depending on whether the employer terminates without cause, whether the physician completes a stated service period, or whether the physician buys replacement coverage with prior-acts protection. If the agreement uses a vesting schedule, the percentages and dates need to be clear. The financial distinction is addressed in more detail in the resource on tail insurance for physicians.

Noncompetes and Other Post-Employment Restrictions

A noncompete must be read by location, distance, duration, and restricted activity. A 10-mile radius from one clinic is not the same restriction as 10 miles from every hospital, outreach site, and satellite office where the physician provided services. If the definition includes locations where the physician worked only occasionally, the restricted territory can cover a much larger market than expected.

Non-solicitation provisions can separately restrict contact with patients, referral sources, or employees. The language may prohibit active solicitation, or it may be drafted broadly enough to restrict accepting a patient who independently seeks care. Enforceability depends on applicable law and the wording of the clause, but the immediate client question remains concrete: If I leave in two years, which employers and practice locations remain available? Chelle Law’s guide to physician restrictive covenants explains how these provisions fit together.

Termination Notice, Final Pay, and Repayment Clauses

Without-cause termination allows either party to end the relationship without proving a breach, usually after giving advance notice. The length of that notice period affects when a physician can start another job. A 90-day notice requirement can delay a move even when the noncompete is narrow, while a clause allowing the employer to remove the physician from the schedule raises a separate question about whether salary and benefits continue through the notice period.

For-cause termination provisions identify events that permit immediate or accelerated termination. Loss of licensure, exclusion from a federal program, or loss of privileges may be addressed differently from an administrative breach. When a problem can be corrected, the presence and length of a cure period matter. The agreement also needs to explain what happens to earned bonuses, unused leave, benefits, and collections after termination. Physicians can review the broader mechanics in Chelle Law’s resource on ending a physician contract.

Repayment language must be coordinated with both for-cause and without-cause termination. A signing bonus described as “forgiven” over two years may still require full repayment if the physician leaves one day before the second anniversary. Other clauses prorate the amount monthly or waive repayment when the employer ends the agreement without cause. The trigger, calculation method, and repayment deadline determine the actual exposure.

State Law and Incorporated Documents Can Change the Result

Governing law can change how a restrictive covenant, wage deduction, final payment, or repayment provision operates. States take different approaches to physician noncompetes, and some rules depend on the physician’s specialty, compensation, termination circumstances, or access to patients. State wage laws may also affect deductions and the timing of earned compensation. A contract should therefore be evaluated under the law named in its governing-law clause rather than under a general assumption about physician agreements.

Licensure and professional obligations matter when the contract connects continued employment to board status, hospital privileges, payer enrollment, or reporting duties. A clause may permit termination after any investigation, while another requires a final adverse action. Those triggers are not equivalent. The physician needs to know whether an allegation, temporary restriction, or delayed renewal can end employment before the underlying issue is resolved.

Policies and exhibits can be just as consequential as the main agreement. A compensation plan may define credit for shared visits; a handbook may contain leave rules; and a malpractice certificate may reveal that coverage is claims-made. The contract’s incorporation and amendment clauses determine whether the employer can revise those documents without the physician’s written consent. If an incorporated policy changes the wRVU formula or repayment obligation, the economic terms can shift even though the signed agreement remains unchanged.

Which Contract Terms Deserve Priority?

Not every sentence carries the same risk. Compensation definitions, malpractice and tail allocation, work locations, call, restrictive covenants, termination rights, and repayment triggers usually deserve attention first because they control money, workload, and the cost of leaving. A physician with an RVU-heavy model needs exact calculation terms. A physician entering a small specialty market may place greater weight on the geographic restriction. A physician receiving substantial recruitment assistance needs to know each event that activates repayment.

Alternative language needs to address the mechanism creating the risk. Replacing an undefined “reasonable call” obligation with a fixed number may clarify workload. Limiting a noncompete to the primary practice site may reduce the territory. Prorating a signing-bonus repayment each month can prevent an all-or-nothing obligation near the end of the service period. For tail coverage, the parties might allocate cost according to who ends the agreement and why. The appropriate issue to raise depends on the complete agreement and the physician’s likely career path.

Residents and fellows also need to distinguish a term worth addressing from one that is mainly administrative. An ambiguous productivity formula can change annual compensation; a minor formatting issue cannot. Prioritizing the clauses with measurable financial or career effects keeps the physician focused on the provisions that will matter after training.

What a Resident and Fellow Contract Review Provides

Chelle Law evaluates the agreement as a connected set of obligations rather than a collection of isolated clauses. The review compares the compensation exhibit with termination language, tests tail responsibility against each exit scenario, and maps restrictive covenants to the physician’s actual work locations. It also checks whether start dates, credentialing conditions, vesting schedules, repayment terms, and bonus dates are internally consistent.

The physician receives an explanation of the clauses that create financial or professional risk and the provisions that may warrant clarification or revision. Where the language is incomplete, the assessment can identify the missing definition or trigger. If a recruiter promised protected research time, a specific call schedule, an early compensation review, or employer-paid tail coverage, that promise can be compared with the final written documents before execution.

Timing matters. Once employment begins, the employer may have little reason to revisit a formula, restriction, or repayment term the physician already accepted. Reviewing the documents before signing allows the resident or fellow to make the decision with the full cost of the agreement in view.

Frequently Asked Questions

What should a resident or fellow check before signing a first attending contract?

Check the compensation formula, clinical duties, FTE, call schedule, work locations, benefits, start-date conditions, malpractice coverage, tail responsibility, restrictive covenants, termination notice, and repayment obligations. The offer letter, compensation exhibit, policies, and addenda also need to match the main agreement.

How is a wRVU bonus evaluated in a first physician contract?

Identify the wRVU threshold, conversion factor, measurement period, reconciliation date, data source, and treatment of leave and post-termination production. The agreement should also reveal whether the employer can change the formula and whether the physician must remain employed on the payment date.

Who pays for tail insurance after the physician leaves?

The contract controls the allocation. Responsibility may depend on whether the policy is claims-made, who ends employment, why the agreement ends, and how long the physician worked. Some contracts use a vesting schedule or allow replacement coverage with prior-acts protection instead of a separate tail policy.

How can a noncompete affect an early-career physician?

A noncompete can restrict the physician’s next job by geography, duration, facility, and type of practice. A radius measured from every location where the physician worked can cover a much larger market than the same radius measured from one primary clinic. Applicable state law also affects how the restriction is evaluated.

What happens if credentialing delays the physician’s start date?

That depends on whether employment and salary begin on a fixed date or only after licensing, payer enrollment, credentialing, and privileges are complete. The contract may also allow cancellation if approval is not obtained by a deadline, so the physician needs to understand who bears the financial risk of delay.

Do recruitment promises need to appear in the written contract?

Material promises should appear in the signed agreement, an incorporated exhibit, or a signed addendum. An integration clause may state that the final contract replaces earlier emails, offer letters, or oral discussions. Protected time, call limits, compensation guarantees, and tail commitments should therefore be documented clearly.

Have Your First Attending Contract Reviewed Before You Sign

Chelle Law can analyze the compensation formula, call obligations, malpractice coverage, noncompete, termination terms, and repayment triggers in your proposed agreement.

Contact Chelle Law