Negotiate before you sign.
Your first attending contract: pay models and wRVU fine print, termination and notice, where non-competes stand in 2026, malpractice and tail, bonuses and clawbacks, loan repayment, and what to negotiate.
Reviewed October 2026 · verify against current guidelines
Contract · 1 of 6
Follow the money.
Compensation models
| Base salary | A guaranteed amount. Predictable, but there is no upside if you work harder. |
|---|---|
| Productivity (wRVU) | Pay equals the work RVUs you generate times a dollar rate per wRVU. Upside if you're busy, risk if you're not. |
| Hybrid | A base salary plus a productivity bonus above a wRVU threshold. Often a guarantee for 1–2 years, then a shift to productivity. |
| Quality and value | Bonuses tied to metrics such as quality scores, access or patient experience. Usually a small slice of total pay. |
Questions for any wRVU deal
- What is the dollar rate per wRVU, and what is the threshold before a bonus starts?
- Which year's RVU values are used? CMS revalues every year. For CY 2026 it applied a −2.5% efficiency adjustment to work RVUs of non-time-based services, so the same procedures now earn fewer wRVUs.
- How are shared visits, APP supervision, teaching and administrative time credited?
- Do you get credit for work done while credentialing or payer enrollment is pending?
- When is the reconciliation, and must you repay if your production falls short of the guarantee?
Benchmarks
Compare offers against recent published compensation surveys, such as MGMA or AAMC faculty salary data, through your program, society or attorney. Compare like with like: specialty, region, practice type, call burden and wRVU expectations. A high rate per wRVU paired with an unreachable threshold is a low offer.
wRVU work relative value unitRVU relative value unit: work, practice expense and malpractice componentsCMS Centers for Medicare & Medicaid ServicesAPP advanced practice provider
Contract · 2 of 6
Term, termination, notice.
Read these clauses together
| Term and renewal | The initial length, and whether it renews automatically. Does pay change at renewal? |
|---|---|
| Without cause | Either side can end the contract with notice. Insist the notice period is the same for both sides. |
| For cause | Should be a specific list (loss of license, exclusion from federal programs, etc.) with a cure period for fixable issues. "Any conduct the employer deems detrimental" is too broad. |
| What survives | Non-compete, tail coverage, bonus repayment and confidentiality often outlast the job. Know which ones apply to you. |
| Assignment | Can the employer transfer your contract if it's sold? You may end up working for an entity you never chose. |
The dangerous combination — A without-cause termination clause plus a broad non-compete means they can end the job and still bar you from practicing nearby. Ask that the non-compete fall away if you are terminated without cause, are not renewed, or the employer breaches.
Contract · 3 of 6
Non-competes in 2026.
Federal status: there is no federal ban
| May 7, 2024 | The FTC published a rule banning most worker non-competes. |
|---|---|
| 2024 | A federal court in Texas set the rule aside (Ryan, LLC v. FTC). It never took effect. |
| Sept 5, 2025 | The FTC voted 3–1 to drop its appeals and accept the vacatur. |
| Feb 12, 2026 | The FTC removed the rule from the Code of Federal Regulations. |
| Now | The FTC still challenges unreasonable non-competes one case at a time under Section 5 of the FTC Act. In September 2025 it sent warning letters to healthcare employers and staffing firms, naming roles such as physicians and nurses. |
State law decides: two verified examples
| Minnesota | Non-competes are void in agreements entered into on or after July 1, 2023 (Minn. Stat. §181.988). The ban covers independent contractors as well as employees. Narrow exceptions apply for the sale or dissolution of a business. |
|---|---|
| Texas | For physician covenants entered into or renewed on or after Sept 1, 2025, the covenant needs a buyout no greater than your total annual salary and wages, can last at most one year, and can cover at most a 5-mile radius from your primary practice site. It must be stated clearly in writing. It is void if you are involuntarily discharged without good cause (SB 1318). |
| Everywhere else | Many states restrict physician non-competes, and the rules differ and change often. Your attorney should check the law of the state named in the governing-law clause and the state where you will practice. |
Negotiate the covenant
- Measure the radius from the one site where you work, not from every location the employer owns.
- Shorten the duration.
- Narrow the scope to your specialty, not "the practice of medicine."
- Carve out academic, VA, telehealth and locums work.
- Get a defined, reasonable buyout amount.
- Make it void if you are terminated without cause or not renewed.
Still in training? ACGME Institutional Requirement 4.13 bars sponsoring institutions and programs from requiring residents or fellows to sign a non-competition guarantee or restrictive covenant. Attending contracts are a different matter.
Contract · 4 of 6
Malpractice and the tail.
Policy types
| Occurrence | Covers incidents that happen during the policy period, whenever the claim is filed. No tail is needed when you leave. |
|---|---|
| Claims-made | Covers claims made while the policy is active, for incidents after the retroactive date. When the policy ends, you need tail coverage (an extended reporting endorsement) or nose coverage (prior acts) from your next insurer. |
| Limits | Check the per-claim and aggregate limits, and whether they meet the hospital's credentialing requirements. |
| Consent to settle | Can the insurer settle in your name without your agreement? Settlements are reported to the National Practitioner Data Bank. |
Tail is a clause many new attendings regret — Tail can be expensive, and the bill comes due exactly when you are changing jobs. Get it in writing: who pays for the tail if you resign, if you are terminated with or without cause, if the contract isn't renewed, or if the employer is sold.
Contract · 5 of 6
Bonuses, loans, start date.
The money around the salary
| Signing bonus | When is it paid, what commitment is it tied to, and is repayment prorated or all-or-nothing if you leave early? It is taxed as wages. |
|---|---|
| Relocation | A capped reimbursement or a lump sum, with the same clawback questions. |
| Loan repayment | Employer payments toward your student loans are tax-free up to $5,250 a year, but only through a written §127 educational assistance program. That $5,250 is one cap shared with any other educational assistance the employer gives you, such as tuition. This is permanent for payments after 2025, and the amount is indexed after 2026. Anything above that is taxable wages. Get the amount, schedule and forfeiture terms in writing. |
| CME | The dollar amount, the number of days, and whether it rolls over. Does it also cover licenses, DEA, board fees and society dues? |
| Call | Frequency, home vs in-house, how many sites, and pay for extra call. Define it with numbers, not "shared equitably." |
| Benefits | Retirement match and vesting, disability coverage (own-occupation?), health insurance, and PTO. |
Start date and credentialing
State licensure, DEA registration, hospital privileges and payer enrollment can take months, so start the paperwork as soon as you sign. Ask what happens to your pay if credentialing delays your start, whether a guarantee period starts on your actual first day, and who pays the license and DEA fees. Make the start date contingent on credentialing, with no penalty to you.
Contract · 6 of 6
Get it reviewed. Then ask.
Hire the right lawyer
Use a healthcare employment attorney who is licensed in the contract's state. Not a generalist, and never the employer's counsel. Ask for a flat-fee quote before you send the contract, because fees vary by region and scope. Ask whether the review covers whether the pay is fair, or only the legal terms.
Often negotiable
- Signing and relocation amounts, and the clawback terms.
- Start date.
- Who pays the tail.
- Non-compete radius, duration and scope.
- Call schedule and pay for extra call.
- CME amount, guarantee length and productivity threshold.
- Notice periods that are the same for both sides.
- Loan repayment.
Red flags
- Vague "for cause" definitions with no cure period.
- The employer can change your pay, duties or site without your consent.
- A non-compete covering every site the employer owns.
- You pay the tail in every scenario.
- The whole bonus must be repaid even if you leave in the final month.
Get every promise in the written contract — Recruiter emails and verbal assurances don't bind anyone. If it matters, it goes in the document or an addendum.
FTC Federal Trade CommissionDEA Drug Enforcement AdministrationCME continuing medical educationPTO paid time offVA Veterans Affairs
Educational reference only — not financial, tax or legal advice. Rules change; confirm with the official source, your plan documents, or a fee-only advisor.
Sources
Verify against current guidelines and local protocol before acting.
- Federal Trade Commission. Revision of the Negative Option Rule, Withdrawal of the CARS Rule, Removal of the Non-Compete Rule To Conform These Rules to Federal Court Decisions. Final rule, Federal Register, February 12, 2026 (FR Doc. 2026-02866); effective February 12, 2026.
- Federal Trade Commission. Federal Trade Commission Files to Accede to Vacatur of Non-Compete Clause Rule. Press release, September 5, 2025.
- Ryan, LLC v. FTC, 746 F. Supp. 3d 369 (N.D. Tex. 2024), setting aside the FTC Non-Compete Clause Rule (89 FR 38342, May 7, 2024).
- Federal Trade Commission. FTC Chairman Ferguson Issues Noncompete Warning Letters to Healthcare Employers and Staffing Companies. Press release, September 10, 2025.
- Minnesota Statutes §181.988 (2023 c 53 art 6 s 1, effective July 1, 2023, for agreements entered into on or after that date); subd. 1(c) includes independent contractors. revisor.mn.gov.
- Texas S.B. 1318, 89th Legislature (2025), amending Bus. & Com. Code §15.50: physician non-compete buyout, duration and radius limits; effective September 1, 2025, for covenants entered into or renewed on or after that date. capitol.texas.gov.
- Centers for Medicare & Medicaid Services. Fact sheet: Calendar Year 2026 Medicare Physician Fee Schedule final rule (CMS-1832-F), October 31, 2025: −2.5% efficiency adjustment to work RVUs of non-time-based services.
- 26 U.S.C. 127(a)(2), (c)(1)(B), (d), as amended by Pub. L. 119-21 §70412: a single $5,250 annual exclusion for all educational assistance, including employer student-loan payments; permanent for payments after December 31, 2025; indexed after 2026.
- ACGME Institutional Requirements, effective July 1, 2026, Requirement 4.13 (no non-competition guarantees for residents or fellows).
- 45 CFR 60.7: medical malpractice payments made for a practitioner must be reported to the National Practitioner Data Bank.