The offer is not the agreement
Most physicians read the offer letter closely and the employment agreement quickly. That is backwards. The offer letter describes a salary; the agreement describes a life — where you may work afterward, how much call you owe, who pays if you leave, and how the number in the offer letter can be changed without your signature.
The document is rarely hostile. It is simply written by people whose job is to protect the organization. Nobody in that process is assigned to protect you, which means reading carefully is not adversarial. It is the only version of the process where both sides are represented.
Clause one: how compensation can change
A base salary with a wRVU bonus looks stable until you find the sentence that allows the employer to revise the compensation exhibit annually at its discretion. That single line converts a five-year agreement into a one-year agreement that renews on someone else's terms.
Ask three questions in writing before you sign: what was the median wRVU production for this role last year, has the conversion factor changed in the past three years, and what notice is required before a change takes effect. The answers are usually available and rarely volunteered.
Clause two: the restrictive covenant's geometry
Two covenants can both say 'fifteen miles, two years' and mean entirely different things. A radius measured from your primary clinic is a neighborhood. A radius measured from every site the system operates is a state.
Scope matters as much as geography. 'Practicing medicine' is far broader than 'practicing your specialty', and the difference decides whether an urgent care shift across town is permitted. Ask for a carve-out that voids the covenant when the employer terminates you without cause — it is one of the most frequently granted requests and one of the least frequently made.
Clause three: who buys the tail
Claims-made malpractice coverage protects you only while the policy is active. When you leave, someone must buy tail coverage for the years you already worked, and that figure commonly runs one and a half to two times your annual premium.
Contracts often assign the tail to whichever party terminates. Read it literally: if you resign for family reasons, you may owe a five-figure invoice on your way out. Negotiating a shared cost, or an employer-paid tail after a defined period of service, is ordinary and reasonable.
What good review actually costs
A healthcare attorney reviewing a physician employment agreement typically charges a few hours of time. Measured against a covenant that could force a household move, it is the least expensive decision in the entire process.
Read the agreement yourself first, mark every sentence you cannot restate in your own words, and bring that list to counsel. You will get better advice in less time, and you will negotiate as someone who understands what they are asking for.
Key takeaways
- Compensation exhibits that can be revised unilaterally turn multi-year deals into annual ones.
- Ask where the non-compete radius is measured from, and whether it survives a without-cause termination.
- Confirm in writing who pays malpractice tail coverage under each exit scenario.
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How to cite
Vejayan PD. The Quiet Cost of Not Reading Your Own Contract. On The Beat MD. Published July 29, 2026. Available at: https://www.onthebeatmd.com/insights/quiet-cost-of-not-reading-your-contract
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This material is educational and is not medical, legal, or financial advice. It does not create a physician-patient or attorney-client relationship.
© 2026 Priya D. Vejayan. All Rights Reserved. Except as permitted by applicable copyright law, reproduction, distribution, or commercial use of original content requires written permission.