Smith: Most new physicians don't give a lot of consideration to them because at the time they really have no intention of competing with their employers. That can change, however. For a family physician to be prohibited from practicing within a 50 or 100 mile radius for a period of one to two years simply is not reasonable, though it might be for a spine surgeon. New physicians have to protect their long-term interests by minimizing the scope of non-competes as much as possible. If you think more than 10 miles is unreasonable, you need to say so.

New Physician: To what extent can new physicians negotiate various points in a contract ?

Smith: There is no particular reason to accept a boiler-plate contract that doesn't reflect the terms of the practice at issue. If a contract is not specific about details such as hours and call, a new physician is certainly within bounds to ask that these details be inserted. The general rule is to ask for what you want and what you believe to be fair. If vacation is important to you, you may ask for more vacation time, though the total financial package may be altered downward.

Physician contracts today are not "take it or leave it" propositions. There is room to negotiate on things like salary, educational loan forgiveness and call. Again, physicians in demand are more likely to get favorable terms, which is one of the advantages of locating in a region where they may need doctors, such as a medium sized or rural community. Remember, there is give and take. A rural area may be able to provide complete educational loan forgiveness and a high salary, but they may not be able to offer extensive call.

Part of this falls under the category of knowing what you what in a practice, which we discuss in Three Keys to Practice Selection.

New Physician: Many new physicians leave their initial sites of employment after just a year or two. How do contracts play into this high rate of turnover?

Smith: Quite a bit. We hear many complaints from new physicians. They may find that after working for years and carrying the load the partner was "not ready" to make them a partner yet. Some sense they are not being told what the practice is truly generating and that they are being short-changed. Others are told they have to work an unreasonable number of hours and have no choice in the matter.

Clarity in the contract can avoid these misunderstandings. If the employer is unwilling to be clear about these and other points addressed above, it is a strong signal to walk away from the offer.

Consultation is a key component. You should have senior physicians you know examine the contract or advise an attorney. A well trained, conscientious recruiter also can be an important asset. You don't have to go it alone.