Residency Advisor
What’s really happening when a recruiter tells you, “Don’t worry, this is our standard physician contract—everyone signs it”?
They’re hoping you do not realize one simple thing: there is no such thing as a standard physician contract that you have to accept as-is. “Standard” is a sales tactic, not a legal category.
Let me walk through what the data, real-world offers, and actual negotiated contracts show—because it is wildly different from what new attendings are told.
The Power Play Behind “Standard Contract”
The phrase “standard contract” shows up in three situations over and over:
- A hospital HR rep or recruiter trying to move you quickly to signature.
- A private practice partner who has seen 10 contracts in his life and assumes they’re all the same.
- A national group with a templated agreement for their convenience, not yours.
Here’s the punchline: the common parts of physician contracts are only common because they work well for the employer. Not because they’re legally required. Not because “no one changes this.” And certainly not because they’re fair.
Common clauses that get marketed as “standard,” but are absolutely negotiable:
- Non-compete radius and duration
- Call schedule expectations
- RVU thresholds and conversion factors
- Termination without cause notice period
- Tail coverage responsibility
- Signing bonus repayment terms
- Moonlighting and outside income restrictions
I’ve seen two new hospitalists hired the same month, same system, same “standard” contract template. One had a 10-mile non-compete and 60-day termination notice. The other, who pushed, walked away with a 5-mile non-compete and 30-day notice—and a higher RVU conversion. Same HR office. Same year. “Standard” my ass.
What the Data Actually Shows: Variation Is the Rule
If contracts were truly “standard,” you’d expect very similar structures across physicians in the same specialty and region.
That’s not what shows up in surveys and real contracts.
| Category | Value |
|---|---|
| Non-compete radius miles | 50 |
| Termination notice days | 40 |
| Tail coverage cost share % | 60 |
Those percentages are not made up from thin air. Multiple surveys from MGMA, AMA, state medical societies, and large law practices show exactly this: within the same specialty and region, core contract terms vary a lot.
Examples pulled from actual offers I’ve seen for general internal medicine in one medium-sized metro:
- Non-compete: One offer with 3 miles, one with 10 miles, one with 25 miles (yes, twenty-five)
- Termination without cause: 30 days vs 60 vs 90
- Tail coverage: Fully employer-paid vs shared 50/50 vs 100% physician responsibility
Same city. Same year. Same general job market. If “standard” were real, that level of variation wouldn’t exist.
The “Boilerplate” Sections That Actually Matter
Another classic line: “Everything marked as boilerplate is just standard legal language—no need to worry about that.”
That’s usually where the danger is hiding.
The so-called “boilerplate” section is where you find:
- Restrictive covenants (non-compete, non-solicitation)
- Arbitration and venue clauses
- Amendment and integration clauses
- Assignment (can they sell your contract to another group without your consent?)
- Indemnification (who pays when something goes wrong?)
A few real-world landmines I’ve seen in “just boilerplate”:
- A non-compete that applied not only to the clinic location but any affiliated entity of the health system—effectively the whole metro.
- A venue clause requiring all disputes to be brought in a county three hours away where the system dominates the local bench and bar.
- An assignment clause letting the practice sell to a private equity group and keep you locked in under the same terms with no right to renegotiate.
None of those were highlighted. All were in the fine print an HR rep dismissed as “standard legal language.”
Standard for whom? The people trying to keep you stuck and cheap.
What Employers Actually Mean by “Standard”
When an employer says “standard,” they usually mean one of three things:
“This is our default template and it’s easier for us if you just sign.”
Translation: Legal already blessed this, and they do not want to spend time revising it. That’s about their workload, not your rights.“Other physicians have signed this, so we’re hoping you feel social pressure to do the same.”
Translation: They’re invoking herd behavior. “Everyone else did it” is not a legal argument.“These are the terms most favorable to us that we think we can get away with.”
Translation: Anchoring. Start with the employer-maximal position, then move only if you push.
Notice what’s missing from all three: anything about what’s actually required by law or regulation.
There are a few things that truly must be in a physician contract (Medicare compliance, Stark/AKS concerns, certain call coverage representations), but they’re about fraud and abuse prevention, not about your non-compete distance or who pays tail.
What’s Actually Negotiable (That People Assume Isn’t)
Most new attendings massively underestimate what is negotiable. The myth is not just “there’s a standard contract,” it’s “that standard contract can’t be changed.”
Here’s the reality from post-residency offers I’ve seen negotiated over the last several years:
| Contract Term | How Often It Changes When Pushed* |
|---|---|
| Base salary | Often |
| Signing bonus amount/forgiveness | Often |
| Non-compete radius/duration | Often |
| Tail coverage responsibility | Sometimes to Often |
| Call schedule expectations | Often |
| Termination without cause notice | Often |
| RVU threshold or conversion | Sometimes |
*“When pushed” means when the physician actually asked, backed by data or a lawyer, not when they just complained to the recruiter.
Some specific examples:
Non-compete
A cardiology group started with 15 miles and 2 years. The physician pushed, citing state norms and being the sole wage earner with family ties. Ended at 7 miles and 1 year, plus carve-outs for academic and telemedicine work.Tail coverage
Hospitalist offer: physician initially responsible for 100% of tail if leaving before 3 years. After pushback, contract shifted to a graduated schedule (0–1 year = 75% physician, 25% employer, 1–3 years = 50/50, after 3 years = 100% employer).Termination notice
Standard template: 90 days without cause. Physician refused, noting that 90 days effectively traps them if the environment turns toxic. Settled at 45 days with mutual agreement that employer could waive or shorten notice.
None of these changes appeared by magic. They showed up because the physician did not accept “this is standard” as an answer.
Why New Attendings Fall for the Myth
Smart people make dumb contract decisions for very predictable reasons.
1. Exhaustion and relief
You’re coming out of residency or fellowship. You’re tired. The idea of dragging out negotiations feels miserable. Employers know this. That’s why “standard” is so effective—it offers emotional relief: “Stop thinking about this, just sign.”
2. Social proof and fear of rocking the boat
You hear:
- “My co-fellow signed the same thing and seems fine.”
- “The program director said this is a good system to work for.”
- “I do not want to start my first job being seen as difficult.”
So you let a legal document worth hundreds of thousands of dollars a year and controlling your professional geography be driven by not wanting to look “picky.” That is exactly backwards.
3. Lack of reference points
You’ve probably never seen ten different contracts from the same market side by side. Recruiters have. Hospital lawyers have. You haven’t. Without that comparison set, “this is what we usually offer” sounds reassuring instead of self-serving.
How to Call the Bluff Without Blowing Up the Offer
You do not need to turn every negotiation into a war. But you do need to stop letting “standard” end the conversation.
A few lines that work in real life:
- “I understand this is your template. I’d like to review a few specific provisions that I’ve seen handled differently in similar markets.”
- “Can you clarify whether these terms are truly non-negotiable, or just your usual starting point?”
- “Other offers I’m considering handle non-compete/tail/notice this way. Is there flexibility to align closer to that?”
And then you pick your top 3–5 issues. Not 20 minor edits. The big stuff:
- Non-compete (scope, radius, duration, carve-outs)
- Termination without cause and notice
- Compensation structure and RVU thresholds
- Call burden and schedule
- Malpractice coverage and tail
You’re not trying to rewrite the whole agreement. You’re trying to move the contract from “employer-maximal” toward “mutually tolerable,” and away from “career hostage situation if things go bad.”
One More Myth: “Don’t Worry, We Never Enforce That”
This one is my personal favorite. You point out a vicious non-compete or ugly repayment clause and hear:
“Yeah, but we never really enforce that. It just has to be in there for legal.”
No. If it is in the contract, assume it can and will be enforced in the worst possible scenario, at the worst possible time.
I’ve seen:
- A “never enforced” non-compete suddenly enforced when a new CEO takes over and wants to make an example.
- A signing bonus clawback activated to the dollar when a physician left six weeks early due to a toxic CMIO.
- A tail coverage clause strictly enforced after group sale to private equity, leaving the departing physician staring at a $60k bill.
If they “never enforce” it, they should not resist narrowing or deleting it. When they fight to keep it, that tells you exactly how much you should trust their verbal assurances.
Your Contract Is a Career-Defining Document, Not a Formality
Physicians keep treating their first attending contract like a bureaucratic checkbox. HR is very happy when you think that way.
Your contract controls:
- Where you can work next if things go bad
- How much you actually earn relative to your work
- How easily you can leave when priorities change
- Whether a malpractice event bankrupts you if you depart
- How much leverage you have if the group is sold or reorganized
This isn’t paperwork. It’s your professional cage or your professional runway.
Every one of those boxes is usually labeled “standard” by someone who benefits from your passivity.
The Bottom Line: Nothing Is Truly Boilerplate
Strip away the sales language and the myth leaves you with three blunt realities:
“Standard” is not a legal category. It is a negotiating tactic. The only thing standard about most physician contracts is that they start heavily tilted toward the employer.
There is massive variation in supposedly “standard” terms. Same city, same specialty, same year—completely different non-competes, tail responsibilities, notice periods, and RVU deals. That alone blows up the boilerplate myth.
If it’s in writing, it is real. “We never enforce that” is not a protection. You either negotiate it now, or you live under it later when circumstances are worse and leverage is gone.
You do not have to turn into a contract lawyer. But you do need to stop believing in the fairy tale of the “standard physician contract.” The moment you stop accepting that phrase at face value, your leverage—and your future options—go up immediately.
