The need for legal counseling doesn’t end when you sign your contract. In the first few years of employment, situations often arise that require contract interpretation and strategic decision-making. Employers may seek to:
- Change work schedules or call obligations
- Modify compensation plans
- Expand work locations
- Introduce contract addendums without your input
Having a lawyer who understands you and handled your first contract is often the one best prepared to help you with issues that arise down the line. They can help you determine whether these changes are appropriate, what your rights and obligations are, and how best to respond.
Best practice: Engage a lawyer from the interview or offer letter stage through the signing of your contract.
Over the past month alone, I have had multiple discussions with past clients dealing with post-signing employment contract adjustments. Because they had already established a relationship with our firm, we were able to provide quick, efficient, and cost-effective guidance.
Case Studies: Real-Life Employment Challenges and Solutions
Here are a few examples of issues that may arise and how understanding your contract thoroughly with an advocate to turn to for support can improve career outcomes.
Changing Compensation Plans and FTE Allocation
One client, a fellowship-trained physician, initially negotiated a contract that split her Full-Time Equivalent (FTE) work between two specialties. This was important to her as she wanted to maintain her skills in both scopes of practice. Her contract clearly outlined a 50-50 split in workload and included differing compensation structures for each specialty, with separate base salaries and work RVU rates depending on the services provided.
After three years, the employer sought to change her FTE allocation unilaterally, shifting 90% of her work into one specialty and only 10% into the other. This proposed change significantly impacted her compensation, as the specialty that was being expanded had a lower reimbursement rate and was experiencing operational difficulties. The administration framed this change as a routine adjustment, implying they had the unilateral right to modify her workload without her consent.
However, her contract contained explicit language that protected her FTE status, requiring mutual consent for any modifications. Additionally, her contract included a gnarly noncompete clause, but there was a carve-out allowing for its removal in the event of an employer-initiated termination without cause. This carve-out provided leverage in negotiations, as the employer would have to either honor the contract terms or risk triggering an exit strategy that could have led to her departure and elimination of the noncompete restriction.
We re-reviewed her contract together, analyzed the financial and career implications of the proposed changes, and crafted a strategic response. Rather than outright rejecting the change, we used it as an opportunity to renegotiate her compensation while consenting to change a portion of her FTE allocation. By leveraging updated MGMA compensation data and industry trends, we negotiated an extension of her base salary guarantee for an additional year, which resulted in over $40,000 in additional earnings. Additionally, we secured an increase in her work RVU reimbursement rate for the specialty that was being expanded. Ultimately, we reached a mutually acceptable compromise that protected her financial and professional interests. Legal fees were $750.
Unilateral Changes to Work Locations
Another client, a physician employed in a multi-site practice, reached out for assistance when their employer announced plans to expand operations and require coverage at additional work locations. Initially, this physician had a stable schedule, working four days a week at one primary location while occasionally providing supplemental support at a secondary site a few times per month. However, the employer’s expansion plan significantly altered this balance, increasing their required coverage at additional satellite clinics.
The physician’s primary concern was the financial impact of the change. The new locations had a vastly different payor mix, with a higher proportion of Medicare and Medicaid patients compared to their original site, which had a more favorable private insurance payor mix. Under their collections-based compensation model, this shift in patient demographics meant lower reimbursement rates and, ultimately, a reduction in total earnings, even if the overall patient volume remained the same.
During the initial contract negotiations, we attempted to include a provision limiting the employer’s ability to unilaterally modify work locations. Unfortunately, the employer refused this request, retaining the right to reassign the physician as needed. While the physician benefitted from clarity on the drawbacks of the position on the front end, the employer did not approve that request. Given this contractual reality, we explored alternative options.
One key consideration was the impact of the expanded locations on the physician’s noncompete clause. The change in work sites effectively increased the geographical scope of the noncompete restriction, making it more difficult for the physician to transition to another job in the future. We analyzed whether a voluntary termination at this stage would be beneficial to avoid becoming further restricted by an increasingly burdensome noncompete. However, after reviewing competing job opportunities and mapping out potential transitions, we determined that an immediate exit was not the best option.
Instead, we crafted a response highlighting the financial impact of the location changes and requested a stipend increase to offset the reduction in earnings. Although the employer ultimately denied this request, the physician found immense value in understanding their contractual rights and obligations and crafting a strategic response. While ‘winning’ would have been better, clarity gleaned from thoughtful contract negotiations allowed them to make an informed decision about how to proceed and to strategically plan for a possible career transition in the future. Legal fees were $600.
Call Obligation Adjustments
An ENT physician I had previously worked with reached out regarding a sudden change in their call schedule. Their original contract, which we negotiated two years prior, explicitly stated that they would not be responsible for any call duties. This provision was a key component of their agreement, as they were establishing a new service line within a hospital system and did not want the additional burden of call responsibilities.
Despite this contractual protection, the employer later sought to modify the agreement, citing increased patient demand and the need for additional coverage. The hospital administration pressured the physician to accept these new call obligations, presenting it as a necessity rather than a choice.
We revisited the contract together, confirming that the employer had no unilateral right to impose call duties. However, we also examined how taking call might affect the physician’s overall compensation. Since their pay structure was based on work RVU production, adding call duties could potentially increase earnings through additional cases and billable procedures.
After carefully reviewing the changes over the past two years and assessing the physician’s current workload and financial standing, we decided that a compromise was in their best interest. We negotiated an amendment to the contract that included a limited call schedule in exchange for a dedicated call stipend. The employer, although initially resistant, ultimately agreed to this adjustment.
This case reinforced the importance of precise contract language. Having previously negotiated a clear provision excluding call obligations, the physician had leverage when the employer later sought to impose changes. This allowed for a structured and beneficial renegotiation rather than an unfavorable, unilateral imposition. Legal fees were $900.
Is My Compensation Fair?
Another client recently reconnected to discuss whether it was prudent to renegotiate compensation. They were two years into their first position and were quite productive, exceeding the productivity threshold and earning a healthy bonus. However, the compensation rates applied to the production-based bonus structure had not changed, and they wanted to brainstorm renegotiation options.
We did a Compensation Consult and pulled data for Hospital Employed Family Medicine in the Southern region. We also looked specifically at their state-level compensation data and considered data from metropolitan areas with less than 250,000 residents because they practiced in a small town. We noticed that the compensation per work RVU rate offered by the employer was more consistent with Southern Hospital Employed Family Medicine in big cities, but the data suggested there was room to move this higher in less populated areas.
The employer suggested they would make a market rate adjustment in 2025 “based on the MGMA data”… which we know in the firm can be diced up to show many different rates and outcomes. He became more informed and prepared for the inevitable conversation about compensation through our work together.
We also talked about whether the G2211 add-on CPT code was being used. He was unaware of this code and decided to investigate. This code is worth .33 work RVUs and can often be added to 99213s and 99214s. Admittedly, I am not a billing expert, and physicians should not rely on me for billing questions, but this was a question worth exploring. I believe the employer started allowing for this code to be included where appropriate, so he ended up learning of another opportunity to further capture the value of his work.
We decided it was best to stay informed but be prepared for the following conversations about work RVU rates that were set to arise in the summer. Legal fees were $300.
Summary: The Three Key Questions in Physician Contracts
Physician contracts boil down to three core questions:
- What are you required to do?
- Many contracts are vague, allowing employers to change obligations unilaterally. Defining guardrails upfront can prevent future misunderstandings.
- How are you compensated for the work you do?
- Understanding base salaries, productivity-based compensation models, and how these may change over time is crucial for career planning.
- What happens if the job no longer fits your goals?
- Exit strategies, including noncompete clauses, termination rights, moonlighting options, compensation clawback and waiver issues, and malpractice tail coverage, should be carefully considered.
Since many issues related to day-to-day employment will inevitably change over time, having a legal advocate to guide you through these adjustments can provide long-term value to your career. Whether it’s a shift in workload, compensation, or work location, a lawyer who knows you personally and understands your contract and career objectives can help you make informed, confident decisions.
Personal Connection with Your Lawyer is HUGE!
Our firm is not a short-and-quick, high-volume operation. We take the time to get to know you personally, often spending 3 hours or more on Zoom with you over 3 meetings or more, and guide you every step of the way. Each of us may only represent about 200 physicians per year. This allows us to remember and connect with each client on a deeper level and makes future assistance much easier.
Final Thoughts
Every first-contract physician should have a knowledgeable lawyer who can guide them from contract signing to future career transitions. While it doesn’t have to be us, make sure you have an advocate who can step in when you need them most. The value this adds to your career can be substantial.
