Start Date Claims: What Are They, and How Do I Avoid Them?

Many physicians believe that once they have signed their employment contract, their job is done, and they are guaranteed an attending salary on the start date. However, there are still many factors that can disrupt the process between signing the contract and receiving your first paycheck. One of the most common and problematic issues physicians encounter is a delay in their start date—or, in some cases, an outright cancellation of employment—due to clauses within their contracts that allow employers to delay onboarding if certain prerequisites are not met. 

In this blog, we will explore the most common prerequisites employers impose before a physician can start working and how these issues arise. We will also discuss strategies to protect yourself from start date delays and claims that could jeopardize your employment.

I Signed My Contract and Have a Start Date. What’s the Problem?

Most physician employment agreements include clauses that permit the employer to delay a physician’s start date under certain conditions. Before a physician can begin work and generate revenue for the employer, several administrative and regulatory tasks must be completed. These often include:

• Credentialing: Physicians in practices contracting with insurers must undergo credentialing, a process verifying their education, training, experience, competence, and licensure. Hospitals, healthcare employers, and payers require credentialing, often the first step in obtaining hospital privileges.

• Privileging: Privileging grants physicians a defined scope of practice based on credentials and performance. Hospital boards approve, deny, or reconsider privileges based on recommendations from the credentialing committee and the physician’s department.

• Background checks: A background check is a process used by employers, organizations, or institutions to verify an individual’s history, qualifications, and potential risks before hiring or granting privileges. For physicians, background checks typically include criminal history, education and training verification, license status, medical malpractice history, work history, and sanctions check (Medicare and Medicaid exclusions).

• Employee Drug Screening: Employers check for the presence of drugs or alcohol in a job candidate or employee’s system. Drug screening is often a prerequisite for employment, credentialing, or hospital privileges to ensure patient safety and regulatory compliance.

• Physician Warranties: Most physician contracts include a section that speaks to various promises you are making to the employer before signing the contract. For example, you are likely required to promise that there are no legal impediments to you being able to perform the job fully. For example, suppose you have a pre-existing noncompete that prevents you from taking the position. In that case, employers can delay or downright terminate you, even if noncompete enforcement is not threatened by your prior employer!

• • Medical Malpractice Coverage: You must have med mal for everything you do. If there are any issues or delays in getting this in place, even if it’s not your fault, many physician contracts allow for the employer to delay your start date.
  • State Medical License and DEA license: These are also required. I know this is a significant expense for residents and fellows to come out of pocket when they don’t know for sure which state(s) they will be working in, but this can sometimes take several months! Another good reason to get your contract handled many months in advance of your start date is to avoid a scenario where you apply for a medical license in a state you don’t end up working in.

The challenge with these clauses is that employers are rarely required to expedite these processes in a timely manner. If delays occur—especially with credentialing and privileging—the employer may unilaterally postpone the start date. Unfortunately, these processes can take 90 days or more, depending on the situation, and there is no absolute guarantee that they will always be completed in time.

Note: If you believe you may have issues with any of these, seek legal advice on the front end!

What Can I Do to Protect Myself?

The best way to protect yourself from start date delays is to begin the credentialing and privileging process early. Ideally, physicians should secure their contracts six to nine months before their desired start date to allow ample time for administrative requirements to be completed. When this lead time is provided, we see far fewer instances of start date delays. If you sign an employment agreement only 30 to 60 days before your intended start date, be prepared for a potential delay.

Regardless, you need to take proactive steps to ensure you are ready to begin work on time:

1. Act quickly. Submit all necessary documents to the employer as soon as possible, ensuring they are filled out completely and accurately.

2. Follow up regularly. Email your employer four months before your start date and again two months before to check if any outstanding requirements could delay your start.

3. Create a paper trail. Conduct follow-ups via email to document your diligence in completing these requirements. If an issue arises, having a clear record of your proactive efforts can be invaluable.

4. Negotiate for flexibility. Some physicians may be able to negotiate contract language that allows them to start work even if certain administrative processes are incomplete, provided they have been diligent in their efforts. This may be easier in a private practice that does not require hospital privileges, but that’s not always the case. However, many physicians prioritize negotiating more significant contract terms such as compensation, noncompetes, and call schedules, making this a secondary concern at times. Work with your lawyer on negotiation strategy because every situation is a little different.   

I Did Everything Right, but My Employer Won’t Let Me Start. Now What?

If you have followed all the necessary steps but still find yourself unable to start due to employer delays, it is time to consult with a lawyer. Your options may include:

• Exiting the contract. If the delays are unreasonable, you may have grounds to terminate your agreement and seek employment elsewhere. You should check with your lawyer before you do so, as there could be severe penalties associated with early termination or attempting to terminate employment outside of the contract terms.
• Legal claims for damages. If your employer’s delays are unjustified and you are suffering financial harm, you may be able to pursue legal action. However, this approach should be handled cautiously, as taking legal action against your employer before your first day could damage your professional relationship.
• Responding to employer demands. If you choose to exit the contract, your employer may attempt to seek damages from you for recruitment expenses, relocation costs, or other expenses related to your hiring. You should never navigate this situation alone—consulting with an experienced attorney is essential before making any decisions.   

Conclusion

Start date claims and delays are a significant concern for many physicians, but with proper preparation and legal guidance, you can minimize your risk. Signing your contract early, staying proactive in the credentialing process, and maintaining thorough documentation protects you from unnecessary delays.

If you are facing a start date delay or need help negotiating your contract, Michael Johnson Legal is here to assist. We specialize in representing physicians in employment contract matters, ensuring that your rights and financial interests are protected every step of the way.