Tung Giep, MD, was ready to hire the doctor sitting across from him.

Giep’s Texas-based private practice needed another neonatologist. The young doctor in front of him was qualified and clearly in need of a change. Just a year out of training, the physician was working double the days on call he’d signed on for and with no overtime pay.

“How much notice do you have to give your employer?” Giep asked. The interviewee admitted he had no clue, and Giep knew that was a bad sign. The interviewee called later that week to say his contract required a 6-month notice. Giep told him that he was sorry to hear it; he couldn’t wait that long.

“Young doctors have no clue about what’s out there, especially in the contract arena,” Giep told Medscape Medical News. After years of training, debt, and low wages, new doctors are rightfully eager to sign on to their first jobs. But, unbeknownst to them, hospital contracts can be littered with unfavorable terms — noncompetes, vague assignments, lack of overtime or insurance — that cause major problems down the road.

There are ways for new doctors to protect themselves and their future plans. But they can’t go it alone. Experts agree: Legal help is nonnegotiable.

About Medscape Data

Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, the Medscape Physician Compensation Report 2025 found that

Doctors reported seeing an average of 78 patients per week for primary care physicians and 71 for specialists.About 61% of physicians feel underpaid.Nearly two thirds of doctors qualified for an incentive bonus program with the average amount of $48,000 in 2024.Bigger Than Benefits

“The overwhelming majority of physicians are employed now, which is different than what it was pre-COVID,” said Elizabeth Snelson, Esq., attorney and president of the Legal Counsel for the Medical Staff, PLLC. A 2024 analysis funded by the Physicians Advocacy Institute found that more than 77% of doctors are now employed by hospitals, health systems, or corporate entities.

After decades of training, the transition to employee can be abrupt for doctors who are accustomed to the protective academic system, said Snelson, who also authored the American Medical Association’s Physicians’ Guide to Hospital Employment Contracts. Hospitals are very different.

“They are coming at it, in my experience, very trusting and very eager,” Snelson said of new doctors. Residents and fellows are overworked and underpaid for so long, “they’re often dazzled by the zeros in the offer…they’ve never had cash flow like this,” she said.

Worse, the money and benefits are not unimportant. Doctors have debt to repay and years of training to make up for. But there’s more to consider, Snelson said. The same contracts that make it easy to start — with salaries and bonuses — can make it extremely hard to live or leave when you please.

Subtle nuances can have big implications. No mention of tail insurance likely means the doctor is responsible for paying the huge premium whenever they decide to leave. “At least 7 days per month on call” means the employer can ask you to juggle 21 days. And if you’re a specialist, like a neonatologist, but your contract uses the word pediatrician, the employer could assign you to rounds as a pediatric hospitalist.

And that’s just a small taste.

Here are a few of the common contract hurdles new doctors run into:

No compensation for additional call time.Assigned to work outside their subspecialty or outside the hospital location they were hired to work at.Long termination notices requiring 6- or even 18-month advance notice.Payback clauses that require the doctor to repay signing and moving bonuses if they choose to leave the position within the first few years.The absence of tail insurance, meaning the doctor will be on the hook for tens of thousands of dollars for coverage if they decide to leave.Broad noncompete clauses that prevent doctors from working within a radius of any of their locations — not just the primary hospital.No protections if the hospital hires the doctor but privileges are delayed.

“A contract is like a prenuptial agreement; you want to make sure everything is thought of,” according to Giep, author of the new book, “The Business of Medicine: The Definitive Guide to Help New Physicians Start Their Career on the Right Path and Avoid Costly Mistakes.”

Which is why, all experts agree, you need a specialized attorney to review your contract.

Everything Is Negotiable

I don’t blame doctors for missing the problematic details in their contract, said Dennis Hursh, a healthcare employment attorney who specializes in physician contracts. “It’s legalese, and they just don’t see it,” he said.

In fact, most new hires are told their contract is standard and that it can’t be changed. So, they likely skim over it and agree, trusting the system just as they did in training.

Except not being able to change the contract is false. “The recruiter isn’t lying; they can’t change it,” Hursh said. But someone can. In his experience negotiating over 4000 contracts, he’s seen less than 12 cases where the employers refused changes.

The contract you’re offered “may be the one everyone is given, that’s true,” Hursh said, “but it’s not the one everyone signs.”

The reality is that most new physicians don’t know their contract was negotiable until they’re on the job. They find out their colleagues signed different deals: fewer call hours or better provisions, Hursh said. That’s why “I see a lot of second contracts,” he told Medscape Medical News.

Price of Freedom

It’s not enough to have a family lawyer or attorney friend look over your contract, Giep said. “You wouldn’t see a dermatologist for an ob/gyn issue,” he argued.

Doctors need an attorney experienced in healthcare employment, specifically. And contrary to popular sentiment, that’s not selfish, greedy, or combative.

Doctors may worry that hiring a lawyer seems distrusting, “as if that employer doesn’t have a bank of lawyers behind them,” Snelson said. An attorney wrote the contract you’re considering. Hiring one of your own is basic professionalism; it shows you’re taking the opportunity seriously, Hursh added.

But it won’t be free. Prices vary widely, but experts said you can expect to pay at least $1000 for a contract review. It’s pricey amid an already expensive transition. But, consider it the price of protection, Snelson said. It’s just a small piece of the big salary you’re signing on for, and it can make a huge difference in your future quality of life. Even if you don’t make huge changes, a healthcare attorney can help you understand what you’re signing on for, she said.

If you’re hoping to leave a position in 2 years because of your spouse’s job, your attorney can help you decipher what it will take to quit. Is the notice 120 days or 18 months? Will you owe back bonuses or be on the hook for expensive tail insurance?

If you’re in the city you hope to stay in, you want help understanding and minimizing the noncompete. What are your limitations if you leave? Are you prevented from working near your primary hospital, or does the noncompete include any building affiliated with the hospital? That could be tens or hundreds of miles.

“It should be based on where the physician did most of their services,” Hursh said. And some specialties, like anesthesiology, radiology, pathology, or emergency medicine, pose no risk of stealing patients. They shouldn’t have noncompete clauses in their contracts at all, he added.

And even if your first job is at a dream institution, you need legal help protecting your day-to-day. The contract should be specific about the work you’re doing — neonatology not pediatrics, for example — and where you’re doing it. There should be a clear compensation structure for any additional hours.

The employer benefits when the contract uses vague language, Giep said. “The healthcare attorney you hire will help you tighten it up.”

And if you get the sense at any time that a future employer doesn’t want your lawyer involved, “that’s a red flag,” Snelson said. Ask yourself, if “they want a lawyer but don’t want me to have one — Do I want to work here?”

Donavyn Coffey is a Kentucky-based journalist reporting on healthcare, the environment, and anything that affects the way we eat. She has a master’s degree from New York University’s Arthur L. Carter Journalism Institute, New York City, and a master’s in molecular nutrition from Aarhus University in Aarhus, Denmark. You can see more of her work in WIRED, Teen Vogue, Scientific American, and elsewhere.