EM · DATA · LEVERAGE · FAIR PAY
ClauseLine for EM
Specialty-specific analysis calibrated to EM contract structures: shift-rate vs. base+RVU models, tail coverage patterns, and published EM benchmark data.
A few of the things we flag in EM contracts
- Tail coverage — Who pays the malpractice tail when you leave — often a five-to-six-figure surprise.
- Shift-rate vs. base + RVU — Which model you are on, and how it quietly shifts volume risk onto you.
- RVU conversion factor — The dollars-per-RVU that sets your real ceiling, buried below the headline rate.
…and the full contract, clause by clause — compensation, call, scheduling, non-compete, termination, and every other term that moves your pay or your exit.
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What moves your number in emergency medicine
Emergency medicine compensation is a short equation — hours worked times an effective hourly rate — and nearly every clause in the contract quietly adjusts one side of it. Differentials, metric holdbacks, coverage levels, and the definition of a clinical hour routinely move annual pay more than the headline number does. These four terms are where the movement happens.
Night, weekend, and holiday differentials
An emergency department runs around the clock, and a contract that pays the same rate at 3 a.m. Saturday as at 10 a.m. Tuesday hands the scheduling pain to you for free. Meaningful differentials for nights, weekends, and named holidays add real money for the same number of hours worked. A stronger contract states each differential as a fixed per-hour amount in the written compensation schedule, not as a scheduling courtesy.
Caps on metric holdbacks
Door-to-doc, left-without-being-seen, and patient-satisfaction holdbacks put part of your rate at risk on numbers driven by boarding, nurse staffing, and registration flow — none of which you control from a single shift. A stronger version converts holdbacks into upside-only bonus, measures performance at the department level with a defined data source, and caps the total at-risk amount at a small share of the rate.
Coverage and patient-load protections
Your effective wage depends on how many patients each covered hour must absorb, and staffing decisions sit entirely with the group. The same hourly rate at 1.8 patients per hour and at 2.5 is two different jobs at two different effective wages. Stronger contracts commit to defined physician coverage hours, or include a reopener that adjusts the rate if average patients per hour exceeds a stated threshold for a full quarter.
Defined hours and extra-shift premiums
Full-time in emergency medicine is whatever the contract says it is — 1,440 clinical hours per year is a common definition, but some agreements leave it open or quietly fold in meetings and charting time. Pin the annual hour count, state whether non-clinical time counts toward it, and set a premium rate for shifts beyond the floor so extra coverage is voluntary and paid, not assumed.
Common questions
Who pays for tail coverage when an emergency physician changes jobs?
Whoever the contract says — and if it says nothing, that usually means you. Most staffing arrangements in emergency medicine carry claims-made policies, and the tail that covers claims filed after you leave commonly runs 1.5-2x the annual premium. Before signing, get one of three outcomes in writing: the employer pays the tail, the policy is occurrence-based so no tail is needed, or tail responsibility pro-rates with your tenure.
Is a flat shift rate or base-plus-RVU pay better in emergency medicine?
Neither is inherently better; they allocate volume risk differently. A flat shift rate gives you predictable income while the employer keeps the upside of a busy department; base-plus-RVU pays you for productivity but exposes you to payer mix, downcoding, and slow shifts. Run both models against the department's realistic patients per hour and acuity, and check who controls the inputs — the conversion factor in an RVU model and the staffing level in a shift model are where each can be quietly degraded.
Are non-competes enforceable for emergency physicians?
It depends on state and scope, but emergency medicine non-competes face a harder argument than most: you carry no patient panel to take with you, which undercuts the usual business justification. They still appear — and a radius measured from every facility a large group staffs can lock you out of an entire metro area. Negotiate the restriction down to the specific sites where you actually worked, shorten the duration, and confirm what your state currently permits before treating the clause as settled.