FREE — RED FLAG CONTRACT CHECKLIST
The contract provisions that quietly cost you.
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RED FLAG CHECKLIST · HOSPITAL MEDICINE
The contract provisions
that quietly cost you.
Data. Leverage. Fair pay.
7-on/7-off + nocturnist · specialty-specific
The provisions below are the ones most likely to cost hospital medicine physicians money, mobility, or leverage. Read each item against your contract and mark whether it is present, missing, or unclear. A single CRITICAL finding warrants careful review before signing.
THE RED FLAGS
6 CRITICAL · 7 HIGH · 2 MODERATE
No minimum shift or census guarantee
Without a floor on shifts or daily census, the employer controls your income by controlling assignments — earnings drop without breach.
Nocturnist differential below market or missing
Median 2025 nocturnist differential runs roughly 15%; top quartile 20–25%. A missing or below-median differential is below market and underprices nights.
Claims-made malpractice, no tail commitment
Silence leaves who pays unresolved. Ask for employer-paid tail in writing for resignation, termination and nonrenewal; confirm the policy terms.
Termination without cause under 90 days
Hospital credentialing alone runs 90–120 days. A 30- or 60-day window leaves no time to credential, relocate, or negotiate the next contract from strength.
wRVU rate with no named benchmark
Flat dollar-per-wRVU with no reference to 2025 national benchmarks gives the employer full discretion to call any rate market without contractual standard.
Compensation model not clearly specified
If salary vs. shift-rate vs. wRVU vs. hybrid is ambiguous, the model can shift at renewal — a guaranteed base silently converting to production-only is the classic pattern.
Ambiguous call coverage language
Specify in-house vs. remote, number of call days per year, per-call rate, and whether call is included in or additive to base. Ambiguity shifts unpaid work onto you.
APP supervision credit below 75%
You carry medicolegal risk for the APPs you supervise. Receiving only partial wRVU credit means you absorb liability while the employer captures the revenue.
Unilateral schedule modification rights
Language permitting employer discretion over block schedule, site assignment, or shift type strips your control over your working life and family planning.
Bonus threshold not tested against your workload
Test the threshold against your credited production, workload and payout period. Model low, expected and high-production payouts before counting the bonus as income.
Non-compete over 10 miles or 2 years
Hospital systems consolidate locally; an aggressive radius or duration can force relocation. Narrow scope and duration before signing.
No written admission/discharge expectations
Daily census or admission caps that live only in policy can be raised unilaterally. Cap workload in the contract and tie above-cap volume to per-encounter pay.
No rate escalation clause
Without annual increases tied to inflation or benchmark percentile, real compensation declines every year you remain. A flat multi-year rate is a multi-year pay cut.
Sign-on clawback with no pro-ration
Full repayment regardless of tenure treats the bonus as a leash rather than compensation. Negotiate pro-rata over 24 months and a waiver on without-cause termination.
Restrictive moonlighting clause
Broad bans on outside clinical work cap earning potential and remove income diversification. Restrict only true conflicts — same geography, same patient population.
For informational purposes only. Does not constitute legal advice.
NEXT STEP
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