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Emergency Medicine Contract — Sample Analysis
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Contract Analysis · Emergency Medicine
sample-em-contract.pdf
Moderate Risk
0 = physician-favorable · 100 = extreme risk
Income Snapshot
Four numbers: the total revenue your work generates, what you take home, what the CMG collects in professional fees, and what the hospital captures. Estimates, not promises. We do not estimate employer cost — if a CMG wants to argue cost, they can provide their data to you.
Your work generates $1.16M a year — the professional fees the group collects, plus the hospital revenue your work drives. You keep 27.1% of it.
Where every dollar you generate goes
Of the $1.16M in total revenue your work generates each year, here is where every dollar lands — what reaches you, what taxes and expenses take, what the CMG keeps, and what the hospital captures.
Total revenue you generate
$1.16M
Professional fees + hospital revenue
The full economic footprint of your work — what the group collects plus the hospital revenue you drive.
Your estimated take-home
$178,000 – $227,000
Mid-range: $198,000
Gross $285,000 – $350,000 minus your share of insurance, retirement, malpractice tail, and tax.
CMG revenue collected
$352,639
On 7,207 wRVUs (P50)
Professional-fee collections the CMG bills and keeps on your wRVUs.
Hospital revenue captured
$811,069
Separate hospital revenue stream
Hospital facility fee on the same ED encounters, set at ~2.3× the professional fee per Medicare outpatient (OPPS) payment data — a conservative federal floor; commercial payers run higher. On 7,207 wRVUs the hospital captures about $811,069 in facility fees, billed separately. This revenue goes to the hospital, not the group, and never enters the comp negotiation.
These figures count professional and facility fees only. Emergency physicians are also the front door for roughly half of all U.S. hospital inpatient admissions — the downstream imaging, labs, and inpatient revenue you initiate is larger still, and not counted here.
After federal taxes, FICA, health insurance, and mandatory expenses (CME, tail reserve), this contract produces an estimated $178,000–$227,000 in annual take-home for a W-2 physician in Texas. The Texas income tax advantage is real — compared to an equivalent California or New York contract, this adds $15,000–$25,000 in after-tax value. The tail reserve line reflects the contingent liability being pre-funded; if employer covers tail, that $3,000–$5,000/year goes back to take-home.
Executive Summary
This contract presents a below-median compensation structure anchored by a wRVU rate of $38.50 — $17.59 below the national emergency medicine median of $56.09 (2025 national data, hospital and staffing-group employed). At the national median production of 7,207 wRVUs, that rate gap alone costs $126,771 per year versus the median rate — $380,313 over a 3-year term.
The bonus threshold compounds the problem. At 7,400 wRVUs, it sits just above the national median EM volume of 7,207, which means a median producer earns no bonus at all; meaningful bonus value appears only at well-above-median production (about $63,500 per year at the 75th-percentile volume of 9,049). Combined with a $285,000 base that sits below the 25th percentile of national EM base compensation ($291,975), the total package lands most physicians well below the national median total compensation of $397,648.
Malpractice terms add a contingent liability that the compensation figure conceals. The claims-made policy provides no employer-funded tail on separation. EM tail premiums run $35,000–$70,000 — a cost that hits at exactly the moment a physician is least liquid: job transition. The contract also contains a non-compete with a 15-mile radius and 24-month duration; the state-law assessment appears in the dedicated non-compete section of this report.
The contract is not a non-starter, but it requires targeted negotiation on the wRVU rate, the bonus threshold, and the tail coverage obligation before it reaches fair-market terms for the region.
Key Red Flags
- wRVU rate $38.50 vs. national EM median $56.09 — $126,771/year gap at median production (7,207 wRVUs)
- Bonus threshold 7,400 wRVUs sits above the national median volume of 7,207 — a median producer earns no bonus
- Claims-made policy with no employer-funded tail coverage — estimated $35,000–$70,000 physician exposure
- Non-compete present: 15-mile radius, 24-month duration — see the non-compete section for the Texas state-law assessment
- No extra-shift rate defined for coverage above the 10-shift baseline
Key Strengths
- Guaranteed base salary of $285,000 provides income floor regardless of volume fluctuation
- 12-hour shift structure with 10 shifts/month is within standard EM scheduling norms
- wRVU bonus structure creates upside if threshold is renegotiated downward
Compensation Analysis
HIGHYour $/wRVU vs the market
Your effective rate of $38.50/wRVU sits at the 22nd percentile for this specialty. The shaded band is the national middle 50% (P25–P75).
What you earn at each production level
Annual compensation at your contract rate versus the specialty-median rate, across P25 / median / P75 production. The gap is the cost of the rate, and it grows with volume.
Model
Hybrid (Base + wRVU Bonus)
Base Rate
$285,000 / year
Shift differentials: Not specified in contract — no night or weekend differential defined
wRVU Rate vs Benchmark
Contract rate of $38.50/wRVU sits below the national P25 of $43.32 for emergency medicine (2025 national data; median $56.09, P75 $73.13). Against the median rate, the annual gap is $94,904 at P25 production (5,395 wRVUs), $126,771 at median production (7,207), and $159,171 at P75 production (9,049). Three-year cumulative gap at median production: $380,313. Even at the P25 rate of $43.32, this contract underpays by $34,738/year at median volume.
Multiplier: $38.50/wRVU · work RVU
CME Coverage
Not specified — no CME budget or CME days included
Productivity Bonus
$38.50/wRVU on all wRVUs above 7,400 annually (quarterly reconciliation)
Net Take-Home
Gross (P25 – P75)
$285,000 – $350,000
Mid: $315,000
Classification
W-2
Drives the expense math
Estimated take-home
$178,000 – $227,000
Mid: $198,000
| Expense line | Annual range | Note |
|---|---|---|
| Federal income tax (MFJ, ~32% bracket) | $68,000 – $95,000 | Estimated effective rate 24–28% on physician income in this range |
| State income tax (Texas) | $0 | Texas has no state income tax — this is a real benefit vs. CA/NY/IL contracts |
| FICA (Social Security + Medicare) | $11,000 – $13,000 | W-2 employees pay employee share only (7.65%) — self-employed EM pay 15.3% |
| Health insurance (employee share) | $4,200 – $7,200 | Family plan employee share; employer contribution not specified in contract |
| Malpractice tail reserve | $3,000 – $5,000 | Recommended annual reserve since employer does not fund tail — $35K–$70K cost at exit |
| CME and licensure (out-of-pocket) | $3,500 – $5,000 | Professional-society membership, board fees, CME courses — not covered by employer |
| 401(k) contributions (voluntary) | $5,000 – $23,000 | Reduces taxable income; shown here as a real cash outflow |
Assumptions
- Mid scenario anchored near the national median EM volume of 7,207 wRVUs — low assumes below-median production, high assumes production above the 7,400 bonus threshold
- MFJ filing status, standard deduction, no large itemized deductions
- No 401(k) employer match assumed (not specified in contract)
- Tail reserve treated as a required expense since employer does not fund tail
- Health insurance employee share estimated at family plan rates for Texas regional employers
Revenue Breakdown
Total revenue your work generates, what you take home, what the CMG collects, and what the hospital captures. We do not estimate employer cost; if a CMG wants to argue cost, they can provide their own data.
Where every dollar you generate goes
Of the $1.16M in total revenue your work generates each year, here is where every dollar lands — what reaches you, what taxes and expenses take, what the CMG keeps, and what the hospital captures.
Total revenue generated
$1.16M
Professional + hospital, combined
Your take-home
$178,000 – $227,000
After taxes, benefits, expenses
CMG revenue
$352,639
7,207 wRVUs × $49/wRVU
Hospital revenue
$811,069
Separate facility-fee stream
Hospital facility revenue — how it works
Hospital facility fee on the same ED encounters, set at ~2.3× the professional fee per Medicare outpatient (OPPS) payment data — a conservative federal floor; commercial payers run higher. On 7,207 wRVUs the hospital captures about $811,069 in facility fees, billed separately. This revenue goes to the hospital, not the group, and never enters the comp negotiation.
On 7,207 wRVUs — the national median EM volume — this physician’s work generates about $1,163,708 a year: $352,639 in professional fees the group collects, plus roughly $811,069 in hospital facility fees on the same encounters. Paid $315,000, the physician captures about 27% of the revenue their work generates. That is before the downstream: emergency physicians are the front door for roughly half of all U.S. hospital inpatient admissions, so the imaging, labs, and inpatient revenue they initiate is larger still. We deliberately do not estimate employer cost — that is the employer’s data to share.
Professional collections use the specialty median collected revenue per wRVU ($48.93). Facility revenue uses the Medicare outpatient (OPPS) emergency-department facility-to-professional ratio (~2.3×), a conservative federal floor — commercial payers run higher. Collection rates and facility ratios vary by payer mix, acuity, and geography; these are estimates for context, not guarantees. We do not estimate employer cost; that opacity is the employer’s choice.
Missing Protections
Employer-funded malpractice tail coverage
Claims-made policy with no tail obligation leaves a $35,000–$70,000 liability entirely on the physician at separation — regardless of the reason for departure.
"Add language that the employer funds tail coverage upon any separation, including termination without cause and voluntary resignation with standard notice."
Defined per-shift rate for extra shifts above baseline
The contract specifies 10 shifts/month but is silent on compensation for additional shifts. Groups regularly request coverage above baseline; without a defined rate, no premium applies.
"Define a per-shift rate of at least $X (at or above blended shift value) for any shifts worked above 10/month."
CME allowance and paid CME days
Professional-society guidance recommends $3,500–$5,000 annually plus 5 CME days. Absence in the contract does not mean the employer will cover it informally — expenses become out-of-pocket.
"Add a CME allowance of $4,000/year plus 5 paid CME days."
Independent wRVU audit right
The CMG controls the billing vendor relationship. Without an audit clause, the physician cannot verify the wRVU count that determines quarterly bonus payouts.
"Add a provision allowing the physician to request supporting billing data for any quarterly period within 60 days of payout."
Non-compete buyout right (statutory in Texas)
Texas law (SB 1318, effective 9/1/2025) requires physician non-competes to include a buyout capped at the physician’s total annual salary and wages at termination. This covenant contains no buyout language — a missing statutory term that also serves as the release valve if circumstances change.
"Add a buyout provision allowing release from the non-compete for an amount not exceeding my total annual salary and wages at termination, as Tex. Bus. & Com. Code § 15.50(b) requires."
Clause Analysis
"Physician shall receive $38.50 per qualifying work RVU generated above the annual threshold of 7,400 wRVUs."
The rate of $38.50/wRVU is $17.59 below the national median ($56.09) and $4.82 below the P25 ($43.32) for emergency medicine (2025 national data). The threshold of 7,400 sits just above the national median volume of 7,207 wRVUs (P75 is 9,049), meaning a median producer earns no bonus and meaningful payout begins only at well-above-median production. The combination of a below-P25 rate and an above-median threshold eliminates most of the incentive value.
Negotiate the rate to at least $48–$56/wRVU (the national median is $56.09) and the threshold down to 5,400 (P25 volume). Either change alone improves the economics meaningfully; both together close the majority of the market gap.
"Employer shall provide claims-made professional liability insurance with limits of $1,000,000/$3,000,000. Physician is responsible for all costs associated with extended reporting period coverage upon separation."
Claims-made policies require a tail (extended reporting period endorsement) to cover claims filed after the policy expires. The employer explicitly shifts this cost to the physician. EM tail premiums currently run $35,000–$70,000 depending on state, limits, claim history, and years of coverage. This is a contingent liability that is not visible in the headline compensation number.
Request that employer provide tail coverage on any separation. If employer resists full coverage, negotiate a tail allowance of $50,000 escrowed upon hire, vesting pro-rata over 3 years.
"Physician shall accrue ten (10) days of paid time off per contract year, prorated during the first contract year. Paid time off does not include continuing medical education days."
Ten days of PTO — 120 hours at this contract’s 12-hour shift length — sits below the national EM median of 160 PTO hours (2025 national data; P25 is 96 hours, P75 is 200 hours). Because CME days are expressly excluded and the contract defines no CME allowance elsewhere, any education time comes out of the same below-median pool or goes unpaid.
Request 160 PTO hours (the national median) and 5 separately designated CME days. If the employer holds at 10 days, secure the 5 CME days as a standalone add — a low-cost concession that protects the PTO pool.
"Either party may terminate this Agreement without cause upon 60 days written notice."
60 days is acceptable but does not address what happens during the notice period. The contract is silent on whether the physician continues to be scheduled for shifts and paid during the notice window, or whether the employer can place the physician on administrative leave without pay while serving out the 60 days.
Add language requiring that the physician continues to receive full base compensation during any notice period, regardless of scheduling status, and that the employer may not accelerate the termination date without paying compensation through the full notice period.
"The Company reserves the right to modify the Productivity Compensation Plan, including wRVU rates and threshold levels, upon 60 days written notice to Physician."
This provision allows the CMG to reduce the wRVU rate or raise the threshold unilaterally, with only 60 days notice. Combined with the 60-day termination clause, the effective notice period before economics change is 60 days — with no right to exit on better terms than offered at hire. Most national EM staffing groups include similar language, but it remains a risk that should be acknowledged.
Negotiate a rate floor provision: wRVU rate may not be reduced below the lesser of (a) the rate at hire or (b) the then-current P25. If employer will not agree to a floor, request a reciprocal right to terminate without penalty if the wRVU rate is reduced below a negotiated floor.
"Physician agrees to work a minimum of ten (10) twelve-hour shifts per month as scheduled by the Department Medical Director."
The 10-shift minimum is standard for full-time EM. The problem is the absence of any provision for shifts above the baseline. EM departments routinely face call-outs and coverage gaps. The Medical Director can schedule a physician for additional shifts; the contract does not define the compensation rate for those additional shifts, leaving the employer the ability to argue that extra shifts are covered by the base salary.
Add: "Compensation for shifts worked in excess of 10 per calendar month shall be paid at a per-shift rate of not less than [base ÷ 120 shifts/year], or at a separate per-shift rate to be agreed in writing by the parties."
"This Agreement shall be governed by the laws of the State of Texas. Any dispute arising under this Agreement shall be submitted to binding arbitration under the AAA Commercial Arbitration Rules."
Texas governing law is consistent with the employer location. AAA Commercial arbitration is standard; the physician should confirm whether the arbitration cost-sharing provision is neutral (each party bears own costs plus half of arbitrator fees) or tilted toward the employer.
Confirm the arbitration cost clause is symmetric. If employer pays for arbitration in full, that is a positive term; if costs are on the physician when the employer prevails, request that each party bear its own arbitration costs regardless of outcome.
Non-Compete
HIGHExists
Yes
Radius
15 miles
Duration
24 months
Governing State
Texas
Enforceability
Likely Unenforceable
Landmark cases: Sadler Clinic Ass'n, P.A. v. Hart (2013, Tex. App.—Beaumont (9th Dist.)): Held that if a physician contends the contractual buyout price is unreasonable, the remedy is binding arbitration to set a reasonable price, not voiding the covenant; covenant remained enforceable subject to arbitration. Note: SB 1318 superseded this arbitrated 'reasonable price' mechanism by imposing a salary-capped buyout, but the case remains accurate as pre-2025 framework.
Texas subjects physician non-competes to physician-specific statutory caps (1-year / 5-mile / salary-capped buyout); a clause exceeding those caps generally does not stand as written. Your 15-mile radius EXCEEDS the 5 mile limit Texas law permits for physician non-competes — as written, this term is broader than the statute allows. Your 24-month term EXCEEDS the 12 month limit Texas law permits — as written, this term is longer than the statute allows. Governing law: Tex. Bus. & Com. Code 15.50(b) (as amended by SB 1318, eff. 9/1/2025); new 15.501 (dentists, nurses, PAs); 15.52.
Malpractice Insurance
HIGHType
claims-made
Coverage Limits
$1,000,000 per occurrence / $3,000,000 aggregate
Tail Coverage
Not provided — physician responsibility on separation
Tail Cost Estimate
$35,000–$70,000 (claims-made policy; dependent on state, limits, and claim history)
Require employer-funded tail on separation and negotiate a "consent to settle" clause that prohibits settlement without physician consent above a de minimis threshold ($5,000–$10,000).
Termination Provisions
MODERATEWithout-Cause Notice
60 days written notice by either party
With-Cause Provisions
Immediate termination for: (1) loss of medical license, (2) DEA registration suspension, (3) conviction of a felony, (4) material breach of the agreement not cured within 10 days of written notice, (5) exclusion from federal healthcare programs.
Physician Rights
60 days written notice to terminate without cause. No right to terminate immediately for cause against the employer (e.g., if the employer breaches compensation obligations). This asymmetry is common but worth noting.
Add a physician right to terminate immediately for cause if employer fails to pay compensation within 15 days of the due date, or unilaterally reduces the wRVU rate below a stated floor without mutual agreement. Also clarify that the physician will be paid in full through the notice period regardless of whether the employer chooses to continue scheduling.
Benefits & Leave
MODERATEHealth Insurance
Group health plan available — employee portion deducted from pay. Employer contribution not specified.
CME
Not specified in contract — no CME budget or CME days allocated
PTO
10 days per year (prorated in first year). Does not include CME days.
Retirement
401(k) participation available after 90 days; employer match not specified
Disability
Not addressed in contract
Malpractice
Claims-made coverage provided; tail not included (see Malpractice section)
Negotiation Approach
This contract has three distinct negotiation fronts: (1) the wRVU rate and threshold, which are the highest-value issues by far; (2) the tail coverage liability, which is a contingent cost that should be treated as a compensation item; and (3) the non-compete scope. Sequence matters. Lead with the wRVU rate because it is the most defensible with the 2025 national emergency medicine data. Tail coverage is a second ask that most hospital-employed groups concede more readily than CMGs — frame it as standard practice rather than a concession.
Opening Move
"I have reviewed the compensation structure against the 2025 national emergency medicine benchmarks. The wRVU rate of $38.50 is below the national P25 of $43.32. Before I can move forward, I would like to discuss getting the rate to the median level ($56.09) and moving the bonus threshold below the national median volume of 7,207 wRVUs so the incentive pays at typical production. I am happy to proceed on everything else once we have alignment on those two figures."
Key Principles
- Lead with data. The 2025 national emergency medicine benchmarks are the authority here — bring the specific percentile figures to every conversation, not feelings.
- Do not bundle more than 2 asks in a single conversation. Sequence: (1) wRVU rate + threshold, (2) tail coverage, (3) non-compete, (4) minor items.
- Frame tail coverage as a market norm, not a demand. "Every hospital system I have spoken with provides tail on termination" is more effective than "I need you to cover this."
- If the wRVU rate is non-negotiable, pivot to the threshold. Lowering the threshold from 7,400 to 5,400 at the current $38.50 rate is worth about $69,600/year at median volume (7,207 wRVUs) — nearly as valuable as a $10/wRVU rate increase.
- Document all verbal agreements in writing before signing. Email confirming oral modifications is not sufficient — require a formal amendment or addendum.
Sequencing
- 1Request a benchmarking conversation grounded in the 2025 national emergency medicine data with the Medical Director or recruiter before formal offer acceptance
- 2Submit written counter-proposal covering wRVU rate and threshold as a single package ask
- 3If rate is accepted, raise tail coverage in the same conversation or within 48 hours
- 4Address non-compete scope as a separate conversation after compensation is settled — treat it as a standalone item anchored on the Texas statutory caps (5 miles / 12 months / salary-capped buyout)
- 5CME and extra-shift rate are low-resistance asks — bundle them into the final redline
Negotiation Priorities
Financial Impact
Versus the median rate: $94,904/year at P25 production (5,395 wRVUs), $126,771/year at median (7,207), $159,171/year at P75 (9,049). Three-year cumulative at median production: $380,313. The largest single financial lever in this contract.
Current Terms
$38.50/wRVU — below the national P25 of $43.32
The Ask
$56/wRVU (the 2025 national EM median is $56.09)
Fallback
If the median is refused, accept $48.00–$50.00/wRVU paired with the threshold reduction in Priority 2. Moving from $38.50 to the P25 rate of $43.32 alone recovers $34,738/year at median production.
Walk-Away Point
$43.32/wRVU (the national P25). Below this, the total package is not competitive for emergency medicine.
Say this
“The 2025 national emergency medicine median is $56.09 per wRVU, and this contract offers $38.50. At the national median production of 7,207 wRVUs, that is a $126,771 annual gap — $380,313 over a three-year term. I would like the conversion factor aligned to the median, and I am ready to move forward on the rest of the agreement once we have alignment on that rate.”
Financial Impact
At $38.50/wRVU, lowering the threshold to 5,400 adds about $69,600/year at median production (7,207 wRVUs) — roughly $208,700 over a 3-year term.
Current Terms
7,400 wRVUs/year (above the national median volume of 7,207)
The Ask
5,400 wRVUs/year (P25 volume) so the bonus pays at typical production
Fallback
If 5,400 is refused, settle between 6,300 and 7,200 wRVUs — at 6,300 the bonus is worth about $34,900/year at median production. Pair any threshold above 6,500 with a written quarterly reconciliation statement.
Walk-Away Point
7,200 wRVUs (median volume). Above the median, the bonus excludes more than half of EM physicians.
Say this
“The bonus threshold of 7,400 wRVUs sits above the 2025 national median volume of 7,207 for emergency medicine, so as written a typical producer earns no bonus at all. I would like the threshold set at 5,400 — the 25th-percentile volume — so the incentive starts paying at realistic production. At the current $38.50 rate, that change is worth about $69,600 a year at median volume.”
Financial Impact
$35,000–$70,000 one-time contingent liability eliminated — equivalent to $11,700–$23,300/year reserved across a 3-year term. Typically hits at job transition when the physician is least liquid.
Current Terms
Physician responsible for all tail costs on separation
The Ask
Employer provides or pays for tail coverage on any separation
Fallback
If full employer-funded tail is refused, secure a $50,000 tail allowance escrowed at hire, vesting pro-rata over 3 years — converting an unpredictable $35,000–$70,000 exit cost into a funded benefit.
Walk-Away Point
Minimum acceptable: $50,000 tail allowance escrowed at hire, vesting over 3 years.
Say this
“The claims-made policy leaves me with a $35,000 to $70,000 tail obligation at separation, regardless of who initiates it or why. Employer-funded tail on any separation is the standard across comparable positions, and I would like that language added. If the company prefers, a $50,000 tail allowance escrowed at hire and vesting over three years accomplishes the same protection.”
Financial Impact
As written, the covenant exceeds the Texas statutory caps on both radius and duration. Conforming it cuts the restricted period from 24 to 12 months and the restricted area from 15 to 5 miles, and the statutory buyout — capped at about one year of total salary and wages, roughly $285,000–$315,000 under this contract — sets a hard one-time ceiling on exit cost for the full 3-year term instead of an open-ended constraint.
Current Terms
15-mile radius, 24-month duration, no buyout provision — Texas governing law
The Ask
5-mile radius and 12-month duration (the Texas statutory maximums under SB 1318), a buyout capped at total annual salary and wages at termination, and language voiding the covenant on involuntary discharge without good cause
Fallback
There is no fallback above the statutory caps — any radius over 5 miles or duration over 12 months exceeds what Texas law permits for physician non-competes. If the employer resists a full rewrite, secure the 12-month duration and the salary-capped buyout first; the buyout is a mandatory statutory term, not a concession.
Walk-Away Point
Any covenant broader than 5 miles / 12 months, or without the salary-capped buyout, exceeds what Texas law permits — do not accept terms broader than the statute.
Say this
“Texas law caps physician non-competes at a 5-mile radius and 12 months and requires a buyout capped at one year of total salary and wages — this covenant is written at 15 miles and 24 months with no buyout. I would like the covenant conformed to the statutory limits and the buyout language added, as Tex. Bus. & Com. Code § 15.50(b) requires.”
Generate Counter-Proposal
What this section does
- Generates a full counter-proposal letter in your chosen tone (warm or firm), addressed to the employer, citing specific specialty benchmarks and your negotiation priorities.
- Lets you select which priorities to include, and supports both new-offer and renegotiation letter types with an optional contract start date.
- Output is editable, copyable, and prints to PDF alongside the report — ready to send, or revise it first.
Unlimited Q&A
Example question
Unlimited Q&A — ask follow-up questions about your analysis
Ask about any clause, negotiate strategy, what specific language to request, or what a term means in practice. Answers are grounded in your actual contract text and benchmarks for your specialty. Yours forever — come back any time.
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