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Sample Report
Anesthesiology Contract — Sample Analysis
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Contract Analysis · Anesthesiology
sample-anesthesia-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 your group collects in professional fees, and what the hospital captures. Estimates, not promises. We do not estimate employer cost — if the group wants to argue cost, they can provide their data to you.
Total revenue you generate
Coming soon
Revenue breakdown is rolling out specialty by specialty — live now for emergency medicine and hospital medicine.
Your estimated take-home
$268,000 – $325,000
Mid-range: $295,000
Gross $425,000 – $500,000 minus your share of insurance, retirement, malpractice tail, and tax.
Professional fees collected
Coming soon
Specialty-specific revenue ranges are rolling out — live now for emergency medicine and hospital medicine.
Hospital revenue captured
N/A
Hospital facility-fee math is currently scoped to emergency medicine.
After federal taxes, FICA, and mandatory expenses, this contract produces an estimated $268,000–$325,000 in annual take-home for a W-2 physician in Florida. Florida's zero state income tax advantage adds approximately $22,000–$28,000 vs. an equivalent Illinois or California contract at the same gross. The tail reserve line is the largest non-tax expense — reflecting the $80,000–$150,000 contingent liability being pre-funded annually. Employer-funded tail would add $8,000–$15,000/year back to take-home.
Executive Summary
This contract presents a base salary of $425,000 — about $45,000 below the 2025 national anesthesiology P50 base compensation of $470,467 — and projected total compensation near $460,000 sits below the P25 total compensation of $480,161 for anesthesiologists nationally (P50: $563,750). The compensation structure widens that gap: the $22/ASA unit marginal rate is low enough that even strong volume does little to close the distance to the P50 total compensation of $563,750, and the base is measured against billed units — not performed units — which means billing office errors and denial patterns directly reduce the physician's bonus through no action of their own.
The ownership structure creates a risk that operates independent of compensation. Section 11.3 permits assignment of this contract upon sale of the practice without physician consent. PE-backed anesthesia consolidation is the dominant M&A pattern in 2025–2026 — your terms can change materially when the group is rolled up. The companion tail coverage provision eliminates any natural exit backstop: if the sale triggers a departure, the physician owes the full Florida tail, which runs $80,000–$150,000 at major carriers.
The non-compete runs 24 months and is measured 25 miles from every PE-platform facility — not just the ones you work at — and facilities added to the portfolio after signing fall inside it automatically. As the platform acquires additional groups, the restricted footprint grows without any amendment or consent. The state-specific enforceability assessment for this clause appears in the Non-Compete section of this report.
The contract requires negotiation on five fronts before it is acceptable: PE assignment consent, tail coverage cap, non-compete scope, the marginal ASA unit rate, and the productivity basis (performed vs. billed). The assignment clause alone is non-negotiable from a risk perspective — do not sign this contract without addressing it.
Key Red Flags
- PE assignment clause (§ 11.3) permits group sale without physician consent — terms can change on any acquisition
- Tail coverage uncapped — Florida anesthesia tail runs $80,000–$150,000, triggered on any departure including PE-sale exit
- Marginal ASA unit rate of $22/unit — low enough that incremental volume barely moves total compensation toward the specialty P50
- Productivity calculated on billed units, not performed units — billing errors reduce bonus through no physician fault
- 25-mile, 24-month non-compete measured from all PE-portfolio facilities — footprint expands automatically with each acquisition
Key Strengths
- Base salary of $425,000 sits between the 2025 national P25 ($380,547) and P50 ($470,467) base compensation for anesthesiologists — a guaranteed floor, though below median
- 1:4 CRNA supervision ratio is within standard anesthesia care team norms
- Florida is a high-demand anesthesia market with leverage to negotiate structural changes
Compensation Analysis
HIGHModel
Base Salary + ASA Unit Bonus
Base Rate
$425,000 / year
Shift differentials: Not specified — no call differential or after-hours premium defined
wRVU Rate vs Benchmark
Not applicable — see asaAnalysis for unit rate comparison
Sign-on Bonus
$25,000
2-year pro-rated clawback — $12,500 owed if departure before year 1, $6,250 if before year 2
CME Coverage
$3,000/year CME allowance, 4 CME days — at the low end of the $3,000–$5,000 range typical in 2025 national anesthesiology contract data
Productivity Bonus
$22/ASA unit on all billed units above 8,500/year (quarterly reconciliation)
Net Take-Home
Gross (P25 – P75)
$425,000 – $500,000
Mid: $460,000
Classification
W-2
Drives the expense math
Estimated take-home
$268,000 – $325,000
Mid: $295,000
| Expense line | Annual range | Note |
|---|---|---|
| Federal income tax (MFJ, ~32–35% bracket) | $108,000 – $140,000 | Estimated effective rate 26–30% at this income level; anesthesiologists frequently in the 32–35% marginal bracket |
| State income tax (Florida) | $0 | Florida has no state income tax — a real advantage vs. IL, CA, or NY contracts at the same gross |
| FICA (Social Security + Medicare) | $13,000 – $15,000 | W-2 employee share of Social Security and Medicare payroll taxes, including the additional Medicare surtax that applies at this income level |
| Health insurance (employee share) | $4,200 – $7,200 | Family plan employee share; employer contribution not specified |
| Malpractice tail reserve | $8,000 – $15,000 | Annual reserve for FL anesthesia tail — $80K–$150K at exit; no employer cap in this contract |
| CME and licensure (out-of-pocket above $3,000 allowance) | $1,000 – $3,000 | Specialty society membership, board maintenance, additional CME above the contract allowance |
| 401(k) contributions (voluntary) | $5,000 – $23,000 | Reduces taxable income; employer match not specified in PE-group contract |
Assumptions
- Mid scenario uses $460,000 gross — base $425,000 plus modest above-threshold bonus at $22/unit on 500 units over baseline
- MFJ filing status, standard deduction
- No 401(k) employer match assumed — not specified in PE-group contract
- Tail reserve treated as required expense given no employer cap and no change-of-control exit protection
- Florida zero state income tax applied
Revenue Breakdown (rolling out)
Revenue breakdown is rolling out specialty by specialty. Emergency medicine is live first; other specialties follow as we tune collected-revenue ranges per specialty and practice setting.
Missing Protections
Physician consent requirement for assignment upon sale
Section 11.3 permits contract assignment to any successor entity upon PE group sale without physician consent. This is the most dangerous clause in any PE-backed contract — the acquiring entity can change compensation, locations, and supervision ratios on the same terms that applied to the seller.
"Replace Section 11.3 with language requiring physician written consent to any assignment, or alternatively, granting a right of first refusal to accept the same terms offered by the acquiring group, with a 30-day election window."
Dollar cap or employer contribution on malpractice tail
Florida anesthesia tail premiums are among the highest in medicine — $80,000–$150,000 per major carrier. The contract places this cost entirely on the physician at the worst possible time: departure, which can be triggered by a PE sale the physician did not consent to.
"Cap physician tail responsibility at $25,000, with employer responsible for any premium above that amount. Alternatively, have employer provide and pay for tail coverage on any separation including change-of-control departures."
Performed-unit basis for productivity bonus
Current language ties the bonus to billed units rather than performed (case-logged) units. Billing errors, late submissions, and denial management — all outside physician control — directly reduce the bonus.
"Change Section 5.1 to tie productivity to performed units as recorded in anesthesia case logs, with billed units used only as a cross-reference, not the primary measurement."
Fixed non-compete geographic definition
The non-compete radius is measured from all PE-platform facilities, which expands automatically as the platform acquires additional groups. A non-compete with an expanding scope is not a fixed, definable restriction — it is open-ended.
"Redefine the non-compete radius from the specific facilities at which Physician provided services during the contract term, with an enumerated list attached as an exhibit, not subject to expansion by subsequent acquisition."
Clause Analysis
"This Agreement may be assigned by Employer to any successor entity, including any entity acquiring all or substantially all of the assets of Employer, without the prior written consent of Physician."
PE-backed anesthesia consolidation is the dominant M&A pattern in 2025–2026. This clause allows the group to be sold to any buyer — a national staffing company, a hospital system, or a competing PE platform — and the new owner steps into the same contract terms. In practice, acquirers renegotiate within 12–18 months of closing; physicians without consent rights have no leverage to resist changes. The absence of a right of first refusal or consent requirement is the single most important clause in this contract to fix.
Require physician written consent for any assignment, or a right of first refusal at the acquirer's offered terms with a 30-day election window. If the employer refuses any consent mechanism, add a change-of-control termination right allowing physician to exit without the non-compete or tail obligations if the contract is assigned without consent.
"Employer shall provide claims-made professional liability insurance during the term of employment. Physician shall be solely responsible for all costs of extended reporting period coverage upon separation from employment for any reason."
Florida anesthesia tail premiums from major carriers currently run $80,000–$150,000 depending on claim history, years of coverage, and case mix. The combination of a PE assignment clause (which can trigger departure) and uncapped tail responsibility creates a scenario where the physician exits on a change-of-control event and immediately owes six figures. This is the highest tail exposure of any specialty in the highest-premium state.
Cap physician tail responsibility at $25,000 with employer funding the remainder, or require employer to provide tail on any separation. If a dollar cap is the compromise, escrow the physician portion at hire over a 3-year vesting schedule so it is available at departure.
"Physician shall receive a productivity payment of $22.00 per ASA unit for all units billed above 8,500 per calendar year."
At the national median anesthesia production volume of approximately 9,000 units/year, the marginal rate applies to only 500 units — producing about an $11,000 bonus at $22/unit. Raising it to the $60/unit negotiation target on the same 500 units would roughly triple that. The practical effect of the rate as written is that above-median productivity is nearly worthless from a compensation standpoint.
Negotiate the marginal rate to at least $60/unit above 8,500 units — a defensible ask relative to the 2025 national median. Alternatively, lower the threshold to 8,000 units and raise the rate to $50/unit to achieve a similar expected-value improvement with a more modest rate ask.
"For purposes of calculating Physician's productivity bonus, ASA units shall mean the units billed by the Practice to payors on claims attributed to Physician."
Billed units are controlled by the billing office, not the physician. Claim denials, coding downgrades, late submissions, and attribution disputes directly reduce the unit count used to determine the physician's bonus. Industry-standard anesthesia productivity language ties bonus to performed units from case logs — a measurement the physician controls and can audit independently.
Change the productivity basis to performed units documented in anesthesia case logs. Add an audit right allowing the physician to compare case logs to billing records for any quarter within 60 days of reconciliation.
"Physician shall supervise Certified Registered Nurse Anesthetists at a ratio of up to 1:4 as required by Employer."
A 1:4 supervision ratio is at the upper end of standard anesthesia care team models. The contract assigns this supervision responsibility but makes no compensation adjustment. Supervision at 1:4 limits the physician's ability to run concurrent cases and affects personal case volume, which feeds back into ASA unit production and bonus.
Request a cap at 1:3 for complex cases (cardiac, pediatric, OB) and a compensation adjustment of $X/day for any day where supervision ratio exceeds 1:2, recognizing that higher supervision ratios reduce personal billing capacity.
"Either party may terminate this Agreement upon 90 days written notice. Physician shall continue to provide services during the notice period."
90 days is standard for anesthesia contracts. The clause requires continued service during the notice period but is silent on compensation continuation if the employer reduces or eliminates scheduling during those 90 days. Combined with the tail obligation, an employer who wants the physician out quickly can construct a notice period that reduces income while the tail clock starts.
Confirm that full compensation continues during the notice period regardless of scheduling adjustments. Add language that employer may not accelerate termination without paying through the full 90-day window.
"Physician's scope of practice may evolve based on group needs and service line development, with reasonable notice provided by Employer."
"Scope may evolve" is the contractual vehicle used to add supervision locations, new case types (OB, cardiac, trauma), or administrative duties after hire. Without defined scope, the employer can expand responsibilities materially while compensation remains static. "Reasonable notice" is undefined.
Define the initial scope of practice in an exhibit: case types, supervision ratio, primary facility, and any secondary facilities. Require a signed amendment for any addition to scope, and define "reasonable notice" as not less than 60 days.
Non-Compete
HIGHExists
Yes
Radius
25 miles
Duration
24 months
Governing State
Florida
Enforceability
Strongly Enforceable
Landmark cases: 21st Century Oncology, Inc. v. Moody (2019, N.D. Fla.): Upheld constitutionality of § 542.336 against Contracts/Due Process/Equal Protection challenges; employer (which had all 9 radiation oncologists in Lee County) failed to show likelihood of success and was denied a preliminary injunction. A government/statute win rather than a clean employer or physician outcome — the specialty-monopoly void rule survived.
Florida enforces reasonable physician non-competes (Enforceable — strongly employer-favorable statute). Treat this as binding and negotiate the scope down now. Your 25-mile radius exceeds what Florida courts typically uphold (5–15 miles) — push it into that range. Governing law: Fla. Stat. § 542.335 (general); Fla. Stat. § 542.336 (physician specialty-monopoly void rule).
Malpractice Insurance
HIGHType
claims-made
Coverage Limits
$1,000,000 per occurrence / $3,000,000 aggregate
Tail Coverage
Not provided — physician sole responsibility with no dollar cap
Tail Cost Estimate
$80,000–$150,000 (Florida anesthesiology, major carriers, 2025 pricing)
Require employer-funded tail on any separation. At minimum, cap physician responsibility at $25,000. Also negotiate a consent-to-settle clause — settlement of anesthesia claims without physician consent has material NPDB and credentialing consequences.
Termination Provisions
HIGHWithout-Cause Notice
90 days written notice by either party
With-Cause Provisions
Immediate termination for: (1) loss of medical license, (2) DEA registration suspension, (3) felony conviction, (4) material breach not cured within 10 days, (5) exclusion from federal healthcare programs, (6) loss of anesthesia privileges at any group facility.
Physician Rights
90 days written notice to terminate without cause. No physician right to terminate for cause if employer fails to pay compensation or assigns contract without consent. The assignment clause creates a significant gap — the physician has no explicit termination trigger if the group is sold.
Add a physician change-of-control termination right: if the contract is assigned without physician consent, physician may terminate immediately with no non-compete or tail obligation. Also add a compensation non-payment trigger for immediate termination with no tail obligation.
Benefits & Leave
MODERATEHealth Insurance
Group health plan available — employee contribution deducted from pay; employer contribution not specified
CME
$3,000/year CME allowance and 4 paid CME days — at the low end of the $3,000–$5,000 range typical in 2025 national anesthesiology contract data
PTO
15 days PTO per year; no sabbatical or additional leave specified
Retirement
401(k) available; employer match not specified — PE ownership typically means defined-contribution only
Disability
Short-term disability provided; long-term disability not addressed in contract
Malpractice
Claims-made coverage provided during employment; tail uncapped on physician (see Malpractice section)
Negotiation Approach
The PE assignment clause is the non-negotiable item — do not sign without a consent mechanism or change-of-control exit right. That is the opening conversation. Tail coverage follows immediately because the two clauses are mechanically linked: PE sale can trigger departure which triggers tail. After those two structural issues are resolved, the non-compete scope is the next conversation — Florida law is strongly employer-favorable, so the clause must be treated as binding and narrowed contractually. The marginal ASA unit rate and the performed-vs.-billed basis follow. Sequence: (1) assignment consent + tail cap, (2) non-compete scope, (3) unit rate + productivity basis, (4) supervision ratio.
Opening Move
"Before I can move forward on any terms, I need to address Section 11.3. PE consolidation in anesthesia is moving fast, and I cannot sign a contract that allows the group to be sold without my consent — or at minimum without a right to exit on the same terms if I don't accept the acquirer's offer. I'd like to discuss a consent-to-assign provision. Everything else is negotiable once that clause is resolved."
Key Principles
- Lead with the assignment clause every time. It is the highest-risk item and the most defensible ask — physician consent rights in PE contracts are increasingly standard.
- Frame the tail cap as the companion to the assignment clause. "If I have no control over whether the group is sold, I need a defined exit cost." These two asks are logically linked.
- Anchor on total compensation: projected pay sits below the P25 ($480,161) against a P50 of $563,750, and the $22/unit marginal rate is the lever holding it there. Bring the percentile gap.
- Treat the non-compete as binding — Florida's statute is strongly employer-favorable, and a physician non-compete in the 5–15 mile range generally tends to stand. The leverage is contractual, not judicial: a fixed facility exhibit and a radius inside that range are the asks.
- Do not accept verbal commitments. All PE group agreements must be in writing as formal amendments before signing.
Sequencing
- 1Request a dedicated conversation on the assignment clause before discussing any compensation items
- 2Submit written counter-proposal on assignment (consent required or change-of-control termination right) and tail cap ($25,000 maximum) as a linked package
- 3Once structural protections are accepted, negotiate unit rate and productivity basis together
- 4Address non-compete scope immediately after the structural package — Florida courts typically uphold these restrictions, so the clause binds as written unless it is narrowed before signing
- 5CRNA supervision ratio and scope-of-practice definition are final redline items
Negotiation Priorities
Financial Impact
Protects against involuntary term changes post-acquisition — post-rollup repricing commonly reduces compensation $50,000–$100,000 per year, $150,000–$300,000 over three years.
Current Terms
Contract assignable to any successor without physician consent
The Ask
Physician written consent required for any assignment, OR right to terminate without NC/tail obligation on change of control
Fallback
Right of first refusal to accept the acquirer's offered terms with a 30-day election window, paired with a change-of-control termination right that releases the non-compete and tail obligations if the physician declines the new terms.
Walk-Away Point
Walk away if neither consent nor change-of-control exit right is granted. Signing this clause without protection is the highest-risk act in any PE-backed contract.
Say this
“Before we discuss any compensation terms, I need to address Section 11.3. As written, this contract can be assigned to any successor without my consent, and PE consolidation is the dominant pattern in anesthesia right now. I am asking for a written consent requirement on any assignment, or at minimum a change-of-control termination right that releases the non-compete and tail obligations. Everything else is negotiable once that clause is resolved.”
Financial Impact
$55,000–$125,000 one-time contingent liability reduction at separation — the equivalent of $18,000–$42,000 per year of protection over a 3-year tenure. Florida anesthesia tail at $80K–$150K is the highest in medicine.
Current Terms
Physician solely responsible for all tail costs — no cap
The Ask
Employer provides or pays for tail coverage, OR physician responsibility capped at $25,000
Fallback
Physician responsibility capped at $40,000 with employer funding the remainder, and the physician portion escrowed at hire over a 3-year vesting schedule so the funds are available at departure.
Walk-Away Point
$40,000 physician cap maximum, with employer responsible for the remainder. Above this, the exit cost is prohibitive.
Say this
“Florida anesthesia tail coverage runs $80,000 to $150,000 at major carriers, and this contract places the entire cost on me — including a departure triggered by a sale I did not consent to. I am asking for employer-funded tail on any separation, or a cap on my responsibility at $25,000. This item and the assignment clause are mechanically linked, and I'd like them resolved as a package.”
Financial Impact
Estimated $50,000–$100,000 per year in displaced income and relocation costs if the restriction forces a market change at exit — $150,000–$300,000 over three years. Estimate basis: cost of practicing outside a 25-mile metro footprint, not a computed contract figure.
Current Terms
25 miles from any PE-portfolio facility for 24 months, including facilities added after signing
The Ask
Radius reduced to 15 miles, measured only from a fixed exhibit of facilities where the physician works at signing — no expansion for future acquisitions
Fallback
Fixed facility exhibit listing only the facilities where the physician provides services at signing, with the 25-mile radius retained — any facility acquired later requires a signed amendment to be covered.
Walk-Away Point
Fixed facility exhibit at minimum. Florida law is strongly employer-favorable — do not sign assuming a court will narrow an overbroad clause for you.
Say this
“Florida courts typically uphold physician non-competes in the 5-to-15-mile range; this contract draws 25 miles around every facility in the portfolio, including facilities acquired after I sign. I am asking for a fixed exhibit naming the specific facilities where I work, with the radius reduced to 15 miles. Any facility added after signing should require a signed amendment to fall within the restriction.”
Financial Impact
At 500 units above threshold, the rate increase from $22 to $60 adds $19,000 per year — $57,000 over three years. At 1,000 units over threshold, the gain is $38,000 per year and $114,000 over three years.
Current Terms
$22/ASA unit above 8,500 units billed annually
The Ask
$60/ASA unit above 8,500 units (performed basis)
Fallback
Threshold lowered to 8,000 units with the rate raised to $50/unit — a similar expected-value improvement with a more modest rate ask. Absolute floor: $45/unit above the 8,500-unit threshold.
Walk-Away Point
$45/unit minimum above threshold. Below this, above-median production barely compensates.
Say this
“My projected total compensation lands below the P25 for anesthesiology, and the $22-per-unit marginal rate above the threshold is the reason — at 500 units over 8,500 it adds only about $11,000. I am asking for $60 per unit above the threshold, calculated on performed units, to move pay toward the specialty median.”
Financial Impact
Claim denial rates in Florida anesthesia billing run 5–12%. At a 10% denial rate on 9,000 performed units, roughly $19,800 of bonus disappears each year — about $59,400 over three years.
Current Terms
Productivity calculated on ASA units billed by the practice
The Ask
Productivity calculated on ASA units performed (case logs), with billing records for cross-reference only
Fallback
Billed-unit basis retained, but with a written audit right allowing the physician to compare anesthesia case logs against billing records for any quarter within 60 days of reconciliation.
Walk-Away Point
Performed-unit basis is the market standard. If employer will not change the language, require an audit right over billing records for any quarter within 60 days of reconciliation.
Say this
“Section 5.1 ties my bonus to units billed, which means claim denials and coding corrections — none of which I control — reduce my compensation. Denial rates in Florida anesthesia billing run 5 to 12 percent; at a 10 percent denial rate on 9,000 units, roughly $19,800 of bonus disappears at the contract rate. I am asking for productivity measured on performed units from case logs, with billing records used as a cross-reference only.”
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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