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Sample Report
Pediatrics Contract — Sample Analysis
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Contract Analysis · Pediatrics — General
sample-pediatrics-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
$151,000 – $244,442
Mid-range: $193,300
Gross $232,000 – $379,842 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.
Take-home after taxes, dependent health premium, and disability supplement runs $151,000–$244,000 on a gross of $232,000 (base only, at P25 production below the bonus threshold) to $380,000 (P75 production). The gross-to-net ratio is 64–65% — favorable compared to high-tax states, reflecting Ohio's modest state income tax and the favorable dependent health coverage.
Executive Summary
This contract presents a $232,000 base salary against a 2025 national general pediatrics P50 base of $228,805 — about $3,200 above median base. Median total compensation for the specialty is $264,322, so the wRVU bonus must carry roughly $32,000 to reach a typical all-in number. The headline rate is competitive for Ohio general pediatrics. The structural issues are around the unbounded volume the contract assigns and the uncompensated work that sits outside the wRVU pool.
The single largest issue is panel size. The contract assigns the physician a primary care panel with no defined cap and no productivity adjustment as the panel grows. 2025 national pediatrics workforce data shows general pediatric panels in employed primary care typically run 1,200–1,800 patients before refill volume, message volume, and form completion become unsustainable. The contract pays the same regardless of whether the panel is 1,500 or 2,500. Practical experience: every quarter the panel grows by 50–80 net new patients without compensation adjustment.
After-hours phone triage is uncompensated. The contract assigns 1-in-5 weeknight phone-call rotation and 1-in-8 weekend phone-call coverage as part of the general professional obligation. Pediatric after-hours phone work is high-volume — fever calls, medication questions, vomiting follow-up — and runs 5–15 calls per night during winter respiratory season. The market structure compensates this work at $300–$500/weeknight call shift or $100–$150/weekend call day. The contract assigns zero.
The productivity bonus threshold sits at 4,400 wRVUs/year — between the 2025 national general pediatrics P25 (4,279) and P50 (5,555), so a typical producer clears it. At median production the bonus is worth roughly $67,000, and the $58/wRVU rate sits just under the national P75 of $59.37 for hospital-employed general pediatrics. The exposure is structural rather than arithmetic: the employer can modify the threshold or the rate on 60 days written notice, and the highest-volume uncompensated work — after-hours phone triage, form completion, panel growth — sits entirely outside the wRVU pool.
The contract also contains a non-compete — 15-mile radius, 12-month duration — with carve-outs for school physicals, sports clearance, and after-hours urgent care. The contract is signable with three changes: panel cap or per-patient overage payment, after-hours phone call compensation, and a quality bonus that the physician can actually influence.
Key Red Flags
- Panel size uncapped with no per-patient overage payment — unbounded growth in message, refill, and form-completion volume at flat pay
- After-hours phone-call triage (1-in-5 weeknight, 1-in-8 weekend) uncompensated — market rate $300–$500/weeknight shift
- Productivity bonus worth roughly $67,000 at median production (5,555 wRVUs) carries no rate protection — employer can modify the 4,400 threshold or the $58 rate on 60 days written notice
- Quality bonus denominator system-wide and uncontrolled by physician — structurally unpayable for a single-physician panel
- NICU weekend coverage (1/month) without subspecialty differential despite higher acuity work
Key Strengths
- Base salary of $232,000 sits just above the 2025 national general pediatrics P50 base of $228,805 — competitive headline rate for Ohio
- Employer-funded claims-made malpractice with tail commitment on without-cause separation
- Non-compete carve-outs for school physicals, sports clearance, and after-hours urgent care preserve income optionality during the 15-mile / 12-month restriction period
Compensation Analysis
MODERATEYour $/wRVU vs the market
Your effective rate of $53.82/wRVU sits at the 63rd 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
Base Salary + wRVU Productivity Bonus
Base Rate
$232,000 / year
Shift differentials: No after-hours phone differential; no NICU weekend differential
wRVU Rate vs Benchmark
2025 national general pediatrics $/wRVU benchmark: P25 $39.73, P50 $47.95, P75 $59.37. The $58 contract rate on above-threshold production sits just under P75 — strong for the specialty. General pediatrics carries the lowest $/wRVU of the major specialty cohorts, reflecting a Medicaid-heavy payer mix, which makes the uncompensated work outside the wRVU pool the real lever in this contract.
Multiplier: $58.00/wRVU · work RVU
Sign-on Bonus
$25,000
3-year linear vest with full repayment if separation in year 1; pro-rata months 13–36
CME Coverage
$3,000/year allowance, 5 CME days
Productivity Bonus
$58/wRVU on production above 4,400 wRVUs/year, paid quarterly in arrears
Net Take-Home
Gross (P25 – P75)
$232,000 – $379,842
Mid: $298,990
Classification
W-2
Drives the expense math
Estimated take-home
$151,000 – $244,442
Mid: $193,300
| Expense line | Annual range | Note |
|---|---|---|
| Federal and Ohio state income tax | $58,000 – $100,000 | Federal marginal 24–32%; Ohio state marginal 3.5–3.99% on the general pediatrics W-2 bracket. |
| Payroll taxes (FICA + Medicare physician portion) | $12,000 – $17,000 | Social Security capped at the annual wage base; Medicare applies to all wages. |
| Dependent health insurance premium (employer pays 60% of dependents) | $8,000 – $13,000 | Above-market 60% dependent contribution from employer reduces this line versus typical 0–50% employer dependent coverage. |
| Disability insurance (own-occupation supplemental policy) | $1,800 – $3,200 | Group LTD covers 60% of base salary only. Own-occupation supplemental is essential for procedural pediatric subspecialties; less critical for general outpatient pediatrics. |
| Professional dues, board recertification, Ohio medical license | $1,200 – $2,200 | Professional society dues, Ohio medical license biennial renewal, DEA renewal, board recertification accruals. |
Assumptions
- Married filing jointly with one dependent on physician's health plan
- No additional W-2 income from spouse
- No 1099 side income or moonlighting
- Employee 401(k) contributions excluded from the net calculation
- Ohio state income tax computed at the 3.99% top marginal rate; figures would differ materially in CA or NY
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
Panel size cap or per-patient overage payment
2025 national pediatrics workforce data shows sustainable general pediatric panels in employed primary care run 1,200–1,800 patients. The contract assigns no cap, and the practice manager will accept new patients as a function of capacity in the schedule, not on a defined panel-size limit. Panel growth of 50–80 net patients per quarter is typical and translates to growing uncompensated workload in messages, refills, results review, and school/sports form completion.
"Add a panel cap of 1,800 patients, OR a per-patient-above-cap payment of $100/year for any patient added beyond 1,500. Either structure ties compensation to workload."
After-hours phone-call triage compensation
The contract assigns 1-in-5 weeknight and 1-in-8 weekend phone-call rotation as part of the general professional obligation. Pediatric phone-call volume during respiratory season (October–March) runs 5–15 calls per weeknight shift and 10–25 calls per weekend day. The work involves clinical judgment under fatigue at high call volume. Market structures compensate at $300–$500/weeknight shift or $100–$150/weekend day.
"Add a phone-call differential: $400 per weeknight call shift (5 PM to 7 AM) and $300 per weekend call day, paid monthly in arrears."
Quality bonus denominator and attribution transparency
The current quality bonus is tied to system-wide pediatric quality metrics with no defined denominator at the physician panel level. The bonus pays only if the entire pediatric service line achieves benchmark — meaning the physician's panel could exceed all targets and still earn zero. The structure is unenforceable in practice for a single-physician panel.
"Restructure the quality bonus: physician earns full bonus if physician's personal panel achieves benchmark on the four metrics most under physician control (well-child visit compliance, immunization completion, ADHD follow-up, asthma medication ratio). Remove the system-wide gate."
NICU coverage differential
The contract assigns 1 weekend per month of newborn nursery and well-baby NICU coverage at base rate. NICU coverage carries materially higher acuity — preterm management decisions, parental counseling on critical care decisions, neonatologist consultation thresholds. Market structures compensate at $500–$750/weekend NICU shift in community hospital settings without dedicated neonatology coverage.
"Add a NICU weekend coverage differential of $600/shift in addition to base salary."
Sports / school physical form completion payment
Pediatric practices generate substantial uncompensated work in school physical forms, sports clearance forms, camp medical forms, daycare forms, and travel medical clearances. Many of these forms require a clinical visit but the form completion itself takes 10–20 minutes of physician time outside the encounter. Market structures pay $25–$50 per completed form.
"Add a forms-completion stipend: $30 per completed school, sports, camp, daycare, or travel medical form, paid quarterly in arrears."
Clause Analysis
""Physician shall be assigned a primary care patient panel by Practice Manager. Panel size shall be determined based on operational capacity in Physician's scheduled clinic time and patient access targets established by Employer. Physician shall accept new patients into panel until Practice Manager closes panel to new patients in writing.""
The clause delegates panel sizing to the Practice Manager with no contractual ceiling and no compensation adjustment as the panel grows. The phrase "patient access targets established by Employer" gives the employer near-total discretion. In real practice, panels grow by 50–80 net new patients per quarter for several years before the Practice Manager closes the panel — typically only after physician burnout becomes operationally evident.
Negotiate a panel cap of 1,800 patients with practice required to close panel in writing once cap is reached, OR a per-patient overage payment of $100/year for any patient added above 1,500. The per-patient overage aligns incentives — Practice Manager is then explicitly paying for additional workload.
""Physician shall participate in the after-hours phone-call rotation on a one-in-five (1:5) weeknight basis and a one-in-eight (1:8) weekend basis, providing telephonic clinical advice to established patients. Phone-call coverage is considered part of Physician's general professional obligation and is not separately compensated.""
Pediatric after-hours phone-call volume in a community pediatric practice with a substantial established panel runs 5–15 calls per weeknight shift during respiratory season and 10–25 calls per weekend day. The work involves clinical decision-making under fatigue at high call volume — fever management, medication questions, vomiting and dehydration triage, behavioral concerns. The clause assigns this work at zero compensation.
Negotiate $400/weeknight call shift and $300/weekend call day. At a 1:5 weeknight rotation (roughly 4 shifts/month) and a 1:8 weekend rotation (roughly 13 call days/year), the ask recovers approximately $23,000/year for work the contract currently assigns at zero.
""Physician shall be eligible for an annual quality bonus of up to five thousand dollars ($5,000), paid annually in arrears, contingent upon Employer's pediatric service line achieving its overall quality benchmark performance for the calendar year, as determined by Employer's quality department in its sole discretion.""
The bonus is gated on system-wide pediatric service line performance, not the physician's personal panel. A physician whose personal panel exceeds all four major quality pediatric metrics still earns zero if the broader service line falls short. The "sole discretion" language compounds the problem — the physician has no audit right and no defined metric. The clause is a phantom bonus.
Restructure to physician-panel attribution: physician earns full $5,000 bonus if physician's personal panel achieves benchmark on four defined metrics (well-child visit compliance, immunization completion, ADHD follow-up, asthma medication ratio). Each metric pays $1,250 independently. Remove the system-wide gate.
""Physician shall provide weekend newborn nursery and NICU coverage on a one weekend per month rotation. Coverage shall be at Employer's primary hospital facility from 7:00 AM to 5:00 PM Saturday and Sunday. Coverage is compensated as part of base salary.""
Newborn nursery rounds are typically lower acuity but the inclusion of NICU coverage materially raises the work intensity. NICU coverage in a community hospital without dedicated neonatology requires the pediatrician to make critical-care decisions on premature infants, manage parental counseling on adverse outcomes, and decide on neonatologist transfer thresholds. Market structures pay $500–$750/weekend NICU shift.
Two options: (a) Negotiate a $600/weekend differential for NICU coverage (~$7,200/year). (b) Limit the coverage to nursery only and exclude NICU consultations, with NICU staffed by neonatology or pediatric hospitalist.
""Employer reserves the right to amend the Pediatric Services Productivity Plan, including the wRVU threshold and the conversion factor, upon sixty (60) days written notice to Physician. Physician's continued employment following the effective date of any amendment shall constitute acceptance of the amended Plan.""
At the 2025 national general pediatrics median of 5,555 wRVUs, the productivity bonus is worth roughly $67,000/year — the largest variable line in this contract. This clause lets the employer reprice that entire line unilaterally on 60 days notice: raising the 4,400 threshold or cutting the $58 conversion factor flows straight through to take-home pay with no physician consent required. The continued-employment-as-acceptance language removes any practical objection mechanism.
Negotiate a floor for the initial term: the wRVU threshold may not rise above 4,400 and the conversion factor may not fall below $58. Fallback: any Plan amendment that reduces projected bonus by more than 10% gives the physician a 90-day right to terminate without cause, with employer-funded tail.
""Either party may terminate this Agreement without cause upon ninety (90) days written notice. Upon separation, Physician shall be responsible for orderly transition of all primary care panel patients to remaining physicians or to an outside referral as appropriate.""
90 days is standard for pediatric primary care. The panel transition language is operationally important — it sets the expectation that physician will engage in orderly handoff, which protects continuity of care for chronic patients (asthma, ADHD, complex medical kids).
No urgent changes. Consider asking for the right to continue care for medically complex patients on a fee-for-service basis post-separation if those patients have not yet been transitioned by the practice.
Non-Compete
MODERATEExists
Yes
Radius
15 miles
Duration
12 months
Governing State
Ohio
Enforceability
Moderately Enforceable
Landmark cases: Castillo-Sang v. Christ Hospital Cardiovascular Associates, LLC (2020, Ohio Ct. App. (1st Dist.)): Non-compete against a rare mitral-valve cardiac surgeon held unenforceable and NOT reformed; court found no reasonable restriction existed and that barring his surgeries would injure the public. 2020-Ohio-6865.
Ohio enforces reasonable physician non-competes (Enforceable, but physician covenants get heightened scrutiny). Treat this as binding and negotiate the scope down now. Your 15 miles / 12 months terms sit within the range Ohio courts have upheld, so a court would likely enforce them — your leverage is to narrow them before signing.
Malpractice Insurance
MODERATEType
claims-made
Coverage Limits
$1,000,000 per occurrence / $3,000,000 aggregate
Tail Coverage
Employer-funded on without-cause termination by employer; silent on voluntary resignation
Tail Cost Estimate
Ohio general pediatrics tail typically runs $12,000–$25,000 under claims-made policies. Lower than procedural specialties but material at job transition.
Extend tail funding to voluntary resignation with 90 days notice. Add consent-to-settle language with reasonableness standard.
Termination Provisions
LOWWithout-Cause Notice
90 days mutual
With-Cause Provisions
For-cause includes: (a) loss of Ohio medical license; (b) loss of hospital privileges; (c) loss of DEA registration; (d) felony conviction; (e) material breach uncured after 30 days notice; (f) loss of board certification in pediatrics.
Physician Rights
Limited. Physician may terminate for: (a) Practice material breach uncured after 30 days notice; (b) sale, merger, or change of control. No express right to terminate for substantial schedule modification, panel-size increase above 2,500, or material reduction in compensation.
Add physician termination rights for: (a) panel size growth above 2,000 patients (above which the contract material breach standard is triggered); (b) substantial schedule modification (>20% clinical time change); (c) NICU coverage volume increase above 12 weekends/year.
Benefits & Leave
LOWHealth Insurance
Group health plan effective first day. Employer pays 85% of physician premium and 60% of dependent premium. Above market for Ohio general pediatrics.
CME
$3,000/year allowance and 5 CME days. Typical for hospital-employed community general pediatrics.
PTO
20 days PTO + 5 sick days + 6 federal holidays + 3 personal days. Standard for hospital-employed pediatrics.
Retirement
401(k) with 4% employer match after 1 year of service. At Ohio market for hospital-employed pediatrics.
Disability
Group long-term disability covering 60% of base salary. Own-occupation supplemental not included.
Malpractice
Claims-made, $1M / $3M, employer-paid during active employment. Tail on without-cause termination only (see Malpractice section).
Negotiation Approach
Lead with panel cap — it is the largest workload lever and the most defensible ask given 2025 national pediatrics panel-size norms. Stack after-hours phone compensation and quality bonus restructuring next. The panel and phone-call asks together represent up to $73,000/year of compensation recovery at a 2,000-patient panel without changing the base salary number — frame them as workload-aligned rather than compensation-increase asks.
Opening Move
Email the recruiter or medical director: "I want to flag three operational items in the contract before signing — panel sizing, after-hours phone call compensation, and how the quality bonus is calculated. I have 2025 national pediatrics data on each. Can we set 30 minutes to walk through?" The framing of "operational items" — not "compensation items" — anchors the conversation in workload sustainability rather than salary negotiation.
Key Principles
- In pediatric primary care, panel size is the largest lever and the easiest to defend with 2025 national pediatrics panel-size norms.
- Frame after-hours phone-call compensation as a market-norm correction, not a salary increase.
- Lead with the workload protections (panel, phone), not the bonus restructuring — they cost the employer the same in dollar terms but feel less adversarial.
- Quality-bonus restructuring is the trickiest because it requires the quality department to engage — sequence after the workload items are anchored.
Sequencing
- 1Email opening with three operational topics
- 230-min call: lead with panel cap, then phone call, then quality structure
- 3Receive counter in writing within 7 business days
- 4One round of refinement; consider walking only if no panel cap or phone-call differential offered
- 5Final redlined contract for execution
Negotiation Priorities
Financial Impact
At 2,000 patients with the $100/patient/year overage above 1,500, recovery is $50,000/year — $150,000 over three years. At 2,200 patients, $70,000/year. The structure aligns workload and compensation.
Current Terms
No cap; panel sized by Practice Manager discretion
The Ask
Hard cap at 1,800 patients OR $100/patient/year above 1,500 patients
Fallback
Panel-size review trigger at 2,000 patients with the panel closed to new patients in writing once reached, plus a $100/patient/year overage payment above 1,800 instead of 1,500
Walk-Away Point
Without a panel cap or overage payment, panel growth is operationally inevitable and structurally uncompensated. Contract is acceptable only with one of the two protections.
Say this
“The 2025 national general pediatrics data shows sustainable employed panels run 1,200 to 1,800 patients, and this contract assigns a panel with no cap and no compensation adjustment as it grows. I'd like a hard cap at 1,800 patients, or a $100 per patient per year payment for every patient added above 1,500. Either structure ties my compensation to the workload the practice assigns.”
Financial Impact
Approximately $23,000/year at the requested rates (about 4 weeknight shifts/month and 13 weekend call days/year) — $69,000 over three years. The fallback rates recover about $16,000/year, or $49,000 over three years. Actual rotation frequency varies with team size.
Current Terms
1:5 weeknight + 1:8 weekend phone-call rotation uncompensated
The Ask
$400/weeknight call shift and $300/weekend call day
Fallback
$300/weeknight call shift and $150/weekend call day — within the market ranges cited in this analysis — with a written rate review after the first October–March respiratory season
Walk-Away Point
Without phone-call compensation, the effective hourly rate for after-hours triage is below comparable urgent-care moonlighting rates. Contract is materially under-compensated without this protection.
Say this
“Pediatric after-hours phone triage runs 5 to 15 calls per weeknight during respiratory season, and the market compensates this work at $300 to $500 per weeknight shift. I'm asking for $400 per weeknight call shift and $300 per weekend call day, paid monthly in arrears. This is a market-norm correction for work the contract already assigns, not a salary increase.”
Financial Impact
If triggered, the lockout puts the full $232,000 base at risk for the 12-month restriction period — relocation, a 15-mile-plus commute, or a year out of the local market. Over three years it also suppresses renegotiation leverage: every $10,000 of base concession made under an enforceable lockout compounds to $30,000.
Current Terms
12-month, 15-mile restriction on outpatient pediatric services, with carve-outs for school physicals, sports clearance, and after-hours urgent care
The Ask
Strike the non-compete entirely; failing that, cut the radius to 8 miles with the existing carve-outs preserved plus an express exemption for any facility where the physician already holds privileges
Fallback
10-mile radius with the 12-month term unchanged, or a defined buyout amount written into the contract that converts the lockout into a priced release
Walk-Away Point
Any expansion beyond the current scope — a radius above 25 miles or a term beyond 24 months exceeds what Ohio courts typically uphold and is career-limiting in any Ohio metro. The existing 15-mile / 12-month terms are signable only if the carve-outs stay.
Say this
“Ohio enforces reasonable physician non-competes, and a 15-mile, 12-month restriction sits within the range Ohio courts have upheld — so I'm treating this clause as binding and negotiating it before signing. I'd like the non-compete struck; if that's off the table, cut the radius to 8 miles and keep the existing carve-outs. Ohio courts apply heightened scrutiny to physician covenants because they affect patients' access to care — a narrower radius protects the practice's legitimate interest without locking me out of the metro.”
Financial Impact
Defensive — under the current structure the bonus is structurally unpayable for a single-physician panel. Restructured to physician-panel attribution, the full $5,000/year is achievable — $15,000 over three years.
Current Terms
$5,000 system-wide pediatric service line bonus, employer sole discretion
The Ask
$5,000 paid as $1,250 per metric for four physician-panel metrics: well-child visit compliance, immunization completion, ADHD follow-up, asthma medication ratio
Fallback
Drop the quality bonus and take a $5,000 base-salary increase instead — the current system-wide structure is unpayable for a single-physician panel.
Walk-Away Point
If employer refuses any restructuring, drop the quality bonus and request a $5,000 base-salary increase to compensate. The current structure is a phantom bonus.
Say this
“The $5,000 quality bonus is gated on system-wide service-line metrics I can't individually move — structurally, it will never pay. I'd like it restructured to four physician-panel metrics at $1,250 each: well-child compliance, immunization completion, ADHD follow-up, and asthma medication ratio. Same dollars, but tied to work I actually control.”
Financial Impact
NICU differential recovers $7,200/year across roughly 12 weekend shifts — $21,600 over three years. Tail extension eliminates a $12,000–$25,000 contingent liability at any separation.
Current Terms
NICU weekend (1/month) at base rate; tail funded only on without-cause employer termination
The Ask
$600/NICU weekend shift; tail funded on any separation except for-cause involving moral turpitude
Fallback
If NICU differential is refused: exemption from the NICU rotation with a $5,000 base increase. If tail extension is refused: a tail-reserve stipend vesting over the contract term.
Walk-Away Point
Either ask alone is acceptable; bundled, they represent meaningful workload-aligned compensation. If NICU coverage is rejected, exempt the physician from NICU rotation in exchange for $5,000 base-rate increase.
Say this
“Two asks that align pay with risk. First, the monthly NICU weekend at base rate — I'd like $600 per shift, about $7,200 a year for the highest-acuity coverage in this contract. Second, tail currently funds only on a without-cause termination; I'd like it funded on any separation except for-cause. That removes a $12,000 to $25,000 contingent liability.”
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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