The Fine Print That Costs Physicians Their Freedom

For many physicians, the first employment contract feels like a finish line. After years of medical school, residency, and fellowship, finally there’s an offer in hand - a job that promises stability after years of deferred milestones. Signing feels like the symbolic moment when all the sacrifice pays off.

But what looks like stability on the surface can quietly reshape the next chapter of your life. A contract is not simply paperwork; it's the framework that governs where you can live, how you'll be paid, and how much control you have over your own future. Those terms, often hidden in dense legal language, can end up carrying more weight than your title, your department, or even your salary.

I think of one physician I spoke with who accepted a position at a regional hospital in her hometown. On paper, it was everything she wanted: proximity to family, steady pay, and a chance to build her life in the community where she had grown up. What she didn’t realize was that the contract included a sweeping non-compete clause. When the hospital later merged with a larger system and her position was eliminated, she discovered she couldn’t practice within fifty miles. The very job that was supposed to anchor her ended up forcing her away from her family and her patients.

Here are the clauses that can uproot your life

Non-competes are presented as standard, and in legal terms, they often are. But their impact on physicians goes far beyond business competition. A non-compete doesn’t just restrict where you can work; it can determine whether your children stay in the same school district, whether you remain in your support network, and whether patients you’ve built trust with can continue under your care.

Hospitals argue these clauses protect their business interests. But for physicians, the effect is far more personal; it can dismantle an entire community connection. That's why every non-compete deserves scrutiny. If it cannot be eliminated, it should be narrowed. Push for fewer miles, fewer years, and clearer exceptions. If the institution truly values your contribution, they should be willing to adjust. At Tessellate, we tell physicians: if a contract dictates your zip code, it’s not just a job; it’s your life on someone else’s terms.

When productivity isn’t really yours

Compensation tied to productivity often seems fair. After years of being evaluated by exam scores, case numbers, and benchmarks, physicians are accustomed to metrics. Relative Value Units (RVUs) and other formulas are presented as objective, scientific measures of output. On the surface, they feel like a meritocracy: the harder you work, the more you earn.

In practice, the formulas can be anything but clear. Conversion rates shift annually, often at the discretion of the institution, and definitions of what counts toward productivity can change midstream. Incentives may be tied to factors outside your control, from patient mix to scheduling.

I remember a surgeon who described how his second-year compensation fell flat despite working longer hours and taking on more complex procedures. The hospital had quietly changed the RVU conversion rate, and the work he poured in simply didn’t translate to his paycheck. He wasn’t underperforming; the formula was.

Productivity measures are not inherently bad, but vagueness is. Physicians deserve clarity on how formulas are calculated, how often they can change, and who controls the levers. Without that, productivity becomes less about your effort and more about institutional discretion. At Tessellate, we believe that transparency is not a luxury; it’s a foundation for trust.

The exit door that isn’t safe

Perhaps the most disorienting clause physicians encounter is the termination without cause. Tucked away in nearly every agreement is a sentence that seems harmless at first glance: “This agreement may be terminated by either party without cause.”

For a hospital, it’s a safeguard; for a physician, it can be devastating. You could be dismissed at any time, with little warning, despite years of commitment. And the obligations don’t end there; you may still be bound by a non-compete, forced to cover the cost of malpractice tail insurance, or required to repay signing bonuses or relocation stipends.

I once spoke with a hospitalist who experienced this exact scenario. His hospital outsourced staffing to a national group, and his contract was ended abruptly. He was given sixty days’ notice, no severance, and a malpractice tail bill that exceeded his savings. It wasn't just a professional setback but a personal upheaval…and all because of a clause he barely noticed when he signed.

If termination without cause cannot be removed, it must be tempered with fairness. Longer notice periods, severance pay, or liability coverage are not extravagant asks; they're basic protections against the instability that institutions should share, not shift entirely onto physicians.

Beyond the fine print

Hospitals will tell you that these clauses are standard, and they are. But standard does not mean fair, and it certainly doesn't mean you should accept them without question. Every line of a contract is written to protect the institution’s interests. Unless you intervene, the balance of power will remain firmly tilted in their direction.

You didn't spend a decade training, accruing debt, and postponing the rest of your life just to hand over your autonomy in a few paragraphs of legal language. Redlining isn't about hostility; it's about professionalism. It signals that you understand your value, take your future seriously, and expect a partnership built on respect.

At Tessellate, we believe contracts should sustain a physician’s career, not undermine it. They should protect your ability to remain rooted in your community, reflect your worth with transparency, and share the risk of uncertainty rather than placing it all on your shoulders.

So before you sign...pause, ask questions, highlight the lines that compromise your freedom, and demand adjustments. When you do, you're not only protecting yourself, you're raising the standard for every physician who follows.