Residency contract season is in full swing, and early-career physicians are starting to receive the first wave of employment contracts for 2026 (or even 2027) start dates. At the same time, hospitals and private practices are rolling out updated contract templates that reflect a rapidly shifting financial, regulatory, and reimbursement environment.

Across the resident, fellow, and attending agreements I’ve reviewed over the last few months, I’m seeing some trends that I would consider to be red flags.

Whether you are considering an opportunity for your first post-training job or your next step in your career, here are the five contract issues I’m seeing most in 2025 and how you can protect yourself before signing.

1. Inflated wRVU Requirements Supported By Limited Historical Data

Compensation based heavily on wRVU production is not new, but recently I’ve seen wRVU thresholds that lack historical practice data.

I’m seeing:

• Productivity minimums that are increasing 10-20% year-over-year
• wRVU targets that do not match historical volume
• Limited disclosure of what existing physicians actually produce
• Compensation tied to unrealistic benchmarks

Why is this an issue?

You cannot evaluate a wRVU compensation model without understanding:

• Historical wRVUs by similarly situated physicians
• Payer mix and reimbursement rates
• Scheduling limitations
• Staffing levels, ancillary support, and throughput

If a practice expects you to rely on productivity, they should be willing to show you the data that makes the model workable.

What you should request:

“Please provide historical wRVU production data for comparable physicians over the past two years, along with information about schedule, clinic availability, and payor mix.”

If your prospective employer won’t provide this data, you can assume that the targets are likely inflated.

2. Clawbacks That Overreach (Sign-On, Relocation, Bonuses, and Stipends)

I’ve seen many contracts recently that are full of aggressive clawback language, particularly for:

• Sign-on bonuses
• Relocation payments
• Completion bonuses
• Residency/fellowship stipends
• Loan repayment contributions

The problem isn’t the clawbacks themselves, as these are common. The red flag is with how overreaching they’ve become.

Common issues I’ve seen:

• 100% repayment even if you leave on the very last day of the term
• Repayment timelines that extend beyond the initial term (e.g. 3-year repayment for a 2-year term)
• Repayment triggered even if you are terminated without cause
• No prorating
• Repayment required up-front instead of over time
• No exceptions for circumstances outside your control

What to negotiate:

• Prorated repayment over the entire term (monthly is ideal)
• No repayment if terminated without cause
• Clear repayment schedule
• Carveouts for situations beyond your control

You should never be financially punished for an employer’s decision to restructure, downsize, or terminate without cause.

3. Non-Competes That Don’t Match the Market

Non-compete provisions are an unfortunate reality that almost all physicians face, but many of the ones I’ve seen recently are far too aggressive.

Non-competes that are red flags include:

• Geographic scopes that are unreasonably broad for the market
• Restrictions applying to future locations that the employer may open
• Multi-year restrictions that go beyond state law
• Non-competes triggered even when the employer terminates without cause
• Restrictions on ancillary services you don’t even perform

A non-compete must be:

• Reasonable
• Specialty-specific
• Tied to actual locations where you practiced
• Narrow enough to be enforceable

Yet much of what I see today would struggle to survive legal scrutiny. This can still create major leverage against a physician who wants to change jobs.

What to ask for:

“Limit the non-compete to the specific locations where I actually provide services, and limit it to my specialty only.”

And always familiarize yourself with your state’s specific laws on healthcare non-competes.

4. Compensation Models That Shift Financial Risk to the Physician

The most noticeable contract trend in 2025 is the shift toward risk-transfer compensation models. Employers are increasingly structuring pay so that you bear the financial risk of fluctuations in volume, staffing, and reimbursement.

Examples that I’m seeing:

• Lower guaranteed base salaries
• Higher productivity thresholds
• wRVU bonuses that don’t kick in until after a high minimum is met
• Quality or cost-based bonuses physicians cannot control
• Shared savings programs without transparency
• Incentive compensation tied to criteria that may not be achievable, especially as a new physician

The problem:

Your pay is being tied to variables that the employer controls, not you.

If your prospective employer doesn’t guarantee:

• Patient volume
• OR block time
• Adequate support staff
• Clinic access
• Reasonable scheduling

then your productivity-based compensation becomes inherently unreliable.

What to negotiate:

• Minimum guarantees for clinic and OR access
• Historical data to support the compensation model
• A salary floor or reduced target for year one
• Clarity around how bonuses are calculated

If the employer wants a productivity model, they must also provide the infrastructure to allow the required productivity.

5. Overbroad or Vague Termination Clauses (For Cause & Without Cause)

Termination provisions are often the most overlooked part of physician employment contracts, and often the most dangerous.

Common red flags:

• “Cause” defined so broadly it covers almost anything
• No cure period for administrative or minor issues
• Without-cause termination with only 90 days’ notice
• Notice periods that conflict with malpractice tail obligations
• Termination without cause still triggers non-compete enforcement
• Termination without cause still requires repayment of bonuses
• Violation of procedures set forth in external documents considered “for cause” but such documents are not provided despite being material to the contract

A strong termination clause should include:

• A narrow, objective definition of “cause”
• A notice-and-cure period (typically 30 days)
• A reasonable without-cause notice period
• Clear language addressing how termination interacts with clawbacks and non-competes

If things go wrong, termination language will terminate whether you land safely or face serious challenges.

Final Thoughts: Protect Yourself Before You Sign

As residency contract season continues to heat up and employers continue tightening compensation and compliance terms, it’s more important than ever for physicians to understand exactly what they are signing.

Your contract determines:

• Your compensation
• Your mobility
• Your autonomy
• Your risk
• Your long-term career trajectory

A well-reviewed contract is the best return-on-investment a new physician can make.

If you’re a resident, fellow, or attending physician reviewing or negotiating a new contract, feel free to reach out. I review these agreements regularly, and a brief consultation can prevent years of frustration.

I can be reached by email at aapppleberry@tuckerlaw.com or by phone at (412) 594-5532.