Physician employment has become the dominant practice model in American healthcare. The majority of practicing physicians are now employed by hospital systems, private equity-backed groups, or multi-specialty practices rather than practicing as independent owners. This shift has made the physician employment agreement one of the most consequential documents in a physician's career, governing not just current compensation but future career mobility, financial liability, and professional autonomy. Despite the significance of these agreements, many physicians sign them with limited negotiation, either because they are eager to begin practice, unfamiliar with the contractual terms, or uncertain about what provisions are negotiable. In fact, most provisions in a physician employment agreement are negotiable, and the terms accepted at signing will define the employment relationship for its duration and, through restrictive covenants, potentially for years after it ends. Compensation Structures and Productivity Formulas Physician compensation arrangements have evolved considerably from simple salary models. Most contemporary employment agreements incorporate some form of productivity-based compensation, often tied to work relative value units (wRVUs) generated by the physician. A base salary with productivity bonus represents the most common hybrid model. The physician receives a guaranteed base salary and becomes eligible for additional compensation when productivity exceeds a specified threshold. The agreement should clearly define how wRVUs are counted, whether the threshold is calculated annually or quarterly, the dollar amount per wRVU above the threshold, and whether the bonus is paid periodically or as a lump sum. Pure productivity models pay physicians entirely based on the volume of work they generate, without a guaranteed base. While these models offer the highest earning potential for productive physicians, they also expose physicians to income variability based on patient volume, payer mix, and factors outside the physician's control such as scheduling efficiency and support staff availability. Physicians should pay particular attention to the collections versus charges distinction. Some compensation formulas are based on net collections, meaning the physician's compensation depends not just on the work performed but on the organization's ability to collect payment. Under a collections-based model, billing inefficiencies, payer disputes, and slow reimbursement cycles reduce the physician's compensation even when productivity is high. Fair market value requirements under the Stark Law and the Anti-Kickback Statute constrain physician compensation arrangements involving entities that refer patients for designated health services. Compensation must be consistent with fair market value for the services actually rendered and cannot take into account the volume or value of referrals. These requirements apply to both the base compensation and any productivity bonuses. Call Obligations and Coverage Responsibilities Call obligations represent one of the most significant quality-of-life factors in physician employment and one of the most frequently under-negotiated provisions. The agreement should specify the frequency and duration of call obligations, whether call is restricted (in-house) or unrestricted (available by phone), compensation for call coverage beyond the standard rotation, and the process for arranging coverage during approved absences. For specialists whose call obligations may include emergency department coverage, the agreement should address the volume and acuity of expected call cases, compensation for procedures performed during call, and the availability of support staff and facilities during off-hours coverage. Cross-coverage obligations, where a physician is expected to cover for colleagues in other subspecialties or at other locations, should be explicitly addressed. Physicians should clarify the scope of cross-coverage expectations and whether additional compensation is provided for coverage outside their primary specialty. Malpractice Insurance and Tail Coverage Malpractice insurance provisions can create significant financial liability for physicians if not properly negotiated. The two primary types of malpractice insurance, occurrence-based and claims-made, create fundamentally different coverage profiles and termination implications. Occurrence-based policies cover incidents that occur during the policy period, regardless of when the claim is filed. These policies provide continuing coverage for events that happened while the policy was in effect, even after the policy expires or the physician leaves the practice. Claims-made policies cover claims that are both made and reported during the policy period. When a claims-made policy terminates, the physician has no coverage for incidents that occurred during the policy period but are reported after the policy ends, unless extended repor