BOSTON – The key to successful contract negotiations is preparation, according to Ellen Rathfon, senior director of professional advocacy at the American Academy of Physician Assistants.

She offered simple tips to help ensure clinicians start off on a path to a healthy career during a session today at the IMPACT 2014 meeting.

Clinicians should focus job negotiation preparation on three main areas – salary and benefits, malpractice coverage and noncompete clauses, Rathfon explained.

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Salary & Benefits

When evaluating salary and benefit offers from potential employers, be sure to pay close attention to the terms outlining termination policies. For contracts that stipulate “with cause” termination, be sure to ask potential employers to outline allowable causes for termination.

In the case of contracts that contain “without cause” termination, be sure to discuss severance packages and how unused benefits are handled in the event of dismissal.

“Be wary of contracts that allow termination for any reason with short or no notice,” Rathfon said.

Also sure potential employers clearly delineate services to be provided in your contract. This includes duties and responsibilities and encompasses factors such as work hours, work site, on-call duties and how your time will be allocated if you’re being shared among more than one physician.  Now is also the time to discuss if there will be alternate supervisors and if PA coverage is necessary in the event of a vacation.

Ask employers to specify the professional credentials required for a given position and the expected timeframe for you to obtain those credentials.

Other key things to watch out for include situations in which a potential employer seeks to put you in competition with physicians in terms of number of patients seen.

“You don’t want to be competing  with the other providers in the practice, particularly with your supervising physicians. You want to develop a collaborative relationship.”

Malpractice Insurance

Try to request your own malpractice policy whenever possible. Sometimes employers will pay for this because it’s cheaper than adding a new clinician to their coverage, but this isn’t always the case.

The next step is determining what type of malpractice insurance your practice carries – occurrence or claims mad.

“Occurrence coverage is the cleanest coverage. It covers you for the specified period of time indefinitely, but a lot of coverage is claims made. If the employer provides claims made coverage, ask for a tail in the contract,” Rathfon said.

Also look at your malpractice insurance policy and whether it covers legal costs and the liability limits. ”If it’s $1 million to $3 million for the entire practice, that’s not high enough,” Rathfon said.

 Coverage of the legal costs should be above the liability limits. If you have a group policy with your employer, try to remain separate limits of liability if possible.

“Whatever your malpractice insurance coverage is get a copy of it,” Rathofon said. “Either kind is fine, occurrence or claims made, you just need to know which kind you have and get a copy of the policy or at least the declaration page.”

 The declaration page is the cover page and shows the company, the policy number, the dates of the insurance policy and what the coverage includes. “This way if you’re sued years down the road, you will at least know who the covering insurer was and you’ll be able to access that coverage,” she said.

Noncompete Clauses

Typically noncompete clauses are enforceableand Rathfon urges clinicians try to have  potential employers remove such stipulations from contracts.

“My advice is to try to get it removed from the contract if it’s been included. Just ask if they’ll take it out. Tell them most PA contracts don’t have this, physician contracts do,” Rathfon said. “It’s surprising how often they’ll take them out if you just ask.”

If the potential employer will not budge on a noncompete clause, ask them to modify the terms of the clause.  For example, if a contract specifies a clinician only work within a specific location, urge the employer to modify the geographic limits to include a wider area.

“Whatever you do, assume it’s enforceable. Don’t sign a noncompete contract if you don’t think you can live with it,” Rathfon advised.


  1. Rafthon E. “STAT Consult: Preparing for Contract Negotations.” Presented at: AAPA 2014. Boston; May 23-28, 2014.