Joining a hospital or group: what should I ask before I sign?

Your attorney reads the agreement: pay terms, restrictive covenants, malpractice coverage and what happens if either side ends it. Your accountant looks at the tax: a signing payment, how a buy-in is paid for, and how owner income is taxed. An advisor puts the offer next to the rest of your money: savings, debt, the household budget.

We advise and coordinate with your attorney and accountant. We don't negotiate contracts, value practices or arrange insurance.

Ask whether it's a salary, based on productivity (for example, counted in wRVUs, work relative value units), or a mix. Then ask what can change it, who decides, and how long any fixed amount lasts.

If there's a signing payment or moving allowance, ask what conditions come with it, and whether any of it has to be paid back if you leave early.

To see whether the number is in line, compare it with doctors in your specialty, stage and state. Am I paid fairly? How to compare physician pay

The match depends on the pay it counts. Ask which pay is eligible (base, bonus, call pay, a signing payment), what the match formula is, and how long it takes to vest, meaning to become fully yours.

Ask when you can join, which plans are on offer (a 401(k), 403(b) or 457(b)), and whether the plan will take a rollover from your old one. The IRS doesn't require a plan to accept rollovers, so it's worth asking.

Ask when each benefits election window closes, and whether the disability insurance is own-occupation, meaning it pays if you can't work in your own specialty.

If a hospital offers a 457(b), the kind matters. Should I use my hospital's 457(b)?

This is your attorney's question. Ask what the restrictive covenants cover: where you couldn't practice, for how long, what kind of work, and whether they also limit contacting patients or staff.

Ask what malpractice coverage you'll have. If it's a claims-made policy, tail coverage is what covers claims reported after the policy ends for care you gave while it was in force. Ask who pays for the tail if you leave or the agreement ends, and whether that changes depending on who ends it.

It helps to pull the offer apart. Which amounts are set, which depend on how the practice does, and which are an estimate of what your share is worth? Ownership on paper isn't the same as cash your household can spend.

• The price: what it is, who valued the practice, on what date, and what's included, such as real estate or money the practice is owed.
• Paying for it: a loan, a cut in pay over several years, or cash, and whether you'd be personally liable for any debt.
• What you get: a share of profits, a vote, and any duty to put more money in later.
• The way out: how a buy-out is priced when you leave or retire, and how quickly it's paid.

Your attorney and accountant can take you through the terms. The personal question is what the commitment means for your reserves and your other goals, and that's worth looking at with the real documents in hand.

How we help practice owners

The questions are the same for a hospital, a physician-owned group or a group with outside investors. What differs is where the answers are written: an employment agreement, a benefits plan, an operating or partnership agreement.

More physicians now work in practices owned by hospitals or other organizations rather than by physicians. The AMA found the share of physicians in private practice fell from 60.1% in 2012 to 42.2% in 2024.