Anatomy of a Contract
Knowing what you can and cannot do in radiology contract negotiations may set you up for success
While understanding and negotiating a contract is one of the most challenging aspects of a job search, many radiologists arrive at the table unprepared for either.
More than just stating a salary, a contract governs the entirety of a radiologist’s employment. It dictates everything from how you can leave a job to how you will be compensated. It can even control where you can and cannot work after leaving.
“Employment agreements are usually drafted in the employer’s favor, which is why it is especially important to review the agreement in detail before signing,” explained Katie Rinkus, a senior associate attorney at The Prinz Law Firm in Chicago.
While all employment contracts are state- and situation-specific, and it is always recommended that you contact a licensed and experienced attorney to review any contract before signing, there are a few basics that every radiologist would benefit from knowing.
For instance, what makes a contract a contract?
According to Rinkus, every contract includes an offer, acceptance and consideration, with the latter generally being something of value that is exchanged between the parties. “In an employment contract, consideration takes the form of the employment itself and/or the salary and benefits paid to the employee,” she said.
Beyond stating how much you will get paid, an employment contract should also outline how you will get paid (base salary and/or relative value units) and include any bonuses, allowances and reimbursements.
“If you are paid based on productivity, you should ask the employer for their compensation plan and have them explain it to you in layman’s terms,” Rinkus added. “This will give you a good sense of whether you will be successful under the productivity structure.”
“It’s also important to understand the infrastructure—PACS, reading room support, etc.—as small inefficiencies can quickly affect the radiologist’s bottom line,” added Carrie Anne Orlikowski, MD, JD, diagnostic radiologist at the University of Wisconsin, Madison, and a former attorney.
If You Want It, Ask for It
While salary is important, radiologists should resist the temptation to be completely driven by numbers. “Make sure the promise of a good salary isn’t masking a sub-optimal agreement,” said Kimberly Beavers, MD, a breast imaging radiologist at Brevard Physician Associates in Melbourne, FL, who presented an RSNA 2024 session on contract review and negotiation.
Radiologists should pay particular attention to such terms as time to partnership, clinical and non-clinical duties, subspecialties, termination and renewal, vacation time, sick and parental leave, retirement benefits and expected work hours.
“The contract is presumed to be the entire agreement between the parties,” Dr. Orlikowski explained. “In other words, if it’s not in the contract, it doesn’t exist, so get everything in writing.” If something that you want is not in the contract, ask for it. “Employers, especially with physicians, expect you to negotiate and ask questions,” Rinkus said. “If you don’t, it could reflect poorly on you.”
When negotiating the terms of a contract, one should be friendly and express gratitude for the opportunity, but also clearly state your concerns, questions and, most importantly, expectations.
Other tips for a successful negotiation include opening and closing each step with appreciation and enthusiasm, keeping detailed notes and following up on every conversation with an email summary of agreed on points.
Experience Matters
In Rinkus’ experience, many large hospitals are unwilling to negotiate much of their standard contracts, especially for someone just out of residency or fellowship.
However, a more experienced physician could have more negotiating power. “A seasoned radiologist may also need assistance and counseling with leaving their current position and potentially negotiating a separation or release from their non-compete,” Rinkus said.
Other things to look out for when leaving a job include notice requirements, timing of bonuses and incentive compensation and malpractice insurance. “It’s not unusual for a prospective employer to ask for answers to these questions as they will not want to have a gap in malpractice coverage or a radiologist subject to a non-compete,” Dr. Orlikowski added.
“You may not get everything you want, but if you understand what is expected of you and know what you can—and cannot—do, you will set yourself up for success.”
— KATIE RINKUS
What Can Be Negotiated?
Regardless of one’s experience, Rinkus said she always encourages her clients to negotiate the salary, tail coverage (if applicable), termination notice timeframe, and the scope of any restrictive covenants. “If you are working for a private practice, make sure to ask that they cover tail insurance after you leave,” she said. “Tail insurance can be very expensive, and it is common for the employer to cover, or at least share, this cost.”
She also recommends trying to negotiate a shorter notice period for terminating the contract, which can often be as many as 180 days. Rinkus noted that non-solicitation or non-compete clauses could also be a potential red flag. “Restrictive covenants in physician agreements can be very detailed and confusing, so it is imperative that you understand exactly what you are signing,” she said.
For example, if the agreement limits you from taking a job within 10 miles of the hospital where you work, consider doing an internet search to see what is located within that radius. If there are other hospitals or practices nearby, think about negotiating a smaller geographic area.
It’s important to note that the landscape of non-compete agreements continues to shift, with increased scrutiny from both lawmakers and regulators. In 2024, the U.S. Federal Trade Commission proposed a nationwide ban on most non-compete clauses, while various state-level legal challenges and legislative reforms continue to redefine their enforceability.
“When it comes to contract negotiations, know your bottom line and be willing to walk away if the employer won’t meet it,” Dr. Orlikowski said.
While an attorney familiar with medical contracts can help you get that bottom line, it is generally preferable that this happens in the background.
“Negotiations are your chance, as a potential new employee, to build rapport with the employer,” Rinkus added.
You may also want to inform your potential employer that you are speaking with counsel about the agreement and confirm what their timeline is for responding.
Set Yourself Up for Success
Although there is no such thing as the perfect job, with just a little prep work, you can at least optimize the terms.
“Knowing the basics of contract law will position you to understand and negotiate an employment contract that meets your needs and find a position that you can enjoy,” Dr. Orlikowski said.
“You may not get everything you want, but if you understand what is expected of you and know what you can—and cannot—do, you will set yourself up for success,” Rinkus concluded.
For More Information
Access RSNA career and professionalism resources.
Read about legislative efforts to ban non-compete agreements in the U.S.
Read previous RSNA News stories about career and professionalism: