What every cardiologist should consider before signing a contract
At ACC.26, the annual conference of the American College of Cardiology (ACC), one of the most heavily attended business sessions focused on the importance of contracts.
The packed room reflected a growing concern among cardiologists about how to evaluate employment contracts and practice opportunities in an increasingly complex healthcare environment, Cathie Biga, MSN, a former ACC president and current president/CEO of Cardiovascular Management of Illinois, explained to Cardiovascular Business.
“We just have not really educated our physicians as well as we should in many areas of the business side of cardiology, with contracts being one of them,” Biga said.
According to Biga, many physicians focus too heavily on compensation before fully considering what type of practice environment best fits their long-term goals.
“Do I want to work in academia? Do I want to look at a private practice? Do I want to be in an employed group?” Biga said, listing different questions cardiologists should be asking themselves. “What does the culture look like? What are my partners like?”
She added that cardiologists should begin evaluating career options early on during their fellowship training and ask strategic questions before ever reaching the contract stage. This is becoming more important as physician staffing shortages in cardiology continue to grow, putting cardiologists in a batter bargaining position.
She emphasized that organizational culture, day-to-day workflow and schedules can ultimately have a greater impact on physician satisfaction than salary alone.
“Sometimes as physicians go through fellowship and training, they sort of think of the contractual dollar amount as opposed to all those other things that are really so important,” Biga explained.
The session generated discussions around contract provisions that many physicians may not fully understand, including termination clauses, malpractice liability and restrictive covenants, commonly referred to as noncompete agreements.
Biga said restrictive covenants remain one of the most misunderstood aspects of physician contracts, because regulations vary significantly from state to state. While there has been discussion nationally in recent years about limiting or standardizing noncompete agreements, Biga said little progress has materialized. As a result, physicians must carefully review how these clauses are structured in their individual states.
She explained that these clauses often have geographic restrictions where a doctor can practice after they leave to limit competition. But may have very different implications depending on where a physician practices. In a densely populated market such as Chicago, for example, she said a five-mile restriction could significantly limit practice opportunities, whereas the same distance in a rural market may have less impact.
“These agreements want to protect a health system and maybe your practice partners, but you don’t want to restrict an individual’s ability to practice,” Biga said.
She also noted that restrictive covenants may become broader or longer when physicians hold equity positions in ambulatory surgery centers (ASCs) or other business ventures tied to the practice.
“As ASCs become more and more relevant and prevalent, your restrictive covenant may be a little wider, longer because of that,” she explained.
Another major topic discussed during the session was physician workload expectations. Many early-career cardiologists expect contracts to define daily schedules and responsibilities in detail, but Biga said contracts generally serve only as legal frameworks rather than operational documents.
“Your workday will not be listed out in the contract,” she said. “Your day-to-day workflow really is between you and your partners.”
That distinction, she said, makes it even more important for physicians to ask direct questions during interviews about call schedules, procedural volume, staffing support and work-life balance expectations before accepting a position.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]