DermatologistsStart with the practice's needs and the role
Begin by writing down what the practice is hiring the provider to do. Identify the expected clinical services, patient volume and days, locations, call or coverage responsibilities, documentation expectations, and any administrative work. A dermatologist joining a medical dermatology clinic may have a different useful schedule from one expected to support procedural services, consultations, or a new site. The agreement should describe a role that fits the practice's actual schedule and services. Put recruitment promises in writing.
Compare those needs with each description of duties. Look for broad phrases such as "other duties as assigned" and ask what they are intended to cover. A general flexibility clause may accommodate ordinary operational changes, but it should not silently authorize a material change in location, workload, specialty focus, or leadership responsibility. Consider whether the practice can assign work consistent with the provider's qualifications and the purpose of the position, and whether a significant change calls for discussion or a written amendment.
Check whether the agreement's schedule can produce the capacity the practice expects. A stated number of clinic sessions is not necessarily the same as a stated number of hours, and neither tells you how much time is reserved for chart completion, meetings, procedures, or administrative work. Clarify who controls template design, how far ahead schedules are set, how holidays and leave are handled, and whether additional sessions are required or voluntary. If the provider is expected to work at more than one site, make the locations and travel expectations understandable.
Match benefits and support to the role as carefully as pay. Confirm how the practice handles paid leave, continuing education and licensing costs, professional liability coverage, tail coverage if applicable, equipment, staff support, and any retirement or health benefits. Verify eligibility rules and whether the agreement incorporates a separate handbook or plan document that controls important details. A promised benefit in a recruiting conversation may not be a contractual entitlement unless it appears in the governing documents.
Test compensation against the business model
Read the compensation section as a calculation, not as a headline. Determine whether pay is salary, production-based, a guarantee with later reconciliation, or a combination. If compensation depends on collections or work units, identify the exact measure, the period used and adjustments, the source records, and the timing of reports and payment. Ask how refunds, payer recoupments, denied claims, credit balances, and services performed near the end of employment affect the calculation. Avoid assuming that "production" has one standard meaning.
Check the mechanics from service to payment. Which entity bills? Does the calculation use charges, allowed amounts, receipts, or another figure? Are procedures credited differently from office visits? How are shared services, incident-to arrangements where applicable and supervision performed by staff treated? Can the provider inspect the underlying reports or submit a question about a calculation? Set a practical process and response window for resolving discrepancies. These details matter because a formula that sounds attractive can yield an unpredictable result when its inputs are unclear.
Model the compensation using the practice's real operating assumptions. Include ramp-up time for payer enrollment and scheduling, expected clinic capacity, payer mix and cancellations lag. Separately calculate the practice's cost of employer payroll taxes, benefits, malpractice coverage and staff. A guaranteed amount may be justified to recruit a provider, but the agreement should explain whether it is recoverable from later production, when reconciliation occurs, and whether any balance can be carried forward or deducted. Confirm deductions and offsets with counsel and payroll professionals.
For an illustrative worked example, assume a provider receives an illustrative annual salary guarantee of $300,000 and then earns 35% of illustrative eligible collections above an illustrative $600,000 threshold, measured over a full year. If eligible collections are illustratively $900,000, the amount above the threshold is illustratively $300,000; 35% of that is illustratively $105,000. The resulting illustrative annual compensation would be $405,000 if the agreement treats the additional amount as payable on top of the guarantee. But if the $300,000 is instead a recoverable draw against total production compensation, the outcome may differ. The labels and arithmetic do not settle the issue: the contract must state whether the guarantee is additional, a floor, or an advance, and how partial years and leave collections are handled.
Make the term and renewal provisions workable
Identify the initial term and how renewal occurs. Some agreements renew automatically unless a party gives notice within a specified window. Others require a new signed agreement. Record the notice deadline in the practice's contract calendar and decide who is responsible for acting on it. Check whether renewal changes compensation or duties, whether amendments must be written, and what happens if the parties are still negotiating when the current term ends.
Read termination rights for both sides and compare them. Determine whether either party can end employment without cause, how much advance notice is required, and whether the practice can waive work during the notice period while continuing or ending pay and benefits. Identify "for cause" grounds and any opportunity to cure a remediable breach. Serious misconduct, loss of a required license, or exclusion from a program may need distinct treatment from a correctable administrative failure. Make sure the agreement explains when termination is effective and what payments remain due.
Plan for the practical handoff. The agreement should address final compensation, accrued leave if applicable, return of property, access to records and systems, cooperation with billing or audits, and the treatment of incomplete work. For a production formula, establish how post-departure receipts for pre-departure services are attributed and when the final report and payment will be issued. Consider whether the provider must remain available for transition questions, how that time is compensated, and what limits apply. These are operational terms with financial effects, not boilerplate to skip.
Restrictive provisions deserve a separate, jurisdiction-specific review. They may concern competition, solicitation of patients or staff, confidentiality, intellectual property, or use of practice information. Read the defined geography, covered activities, duration, triggering events, and exceptions together. Ask how each restriction would apply if the provider is terminated without cause, the practice closes a location, or the role changes. Enforceability varies widely, so neither a broad clause nor a reassuring verbal description should substitute for local legal advice. The owner should understand the business purpose and likely practical effect of every restriction being requested.
Define administrative duties and the authority behind them
Administrative responsibility should be paired with enough authority and time to perform it. If a provider is expected to lead quality meetings, oversee a service line, mentor colleagues, supervise staff, or serve as medical director, state the scope and expected hours. Clarify who provides administrative support, what decisions are delegated, and which matters remain with the owner, governing body, or another designated leader. A title alone does not give someone the power to approve budgets, hire staff, change clinical templates, or bind an entity.
Separate clinical judgment from business authority in the written arrangement. Identify the channels for concerns about staffing and equipment barriers, along with who resolves them. The agreement can explain that the provider is responsible for defined tasks while preserving the practice's authority over business operations. If a committee or board must approve a decision, name the process and identify who has final authority. This reduces confusion when an urgent issue arises or when the provider's and owner's priorities differ.
Check how administrative work affects compensation and productivity measures. If meetings, supervision, recruiting, or leadership duties reduce clinic time, a production formula should not quietly penalize the provider for work the practice requires. Conversely, if the administrative role is paid through a stipend or reduced target, define the amount, the deliverables, review cadence, and what happens if duties are reassigned. Confirm that the arrangement fits applicable rules and the practice's governance documents with counsel.
Reconcile the agreement with entities and payers
Confirm which legal entity employs the provider, which entity bills for services, which entity owns or leases the equipment and space, and which entity pays compensation and benefits. A practice may use related entities for professional services, management, real estate, or staffing. The agreement should identify the actual employer and should not imply that a different affiliate assumes obligations unless that affiliate is properly bound. Verify entity names and signature authority against organizational records.
Compare the agreement's terms with payer enrollment and billing arrangements. The provider's name, credentials, service locations, billing identifiers, and supervision or reassignment arrangements should match the operational setup. A contract cannot by itself make a provider eligible with a payer or authorize billing under an entity's enrollment. Ask the credentialing and billing teams to flag any gap between the planned start date, enrollment status, and the agreement's compensation assumptions. Specify how a delayed enrollment affects duties and pay start of any productivity period.
Review location language against leases and licenses site plans. The right to assign work to a site does not resolve whether the employer has access to that site, whether it is properly enrolled, or whether the provider's professional practice can operate there under local requirements. If the practice anticipates opening, moving, or closing a location, decide how those changes affect the provider's schedule and any restrictive terms. A defined primary site with a clear process for adding locations is often easier to administer than an unbounded location clause.
Finally, compare the agreement with the policies and documents it incorporates. Identify whether a handbook, compensation plan, professional liability policy, benefit plan, or separate confidentiality agreement can be amended unilaterally or takes precedence if terms conflict. Keep a complete signed set of documents and a record of any incorporated version. If a promise matters to the hiring decision, make sure the controlling document contains it and that the employer has authority to make it.
Use counsel to resolve open issues before signature
Send counsel a short issue list with the contract. For each concern, identify the section, describe the business result you need, and ask a focused question. Examples include how a guarantee is reconciled, whether a notice period is mutual, how post-termination collections are calculated, and whether a site assignment conflicts with the intended entity structure. Counsel can then explain the legal effect, identify negotiation options, and flag terms that require coordination with tax, payroll, credentialing, or benefits advisers.
Send counsel the related documents and facts needed to evaluate the agreement. Include the compensation model, organizational chart and payer plan, relevant policies, recruiting promises, and any prior drafts or side letters. Explain what is negotiable and what operational constraint is fixed. Ask counsel to distinguish legal requirements from business choices and to mark ambiguous language that should be revised. If the parties agree to a change, put it into the agreement or a properly executed amendment and do not rely on an informal email or recollection.
Do not sign while material terms remain open or inconsistent. Resolve missing exhibits, undefined compensation inputs, conflicting notice periods, unclear employer identity, and unapproved authority before execution. Confirm who will sign for each entity, when the agreement becomes effective, and which version is final. A clean closing process protects the owner and gives the provider a shared understanding of the job from the outset.
Common mistakes and a closing checklist
Owners often focus on salary while overlooking the workload required to earn variable pay. They may accept an attractive percentage without defining eligible collections, assume that "full time" means a particular number of sessions, or trust a verbal promise about leave or administrative time. Another frequent mistake is treating a standard form as automatically suitable for a dermatology practice, even when the role includes multiple locations, procedures, leadership tasks, or a startup ramp. Review the agreement against how this particular practice will operate.
Other avoidable problems arise after signature. A practice may miss an automatic renewal deadline, change a compensation plan without amending the agreement, assign new administrative work without adjusting time or authority, or discover that the entity named as employer is not the one running payroll. Keep the signed agreement and incorporated documents accessible, assign an owner for renewal and notice dates, and route any material role change through a written review. Documenting administration is part of making the agreement function as intended.
Before signing, use this short action checklist:
- Confirm the duties and schedule workload match the practice plan.
- Verify the compensation formula with sample calculations, clear inputs, reporting access, and a dispute process.
- Check benefits, insurance, expenses, administrative time, and any separate controlling documents.
- Compare the term and renewal provisions, then check that each party has a clear notice period.
- Define delegated duties, decision rights and approvals time or pay attached to administrative work.
- Reconcile employer, billing entity, payer enrollment and locations authority.
- Send counsel a focused list of open issues and the documents needed to answer them.
- Execute the final reviewed version with all exhibits and amendments, then calendar key obligations.
Questions about your own practice? Contact Richard@DoctorsInvestorClub.com.
