In their haste to start a new career in academic medicine or to accept a long-coveted position at another institution, physicians and researchers often pay far less attention to the details of their employment contracts than they should. Figuring that most such contracts are "boilerplate" documents that cannot be negotiated, many prospective faculty members fail to review the contract from the perspective of how well they are protected not only during employment but in the event they leave the organization.

That oversight, especially when coupled with an inadequately detailed job description, can set the stage for potentially serious issues down the road. To avoid having a dream job turn into a disappointment, physicians should ensure that the employment contract addresses the following issues satisfactorily, in writing:

Job description, duties and protected time. The contract should spell out, in detail, the duties and responsibilities of the position - including a breakdown of how many hours the faculty member is expected to spend on key duties: teaching, research, patient care and clinic work, and committee responsibilities. For example, if the position is largely clinical, the number of weekly clinic sessions - and responsibilities for weekend coverage or indigent care - should be delineated.

The contract also should address the resources available to allow the faculty member to perform those tasks and, more important, how time will be protected for key activities. It's not uncommon for a physician who joins an institution expecting to focus on research to find herself spending two-thirds of her time in the clinic because a faculty member has left. 

Compensation, expectations and productivity. Academic medicine has moved increasingly toward productivity-based compensation and "quantifiable" accomplishments - whether its billings, RVUs (relative value units, multiplied by a dollar conversion factor to become payment amounts), patient volume or collections in the case of clinical work, or grant amounts and numbers of published articles in the realm of research. Institutional expectations regarding research should also include a timeframe. For example, if the junior faculty member is expected to become fully "self-supporting" through grants by the end of the third year, that should be stated clearly in the contract.

Compensation, as well as any variables that might affect compensation in the near or long term, should be well delineated. If failure to meet established goals in increasing clinic volumes or securing grants, for example, will affect salary or delay a raise or promotion, the contract should state that. 

Career advancement opportunities, tenure and entrepreneurial activities. Time to tenure, the promotion path and the opportunities for advancement, as well as the activities or conditions that trigger a status change - from non-tenure track to tenure-track, for example--should be clearly detailed in the body of the contract. Never, never rely on a verbal commitment, cautions Bruce Armon, an attorney with the Philadelphia office of Saul Ewing LLP, who has considerable experience in health law and related contractual issues. "If the career possibilities are in writing there is a much greater likelihood their being enforced than if they were discussed in a conversation or addressed in a side arrangement," Armon said. "If it's an addendum that's not part of the main contract, it might not be enforceable."

If the organization is unwilling to contractually agree to a specific advancement timeline, Armon recommends requesting a contract clause that states something like: "No longer than X years after I start, I shall be informed whether I will be advanced to associate professor."

Finally, the contract should state how entrepreneurial activities and intellectual property will be handled. Some organizations' contracts grant the institution all rights to and revenues from activities or intellectual property developed there, while others allow the faculty member to retain all or partial ownership. There may be room for negotiation in this area, Armon notes, especially if a researcher is being wooed by several academic centers.

Term, termination and "tail" coverage. Few junior faculty members are thinking about their ultimate exit plan when they join an academic medical center. But they should have a clear picture of not only the term of their employment but also the conditions under which they or their employers can terminate the arrangement. That means ensuring that verbiage such as "with-cause" and "without-cause" are clearly defined.

The key here is fairness: If the employer can terminate the faculty member "without cause" by providing a 90-day written notice, the faculty member who decides to leave should be allowed to provide comparable notice. Beware of large disparities between the two notice periods and request a modification if, for example, the employer can give a 90-day notice while the faculty member must provide 180 days' notice.

Junior faculty members should also beware of and request deletion of onerous non-compete clauses - contract provisions that might prevent the departing faculty member from practicing in the same city for an inordinately long period after leaving or deny him or her admitting privileges. Although such clauses have become more difficult to enforce in recent years, they might still have to be fought legally if they're in the contract, which can be an expensive proposition.

Finally, every physician employment contract should provide details on how "tail" professional liability - malpractice coverage that extends to cover lawsuits or claims that arise after the clinician has left the organization - is covered. Most organizations agree to pay for that coverage (which can run well into the five figure range for some specialties), but some do not. Not having such coverage in place could make the leaving faculty member less attractive to a prospective hiring organization.