Orthopaedic Practices

Contract Negotiations for Orthopaedic Surgeons: Securing Favorable Agreements in 2025

How to navigate payor contracts, hospital agreements, and employment contracts in a competitive environment.

Orthopaedic surgeons in 2025 must navigate increasingly complex contracts that shape their careers and financial stability. Payor agreements, hospital contracts, and employment terms are all shifting due to changes in healthcare policies and economic pressures. A poorly negotiated contract can limit professional opportunities and long-term earnings. A well-structured agreement, on the other hand, provides security and room for growth. Understanding key contract components such as compensation models and malpractice coverage can make the difference between a sustainable career and an unsatisfactory arrangement. Successful negotiations require a combination of strategic thinking and knowledge of industry standards.

Identifying the employer: who holds the reins?

First off, it’s crucial to pinpoint exactly who you’re dealing with. Is it a hospital, a nonprofit foundation, a professional medical corporation, or perhaps a limited liability company? Understanding the organizational structure sheds light on decision-making processes and reporting lines, ensuring clarity on who calls the shots and to whom you’ll be answering.

Clarifying duties, expectations, and on-call obligations

Orthopaedic surgeons should ensure that all professional responsibilities are explicitly stated in the contract. Work hours, required practice locations, administrative duties, and expectations for teaching or research should all be documented. If there are opportunities for additional work such as consulting, expert witness testimony, or moonlighting, it should be approved in writing to avoid conflicts later.

On-call duties, which can significantly impact work-life balance and overall compensation, should also be detailed. Some contracts require covering multiple hospitals or trauma centers without additional pay. If call coverage is included, the agreement should state whether it is compensated separately, how frequently the surgeon is expected to take calls, and whether extra call shifts are available.

Compensation models and financial incentives

Signing bonuses, relocation assistance, and loan repayment incentives may be offered, but these often come with repayment clauses if the contract is terminated early. Some contracts include deferred compensation, which means part of the salary is withheld and paid later. Ensuring transparency in how compensation is calculated, including access to financial records, can prevent disputes down the line.

Benefits and additional income opportunities

A strong benefits package adds substantial value to an employment contract. Health, dental, disability insurance, and life insurance should be clearly outlined. Some employers provide malpractice coverage, but surgeons need to confirm whether this includes tail coverage in case they leave the practice.

Malpractice insurance is one of the most critical components of an orthopaedic contract. Standard policies provide coverage limits such as $1 million per claim and $3 million aggregate per year, but these amounts should be verified. Again, the most important detail to confirm is whether the employer provides tail coverage, which protects the surgeon from claims filed after they leave the job. If the employer does not cover it, tail insurance can be a significant out-of-pocket expense.

Ancillary income opportunities such as ownership in imaging centers, therapy services, ambulatory surgery centers, or real estate investments can enhance long-term financial stability. However, the contract should specify buy-in terms, revenue-sharing models, and potential buy-out costs if the surgeon leaves the group.

Restrictive covenants and termination clauses

Non-compete clauses can severely limit a surgeon’s ability to practice in the same geographic area after leaving a job. Some contracts prohibit practicing within a 50- or 100-mile radius for multiple years, effectively forcing relocation. While non-compete agreements are standard in many states, they may be negotiable, especially in regions with physician shortages.

Termination clauses should also be carefully reviewed. Some contracts allow termination without cause with as little as a 30-day notice, while others require six months or more. Understanding the financial obligations upon termination, including repayment of bonuses, is essential to avoid unexpected costs.

Negotiation strategies and legal review

Before signing any contract, orthopaedic surgeons should research industry benchmarks for compensation, benefits, and contract terms. Organizations such as the American Academy of Orthopaedic Surgeons (AAOS) provide data that can be useful in negotiations.

Hiring a healthcare attorney with experience in physician contracts is one of the best ways to identify potential issues. Legal professionals can clarify vague language, suggest revisions, negotiate on behalf of the surgeon, and secure more favorable terms.

Adapting to shifts in healthcare policy and reimbursement

The financial and regulatory environment for orthopaedic surgery is constantly changing. Value-based care models and bundled payments may impact long-term earning potential. Surgeons should stay informed on healthcare policy trends and advocate for contract terms that protect against sudden changes in compensation or workload expectations.

Contract negotiations checklist

To summarize, this checklist distills the key points from the article into actionable steps for orthopaedic surgeons navigating contract negotiations. Use this quick reference guide to ensure your agreements are fair and aligned with your career goals.