Non-Compete Radius Over 30 Miles
highWhat it looks like:
A non-compete clause that restricts you from working within a geographic radius of the facility after termination.
Why it matters:
Non-competes over 30 miles or longer than 12 months can effectively exile you from your region. In rural areas, even 15 miles can eliminate every hospital.
How to negotiate:
Push for 15-20 miles / 12 months max. In states where non-competes are unenforceable (CA, CO, MN, ND, OK, OR), this clause is void — but the employer may not know that. Some states have specific healthcare worker exemptions.
No Tail Coverage for Claims-Made Malpractice
highWhat it looks like:
Your contract provides claims-made malpractice insurance but doesn't address who pays for 'tail' coverage (extended reporting period) when you leave.
Why it matters:
Tail coverage costs 1.5-2x your annual premium ($5,000-$15,000+). If the contract is silent on tail, YOU pay when you leave — even if they terminate you without cause.
How to negotiate:
Require explicit language: 'Employer shall provide and pay for tail coverage upon termination for any reason.' Or negotiate occurrence-based coverage, which has no tail requirement.
Full Repayment Signing Bonus Clawback
highWhat it looks like:
A signing bonus with a clawback clause requiring full repayment of the GROSS amount if you leave before the commitment period ends — regardless of how long you've worked.
Why it matters:
Full clawback at month 23 of 24 means you repay the entire $30K+ gross amount, even though you only received ~$20K after taxes. This is a financial trap.
How to negotiate:
Always negotiate prorated clawback. Ensure clawback only triggers on voluntary resignation, not termination without cause. Try our Signing Bonus Analyzer to model the real risk.
Vague or Undefined Call Requirements
highWhat it looks like:
Contract says 'call as required' or 'call shared equally' without specifying maximum frequency, compensation rates, or callback minimums.
Why it matters:
Without defined limits, you could end up taking call every other night. 'Shared equally' in a 3-person group means a lot more call than in a 15-person group — and group size can change.
How to negotiate:
Specify: maximum call shifts per month, standby rate ($/hr), callback rate and minimum hours, holiday multiplier, and a mechanism for renegotiating if group size decreases below a threshold.
Termination Without Cause on 30 Days Notice
mediumWhat it looks like:
Employer can terminate the contract for any reason with only 30 days notice, while your resignation notice requirement is 60-90 days.
Why it matters:
This asymmetry means they can fire you with minimal warning while requiring you to give double or triple the notice. In combination with a non-compete, this is devastating.
How to negotiate:
Require symmetry: if they want 90 days from you, they give you 90 days. 60/60 is standard. Some CRNAs negotiate severance (3-6 months base salary) in lieu of longer notice.
No CME Allowance or Time Off
mediumWhat it looks like:
Contract doesn't mention continuing medical education (CME) funding or time off for conferences and courses.
Why it matters:
CPC requires 100 credits per 4-year cycle. Conferences cost $1,000-$5,000+ per event. If the employer provides no CME budget, that's $3,000-$10,000/year out of pocket plus unpaid days off.
How to negotiate:
$3,000-$5,000/year CME allowance is standard. 5-7 paid CME days is standard. Get both in writing — a verbal promise of 'we'll cover it' is worth nothing when you submit the receipt.
PTO Forfeiture on Termination
mediumWhat it looks like:
Accrued but unused PTO is forfeited upon termination, or only paid out on 'voluntary resignation with full notice.'
Why it matters:
If you accrue 4 weeks of PTO and get terminated, that's $8,000-$15,000 in earned compensation that disappears. Some states require PTO payout by law (CA, IL, MA, CO, MT, NE) — check yours.
How to negotiate:
Require payout of accrued PTO upon termination for any reason. If the employer won't agree, negotiate a use-it-or-lose-it cap instead of forfeiture.
Restrictive Non-Solicitation Clause
mediumWhat it looks like:
Contract prevents you from soliciting patients, referring physicians, or fellow CRNAs for a period after leaving.
Why it matters:
A broad non-solicitation clause can prevent you from bringing your established surgical team relationships to a new position. If combined with a non-compete, your professional network is frozen.
How to negotiate:
Limit to active solicitation (not passive acceptance). Remove 'referring physicians' — that's too broad. CRNAs don't 'take patients' like surgeons do. 6-12 months max.
No Disability Insurance Coverage
mediumWhat it looks like:
Contract doesn't include group long-term disability insurance, or provides only basic coverage (60% of base, capped at $10K/month).
Why it matters:
At $250K+ income, a $10K/month disability cap replaces less than 50% of your income. CRNAs have high occupational disability risk. Without own-occupation coverage, any disability that prevents anesthesia work but not other jobs won't qualify.
How to negotiate:
Require own-occupation disability coverage. If the group plan is inadequate, negotiate an additional stipend for individual supplemental coverage ($200-$400/month).
Mandatory Arbitration with Employer-Selected Arbitrator
mediumWhat it looks like:
All disputes must go to binding arbitration, and the employer selects the arbitration firm or arbitrator.
Why it matters:
Employer-selected arbitrators statistically favor the employer. You waive your right to a jury trial, class action, and often to appeal. This tilts every future dispute in their favor.
How to negotiate:
If you can't remove the arbitration clause entirely, require mutual selection of the arbitrator (each party picks one, those two pick a third). Require AAA or JAMS rules. Preserve your right to injunctive relief in court.
Unclear Compensation Structure
mediumWhat it looks like:
Base salary is stated but bonuses, productivity incentives, or RVU targets are 'to be determined' or reference a separate document you haven't seen.
Why it matters:
If 20-30% of your expected compensation depends on bonuses or productivity, those terms need to be defined in the contract. 'As determined by the department' means they can change it anytime.
How to negotiate:
Every compensation component must be in the contract: base, bonus formula, RVU thresholds, call pay rates, and the specific metrics used. Get historical data on what current CRNAs actually earn under the formula.
Automatic Renewal Without Salary Review
lowWhat it looks like:
Contract auto-renews annually with no mandatory salary renegotiation or cost-of-living adjustment.
Why it matters:
After 3 years of auto-renewal with no raise, inflation has effectively cut your salary by 10-15%. New hires may be earning more than you for the same work.
How to negotiate:
Include an annual compensation review clause. Even if not guaranteed, a formal review process with market benchmarking gives you leverage. Tie auto-renewal to satisfactory completion of the review.
Assignment Clause
lowWhat it looks like:
Contract can be assigned to a successor if the practice is sold or merged — with no consent required from you and no opt-out.
Why it matters:
Your contract was negotiated with one employer. If they sell to a private equity firm or merge with another group, your terms may be honored on paper but the culture, expectations, and call burden change dramatically.
How to negotiate:
Require written consent for assignment. Or include a termination right: if the contract is assigned, you can terminate within 90 days without triggering non-compete or clawback provisions.
Scope of Practice Language Too Broad
lowWhat it looks like:
Contract says you'll perform 'anesthesia services and such other duties as may be assigned' or includes administrative responsibilities without defined limits.
Why it matters:
'Other duties as assigned' can mean supervision of CAAs or SRNAs beyond what you agreed to, administrative roles you didn't sign up for, or cases outside your comfort zone (cardiac, pediatric) without the training.
How to negotiate:
Define your clinical scope explicitly. List case types you're expected to cover. If supervision duties are expected, specify the ratio and compensation. 'Other duties' should require mutual agreement.
No Professional Development or Leadership Path
lowWhat it looks like:
Contract is purely clinical with no mention of advancement opportunities, committee participation, teaching roles, or partnership track.
Why it matters:
This isn't a red flag per se — but it signals that the employer views you as a production unit, not a professional. After 3-5 years, you'll want growth opportunities. If they don't exist, you'll leave.
How to negotiate:
For long-term positions, discuss leadership track (chief CRNA, department leadership), quality committee participation, teaching/precepting compensation, and any partnership or equity track if applicable.