Dennis Hursh, Esq, on physician employment contracts: a KevinMD subscriber spotlight

Dennis Hursh, Esq is a health law attorney with more than 40 years of experience and the founder of Physician Agreements Health Law, which reviews physician employment agreements for a fixed fee. He has published 27 essays on KevinMD since January 2022 and has been a guest on The Podcast by KevinMD 25 times. Nearly all of that work makes one argument from across the negotiating table: physicians underrate their own value in a country short of doctors, and the contract they sign decides what happens to them when a job goes wrong.

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He published six essays in 2022, seven in 2023, four in 2024, eight in 2025, and two so far in 2026. The early essays introduced his subject, from contract horror stories and academic agreements to the issues women physicians and physicians leaving the military face. The 2023 essays turned to the mechanics of a job: letters of intent, patient contact hours, notice periods, and locum tenens work. Since 2024 he has written mostly about the clauses he sees cost physicians the most, from missing or vague termination provisions to salary caps, work relative value unit (wRVU) thresholds, private equity, and partnership offers, plus one essay on a pediatrician blamed for an electronic medical record (EMR) error.

Dennis Hursh at a glance

27essays on KevinMD

25podcast episodes

January 2022writing on KevinMD since

11questions answered below

Questions Dennis Hursh answers

Should a new physician negotiate a first employment contract?
What happens if a physician contract has no without-cause termination clause?
Can a hospital fire a physician for poor-quality care on a whim?
What happens if a doctor quits without giving the notice the contract requires?
Why do hospital contracts cap physician pay?
How much should a locum tenens physician be paid?
What is a wRVU threshold, and why is it risky for physicians?
What should a physician check before buying into a medical practice?
What happens to an employed physician when private equity buys the practice?
Are hospital chief executives overpaid?
Who gets blamed when an electronic medical record hides a patient’s history?

Should a new physician negotiate a first employment contract?

Yes, Hursh argues, almost always. In “Very rarely, a physician can ask for too much,” January 2024, he repeats that physicians “get 0 percent of what they don’t ask for,” and describes the only offer he had seen withdrawn over a physician’s own requests in 40 years: a candidate who wanted immediate partnership at no cost, among other requests. “Partnership is a rare privilege,” he concludes, “and it is fair to have to earn that privilege.” In “First physician employment agreement mistakes,” October 2025, he writes that young physicians still ask whether they can request even the median signing bonus, when “the competition is over” once an offer is made: “Once a job offer has been made, the physician is now the prize.” The KevinMD record on physician careers collects what physicians themselves say about job offers and contracts.

What happens if a physician contract has no without-cause termination clause?

The physician may not be able to leave without a fight, Hursh has found. In “The legal trap every doctor needs to know before signing a contract,” September 2024, he writes that for over 40 years he assured physicians that “nobody wants to employ a physician who doesn’t want to be there,” and that recent cases proved him wrong. One hospital proposed that a physician leaving in a little over six months pay nearly $400,000, the cost of a locum tenens physician for that time, without subtracting the salary it would save. Another hospital sent the physician’s future employer a letter threatening a lawsuit for tortious interference with contractual relations, and that physician will most likely stay until the contract expires. His lesson is that a contract should let a physician leave before it ends.

Can a hospital fire a physician for poor-quality care on a whim?

Under many first drafts, yes, Hursh warns. In “Doctors beware: How vague contracts put your job at risk,” February 2025, he describes a rural physician threatened with termination for calling out after a death in the family, and an interventional radiologist terminated without warning for wearing a purple flowered lead apron. “A better provision would be one that requires a good-faith, reasonable determination,” he writes. He proposes that a mutually agreeable physician in the same specialty review the practice at the employer’s expense, with a reasonable period, such as 60 days, to correct any problem. Avoiding a hearing that way, he notes, also means the employer is not compelled to report the termination to the National Practitioner Data Bank.

What happens if a doctor quits without giving the notice the contract requires?

More than most physicians expect, Hursh writes. In “What happens if I don’t give the notice required under my physician employment agreement?” July 2023, he explains that even when a contract names no penalty, the employer can sue for its damages, such as the cost of a locum tenens physician minus what the departing physician would have been paid. A former employer can also give a lukewarm recommendation when new hospitals check credentials, send patients a negative notice of the departure, and hold back money it owes, under what he calls the attorney.s Golden Rule: “He who has the gold rules.” His advice: “I generally recommend that the physician continue to work for the entire notice period.” The essay is cited on the KevinMD record on physicians and administrators.

Why do hospital contracts cap physician pay?

Hospitals say the caps are for “fraud and abuse” reasons, Hursh writes, and he calls that position ludicrous. In “Why hospitals are quietly capping top doctors’ pay,” July 2025, he reports a spike in agreements that cap salary plus productivity pay at the 90th, or even the 75th, percentile of a benchmark such as the Medical Group Management Association (MGMA) survey, although by definition 10 percent of physicians earn above the 90th percentile. When a hospital insists on reviewing pay above the cap, he wants the review done by a nationally recognized valuation company, with the physician free to hire one as well: “One side of the transaction should not be able to dictate the price.”

How much should a locum tenens physician be paid?

No less than an employed physician costs, Hursh argues. In “Locum tenens agreements for physicians,” August 2023, he notes that an independent contractor pays the full 12.4 percent Social Security tax that an employer would otherwise split. In “What independent and locum tenens doctors need to know about fair market value,” May 2025, he walks through the federal Stark Law’s definition of fair market value and its test of “commercial reasonableness,” then prices an employed family physician at national median benchmarks: $216.37 an hour once paid time off, benefits at 30 percent, and signing and relocation bonuses are counted, which he treats as the minimum acceptable rate for a family medicine locum tenens physician.

What is a wRVU threshold, and why is it risky for physicians?

It can turn a salary into a loan, Hursh writes. In “wRVU threshold risks in physician contracts,” November 2025, he explains that when pay may be cut or repaid if a production threshold is missed, “the physician does not really have a salary at all,” only a draw against future earnings, although physicians “can only treat patients that present to them.” He often sees thresholds far above median production tied to a median or lower salary. He argues that no physician should face a threshold in the first year or two of practice. He also wants the physician able to confirm the employer’s calculations, with each wRVU credited on the date of service. The essay is cited on the KevinMD record on physician careers.

What should a physician check before buying into a medical practice?

Mostly who really controls the practice and how sound its finances are, Hursh writes. In “What every physician should know before buying into a medical practice,” March 2025, he describes bylaws that gave a founding partner a majority vote, and practices with classes of “junior partners” who carried the risk of ownership with no real say. He wants the buyout price set by the same method as the buy-in price, with purchased shares released as they are paid for. In “The partnership offer that cost her $325,000,” July 2026, he describes a physician who paid over $60,000 for a partnership interest and also agreed to cover all of a $325,000 bonus the two existing partners had declared for themselves, through a pay cut of over $9,000 a month. “Trust but verify,” he advises, and ask to see the partners’ own agreements before joining.

What happens to an employed physician when private equity buys the practice?

The promise of partnership can vanish with the sale, Hursh writes. In “Private practice employment agreements: What happens if private equity swoops in?” August 2025, he describes physicians who accepted below-median pay for years expecting to become owners, only to find their sweat equity is something “that can never be used” once the owners sell. Because buyers price a practice on its revenue, including the employed physician’s, he argues that physician has leverage at the sale, and he usually asks for a contract bonus equal to what the physician would have received as an owner, or the lesser of that amount and a fixed sum. He adds that some physicians he has represented were quite pleased with their private equity owners. The essay is cited on the KevinMD record on private equity and corporate medicine.

Are hospital chief executives overpaid?

Hursh is skeptical of chief executive officer (CEO) pay, and his larger complaint is secrecy. In “Are hospital CEOs overpaid? One lawyer’s skeptical take on executive compensation.” February 2024, he notes one health system CEO reported to have been paid $35.5 million in 2021, while the MGMA survey put median hospital CEO total compensation at $280,437 and the 90th percentile at $605,296, figures he calls “highly suspect.” He found state benchmarks for orthopedic trauma surgeons but none for a chief medical officer. “What frustrates me is the lack of transparency,” he writes. The essay is cited on the KevinMD record on physicians and administrators.

Who gets blamed when an electronic medical record hides a patient’s history?

Too often the physician, Hursh writes. In “EMR errors get blamed on physicians, not systems,” June 2026, he describes a pediatrician who recommended vaccines that a child’s chart said were due, while the earlier vaccination record sat as a document file in the media section of the record system. The health system formally counseled her and was on the verge of placing her in a corrective action program, and she resigned. Because of the covenant not to compete in her contract, he writes, “she will probably never see any of her patients again.” “This was quite obviously a systemic issue,” he writes. The KevinMD record on the electronic health record collects what physicians say about the systems they chart in.

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Hursh has been on The Podcast by KevinMD 25 times, from March 2022, when he asked whether hospitals are evil, to September 2026, when he talked about the pediatrician blamed for a record-system error. Asked for a take-home message in June 2023, he said “don’t sign what’s handed to you,” and in November 2025 he told new physicians to “remember how valuable you are when you’re coming out of school.” On the show he points listeners to his firm, whose fixed-fee contract reviews his essays describe, and he has written a book on negotiating physician employment agreements.

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