Red Flags in ICU Contracts: What Every APP Should Review Before Signing
Landing an ICU position is exciting, but before you sign that contract, pause. Employment agreements in critical care come with unique considerations that can significantly impact your career trajectory, earning potential, and legal liability.
Non-Compete Clauses: The Career Killer
Non-compete agreements are increasingly common in healthcare, and they can severely limit your options if you decide to leave.
What to Watch For:
- Geographic radius: A 50-mile radius in rural Montana is very different from 50 miles in metropolitan areas
- Duration: Anything beyond 12-18 months is aggressive
- Scope: Does it cover all critical care, or specifically your subspecialty?
Negotiation Tip:
Push for carve-outs that allow you to work in different healthcare settings (outpatient, telehealth) or negotiate a buyout clause with a reasonable dollar amount.
Tail Coverage: Don't Get Burned
Malpractice insurance is either "claims-made" or "occurrence-based." If your employer provides claims-made coverage, you need tail coverage when you leave—and it's expensive.
Key Questions to Ask:
- Who pays for tail coverage if you leave voluntarily?
- Who pays if you're terminated without cause?
- What's the estimated cost? (Often 2-3x your annual premium)
Pro Tip:
Negotiate tail coverage as part of your contract upfront. Many employers will agree to pay if you stay for a minimum period (typically 2-3 years).
Collaborative/Supervisory Agreements
For NPs, the collaborative agreement is foundational to your practice. For PAs, supervisory requirements vary by state.
Red Flags:
- Vague language about who your collaborating physician will be
- No backup plan if your collaborating physician leaves
- Unrealistic supervision ratios (one physician "supervising" 8+ APPs across multiple sites)
What You Need in Writing:
- Named collaborating physician(s)
- Clear protocol for collaborator changes
- Defined chart review expectations and meeting frequency
Compensation Structure Pitfalls
Base salary is just part of the equation. Understand the full picture.
Watch Out For:
- RVU-based bonuses with unrealistic targets
- Quality metrics tied to factors outside your control
- Clawback provisions on sign-on bonuses (read the fine print!)
Get Clarity On:
- How bonuses are calculated and when they're paid
- What happens to your bonus if you leave mid-year
- Whether productivity targets are based on historical data or aspirational goals
Schedule and Call Expectations
"Flexible scheduling" means different things to different people.
Ensure the Contract Specifies:
- Expected shifts per week/month
- Call frequency and compensation for call
- Weekend and holiday requirements
- What "extra shifts" pay looks like
Termination Clauses
How easily can they let you go, and what happens if they do?
Look For:
- Without cause termination: 90 days notice minimum is standard
- With cause definition: Should be specific, not vague "conduct unbecoming"
- Severance: Especially important if you're relocating
The Bottom Line
Never sign a contract the same day you receive it. Take it home, read every word, and consider having a healthcare attorney review it. The few hundred dollars for legal review can save you thousands—and years of career headaches—down the road.
At VitalJobs.ICU, we encourage all APPs to negotiate from a position of knowledge. Your skills are in demand—make sure your contract reflects your value.