Physician Assistant Contract Red Flags to Catch Before You Sign

The most expensive physician assistant contract red flags are claims-made malpractice coverage with no employer-paid tail, a wRVU or productivity bonus with a threshold nobody in the practice actually clears, no paid administrative time for charting, a sign-on bonus with a full clawback rather than a prorated one, and a non-compete written broadly enough to push you out of your own metro area. None of these appear in the offer letter. All of them appear in the full employment agreement, which is why the first thing to ask for is the contract itself, not the salary. This is career coaching, not legal advice, and a health-law attorney should review any contract before you sign.

Red flag 1: claims-made malpractice coverage with no tail

This is the single costliest clause PAs overlook, and it hides behind reassuring language. Most employers do provide malpractice coverage, so "malpractice insurance provided" reads as settled. The question that actually matters is what kind.

Occurrence coverage protects you permanently for anything that happened while you were employed, no matter when the claim is filed. Claims-made coverage only responds while the policy is active. If you leave and a patient files a claim two years later about care you delivered during your employment, a claims-made policy that has since lapsed does not cover you. Closing that gap requires a tail policy, and the premium is often large, sometimes a multiple of the annual policy cost.

What to ask for: occurrence coverage, or an employer-paid tail written into the agreement. A common middle ground is a tail the employer pays down by year of service, for example covering 25 percent for each year you stay, so it is fully covered after four years. Get whichever version you agree on in the contract, not in an email from a recruiter.

Red flag 2: a wRVU bonus with an unreachable target

Productivity bonuses get quoted in interviews as upside, and in a healthy practice they genuinely are. But the threshold, not the per-wRVU rate, decides whether the money exists at all. A generous rate above a target nobody reaches pays exactly zero.

A common PA structure pays a base salary plus a set dollar amount for each wRVU generated above a threshold, often somewhere in the range of 35 to 60 dollars per wRVU, on a formula like actual wRVUs minus the threshold, times the rate, times a payout percentage. Before you judge the rate, ask the one question that settles it: what percentage of the PAs currently in this practice cleared the threshold last year, and by how much? A specific answer is a good sign. Vagueness is the answer. Then check the mechanics:

• Are you measured on wRVUs, on collections, or on visit volume? Collections-based bonuses put the practice billing department between your work and your pay.
• Is the target adjusted for your specialty and patient mix, or is it a flat number applied to everyone?
• How often does it reconcile, and does a shortfall in one period claw back against the next?
• How long is the audit window after the period closes?

What to ask for: a worked example on real numbers, not a formula in the abstract, and a threshold you can see people clearing.

Red flag 3: no paid administrative time

If the schedule books patients back to back with no protected non-clinical time, the charting, refills, prior authorizations, and patient messages get done on your evenings. That is an unpaid extension of your workday, and over a year it is worth real money.

What to ask for: paid non-clinical time written into the agreement, commonly four to eight hours a week. This is one of the more winnable asks in a PA negotiation, because it costs the practice less than a salary increase and it is a schedule decision rather than a budget one. Ask for the hours in the contract, not as a verbal assurance that things are usually manageable.

Red flag 4: a sign-on bonus with a full clawback

Sign-on bonuses are often easier to win than base salary because they are a one-time cost, but nearly all of them carry a repayment clause tied to a service commitment of one to three years. The amount gets negotiated. The repayment terms usually do not, and that is where the trap sits.

A full clawback means leaving one month before the commitment ends puts the entire bonus back on your card. A prorated clawback reduces the obligation by each month you actually work. The difference between those two sentences can be five figures. Remember too that the bonus is taxed as supplemental income the year you receive it, so the amount you would owe back is larger than the check you kept after withholding, which matters when you file the return for that year.

What to ask for: repayment prorated by months worked, and a carve-out so the obligation does not apply if the practice terminates you without cause. If they are ending the relationship, you should not be repaying a bonus for time you were willing to serve.

Red flag 5: a broad non-compete

Non-compete enforceability varies enormously by state, and the landscape is shifting fast. Several states restrict or bar them outright for healthcare workers, and some now cap the buyout or the term. Texas, for example, limited healthcare-practitioner non-competes effective September 2025, including a cap on the buyout. Where they are still enforceable, courts look at whether the radius and duration are reasonable. The practical risk is that a clause written around every location a multi-site group operates can effectively remove you from your entire metro area for a year or two.

What to ask for: narrow the radius to the site where you actually work rather than all locations, shorten the duration, and add a provision that it does not apply if you are terminated without cause. Ask a health-law attorney in your state how the courts there treat these, because the answer genuinely changes the calculation.

Red flag 6: the supervision arrangement nobody planned for

Depending on your state, you practice under a supervising or collaborating physician arrangement. Two questions get skipped: who bears any cost tied to that arrangement, and what happens to your ability to work if your supervising physician leaves the practice. If the answer to the second one is that you stop being able to see patients until a replacement is found, that needs to be addressed before you sign, not during the crisis.

What should I ask for before signing a PA contract?

Ask for the full employment agreement, not just the offer letter. The offer letter has the salary; the contract has the tail obligation, the bonus formula, the non-compete, the clawback, and the termination terms. Read those first. Then pick two or three priority asks, usually base salary, an employer-paid tail, and paid administrative time, and send them in one written message.

Is the salary itself in range?

Benchmark before you respond to any number. The BLS median for physician assistants was about 133,260 dollars a year as of May 2024, with the lowest ten percent under 95,240 and the highest ten percent above 182,200, and the American Academy of Physician Associates reported median PA compensation near 140,000 dollars in 2025. Surgical subspecialties, dermatology, and emergency medicine typically sit above the median, and geography moves it substantially, so pull data for your own specialty, state, and setting rather than anchoring to a national figure.

The order that works

Read the whole contract. Find the tail, the bonus threshold, the clawback, and the non-compete. Benchmark the base for your specialty and state. Pick your top two or three asks and send one warm, specific email. Then pay a health-law attorney to read the final version before you sign, because a flat fee is small next to a two-year non-compete and a tail bill you did not know was coming.

Counteroffer benchmarks the offer, flags which of these terms are in play, and drafts the counter email for you. See how to negotiate a physician assistant contract, or compare it with the nurse practitioner contract negotiation guide if you are weighing an advanced-practice role against another. This is educational career information, not legal, tax, or financial advice.