Noncompetes, private equity, practice succession: What physicians need to know

Physician employment contracts have grown more sophisticated and, in many cases, more standardized as private equity and large institutions expand their footprint in health care, said two attorneys who represent physicians nationally.

Nick R. Masino, Esq., and Mark D. Abruzzo, Esq., are partners at the Pennsylvania-based firm Wade, Goldstein, Landau & Abruzzo, P.C., representing physicians, physician-owned groups and other health care providers on corporate and transactional matters. Masino and the firm's vice president, Robert J. Landau, are scheduled to present "Buy-Ins, Buy-Outs, and Leadership Risk" at the Medical Group Management Association's fall 2026 conference.

Masino, who has practiced law since 2011, and Abruzzo, who has represented physicians since the mid-1980s, met online with Medical Economics to discuss how ownership transitions, noncompete restrictions and private equity are reshaping physician contracts.

Noncompete clauses remain one of the most consequential, and least understood, terms in a physician's contract. State-level restrictions on noncompetes are shifting rapidly, and more states are banning or limiting them for physicians specifically, the attorneys said. Even so, Abruzzo cautioned that a noncompete's mere presence can shape a physician's career decisions long before enforceability is ever tested in court, since few doctors are willing to challenge one.

The two also discussed other contract terms early-career physicians frequently overlook, including notice and termination provisions, repayment obligations tied to signing bonuses and relocation packages that can reach six figures, and tail insurance coverage for malpractice claims. They addressed how private equity's growing role in practice ownership has changed compensation structures and succession planning, particularly for small, independent practices that risk being forced to sell if they lack a successor physician. Masino and Abruzzo also discussed how shrinking recognition of goodwill value, driven partly by the noncompete landscape, is affecting how practices approach partner buy-ins and buy-outs.