A recent tweet caught the attention of many in medicine:
“Young doctors: Good advice here to limit your exposure to restrictive covenants in employment contracts.”

That single line, brief but critical, speaks volumes. As private practice dwindles and larger systems evolve, employment contracts are becoming harder for doctors to negotiate. But few clauses have more long-term career impact than restrictive covenants, like non-competes and non-solicits. These clauses can seriously limit your freedom to practice and build your career after leaving a job.

The full tweet, posted by Dr. Joseph Marine, continues (in fact, here’s the entire tweet):

Young doctors: Good advice here to limit your exposure to restrictive covenants in employment contracts. Health systems allow you no equity in the practice you build. RCs ensure they keep the goodwill value as well if you leave. They are illegal in 13 states and limited in… https://t.co/9ILiiUoEQd

— Joseph Marine (@DrJMarine) May 26, 2025

Restrictive covenants are contractual terms that restrict your ability to work on your own, join competitors, solicit patients, or practice within a specific geographic region for a defined period after leaving an employer. Common examples include non-compete clauses that prevent you from practicing within a certain radius, non-solicit clauses that bar you from recruiting former patients or colleagues, and “pay-or-pray” clauses that require financial compensation to escape restrictions.

The rules vary depending on where you live. In states like California and Montana, non-competes are banned altogether. Others, like New Jersey and New York, permit them if they are deemed “reasonable” in scope, geography, and duration. But what’s considered reasonable can shift case by case and sometimes, courtroom by courtroom.

Dr. Marine’s warning echoes a broader concern in medicine: restrictive covenants limit more than just your job options. They can fundamentally alter your career trajectory. You might be barred from working anywhere within a large geographic area for a year or more after leaving an employer. Some clauses even prohibit practicing within five miles of any office the employer operates, which in large health systems could cover entire counties or regions.

What makes these restrictions especially concerning is how easily they can be triggered. Many contracts don’t differentiate between being fired, laid off, or choosing to resign. So even if you leave due to a toxic workplace or because your specialty service was discontinued, the covenant may still apply. In other words, your employer can effectively cut ties and still control where you work next.

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The impact extends beyond physicians – it affects patients, too. These restrictions can disrupt continuity of care, preventing patients from following their trusted doctor. The American Medical Association has raised ethical concerns about this, noting that restrictive covenants may prioritize business interests over patient welfare.

Legally, courts typically use a three-part test to determine whether these clauses are enforceable: they must protect a legitimate business interest (like patient loyalty or confidential information), be reasonable in scope and duration, and avoid causing undue hardship for the physician or harming public interest. In practice, this often leads to complex litigation or “blue-penciling,” where courts modify overbroad contracts rather than throwing them out entirely.

Politically, momentum is building to limit or ban non-competes in healthcare. We invited attorney Kyle Claussen (whose profile can be found in our Experts for Doctors Directory) in for a discussion about non-compete clauses recently, after the topic made the news when it seemed like these clauses were being reversed. “Not so quick,” he explained to us in the episode. He’ll be presenting a lecture at our upcoming online Dissecting Healthcare conference, too, so we hope you’ll join us there to hear him speak.

For young physicians, especially those fresh out of training, the stakes are high. You may be eager to land your first job and hesitant to push back on legalese. But this is exactly when you must. A restrictive covenant can shape your entire future. It can prevent you from starting a side gig, going independent, or even accepting a better offer just across town.

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The best protection is preparation. Negotiate before you sign. Insist that restrictions only apply if you’re terminated for cause. Ask to limit the radius to just the office where you worked, not an entire health system. Cap the restriction to six or twelve months. Include clauses that release you if the practice is sold, your service is cut, or your specialty changes.

More importantly, don’t do it alone. Hire a physician-friendly attorney who understands your local laws and can explain your contract in plain terms. Many physicians regret not doing this early on, and pay the price later.

Dr. Marine’s advice is simple, but critical: limit your exposure. These clauses don’t just shape where you can work. They shape how you work. They can stifle momentum, discourage innovation, and prevent you from building the kind of career you envisioned when you entered medicine.

So before you sign: read every clause. Question what doesn’t serve you. Get legal counsel. And plan for the “what if.”

This isn’t about being difficult or ungrateful. It’s about being informed and intentional. Because your career doesn’t belong to the system. It belongs to you.

Own it.