The non-compete is the clause physicians worry about most and negotiate least. That's because it doesn't matter while you are happy in the job. It matters enormously the day the job ends, and by then it's too late.

The three-axis triangle

Every non-compete restricts three things:

  • Geography: a radius (e.g., 15 miles) from defined locations (the main hospital, every facility, every “future” facility).
  • Duration: a time window (e.g., 24 months) after employment ends.
  • Scope: what activity is restricted (“practicing medicine,” “competing specialty,” “any clinical role”).

The wider any one axis, the more restrictive the clause. A 15-mile radius for 1 year on competing specialty only is mild. A 25-mile radius for 3 years on “any clinical role from any facility” is a career restriction.

What's enforceable in 2026

Enforceability varies wildly by state. A few patterns:

  • California, North Dakota, Oklahoma: non-competes are largely unenforceable for physicians. The clause is in the contract because the employer is national, but it likely won't hold up.
  • Most states: enforceable if “reasonable.” Reasonableness is fact-specific, and the burden is usually on the employer to prove it.
  • FTC rule (2024): federal restriction on most non-competes is in legal limbo. Don't rely on it. Negotiate as if your state law applies.
The biggest mistake we see: physicians assume a non-compete won't be enforced and sign it without negotiating. Then the employer sues for an injunction, and even if the physician eventually wins, the legal bill is $40k-$150k and the new job evaporates.

What's negotiable

All of it. In order of how easy each is to move:

Easy: radius

Going from 25 miles to 10 miles is often a layup. Hospitals push the bigger number first because most physicians don't push back. A 5-10 mile radius in an urban specialty market is usually fine; you can switch employers without leaving the city.

Medium: duration

Two years is standard, one year is reasonable, three years is aggressive. Negotiating from 24 months to 12 months is a winnable fight in most specialties.

Harder but possible: scope

“Any clinical role” should be narrowed to “practicing the same subspecialty in a competing facility.” This protects the employer's actual business interest (your patient relationships) without locking you out of unrelated work.

The carve-outs that matter

  • Termination without cause = no non-compete. If they fire you without cause, the restriction should drop. This is fair and increasingly standard.
  • Buyout option. Some contracts allow you to “buy out” the non-compete for a fixed sum (often a year of base salary). Negotiate to know the number up front.
  • Defined locations only. The radius should run from the specific facilities listed in the contract, not from “any current or future facility owned by Employer.”

The before-you-sign checklist

  1. What is the radius, in miles?
  2. From which specific locations?
  3. For how long after termination?
  4. What activities are restricted?
  5. Does the restriction apply if I'm terminated without cause?
  6. Is there a buyout, and if so, how much?

If you can't answer all six from your offer letter, the clause is too vague. Vague non-competes get litigated, and litigation is the worst place to find out what your contract meant.

Already signed something you're worried about? We can review it and walk you through the realistic enforcement risk and what to renegotiate at renewal. Book a free call.