<p><em>This analysis synthesizes 3 sources published the week ending Sep 27, 2026. Editorial analysis by the PhysEmp Editorial Team.</em></p>
<p>The sharpest compensation fight this fall is being waged over the contract rather than the salary line: who is allowed to set a physician’s pay, whether a noncompete can hold them in place, and which parts of an offer ever get written down in dollars. A federal bill introduced September 16 would strip management services organizations of authority over physician compensation and void most physician noncompetes. Meanwhile, new job-market data show employers still leave key package components undisclosed. For anyone tracking <a href=”https://www.physemp.com/compensation-demand/”>Physician Compensation & Demand</a>, leverage is migrating from the number on the offer letter to the terms around it.</p>
<p>The stakes are large because the employment base has changed so quickly. According to the bill’s sponsors, more than 80% of U.S. physicians now work for corporate entities, including private equity firms and insurers, up from 62% in 2019. Contracts written for that workforce have become more standardized and more sophisticated, and many of their most consequential terms have little to do with base pay.</p>
<h2>A Federal Bill Takes Aim at Who Sets Physician Pay</h2>
<p>The Stop Corporate Takeovers of Physicians Act, sponsored by Senators Warren, Wyden and Merkley and Representatives Hoyle, Ocasio-Cortez and Subramanyam, is modeled on Oregon’s 2025 law, SB 951. Its core requirement is that any entity owning a medical practice or employing physicians be majority-owned and majority-governed by licensees. Nonprofit and public providers, hospitals, hospital-affiliated clinics, critical access hospitals and rural emergency hospitals are exempt from that prohibition.</p>
<p>For compensation, the most important provision is the ban on de facto MSO control. A management company could not hold final decision-making authority over a practice’s hiring, compensation, staffing, scheduling, revenue targets, coding, billing, pricing or payer contracting. Management fees would have to reflect fair market value as determined by the FTC, and agreements violating these limits would be void.</p>
<p>That targets the mechanism through which many PE-backed platforms shape physician earnings: compensation formulas designed above the practice level, revenue goals that flow down into scheduling, and productivity expectations set by people who never see a patient. The bill separately bars interference with clinical judgment, including dictating visit times and referral patterns. Those are the levers that convert a revenue target into a physician’s daily workload.</p>
<p>Enforcement is built to bite. It includes FTC authority, a private right of action with treble damages, suits by state attorneys general, court-ordered divestiture with disgorgement of revenue, and possible exclusion from federal health programs. Requirements would take effect one year after enactment, and stricter state laws would remain in force.</p>
<p><em><strong>The bill’s exemptions matter as much as its bans. If PE-backed practices were forced to restructure or unwind, the organizations best positioned to absorb those physicians (hospitals and nonprofit systems) are exactly the ones the ownership prohibition leaves untouched. Consolidation would continue; the buyers would change.</strong></em></p>
<p>Near-term passage is unlikely. Every sponsor is a Democrat, and Foley & Lardner’s analysis notes that bipartisan support does not appear to be forming. But the bill codifies a direction states are already taking. California’s SB 351 took effect in January 2026, and the state’s attorney general secured a $4.5 million settlement in June over a friendly-PC arrangement. Connecticut, Pennsylvania and Rhode Island have moved to expand oversight of PE-backed deals.</p>
<h2>Why Unenforceable Noncompetes Still Keep Physicians in Place</h2>
<p>The bill would void noncompetes, nondisclosure agreements and non-disparagement clauses for physicians, with one carve-out. Noncompetes would remain enforceable against owners holding 25% or more of a practice. California, Colorado, Indiana, New Hampshire, Oregon and Washington already restrict physician noncompetes, though the scope varies considerably.</p>
<p>Enforceability has never been the whole story, though. Attorneys who represent physicians nationally told Medical Economics that a noncompete shapes career decisions long before a court ever weighs in, because few physicians are willing to challenge one. The clause works through deterrence. A physician weighing a competing offer across town is usually pricing the cost and disruption of a lawsuit, not the odds of losing it.</p>
<p>That has two consequences for pay. First, where noncompetes weaken, the retention burden shifts to other contract terms. The same attorneys pointed to terms early-career physicians routinely overlook:</p>
<ul>
<li>Repayment obligations tied to signing bonuses and relocation packages, which can reach six figures</li>
<li>Notice periods and termination provisions</li>
<li>Tail coverage for malpractice claims</li>
</ul>
<p>Clawbacks are the obvious candidate to absorb the work noncompetes used to do. Physicians who read them closely have room to push for prorated forgiveness schedules instead of all-or-nothing repayment.</p>
<p>Second, the shift reaches ownership economics. Shrinking recognition of goodwill value, driven partly by the noncompete landscape, is already changing how practices price partner buy-ins and buy-outs. If a departing partner can’t be restrained from competing nearby, the practice’s patient relationships are worth less on paper. That lowers the entry price for incoming physicians and thins retirement payouts for senior partners. It happens at the same moment that independent practices without a successor face growing pressure to sell.</p>
<p>The bill’s 25% ownership threshold would sharpen that split. Noncompetes would become a feature of meaningful equity rather than of employment. Employed physicians would gain mobility, and owner-physicians would have a reason to structure partnership stakes deliberately rather than by default.</p>
<h2>The Package Terms Offers Leave Unwritten</h2>
<p>Rising mobility only helps physicians if they can compare offers, and many packages still don’t state the numbers. Marit Health, which aggregates more than 36,000 crowdsourced physician salaries, found that roughly 70% of physicians report having a CME allowance. Yet only about a third of job listings mention one, and fewer than 7% state a dollar amount. Reported medians run about $5,000 in surgical and hospital-based specialties and $3,000 in pediatrics, psychiatry and nephrology. Rural physicians report medians around $4,800.</p>
<p><em><strong>Nondisclosure buys employers less than they assume. Listings that do publish CME figures tend to land at market medians, so vagueness rarely hides a below-market package. Mostly it removes the employer from side-by-side comparison with competitors that state their terms plainly.</strong></em></p>
<p>The same dataset cites AMGA figures showing clinical compensation up 4.3% in 2026, with about half of that increase tied to higher productivity rather than better reimbursement. When a growing share of each raise must be earned through volume, the non-salary terms carry more weight in separating one offer from another: CME, call, schedule, notice periods and repayment triggers.</p>
<p>Marit’s ranking of 36 specialties on lifestyle factors makes the point concrete. Preventive medicine, dermatology, allergy and immunology, rheumatology and psychiatry score highest on hours, schedule quality and call. Anesthesiology, OB-GYN, critical care, general surgery and neurosurgery score lowest. In those lower-ranked fields, a clearly stated call schedule or forgiveness term can plausibly outweigh a modest base-pay difference. Recruiters working those searches can treat full disclosure as an inexpensive differentiator, since the published figures will match market norms anyway.</p>
<p>The near-term test is less the federal bill, which has no Republican cosponsor, than how quickly additional states follow Oregon and California. Each state that voids physician noncompetes pushes more of the retention burden onto clawbacks and disclosed benefits, and pushes goodwill values lower in partner buy-outs. The open question is how PE-backed groups respond. They could compete with richer, more transparent packages, or they could sell practices to exempt hospital systems better positioned to carry the regulatory risk. The answer will surface in relocation clawback terms and buy-out prices well before it shows up in median salary surveys.</p>
<h2>Sources</h2>
<p><a href=”https://www.foley.com/insights/publications/2026/09/proposed-federal-cpom-legislation-what-the-stop-corporate-takeovers-of-physicians-act-would-mean-for-private-equity-and-mso-based-transactions/”>Proposed federal CPoM legislation: What the STOP Corporate Takeovers of Physicians Act would mean for private equity and MSO-based transactions – Foley & Lardner LLP</a><br />
<a href=”https://www.medicaleconomics.com/view/noncompetes-private-equity-practice-succession-what-physicians-need-to-know”>Noncompetes, Private Equity, Practice Succession: What Physicians Need to Know – Medical Economics</a><br />
<a href=”https://www.tipranks.com/news/private-companies/marit-health-expands-physician-compensation-and-lifestyle-analytics-to-bolster-recruitment-platform”>Marit Health Expands Physician Compensation and Lifestyle Analytics to Bolster Recruitment Platform – TipRanks</a></p>