How do I read a noncompete when I do not own the OR and the hospital system owns half the metro?

For an anesthesiologist, a noncompete is a map. You cannot take the OR with you, and your patients do not follow you across town. So the covenant controls where you are allowed to work next. Read it like a map, because that is what it is.

Part of the Anesthesiology New Attending hub.

Start with the radius, then count the jobs

A 15 mile radius sounds small. In a metro where one system dominates, a 15 mile radius can cover most of the jobs in town. So count the jobs. The miles do not tell you much.

They read "15 miles" and think it sounds reasonable. Then they realize that within those 15 miles sit eight of the ten hospitals that employ anesthesiologists in the metro. The real limit is the job market inside the radius.

Find where the radius is measured from

In anesthesia, covenants often run from the group's sites, not from your home and not from the hospital where you spend most of your time. If the group staffs a lot of sites, draw a circle around every one of them. Count the sites. Then look at how the circles overlap.

For a group that covers most of the hospitals and surgery centers in town, the combined map can take in nearly the whole metro. Each site gets its own circle. The circles overlap. What looked like a 15 mile restriction becomes a metro wide one. Ask for the site list and map it yourself.

Check duration and scope

How long does it last? And what counts as competing? Some covenants block you from practicing anesthesia anywhere in the zone. Others only block you from working for a direct competitor of the group. That one wording choice changes your options a lot.

A two year, 15 mile, any anesthesia practice covenant is a much bigger deal than a one year, 10 mile, direct competitor only covenant. Read both dimensions. Duration sets how long you would need to sit out or relocate. Scope sets what counts as a violation.

Negotiate carve outs

The most useful ask is usually a carve out, which is an exception written into the covenant. Three are worth asking about.

Hospital employment, so that if a hospital in the zone hires anesthesiologists directly, you can take that job. Academic posts, so you can join a university department without breaking the covenant. And specific facilities, where you name a hospital or surgery center you would want to be able to work at no matter what.

It is also fair to ask whether the covenant applies if they terminate you without cause, or if the group loses its hospital contract. A covenant that survives a termination you did not choose is a rough deal, and it is worth raising before you sign, while they still want you.

Check your state

Whether a noncompete is enforceable depends on your state, and that is a question for a contract attorney. In some states, physician noncompetes are restricted or void. In others, they are routinely enforced. Check your state, because it changes the entire analysis.

Where the covenant is allowed, plan as if they will try to enforce it. Then ask yourself whether you could live inside that map if this job does not work out, because that is the scenario the covenant is written for. If the answer is moving your family, you want to know that now.

Framework box: reading the map