In 2026, the legal landscape around three specific provisions — restrictive covenants, unilateral termination clauses and RVU threshold structures — is shifting fast enough that contracts signed two years ago may already be out of step with.
1. Noncompete clauses
Arkansas and Wyoming have enacted full bans on physician noncompetes. Oregon voided many physician and healthcare provider noncompete agreements in 2025. Maryland banned them for physicians earning under $350,000 and limited higher earners to one year and 10 miles. Pennsylvania capped enforceability at one year and only if a physician voluntarily leaves. Texas now limits physician noncompetes to one year and a five-mile radius and caps buyout clauses at no more than a physician’s annual salary.
The litigation is accelerating alongside the legislation. A Texas appeals court upheld a noncompete injunction against four CRNAs barring them from practicing within a 20-mile radius of their former workplaces for three years, with the case proceeding to trial June 8. In a separate case, the former COO of Yale New Haven Hospital sued the system for refusing to make nearly $1 million in anticipated post-employment noncompete payments after he resigned and relocated more than 1,000 miles away.
“Noncompetes and the way that they’re used serve as a blanket restrictive covenant for physicians when they sign a contract is really problematic,” Marcelo Hochman, MD, an independent physician and former president of the Independent Doctors of South Carolina, told Becker’s.
2. Unilateral termination clauses
Noncompete clauses are standard in physician contracts, but the termination trigger is one of the most consequential and least-scrutinized terms in the document. Several states have moved to codify protections specifically on this point. Connecticut bars noncompetes if employment is terminated by the employer without cause. Pennsylvania’s 2024 noncompete law goes further, stating the covenant is only enforceable if a physician voluntarily terminates employment, meaning a physician fired without cause cannot be held to the restriction at all. Indiana similarly provides that circumstances of termination may render a noncompete unenforceable if the physician was fired without cause, though the law does not define “without cause,” leaving room for dispute.
3. RVU threshold structures
CMS’s 2.5% efficiency adjustment to non-time-based codes in 2026 reduced wRVUs for procedural and imaging specialties performing identical work to the prior year. For physicians paid on wRVU thresholds, that adjustment, when applied without corresponding changes to contract thresholds, effectively became a pay cut without a compensation renegotiation.
MGMA Government Affairs recommended that practices analyze the reduction to wRVUs for non-time-based codes under the 2026 efficiency adjustment and model both productivity impact and compensation impact. Physicians who signed contracts in 2024 without language addressing how CMS efficiency adjustments affect threshold calculations may have limited contractual protection.
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