The passage of the Affordable Care Act (ACA) in 2010 stimulated many things in health care including the looming 2014 mandate for health insurance coverage and state-by-state Medicaid expansion. In addition, the ACA hinted at changes to future payment models in federal health care programs that financially would reward better medical management of patients if such oversight closely monitored hospital stays and effective use of higher cost medical services.

The new jargon in health care delivery became “accountable care organizations” or “coordinated care organizations.” The key to these organizations was control over all of the dollars that flowed into the model to pay for health care. As a result, larger groups and hospitals and even health plans read the tea leaves and began a frenzy of buying up physician practices as one way to control costs.

Many physicians in a post-ACA world found themselves in the position of merging or selling their practices to larger groups or hospitals. Much of the merging or selling seemed to be based upon the perception that the individual physician could no longer make it on their own, that is, the industry had become too complex and getting on the bus of a larger group or hospital was the only way to stay in the game.

A few physicians who signed on to the lure of easier administration and a guaranteed salary have become a bit disillusioned by the micromanagement of their practices and the strict adherence to what can be demanding performance measures. They also are not that clear on what it meant essentially to sell ownership rights associated with their patients to an employer.

Similarly, some of the larger groups and hospitals that bought practices and started to employ physicians quickly have transitioned through the end of the buying up honeymoon phase as they try to pencil out physician salary and benefit packages in a new era of changing reimbursement models. Notably, the industry has yet to experience or even predict accurately what 2014 will mean on the insurance front.

As a result, some physicians and organizations are deciding it was a mistake to enter into employment agreements and have started work to terminate the relationships or substantially modify them to change the original employment terms (i.e., reduce compensation). Now that agreements are being dusted off to determine what rights each party signed off on years earlier, physicians mostly are the parties surprised by what they gave up. Some physicians gave up the right to practice locally, some gave up rights to their patient records, and some even gave up the right to tell their patients they were leaving.

The principle of “a contract is a contract” is the basic starting point each side might assert as they negotiate termination rights or modification of existing terms. How strictly an employer will enforce an agreement depends upon what is at stake. If it is the right to maintain relationships with patients, enforcement probably will be pretty strict. Physicians certainly can try to challenge contracts that may contradict licensing and ethical duties. Still, for physicians who sold all of their practice assets, starting over from scratch may be a difficult task.

Are there any lessons learned in this early cycle of undoing employment agreements? Sure, there are many. The primary lesson is an old one though: Understand what you are signing before you sign it. Try to protect those things that are important to you and if it is as simple as writing a letter to your patients informing them you are leaving, write that into the contract so there is no ambiguity.