The IPM Glossary

Two different ways the IRS sees your income. W-2 means you're an employee — taxes withheld, benefits offered, employer controls how the work gets done. 1099 means you're an independent contractor — you control the work, you pay your own taxes quarterly, you fund your own benefits, and you can deduct legitimate business expenses.

W-2 trades dollars for predictability. 1099 trades predictability for control. Neither is better. The IPM physician knows when to use each.

A flat payment some assignments offer for showing up and being credentialed at the facility — separate from your hourly or daily rate. Sometimes called a "start fee" or "credentialing bonus." Often negotiable. Often forgotten by physicians who don't know to ask.

The clause that lets your employer transfer the contract — including all your obligations — to another entity (often during a merger, acquisition, or PE buyout) without your consent. You signed with one organization. Two years later you're employed by a holding company in another state. The clause made it legal.

Read every assignment clause twice. Then ask for the right to refuse assignment.

What you get paid when you're called in from home during call. Almost always different from your base rate — sometimes a flat fee per callback, sometimes hourly with a minimum, sometimes nothing extra at all if your contract bundles it. The single most-overlooked compensation line in physician contracts.

A malpractice policy that only covers claims filed while the policy is active. The day you leave the job, coverage stops — even for incidents that happened during your employment. To stay covered for prior incidents, you must buy a "tail." See: Tail Coverage.

The hourly or daily rate paid to physicians working assignments outside the W-2 model — typically through agencies or direct contracts with hospitals. Higher than equivalent salaried pay because it carries no benefits, no PTO, no malpractice tail, and no guaranteed pipeline. The number that funds independence — once you understand its true cost and true upside.

A high day rate isn't a high effective rate. Subtract self-employment tax, retirement funding, health insurance, and travel before you compare.

A contract provision that prohibits you from practicing medicine within a defined geographic radius for a defined time period after you leave. Standard ranges: 5–50 miles, 1–3 years. Enforceability varies wildly by state — some states (like California) refuse to enforce them at all; others enforce them aggressively.

A non-compete is a tax on your future autonomy. Always negotiate the radius. Always negotiate the duration. Always know your state's law before you sign.

A malpractice policy that covers any incident that occurred while the policy was active — regardless of when the claim is filed. No tail needed. More expensive on the front end. Cleaner on the back end. The format independent physicians often prefer when they can get it.

The umbrella legal term for any contract clause that restricts what you can do after the contract ends. Includes non-competes, non-solicitation (you can't recruit former colleagues or patients), and non-disclosure (you can't reveal trade secrets — sometimes defined absurdly broadly).

An insurance policy you buy when leaving a claims-made malpractice plan to cover any claims filed after you leave for incidents that happened before you left. Often costs 150–300% of your annual premium — a five-figure expense, sometimes six. Always ask: who pays the tail when I leave?

The answer to "who pays the tail" reveals more about your contract than any other single question.

Work Relative Value Unit — a measure of physician work assigned by Medicare to every billable service. Productivity-based contracts pay you a dollar amount per wRVU you generate (e.g., $55 per wRVU). The number that turns your time into a transaction.

Know your wRVU rate. Know your annual wRVU output. The product is your contract's truth.

The false choice medicine presents physicians: W-2 employment or private practice. Two options. Pick one. The trap is that there have always been more — hybrid arrangements, independent contracts, multi-site practice, partial employment, full independence. The Binary Trap exists because it's easier to recruit a physician who believes there are only two doors.

The first move out of the binary is recognizing the binary.

One employer. One contract. One city. The path medicine chooses for you if you don't choose. It's not bad — it works for many physicians. It becomes the trap when you wake up at year seven and realize you never made the choice. Someone else did. You just signed.

Any sacrifice, assignment, or decision made now that compounds toward the life you're building. The bad week in a small town. The assignment that paid less but taught you the system. The clause you negotiated even though it cost you the offer. Deposits don't feel good. They feel like work. They are work. They become the life later.

Most physicians spend their thirties making withdrawals from a life they never deposited into.

The framework for evaluating any practice arrangement: Autonomy (who controls your time), Stability (how predictable is the income), Flexibility (can you say no), Community (do you have colleagues who matter), Sustainability (can you do this for ten more years). Every job sets the dials somewhere. Most physicians never asked where they wanted theirs.

Five dials. Your settings. Your practice.

The first deliberate move toward the IPM. One call to an agency. One contract reviewed by an attorney. One non-compete renegotiated. One assignment taken outside the system. The first cut is small. Every cut after compounds.

The stability-for-autonomy trade that feels like security until you realize you can't leave. Mortgage on the salary. Lifestyle on the bonus. Kids' schools chosen around the commute. Retention bonus vesting in eighteen months. Every dollar earned tightens the cuff one click. They were always made of gold. They were always cuffs.

Your diagnostic number. A measure of where you stand on the path to work optional — right now, today. Inputs: savings rate, autonomy level, contract leverage, geographic flexibility, time horizon. Output: a single number that tells you how close you are and what to move next.

The Independent Physician Model. The deliberate design of a medical practice that prioritizes the physician's autonomy, time, and life. Not a single arrangement — a posture. The IPM physician may be W-2, 1099, hybrid, or fully independent. What makes them IPM is that they chose. They didn't default.

The IPM is not about quitting medicine. It's about choosing it on your own terms.

A doctor who has deliberately designed their practice rather than defaulted into it. Knows their wRVU rate. Knows their tail policy. Knows their non-compete radius. Knows what dial they're moving next. Doesn't have to be independent to be IPM. Has to have chosen.

The state of practicing medicine because you choose to — not because you have to. Not retirement. Not exit. The arrangement where the work is yours, the schedule is yours, and the option to walk away exists every single morning. The endpoint of the IPM. The reason any of this matters.

Work optional. Life intentional.