Shifting Medical Field Creates Contractual Rift Between Connecticut Hospitals and Doctors

“You have these big systems going around gobbling up smaller practices, and these larger systems are several things,” Pollard said.

“No. 1, they're very well capitalized. Two, they're lawyered up. Three, they're go-ing to protect their interests by any means necessary.”

Even when employers don't want to go after doctors for violating the terms, they often feel they should to avoid setting a precedent, said Maureen Carlson, a partner at Jux Law Firm in Minneapolis who represents employers and employees. “Your previous lethargy can hurt you in any subsequent lawsuit you want to bring forth,” she said.

Carlson said legal disputes over the agreements often can be resolved between attorneys without actually going to court. And many of the disputes, she said, don't involve physicians who work too close to their former employers.

Rather, they're about what doctors are allowed and not allowed to tell patients when they leave a job. “I've seen disputes over wording in a letter, timing of letters, letting patients know what's going on,” she said.

When the disputes do go to court, however, their outcomes can vary largely based on the laws in their particular states, said Robert Horton, head of the labor and employment practice at Bass Berry & Sims. California, for example, generally doesn't enforce noncompete agreements between employers and employees while Tennessee is among the stricter states, he said.

Courts also see disagreements over noncompetes as different from other types of contract disputes, Horton said. In a normal contract dispute, a court tries to decide what the parties intended.

But in disputes over noncompetes, courts often weigh a number of issues, such as whether the business or company trying to enforce the noncompete really needs protection and whether, as the judge concluded in Khurshid's case, enforcing a physician noncompete would affect patient care or access to medical services.

“These are end-of-life patients and continuity of care is crucial to them both emotionally and just to ensure they get the care they deserve,” said Hagerty, Khurshid's lawyer. Neither the practice nor its attorney responded to requests for comment. The case over whether Khurshid's noncompete agreement is valid and enforceable and whether the practice is entitled to any damages is ongoing.

In ruling on the injunction, however, the judge “chose to agree with us that the patients' right to choose to have a physician of their choosing was important and it superseded anything this noncompete may have provided for.”

That's not to say, however, that other judges would agree with that reasoning. “Courts have become more accustomed to enforcing noncompete agreements,” Horton said. “They've become more routine in states where they're enforceable.”