What to Know Before Signing an Employment Contract

By: Daniel Winer, Adv. – CheckMyContract

For many doctors making Aliyah, signing a first medical agreement in Israel is both exciting and daunting. While the Israeli healthcare system is professional and well regulated, the legal structure of doctors’ agreements is often unfamiliar to Olim Chadashim. Contracts that appear standard or administrative on the surface frequently contain provisions that materially affect income, liability, flexibility, and long-term career planning.

Drawing on extensive experience reviewing a wide range of medical employment agreements, HMO contracts ( קּוּפַת חוֹלִים (kupát ḥolím)) , and private clinic arrangements for Olim doctors, this article outlines the key issues every doctor should understand before signing.

1. Employee vs. Independent Contractor 

The most important starting point in any doctors’ agreement is whether you are classified as an employee (שָׂכִיר (sakhír)) or as an independent contractor (עַצְמָאִי (atsmá’i)). This classification determines almost every aspect of your rights, obligations, and exposure.

Doctors engaged as employees benefit from Israeli labor protections, including pension contributions, severance pay, paid vacation and sick leave, convalescence pay, and employer participation in National Insurance. Taxes and social contributions are handled by the employer, and compensation is usually paid as a stable monthly salary.

In contrast, many doctors working with Kupat Cholim or in hybrid frameworks are formally engaged as independent contractors. Even where the work environment feels structured and employment-like, the contract may explicitly deny the existence of an employer-employee relationship. In such cases, the doctor must operate as an registered business (עוֹסֵק מוּרְשֶׁה (ósek murshé)) or through a company (חֶבְרָה בְּע״מ (khev-rá be’ám)), issue invoices, manage tax and reporting obligations, and bear greater personal risk. There are no employment benefits, termination protection is limited, and contractual liability is often broader. For Olim, this distinction is frequently underestimated, particularly in the early years after Aliyah.

2. Payment Structures 

Compensation mechanisms in Israeli doctors’ agreements are often complex and highly technical. Unlike standard employment salaries, payment can be calculated based on patients, points, hours, or mixed formulas, and is commonly reconciled on a quarterly basis rather than monthly.

In many Kupat Cholim agreements, doctors are paid per patient per quarter, meaning that multiple visits by the same patient within a quarter may generate payment only once. If a patient sees more than one doctor, the fee may be divided. Other agreements use hourly rates tied to reporting systems or clock-in requirements.

It is also common for payments to be made only after the end of a quarter, sometimes several weeks later. For doctors who are newly settled in Israel, this can create cash-flow challenges. In addition, many agreements include automatic deductions for clinic expenses, maintenance costs, or administrative fees, often without detailed breakdowns. As a result, the headline rate in the contract rarely reflects the net amount ultimately received.

3. Insurance 

While some institutions arrange malpractice insurance on behalf of doctors, the cost is often deducted from the doctor’s compensation. Coverage is usually limited strictly to services provided under that specific agreement and does not extend to private practice, other institutions, or replacement doctors.

Several agreements require doctors to carry high-value insurance policies, sometimes including extended coverage after termination. Importantly, insurance coverage is often conditional on strict compliance with internal procedures and documentation rules. Failure to follow administrative protocols can jeopardize coverage entirely. Olim doctors should always verify coverage directly with the insurer and not rely solely on assurances from the contracting institution.

4. Kupat Cholim vs. Private Clinics 

A key distinction for olim doctors is between Kupat Cholim employment and private practice, which operate under different legal and financial frameworks.

Kupat Cholim agreements are typically standardized, heavily regulated, and institution-driven. The Kupah controls patient access, systems, documentation, pricing structures, and internal procedures. In return, doctors benefit from an established patient base and administrative infrastructure. However, these agreements almost always classify doctors as independent contractors, impose strict reporting obligations, limit private treatment of Kupah patients, and shift significant administrative and legal risk onto the doctor. Income is often capped, deductions are common, and flexibility is limited.

By contrast, private clinic work offers greater autonomy but also greater responsibility. Doctors operating private clinics are fully responsible for regulatory compliance, accessibility requirements, equipment, staff, data protection, and insurance. All operational costs are borne by the doctor, but income potential and flexibility are generally higher. Many doctors combine Kupat Cholim work with private practice, but contracts must be carefully reviewed to ensure this is permitted and properly disclosed.

5. Working in Multiple Frameworks 

Many Olim doctors expect to work across multiple frameworks, such as several Kupot Cholim, hospitals, research institutions, and private clinics. While this is often possible, contracts can impose restrictions that limit this flexibility.

Common provisions include prohibitions on treating Kupah patients privately, disclosure obligations regarding additional work, geographic or temporal non-competition clauses, and requirements for advance approval of outside activities. Although Israeli courts often limit the enforceability of non-compete clauses, their presence still creates contractual and practical risk, especially when linked to liquidated damages. For doctors still building professional networks in Israel, these clauses can significantly affect future opportunities.

6. Personal Liability and Indemnification

A recurring theme across many agreements is the extent to which liability is shifted onto the doctor. Even where systems, clinics, and procedures are dictated by the institution, contracts frequently require doctors to indemnify the Kupah or employer for claims, damages, regulatory penalties, or losses arising from their work.

This includes liability for administrative errors, documentation failures, or procedural non-compliance. For Olim doctors unfamiliar with Israeli regulatory expectations, this can create exposure unrelated to clinical competence.

7. Documentation, Reporting, and IT Systems

Israeli medical agreements place heavy emphasis on documentation and reporting, often through specific internal IT systems. Doctors are required to document all patient interactions in accordance with strict protocols and within defined timeframes. In some agreements, delayed or incomplete reporting leads to reduced payment, fines, or even loss of entitlement altogether.

For many Olim doctors, the administrative burden is greater than expected and contractually treated as a core obligation rather than a technical detail.

8. Absences and Replacement Obligations

Another common provision is the requirement for doctors to manage their own absences. If you are unavailable due to illness, vacation, or reserve duty, you may be required to find an approved replacement doctor, notify the institution in advance, and in some cases pay the replacement yourself, even though the Kupah pays you.

This obligation can be particularly challenging for doctors early in their Israeli careers who have not yet built a wide professional network.

9.  “Entire Agreement” Clauses 

Almost all doctors’ agreements include an “entire agreement” clause stating that the written contract represents the full understanding between the parties. This means that verbal promises, WhatsApp messages, and informal emails have no legal effect unless explicitly incorporated into the contract.

For Olim doctors accustomed to more informal arrangements, this can come as a surprise. Anything important must be written.

10. Additional Hidden Clauses

Several agreements include automatic termination based on age, shortened limitation periods for claiming unpaid fees, or clauses allowing the institution to change rates, locations, or procedures unilaterally. While these provisions are often buried deep in the contract, they can significantly affect long-term planning and financial recovery.

Final Thoughts

Israeli doctors’ agreements are not inherently unfair, but they are highly structured, institution-oriented, and assume familiarity with the local legal environment. For Olim Chadashim, the main risk lies not in medical practice but in contractual blind spots.

Understanding your legal status, payment mechanics, insurance coverage, liability exposure, and professional flexibility is essential. A careful review before signing is a positive step toward building a stable and sustainable medical career in Israel.

If you have any questions, or would like your medical agreement reviewed, you are welcome to contact me on daniel@checkmycontract.org.