A partner mentions at the Thursday huddle that she has enrolled 40 patients in a vaccine trial. The sponsor pays per subject. The screening visits happen in the practice’s exam rooms, the study product sits in the practice’s refrigerator, the practice’s nurse draws the labs, and the practice’s staff chase the follow-up calls. The check arrives made out to the physician personally. Nobody objects, because nobody has thought about it before, and by the time anyone does the second study is already under way and the objection sounds like an accusation.
Academic and research activity is a whole domain of governance that generic partnership agreements ignore. That is defensible when a practice does none of it. It stops being defensible the moment a sponsor, a medical school, or a residency program sends its first contract—and pediatric practices see all three, because pediatric trials need pediatric panels and pediatric training programs need community sites.
The governing principle is the same one that governs moonlighting and outside directorships, covered in article 39: the practice’s resources are the practice’s, and a partner who commits them commits everyone. So the first provision is an approval gate. Require a partner vote before the practice enters any clinical trial agreement, and set the threshold at the significant-decision tier or above. The vote is not about whether research is worthwhile. It is about what the practice is signing up for—space, staff hours, storage and temperature control, record retention that outlasts the study by years, audit exposure, and the subject-injury and indemnification terms that decide who pays when something goes wrong. Those terms are not administrative boilerplate, and no physician should be agreeing to them alone at the end of a long clinic day.
Then decide the money, in advance and in writing. The default rule that holds up best is that research revenue is practice revenue: per-subject payments, coordinator reimbursements, startup fees, and site stipends all flow to the practice, which is what carried the cost of producing them. Where an individual arrangement is appropriate—a physician’s wholly personal consulting or authorship work, performed outside practice time and without practice resources—the agreement requires disclosure and pricing rather than silence. And the practice’s own billing has to be squared with the sponsor’s budget before the first subject enrolls, because deciding which services are billed to the payer and which the sponsor pays is a compliance determination rather than a bookkeeping preference. Institutional review board oversight, sponsor contracting, and that billing analysis are counsel and compliance work. The partnership agreement’s job is to require that the work happen, and to name who signs off.
Teaching raises a smaller version of the same questions and gets skipped even more often. Decide first whether the practice will host medical students, residents, or fellows at all, as a partnership-level policy rather than an accumulation of individual enthusiasms. Hosting learners is a real cost: precepting slows a clinic session, and a partner who takes three students a year absorbs a production hit her colleagues do not. Then decide where the money lands. Teaching stipends and academic appointment compensation from a school or a program should be assigned by formula—practice revenue with the teaching partner’s schedule adjusted for the time, or individual income with the practice’s resource cost priced and charged back, but one or the other, decided before the first check. Supervision responsibilities get named—which partner is accountable for a given learner, what a resident may document and bill under the practice’s incident-to and teaching-physician rules, and who signs the program’s evaluations—and the practice’s malpractice carrier gets a call before the first learner arrives, confirming that the coverage answers for supervised trainees and learning what the carrier wants documented. That call costs minutes and converts a potential coverage dispute into an underwriting note. The affiliation agreement a school or program sends carries its own indemnification and insurance terms, and those belong in front of the partners rather than in front of whichever physician happened to answer the recruiting email.
Data is where the money moves last and the drafting is thinnest. A practice already owns the clinical templates, protocols, and patient-education materials its partners create in the course of practice, and that ownership language should extend explicitly to what research generates: study datasets, registries, quality-improvement data, de-identified extracts, and anything built on top of them. Say who owns it, who may license it, and who controls commercialization—including the case nobody plans for, in which a partner departs and wants to take the dataset she built with practice patients, practice staff, and practice systems. Sponsor agreements frequently claim broad rights in data and in any resulting intellectual property. Those clauses are negotiable more often than practices assume, and they are unreadable after signature. The agreement should require that any research contract’s data and publication provisions be reviewed against the practice’s own ownership rules before execution, not after.
One legal note belongs on the record without being turned into advice. Compensation flowing to a physician from a research sponsor is a financial relationship, and where that sponsor also supplies products the practice buys or business the practice refers, it gets the same review any other financial relationship gets: the Anti-Kickback Statute’s intent standard, the Stark law’s analysis where designated health services are involved, and the twin gates of fair market value and commercial reasonableness. Whether a specific arrangement fits an exception or safe harbor is a determination for healthcare counsel. What the partnership agreement can require is that the determination be made before the arrangement starts and documented in the compliance file.
Red flags. Trial enrollment that begins without a partner vote. A research stipend treated as personal income, never disclosed, while the practice’s staff and refrigerator carry the study. Data ownership undefined, discovered during a departure or a publication dispute. A teaching stipend routed to one physician while her colleagues absorb the slower clinic. And a sponsor compensation arrangement executed without the legal review its structure required.
Research and teaching create value, and value that nobody has assigned is value everybody will eventually argue about. Assign it while it is still hypothetical.
The default rule that holds up best treats research revenue as practice revenue: per-subject payments, coordinator reimbursements, startup fees, and site stipends flow to the practice, which carried the cost of producing them. Where a physician's wholly personal consulting or authorship work is performed outside practice time and without practice resources, the agreement requires disclosure and pricing rather than silence.
The agreement should require one, at the significant-decision tier or above. The vote is not about whether research is worthwhile but about what the practice is signing up for: space, staff hours, storage and temperature control, record retention that outlasts the study by years, audit exposure, and the subject-injury and indemnification terms that decide who pays when something goes wrong.
The agreement should say. A practice's ownership of clinical templates, protocols, and patient-education materials extends explicitly to study datasets, registries, quality-improvement data, and de-identified extracts, along with who may license them and who controls commercialization. Sponsor agreements frequently claim broad rights in data and resulting intellectual property, and those clauses are negotiable more often than practices assume.
The Partnership Agreement Analyzer scores an existing agreement against the framework this series is built on — or schedule a discovery call to work through it with PMI. The full framework, with the arithmetic, lives in the textbook Pediatric Practice Management: The Fundamentals.