What Is The Best Practice Pact Framework?

Updated

The Best Practice Pact is a framework developed by The Best Practice for establishing a healthy balance between what a medical practice asks of its physicians and what it gives them in return. Its purpose is to turn vague, unspoken expectations into clear, mutual agreements so that physicians and administrators move in the same direction. It is intended for medical practice leaders—the people responsible for physician compensation, retention, and operational performance—rather than for individual physicians negotiating their own contracts.

The problem the framework addresses

The Best Practice's own explanation starts from a familiar pattern: as the business of medicine grows more complex, physicians and administrators end up working in different worlds, with different priorities, pressures, and communication styles. Even when both sides share the goal of providing great care, those differences slow progress, frustrate teams, and undermine financial performance.

Practice leaders tend to see the symptoms rather than the cause:

  • Difficulty recruiting and retaining high-quality physicians
  • Physician compensation models that miss the mark
  • Pressure to deliver clinical and financial results that feel out of reach
  • Untapped potential within the clinical team
  • Resistance to changes everyone knows are necessary
  • Exhaustion from balancing competing priorities

The key insight behind the Pact

The framework rests on an observation The Best Practice says it reached after two decades of working with leaders from more than 100 medical practices across the United States: practices repeatedly invest hope in new physician compensation models, only to find that real change doesn't follow—or that things get worse.

The conclusion is that no compensation model, however sophisticated, can fix deeper operational, financial, or cultural issues on its own. A compensation model needs to sit on a foundation of three things:

  1. Explicit expectations — what the practice actually asks of its physicians, stated rather than assumed
  2. Sufficient resources — the support required for physicians to meet those expectations
  3. Strong leadership — the clarity, fairness, and accountability that successful practices already apply to the rest of their teams

How the Pact works in practice

The mechanism is a shift in the unit of agreement. Instead of a compensation formula handed down to physicians, the Pact frames the relationship as a two-way exchange: what the practice asks of its physicians, and what the practice gives in return. Vague or unspoken expectations on either side become written, mutual commitments.

For example, a practice might move from an unstated assumption that physicians will "help with recruiting" to an explicit agreement: the practice provides protected time and administrative support for interviews, and physicians commit to a set number of candidate conversations per quarter. Both sides can then see whether the exchange is being honored, rather than discovering the mismatch during a compensation review.

The stated goal is alignment—everyone moving in the same direction—rather than a complete overhaul. The Best Practice's framing is that a practice usually needs to reinforce what's working and discard what isn't, not rebuild from scratch.

What the framework is not

  • It is not a compensation formula. The Pact is the foundation the compensation model is built on, not a replacement for one.
  • It is not a one-time document. The emphasis on explicit, mutual agreements implies an ongoing process of clarifying and revisiting expectations.
  • It is not a physician-side tool. The framework is presented to practice leaders as a way to lead physicians with clarity, fairness, and accountability.

Where to go next

The Best Practice offers a Practice Strategy Session as the entry point for leaders who want to apply the framework, alongside advisory services and executive coaching. If you are evaluating whether the Pact fits your practice, the useful first question is whether your current friction comes from a compensation design problem or from unstated expectations and missing resources—the Pact is aimed at the second case, and The Best Practice's position is that the first cannot be solved without it.