Document:

<PAGE>
                                                                     Exhibit 4.6

                          FIFTH SUPPLEMENTAL INDENTURE

     THIS FIFTH SUPPLEMENT INDENTURE (the "Fifth Supplemental Indenture") dated
as of September 9, 2003, among TEAM HEALTH, INC., a Tennessee corporation (the
"Company"), CORRECTIONAL HEALTHCARE ADVANTAGE, INC., a Florida corporation,
GREENBRIER EMERGENCY PHYSICIANS, INC., a West Virginia corporation, and THE
CONTRACTING MIDWEST, LLC, a Missouri limited liability company (the
"Guaranteeing Subsidiaries"), all subsidiary corporations of the "Company, the
other Guarantors (as defined in the Indenture, the First Supplemental
Indenture, the Second Supplemental Indenture, the Third Supplemental Indenture
and the Fourth Supplemental Indenture referred to herein) and The Bank of New
York as successor in interest to the United States Trust Company of New York,
as trustee under the Indenture, the First Supplemental Indenture, the Second
Supplemental Indenture, the Third Supplemental Indenture, and the Fourth
Supplemental Indenture referred to below (the "Trustee").

                                   WITNESSETH

     WHEREAS, the Company has heretofore executed and delivered to the Trustee
an indenture (the "Indenture") dated as of March 12, 1999, providing for the
issuance of an aggregate principal amount of up to $100.0 million of 12% Senior
Subordinated Notes due 2009 (the "Notes"); and

     WHEREAS, the Indenture provides that under certain circumstances the
Guaranteeing Subsidiaries shall execute and deliver to the Trustee a
supplemental indenture pursuant to which the Guaranteeing Subsidiaries shall
unconditionally guarantee all of the Company's Obligations under the Notes and
the Indenture on the terms and conditions set forth herein (the "Subsidiary
Guarantees"); and

     WHEREAS, the Company has heretofore executed and delivered to the Trustee
a supplemental indenture dated as of March 28, 2001 (the "First Supplemental
Indenture"); and

     WHEREAS, the Company has heretofore executed and delivered to the Trustee a
supplemental indenture dated as of May 31, 2002 (The "Third Supplemental
Indenture"); and

     WHEREAS, the Company has heretofore executed and delivered to the Trustee a
supplemental indenture dated as of May 31, 2002 (the "Third Supplemental
Indenture"); and

     WHEREAS, the Company has heretofore executed and delivered to the Trustee
a supplemental indenture dated as of November 11, 2002 (the "Fourth
Supplemental Indenture"); and

     WHEREAS, pursuant to Section 9.01 of the Indenture, the Trustee is
authorized to execute and deliver this Fifth Supplemental Indenture.

     NOW, THEREFORE, in consideration of the foregoing and for other good and
valuable consideration, the receipt of which is hereby acknowledged, the
Guaranteeing Subsidiaries and the Trustee mutually covenant and agree for the
equal and ratable benefit of the Holders of the Notes as follows:

     1.   CAPITALIZED TERMS. Capitalized terms used herein without definition
shall have the meanings assigned to them in the Indenture.

     2.   AGREEMENT TO GUARANTEE. The Guaranteeing Subsidiaries hereby agree as
follows:

                                       1
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     (a)  Along with all other Guarantors, to jointly and severally Guarantee to
each Holder of a Note authenticated and delivered by the Trustee and to the
Trustee and its successors and assigns, irrespective of the validity and
enforceability of the Indenture, the Notes or the obligations of the Company
hereunder or thereunder, that:

          (i)  the principal of and interest on the Notes will be promptly paid
     in full when due, whether at maturity, by acceleration, redemption or
     otherwise, and interest on the overdue principal of and interest on the
     Notes, if any, if lawful, and all other obligations of the Company to the
     Holders or the Trustee hereunder or thereunder will be promptly paid in
     full or performed, all in accordance with the terms hereof and thereof; and

          (ii) in case of any extension of time of payment or renewal of any
     Notes or any of such other obligations, that same will be promptly paid in
     full when due or performed in accordance with the terms of the extension or
     renewal, whether at stated maturity, by acceleration or otherwise. Failing
     payment when due of any amount so guaranteed or any performance so
     guaranteed for whatever reason, the Guarantors shall be jointly and
     severally obligated to pay the same immediately.

     (b)  The obligations hereunder shall be unconditional, irrespective of the
validity, regularity or enforceability of the Notes or the Indenture, the
absence of any action to enforce the same, any waiver or consent by any Holder
of the Notes with respect to any provisions hereof or thereof, the recovery of
any judgment against the Company, any action to enforce the same or any other
circumstance which might otherwise constitute a legal or equitable discharge or
defense of a guarantor.

     (c)  The following are hereby waived: diligence, presentment, demand of
payment, filing of claims with a court in the event of insolvency or bankruptcy
of the Company, any right to require a proceeding first against the Company,
protest, notice and all demands whatsoever.

     (d)  These Subsidiary Guarantees shall not be discharged except by complete
performance of the obligations contained in the Notes and the Indenture.

     (e)  If any Holder or the Trustee is required by any court or otherwise to
return to the Company, the Guarantors, or any Custodian, Trustee, liquidator or
other similar official acting in relation to either the Company or the
Guarantors, any amount paid by either to the Trustee or such Holder, these
Subsidiary Guarantees, to the extent theretofore discharged, shall be reinstated
in full force and effect.

     (f)  The Guaranteeing Subsidiaries shall not be entitled to any right of
subrogation in relation to the Holders in respect of any obligations guaranteed
hereby until payment in full of all obligations guaranteed hereby.

     (g)  As between the Guarantors, on the one hand, and the Holders and the
Trustee, on the other hand, (x) the maturity of the obligations guaranteed
hereby may be accelerated as provided in Article 6 of the Indenture for the
purposes of these Subsidiary Guarantees, notwithstanding any stay, injunction or
other prohibition preventing such acceleration in respect of the obligations
guaranteed hereby, and (y) in the event of any declaration of acceleration of
such obligations as provided in Article 6 of the Indenture, such obligations
(whether or not due and payable) shall forthwith become due and payable by the
Guarantors for the purpose of these Subsidiary Guarantees.

                                       2
<PAGE>
          (h)  The Guarantors shall have the right to seek contribution from any
     non-paying Guarantor so long as the exercise of such right does not impair
     the rights of the Holders under the Guarantees.

          (i)  Pursuant to Section 10.02 of the Indenture, after giving effect
     to any maximum amount and any other contingent and fixed liabilities that
     are relevant under any applicable Bankruptcy or fraudulent conveyance laws,
     and after giving effect to any collections from, rights to receive
     contribution from or payments made by or on behalf of any other Guarantor
     in respect of the obligations of such other Guarantor under Article 10 of
     the Indenture shall result in the obligations of such Guarantor under its
     Subsidiary Guarantee not constituting a fraudulent transfer or conveyance.

     3.   EXECUTION AND DELIVERY. The Guaranteeing Subsidiaries agree that the
Subsidiary Guarantees shall remain in full force and effect notwithstanding any
failure to endorse on each Note a notation of such Subsidiary Guarantees.

     4.   GUARANTEEING SUBSIDIARIES MAY CONSOLIDATE, ETC. ON CERTAIN TERMS.

          (a)  No Guarantor may consolidate with or merge with or into (whether
     or not such Guarantor is the surviving Person) or sell, assign, transfer
     convey or otherwise dispose of all or substantially all of its properties
     or assets in one or more related transactions, to another Person unless:

               (i)    the Company or a Guarantor is the surviving corporation or
          the entity or the Person formed by or surviving any such consolidation
          or merger (if other than a Guarantor or the Company) or to which such
          sale, assignment, transfer, lease, conveyance or other disposition
          shall have been made is a corporation organized or existing under the
          laws of the United States, any state thereof or the District of
          Columbia;

               (ii)   the entity or Person formed by or surviving any such
          consolidation or merger (if other than a Guarantor or the Company) or
          the entity or Person to which such sale, transfer, conveyance or other
          disposition is made assumes all the obligations of such Guarantor
          under the Notes, the Indenture and the Subsidiary Guarantees, pursuant
          to a supplemental indenture in the form of Exhibit F to the Indenture;

               (iii)  immediately after giving effect to such transaction, no
          Default or Event of Default exists; and

               (iv)   the Company (i) will have Consolidated Net Worth
          immediately after the transaction equal to or greater than the
          Consolidated Net Worth of the Company immediately preceding the
          transaction and (ii) will, at the time of such transaction and after
          giving pro forma effect thereto as if such transaction had occurred at
          the beginning of the applicable four-quarter period, be permitted to
          incur at least $1.00 of additional Indebtedness pursuant to the Fixed
          Charge Coverage Ratio test set forth in the first paragraph of Section
          4.09 of the Indenture;

     (b)  In case of any such consolidation, merger, sale, or conveyance and
upon the assumption by the successor corporation, by supplemental indenture,
executed and delivered to the Trustee and satisfactory in form to the Trustee,
of the Subsidiary Guarantees endorsed upon

                                       3

<PAGE>

     the Notes and the due and punctual performance of all of the covenants and
     conditions of the indenture to be performed by the Guarantor, such
     successor corporation shall succeed to and be substituted for the Guarantor
     with the same effect as if it had been named herein as a Guarantor. Such
     successor corporation thereupon may cause to be signed any or all of the
     Subsidiary Guarantees to be endorsed upon all of the Notes issuable
     hereunder which theretofore shall not have been signed by the Company and
     delivered to the Trustee. All the Subsidiary Guarantees so issued shall in
     all respects have the same legal rank and benefit under the Indenture as
     the Subsidiary Guarantees theretofore and thereafter issued in accordance
     with the terms of the Indenture as though all of such Subsidiary Guarantees
     had been issued at the date of the execution hereof.

          (c)  Except as set forth in Articles 4 and 5 of the Indenture, and
     notwithstanding clauses (a) and (b) above, nothing contained in the
     Indenture or in any of the Notes shall prevent any consolidation or merger
     of a Guarantor with or into the Company or another Guarantor, or shall
     prevent any sale or conveyance of the property of a Guarantor as an
     entirety or substantially as an entirety to the Company or another
     Guarantor.

     5.   RELEASES.

          (a)  In the event of a sale or other disposition of all of the assets
     of any Guarantor, by way of merger, consolidation or otherwise, or a sale
     or other disposition of all of the capital stock of any Guarantor, then
     such Guarantor (in the event of a sale or other disposition, by way of
     merger, consolidation or otherwise, of all of the capital stock of such
     Guarantor) or the corporation acquiring the property (in the event of a
     sale or other disposition of all or substantially all of the assets of such
     Guarantor) will be released and relieved of any obligations under the
     Subsidiary Guarantees; provided that the Net Proceeds of such sale or other
     disposition are applied in accordance with the applicable provisions of the
     Indenture, including without limitation Section 4.10 of the Indenture. Upon
     delivery by the Company to the Trustee of an Officers' Certificate and an
     Opinion of Counsel to the effect that such sale or other disposition was
     made by the Company in accordance with the provisions of the Indenture,
     including without limitation Section 4.10 of the Indenture, the Trustee
     shall execute any documents reasonably required in order to evidence the
     release of any Guarantor from its obligations under its Subsidiary
     Guarantee.

          (b)  Any Guarantor not released from its obligations under its
     Subsidiary Guarantee shall remain liable for the full amount of principal
     of and interest on the Notes and for the other obligations of any Guarantor
     under the Indenture as provided in Article 11 of the Indenture.

     6.   NO RECOURSE AGAINST OTHERS. No past, present, or future director,
officer, employee, incorporator, stockholder, or agent of the Guaranteeing
Subsidiaries, as such, shall have any liability for any obligations of the
Company or any Guaranteeing Subsidiaries under the Notes, any Subsidiary
Guarantees, the Indenture or this Fifth Supplemental Indenture or for any claim
based on, in respect of, or by reason of, such obligations or their creation.
Each Holder of the Notes by accepting a Note waives and releases all such
liability. The waiver and release are part of the consideration for issuance of
the Notes. Such waiver may not be effective to waive liabilities under the
federal securities laws and it is the view of the Commission that such a waiver
is against public policy.

     7.   NEW YORK LAW TO GOVERN. THE INTERNAL LAW OF THE STATE OF NEW YORK
SHALL GOVERN AND BE USED TO CONSTRUE THIS SUPPLEMENTAL INDENTURE BUT WITHOUT
GIVING EFFECT TO APPLICABLE PRINCIPLES OF CONFLICTS OF LAW TO

                                       4
<PAGE>
THE EXTENT THAT THE APPLICATION OF THE LAWS OF ANOTHER JURISDICTION WOULD BE
REQUIRED THEREBY.

     8.   COUNTERPARTS. The parties may sign any number of copies of this Fifth
Supplemental Indenture. Each signed copy shall be an original, but all of them
together represent the same agreement.

     9.   EFFECT OF HEADINGS. The Section headings herein are for convenience
only and shall not affect the construction hereof.

     10.  THE TRUSTEE. The Trustee shall not be responsible in any manner
whatsoever for or in respect of the validity or sufficiency of this Fifth
Supplemental Indenture or for or in respect of the recitals contained herein,
all of which recitals are made solely by the Guaranteeing Subsidiaries and the
Company.

     IN WITNESS WHEREOF, the undersigned, through their duly-authorized
representatives, have executed this Fifth Supplemental Indenture effective as
of the date first set forth above.

                           GUARANTEEING SUBSIDIARIES:

                           CORRECTIONAL HEALTHCARE ADVANTAGE, INC.
                           GREENBRIER EMERGENCY PHYSICIANS, INC.

                           By:  /s/ David P. Jones
                              ------------------------------------
                           Name:    David Jones
                           Title:   V.P.

                           TH CONTRACTING MIDWEST, LLC
                           By: Inphynet Contracting Services, Inc., Sole Member

                           By:  /s/ David P. Jones
                              ------------------------------------
                           Name:    David Jones
                           Title:   V.P.

                           COMPANY:

                           TEAM HEALTH, INC.

                           By:  /s/ David P. Jones
                              ------------------------------------
                           Name:    David Jones
                           Title:   V.P.

                                       5

<PAGE>
                    GUARANTORS:

                    ACCESS NURSE PM, INC.
                    AFTER HOURS PEDIATRICS, INC. (formerly After
                         Hours Pediatric Practices, Inc.)
                    CLINIC MANAGEMENT SERVICES, INC. (survivor of
                         a merger with Park Med of Florida, Inc.)
                    METROAMERICAN RADIOLOGY, INC.
                    ROSENDORF MARGULIES BORUSHOK & SCHOENBAUM
                      RADIOLOGY ASSOCIATES OF HOLLYWOOD, INC.
                    TEAM ANESTHESIA, INC.
                    CHARLES L. SPRINGFIELD, INC.
                    DANIEL & YEAGER, INC.
                    DRS. SHEER, AHEARN AND ASSOCIATES, INC.
                    EMERGENCY COVERAGE CORPORATION
                    EMERGENCY PHYSICIAN ASSOCIATES, INC.
                    EMERGENCY PROFESSIONAL SERVICES, INC.
                    INPHYNET CONTRACTING SERVICES, INC. (survivor of
                         mergers with Acute Care Specialists Co., Alliance
                         Corporation, Emergency Management Specialists, Inc.,
                         Inphynet Anesthesia of West Virginia, Inc., Inphynet
                         Louisiana, Inc., Inphynet Medical Management Institute,
                         Inc., Neo-Med, Inc., Paragon Anesthesia, Inc., and
                         Virginia Emergency Physicians, Inc.)
                    INPHYNET SOUTH BROWARD, INC.
                    INPHYNET JOLIET, INC.
                    HERSCHEL FISCHER, INC.
                    INPHYNET HOSPITAL SERVICES, INC.
                    KARL G. MANGOLD, INC.
                    KELLY MEDICAL SERVICES CORPORATION
                    HEALTH CARE ALLIANCE, INC.
                    MEDICAL SERVICES, INC.
                    MEDASSURE SYSTEMS, INC. (survivor of a merger with
                         THBS, Inc.)
                    NORTHWEST EMERGENCY PHYSICIANS INCORPORATED
                    PARAGON CONTRACTING SERVICES, INC. (survivor of
                         mergers with Sarasota Emergency Medical Consultants,
                         Inc. and Emergency Physicians of Manatee, Inc.)
                    PARAGON IMAGING CONSULTANTS, INC.
                    QUANTUM PLUS, INC.
                    REICH, SEIDELMANN & JANICKI CO.
                    SOUTHEASTERN EMERGENCY PHYSICIANS OF MEMPHIS, INC.

                                       6
<PAGE>
                                        SOUTHEASTERN EMERGENCY PHYSICIANS, INC.
                                             (survivor of a merger with Hospital
                                             Based Physician Services, Inc.)
                                        TEAM RADIOLOGY, INC.
                                        THE EMERGENCY ASSOCIATES FOR MEDICINE,
                                             INC. (survivor of a merger with
                                             Sentinel Medical Services, Inc.)
                                        TEAM HEALTH ANESTHESIA MANAGEMENT
                                             SERVICES, INC. (f/k/a Integrated
                                             Specialists Management Services,
                                             Inc.)
                                        MEDICAL MANAGEMENT RESOURCES, INC.
                                        PHYSICIAN INTEGRATION CONSULTING
                                             SERVICES, INC.
                                        SPECTRUM HEALTHCARE SERVICES, INC.
                                        SPECTRUM HEALTHCARE, INC.
                                        SPECTRUM HEALTHCARE RESOURCES OF
                                             DELAWARE, INC.
                                        SPECTRUM HEALTHCARE RESOURCES, INC.
                                        AMERICAN CLINICAL RESOURCES, INC. (f/k/a
                                             Spectrum Healthcare Nationwide,
                                             Inc.)
                                        SPECTRUM PRIMARY CARE OF DELAWARE, INC.
                                        SPECTRUM PRIMARY CARE, INC.
                                        SPECTRUM CRUISE CARE, INC.

                                        By:  /s/ David P. Jones
                                             -----------------------------------
                                        Name:     David Jones
                                                  ------------------------------
                                        Title:    V.P.
                                                  ------------------------------
                                        Address:  1900 Winston Road
                                                  Knoxville, TN 37919

                                        TEAM HEALTH FINANCIAL SERVICES, INC.

                                        By:  /s/ David P. Jones
                                             -----------------------------------
                                        Name:     David Jones
                                                  ------------------------------
                                        Title:    V.P.
                                                  ------------------------------
                                        Address:  300 Delaware Avenue, 9th Floor
                                                  Wilmington, Delaware 19801

                                       7
<PAGE>
                                      IMBS, INC.

                                      By: /s/ Robert Jones
                                         -----------------------------
                                      Name: Robert C. Jones
                                           ---------------------------
                                      Title: Executive Vice President
                                            --------------------------

                                      Address:    1900 Winston Road
                                                  Knoxville, TN 37919

                                      FISCHER MANGOLD PARTNERSHIP, a California
                                      General Partnership

                                      By:    Herschel Fischer, Inc., its general
                                             partner
                                             Karl G. Mangold, Inc., its general
                                             partner

                                      By: /s/ David P. Jones
                                         -----------------------------
                                      Name: David Jones
                                           ---------------------------
                                      Title: V.P.
                                            --------------------------

                                      Address:    1900 Winston Road
                                                  Knoxville, TN 37919

                                      MT. DIABLO EMERGENCY PHYSICIANS, a
                                      California General Partnership

                                      By:    Herschel Fischer, Inc., its general
                                             partner
                                             Karl G. Mangold, Inc., its general
                                             partner

                                      By: /s/ David P. Jones
                                         -----------------------------
                                      Name: David Jones
                                           ---------------------------
                                      Title: V.P.
                                            --------------------------

                                      Address:    1900 Winston Road
                                                  Knoxville, TN 37919

                                      8
<PAGE>
                           PARAGON HEALTHCARE LIMITED PARTNERSHIP
                           By: InPhyNet Hospital Services, Inc., general partner

                           By:     /s/ David P. Jones
                              ----------------------------------

                           Name:    David Jones
                                --------------------------------

                           Title:    V.P.
                                 -------------------------------

                           Address:     1900 Winston Road
                                        Knoxville, TN 37919

                           TEAM HEALTH BILLING SERVICES, L.P.
                           By: Team Health, Inc., general partner

                           By:     /s/ David P. Jones
                              ----------------------------------

                           Name:    David Jones
                                --------------------------------

                           Title:    V.P.
                                 -------------------------------

                           Address:     1900 Winston Road
                                        Knoxville, TN 37919

                           TEAM HEALTH SOUTHWEST L.P.
                           By: Team Radiology, Inc., general partner

                           By:     /s/ David P. Jones
                              ----------------------------------

                           Name:    David Jones
                                --------------------------------

                           Title:    V.P.
                                 -------------------------------

                           Address:     1900 Winston Road
                                        Knoxville, TN 37919

                           TRUSTEE:

                           THE BANK OF NEW YORK as Trustee

                           By:  /s/ Patricia Gallagher
                              ----------------------------------

                           Name:  Patricia Gallagher
                           Title: Authorized Signer

                                       9<PAGE>
                                                                   Exhibit 10.20

                      AMENDMENT NO. 2 TO CREDIT AGREEMENT

     This AMENDMENT NO. 2 TO CREDIT AGREEMENT (this "Amendment"), dated as of
September __, 2003, is entered into among TEAM HEALTH, INC., a Tennessee
corporation (the "Borrower"), FLEET NATIONAL BANK, individually and as
administrative agent (the "Administrative Agent") and the other Lenders
signatory hereto.

                                R E C I T A L S:

     A.   The Borrower, the Lenders, Fleet National Bank, as an Issuing Bank,
as the Swing Line Bank, and as Administrative Agent, Bank of America, N.A., as
an Issuing Bank, Banc of America Securities LLC, as Syndication Agent, and
General Electric Capital Corporation, as Documentation Agent, are parties
to that certain $300,000,000 Credit Agreement, dated as of May 1, 2002 (as
amended by Amendment No. 1 on May 14, 2003, the "Agreement"). Each capitalized
term used but not otherwise defined herein shall have the meaning ascribed to
such term by the Agreement.

     B.   The Borrower, the Administrative Agent and the Lenders wish to amend
the Agreement on the terms and conditions set forth below.

     NOW THEREFORE, in consideration of the premises and the mutual agreements
herein contained, and for other good and valuable consideration, the receipt
and sufficiency of which are hereby acknowledged, the parties hereto agree as
follows:

     1.   Amendment of the Agreement. Effective as of date hereof, the
Agreement shall be amended as follows:

          1.1  Section 1.1 is amended by amending the definition of the term
"EBITDA" by replacing the word "and" immediately prior to clause (xiv) with a
"," and adding the following clause (xv) thereto and replacing in its entirety
the proviso immediately following thereafter, as follows:

          "and (xv) an amount, not less than zero, equal to professional
          liability insurance expense related to the Borrower's self-insurance
          program, less (A) claims paid by the Borrower or the Insurance
          Subsidiary, administrative expenses paid to the Insurance Subsidiary
          and external professional liability insurance premiums, fronting fees,
          related taxes, related broker commissions and related claims
          management fees (net of physician contributions) and (B) the amount of
          the increase incurred in such period of required cash collateral or
          other security in favor of a fronting medical malpractice insurance
          carrier; provided, that for purposes of determining the ratio of
          Consolidated Funded Debt to EBITDA solely as such term is used in
          determining the "Applicable Margin" and as such term is used in
          Section 2.6(b), EBITDA shall be calculated without giving effect to
          the foregoing clause (xv) but after adding, without duplication, the
          $50.8 million non-cash charge taken in the first quarter of 2003 for
          potential professional liability claims in excess of applicable
          insurance

<PAGE>
     limits and after adding any other nonrecurring non-cash charges pertaining
     to the Borrower's self-insurance program, provided, that with respect to
     each of clauses (ii) through (xv) such amounts shall be added to Net Income
     pursuant to this definition only to the extent such amounts are not
     duplicative and, for each of such clauses other than clause (ix), were
     deducted in determining Net Income,"

     1.2  Section 1.1 is amended by amending the definition of the term
"Interest Expense" by adding the following parenthetical after the term "GAAP"
in the fourth line of such definition:

     "(excluding any effects of the application of FASB 150)"

     1.3  Section 1.1 is amended by amending the definition of the term "Debt"
by adding the following sentence to the end of such definition:

     "For the purposes of the Agreement, the term "Debt" shall exclude any
     effects of the application of FASB 150."

     1.4  Section 1.1 is amended by amending the definition of the term "Working
Capital" by replacing the words "Consolidated Current Liabilities relating to
the reserves of any Insurance Subsidiary, if applicable" appearing at the end of
the second parenthetical therein in its entirety with the following:

     "Consolidated Current Liabilities relating to reserves for professional
     liability insurance coverage (including any reserves of the Insurance
     Subsidiary)"

     1.5  Section 5.4(a) is amended by adding the following proviso at the end
of such Section:

     "; provided, however, that the Borrower may self-insure for professional
     liability insurance claims using sound actuarial principles."

     1.6  Section 5.4(b) is amended by adding the following proviso at the end
of the first sentence of such Section:

     "; provided, however, that the Borrower may self-insure for professional
     liability insurance claims using sound actuarial principles."

     1.7  Section 6.1(m) is amended by renumbering such Section to Section
6.1(n) and adding a new Section 6.1(m) in its place as follows:

     "(m) Liens incurred by the Insurance Subsidiary in favor of a fronting
     professional liability insurance carrier to secure the Insurance
     Subsidiary's obligations to pay professional liability insurance claims and
     expenses on a "claims reported" basis; and"

                                      -2-
<PAGE>
     1.8  Section 6.4(f) is amended by adding the following words immediately
after the reference to "Section 6.5(a)" and before the semicolon, as follows:

     "and the borrower may transfer shares of capital stock of Holdings to the
     extent permitted by Section 6.6(i) and may cancel or retire any shares of
     its capital stock acquired in connection with such transfer."

     1.9  Section 6.5(q) is amended by adding the following words at the end of
such subsection and before the semicolon as follows:

     "and Investments consisting of capital stock of Holdings acquired by the
     Borrower in a transaction permitted by Section 6.6(d) hereof."

     1.10 Section 6.6 is amended by (a) adding the words "or equity interests
of Holdings" immediately after the words "capital stock" in the second line
therein and (b) adding the words "and/or Holdings" immediately after the term
"Borrower" in the eighth line therein and the third line of subsection (d)
therein.

     1.11 Section 6.6(i) is amended by renumbering such Section to Section
6.6(j) and adding a new Section 6.6(i) in its place as follows:

     "(i) the Borrower may acquire its capital stock from Holdings in a
     transaction where the sole consideration for such purchase or acquisition
     consists of capital stock of Holdings held by the Borrower and transferred
     to Holdings."

     1.12 Section 6.18(k) is amended by renumbering such Section to Section
6.18(l) and adding a new Section 6.18(k) in its place as follows:

     "(k) the Borrower may incur Guaranteed Obligations in respect of the
Insurance Subsidiary's obligations to pay professional liability insurance
claims and expenses on a "claims reported" basis; and"

     1.13 Section 6.20(b) of the Agreement is amended in its entirety and
replaced with the following:

     "(b) permit any Investment in the Insurance Subsidiary, except for
     Investment not in excess of the amounts as may be required by applicable
     law, regulatory determination or by any reputable insurer fronting coverage
     on behalf of the Insurance Subsidiary."

  2. Conditions Precedent to Amendments. This Amendment shall be effective as
of the date first set forth above; provided, however, that Section 1 hereof
shall not become operative and shall be of no force or effect unless each of
the conditions set forth in this Section 2 shall be satisfied and the delivery
of the following documents to the Administrative Agent, in form and substance
satisfactory to the Administrative Agent and its counsel, shall have occurred.

                                      -3-
<PAGE>
             2.1    Documentation.

                    (a)    This Amendment shall have been duly executed and
             delivered by the Administrative Agent, the Borrower and the
             Required Lenders (without respect to whether it has been executed
             and delivered by all the Lenders).

                    (b)    The Borrower shall have delivered to the
             Administrative Agent a Reaffirmation of Guaranty and Security
             Agreement in the form of Exhibit A hereto executed by the Borrower
             and each of the Guarantors.

             2.2    Payment of Fees. The Borrower shall have paid to the
     Administrative Agent all fees due and owing, including, without limitation,
     for the account of each Lender approving this Amendment and delivering its
     executed signature page (by facsimile or other means acceptable to the
     Administrative Agent) on or prior to 12:00 P.M. (New York time) on
     September 17, 2003 a fee of 7.5 basis points of each such Lender's
     aggregate Revolving Credit Commitment and outstanding Term A Advance and
     Term B Advance.

     3.   Representations and Warranties. The Borrower represents and warrants
to the Administrative Agent and each Lender that:

             (a)    The execution and delivery by the Borrower of this Amendment
     and the performance by the Borrower of its obligations under this Amendment
     are within the corporate powers of the Borrower, have been duly authorized
     by all necessary corporate action on the part of the Borrower, have
     received all necessary governmental approval (if any shall be required),
     and do not and will not (i) violate any provision of law or any order,
     decree or judgment of any court or other government agency which is binding
     on the Borrower or any Subsidiary, (ii) contravene or conflict with, or
     result in a breach of, any provision of any organizational documents of the
     Borrower or any Guarantor or of any material agreement, indenture,
     instrument or other document which is binding on the Borrower or any
     Subsidiary or (iii) result in or require the creation or imposition of any
     Lien on any property of the Borrower or any Subsidiary (other than Liens
     arising under the Loan Documents).

             (b)    There have been no amendments, supplements or modifications
     to any of the Articles of Incorporation, Bylaws, resolutions of the Board
     of Directors or certificate of incumbency of the Borrower previously
     delivered to the Administrative Agent on May 1, 2002.

             (c)    Each of the representations and warranties of the Borrower
     and the Guarantors contained in the Loan Documents, as amended hereby, is
     true and correct in all material respects on and as of the date hereof as
     if made on the date hereof, other than any such representations or
     warranties that, by their terms, refer to a specific date other than the
     date hereof, in which case, as of such specific date.

             (d) As of the date hereof, after giving effect to this Amendment,
     no Default or Event of Default under the Agreement or any other Loan
     Document has occurred and is continuing.

                                      -4-

<PAGE>
     4. Miscellaneous.

          4.1 From and after the date hereof, each reference in the Agreement
to "this Agreement," "hereunder," "hereof," "herein," or words of like import,
and each reference to the Agreement in any of the other Loan Documents shall
mean and be a reference to the Agreement as amended hereby.

          4.2 Except as specifically set forth above, the Agreement and the
Exhibits thereto shall remain unaltered and in full force and effect and the
respective terms, conditions or covenants thereof are hereby in all respects
ratified and confirmed.

          4.3 This Amendment may be executed in any number of separate
counterparts, each of which, when so executed, shall be deemed an original, and
all of said counterparts taken together shall be deemed to constitute but one
and the same instrument.

          4.4 THIS AMENDMENT SHALL BE GOVERNED BY, AND CONSTRUED AND INTERPRETED
IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK WITHOUT REGARD TO ITS
RULES PERTAINING TO CONFLICTS OF LAWS OTHER THAN GENERAL OBLIGATIONS LAW SECTION
5-1401.

                            [signature pages follow]

                                      -5-

<PAGE>
     IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be
executed by their respective officers thereunto duly authorized as of the date
first above written.

                                        TEAM HEALTH, INC.

                                        By /s/ Robert Abramowski
                                          ---------------------------------

                                        Name:  Robert Abramowski
                                              -----------------------------
                                        Title: Executive Vice President
                                              -----------------------------

SIGNATURE PAGE TO AMENDMENT NO. 2
TO CREDIT AGREEMENT FOR TEAM HEALTH, INC.

                                      S-1
<PAGE>
                                ACCESS NURSE PM, INC.
                                AFTER HOURS PEDIATRIC PRACTICES, INC.
                                CLINIC MANAGEMENT SERVICES, INC. (survivor of a
                                  merger with Park Med of Florida, Inc.)
                                METROAMERICAN RADIOLOGY, INC.
                                ROSENDORF MARGULIES BORUSHOK
                                  SCHOENBAUM RADIOLOGY ASSOCIATES OF
                                  HOLLYWOOD, INC.
                                TEAM ANESTHESIA, INC.

                                By: /s/ David P Jones
                                    --------------------------------
                                Name:  David Jones
                                Title: Vice President

                                Address:  1900 Winston Road
                                          Knoxville, TN 37919

SIGNATURE PAGE TO REAFFIRMATION OF
GUARANTY AND SECURITY AGREEMENT

                                      S-2
<PAGE>
                                   CHARLES L. SPRINGFIELD, INC.
                                   DANIEL & YEAGER, INC.
                                   DRS. SHEER, AHEARN AND ASSOCIATES, INC.
                                   EMERGENCY COVERAGE CORPORATION
                                   EMERGENCY PHYSICIAN ASSOCIATES, INC.
                                   EMERGENCY PROFESSIONAL SERVICES, INC.
                                   INPHYNET CONTRACTING SERVICES, INC.
                                      (survivor of mergers with Acute Care
                                      Specialists Co., Alliance Corporation,
                                      Emergency Management Specialists, Inc.,
                                      Inphynet Anesthesia of West Virginia,
                                      Inc., Inphynet Louisiana, Inc., Inphynet
                                      Medical Management Institute, Inc.,
                                      Neo-Med, Inc., Paragon Anesthesia, Inc.,
                                      and Virginia Emergency Physicians, Inc.)
                                   INPHYNET SOUTH BROWARD, INC.
                                   INPHYNET JOLIET, INC.
                                   HERSCHEL FISCHER, INC.
                                   INPHYNET HOSPITAL SERVICES, INC.
                                   KARL G. MANGOLD, INC.
                                   MED: ASSURE SYSTEMS, INC. (survivor of a
                                      merger with THBS, Inc.)
                                   NORTHWEST EMERGENCY PHYSICIANS INCORPORATED
                                   PARAGON CONTRACTING SERVICES, INC. (survivor
                                      of mergers with Sarasota Emergency Medical
                                      Consultants, Inc. and Emergency Physicians
                                      of Manatee, Inc.)
                                   PARAGON IMAGING CONSULTANTS, INC.
                                   QUANTUM PLUS, INC.
                                   REICH, SEIDELMANN & JANICKI CO.
                                   SOUTHEASTERN EMERGENCY PHYSICIANS OF
                                      MEMPHIS, INC.
                                   SOUTHEASTERN EMERGENCY PHYSICIANS, INC.
                                      (survivor of a merger with Hospital Based
                                      Physician Services, Inc.)
                                   TEAM RADIOLOGY, INC.
                                   THE EMERGENCY ASSOCIATES FOR MEDICINE, INC.
                                      (survivor of a merger with Sentinel
                                      Medical Services, Inc.)

                                   By:  /s/ David P. Jones
                                        ----------------------------------------
                                   Name:     David Jones
                                   Title:    Vice President

                                   Address:  1900 Winston Road
                                             Knoxville, TN 37919

SIGNATURE PAGE TO REAFFIRMATION OF
GUARANTY AND SECURITY AGREEMENT

                                      S-3
<PAGE>
                                 TEAM HEALTH FINANCIAL SERVICES, INC.

                                 By: /s/ David P. Jones
                                    ----------------------------------
                                 Name:  David Jones
                                 Title: President

                                 Address: 300 Delaware Avenue, 9th Floor
                                          Wilmington, Delaware 19801

                                 IMBS, INC.

                                 By: /s/ Robert C. Joyner
                                    -----------------------------------
                                 Name:  Robert C. Joyner
                                 Title: Vice President

                                 Address: 1900 Winston Road
                                          Knoxville, TN 37919

                                 FISCHER MANGOLD PARTNERSHIP, a California
                                 General Partnership

                                 By: Herschel Fischer, Inc., its general partner
                                     Karl G. Mangold, Inc., its general partner

                                 By: /s/ David P. Jones
                                    ------------------------------------------
                                 Name:  David Jones
                                 Title: Vice President

                                 Address: 1900 Winston Road
                                          Knoxville, TN 37919

SIGNATURE PAGE TO REAFFIRMATION OF
GUARANTY AND SECURITY AGREEMENT

                                      S-4
<PAGE>

                              MT. DIABLO EMERGENCY PHYSICIANS, a California
                              General Partnership
                              By:  Herschel Fischer, Inc., its general partner
                                   Karl G. Mangold, Inc., its general partner

                              By:  /s/ David P. Jones
                                   ---------------------------------------------
                              Name:   David Jones
                              Title:  Vice President

                              Address:  1900 Winston Road
                                        Knoxville, TN 37919

                              PARAGON HEALTHCARE LIMITED PARTNERSHIP
                              By: InPhyNet Hospital Services, Inc., general
                                  partner

                              By:  /s/ David P. Jones
                                   ---------------------------------------------
                              Name:   David Jones
                              Title:  Vice President

                              Address:  1900 Winston Road
                                        Knoxville, TN 37919

                              TEAM HEALTH BILLING SERVICES, L.P.
                              By: Team Health, Inc., general partner

                              By:  /s/ David P. Jones
                                   ---------------------------------------------
                              Name:   David Jones
                              Title:  Vice President

                              Address:  1900 Winston Road
                                        Knoxville, TN 37919

                              TEAM HEALTH SOUTHWEST L.P.
                              By: Team Radiology, Inc., general partner

                              By:  /s/ David P. Jones
                                   ---------------------------------------------
                              Name:   David Jones
                              Title:  Vice President

                              Address:  1900 Winston Road
                                        Knoxville, TN 37919

SIGNATURE PAGE TO REAFFIRMATION OF
GUARANTY AND SECURITY AGREEMENT

                                      S-5

<PAGE>
                         TEAM HEALTH ANESTHESIA MANAGEMENT
                         SERVICES, INC. (f/k/a Integrated Specialists Management
                         Services, Inc.)
                         MEDICAL MANAGEMENT RESOURCES, INC.
                         PHYSICIAN INTEGRATION CONSULTING
                           SERVICES, INC.

                         By:    /s/ David P. Jones
                                -----------------------------
                         Name:  David Jones
                         Title: Vice President

                                Address: 1900 Winston Road
                                         Knoxville, TN 37919

                         SPECTRUM HEALTHCARE SERVICES, INC.
                         SPECTRUM HEALTHCARE, INC.
                         SPECTRUM HEALTHCARE RESOURCES OF DELAWARE,
                              INC.
                         SPECTRUM HEALTHCARE RESOURCES, INC.
                         AMERICAN CLINICAL RESOURCES, INC. (f/k/a Spectrum
                              Healthcare Nationwide, Inc.)
                         SPECTRUM PRIMARY CARE OF DELAWARE, INC.
                         SPECTRUM PRIMARY CARE, INC.
                         SPECTRUM CRUISE CARE, INC.

                         By:    /s/ David P. Jones
                                -----------------------------
                         Name:  David Jones
                         Title: Vice President

                                Address: 1900 Winston Road
                                         Knoxville, TN 37919

SIGNATURE PAGE TO REAFFIRMATION OF
GUARANTY AND SECURITY AGREEMENT

                                      S-6
<PAGE>
                              KELLY MEDICAL SERVICES CORPORATION
                              HEALTH CARE ALLIANCE, INC.
                              MEDICAL SERVICES, INC.
                              CORRECTIONAL HEALTHCARE ADVANTAGE, INC.

                              By: /s/ David P. Jones
                                 -------------------------------------
                              Name:  David Jones
                              Title: Vice President

                                     Address:     1900 Winston Road
                                                  Knoxville, TN 37919

SIGNATURE PAGE TO REAFFIRMATION OF
GUARANTY AND SECURITY AGREEMENT

                                      S-7
<PAGE>
                                   EXHIBIT A

                REAFFIRMATION OF GUARANTY AND SECURITY AGREEMENT

     Each of the undersigned acknowledges receipt of a copy of Amendment No. 2
to Credit Agreement (the "Amendment") dated as of September   , 2003, consents
to such Amendment and hereby reaffirms its obligations under (i) the Holdings
Guaranty dated as of May 1, 2002 in favor of Fleet National Bank, as
administrative agent and the Secured Parties (as defined in the Credit
Agreement), (ii) the Subsidiary Guaranty dated as of May 1, 2002 in favor of
Fleet National Bank, as administrative agent and the Secured Parties, (iii) the
Holdings Pledge Agreement dated as of May 1, 2002 by and between Team Health
Holdings, L.L.C. and Fleet National Bank, as administrative agent for the
Secured Parties, (iv) the Security Agreement dated as of May 1, 2002 by and
among Team Health, Inc., the Subsidiary Guarantors (as defined in the Credit
Agreement) and Fleet National Bank, as administrative agent for the Secured
Parties, (v) The Pledge Agreement dated April 11, 2003 by and between Team
Health, Inc. and Fleet National Bank, as administrative agent for the Secured
Parties, and (vi) the Intellectual Property Security Agreement dated as of May
1, 2002 by and among Team Health, Inc., the Subsidiary Guarantors and Fleet
National Bank, as administrative agent for the Secured Parties.

Dated as of September   , 2003

                                   TEAM HEALTH, INC.

                                   By:    /s/ Robert Abramowski
                                          ---------------------
                                   Name:  Robert Abramowski
                                   Title: Executive Vice President

                                   Address: 1900 Winston Road
                                   Knoxville, TN 37919

                                   TEAM HEALTH HOLDINGS, L.L.C.

                                   By:    /s/ Robert Abramowski
                                          ---------------------
                                   Name:  Robert Abramowski
                                   Title: Executive Vice President

                                   Address: c/o Madison Dearborn Partners
                                   Three First National Plaza
                                   Suite 3800
                                   Chicago, Illinois 60602

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