Starting your medical career is an exciting milestone, but evaluating your first job offer can feel overwhelming. As a resident transitioning to practice, this is likely your first experience navigating physician contracts, compensation structures, and employment terms. The decisions you make now will shape your career trajectory and financial future, so it’s essential to approach this process with care and preparation.

This guide will help you break down the key components of job offers and contracts, providing you with the knowledge and confidence to make informed decisions. By understanding what to look for and what to ask, you can ensure that your first job aligns with your professional goals, financial needs, and personal priorities.

1. Understand Compensation Structures

Physician compensation often extends beyond base salary to include productivity bonuses, benefits, and incentives. Understanding the full structure is critical to evaluating the true value of an offer.

• Base Salary: Is the salary guaranteed, or will it transition to a productivity model after a set period?
• Bonuses: Does the offer include signing, relocation, or retention bonuses? What are the conditions for receiving them?
• Productivity Metrics: If pay is tied to productivity, understand the benchmarks, such as RVUs (Relative Value Units) or collections. Are these metrics realistic based on expected patient volume?
• Quality Incentives: Some contracts include bonuses tied to quality measures like patient satisfaction or adherence to clinical guidelines. Ensure these metrics are within your control.

Request a breakdown of the total compensation package, including benefits, and compare it to industry standards using resources like MGMA (Medical Group Management Association) data.

2. Evaluate Benefits and Perks

Beyond salary, benefits can add significant value to your overall compensation package. These often include health insurance, retirement plans, and allowances for professional development.

• Health Insurance: Ensure the plan covers your family if needed, and understand the out-of-pocket costs.
• Retirement Plans: Does the employer offer a 401(k) or 403(b) with matching contributions?
• Continuing Medical Education (CME): What annual allowance is provided for CME activities, including travel expenses?
• Relocation Assistance: If you’re moving, does the employer cover moving expenses, and are there repayment clauses?
• Student Loan Repayment: Some employers offer repayment assistance. Confirm the terms and whether this benefit is taxable.

Ensure that these perks align with your financial goals and personal needs, and don’t hesitate to negotiate for improvements if the initial offer falls short.

3. Assess Workload and Call Responsibilities

Your first job will set the tone for your work-life balance, so understanding the expectations around workload and call duties is essential.

• Patient Volume: How many patients are you expected to see daily or weekly? Is the workload sustainable?
• Call Schedule: How frequently will you be on call, and how is call coverage divided among physicians? Are you compensated for extra shifts?
• Administrative Duties: Will you have adequate support staff to handle administrative tasks, or are these part of your responsibilities?

Request specific details about your schedule, including patient care hours, administrative time, and call frequency. A clear understanding of these expectations will help you avoid burnout.

4. Analyze Restrictive Covenants

Many physician contracts include restrictive covenants like non-compete or non-solicitation clauses, which can limit your career options if you leave the position.

• Non-Compete Clause: Review the geographic radius, duration, and scope of the restrictions. Ensure they are reasonable and specific to your specialty.
• Non-Solicitation Clause: Understand whether you’re prohibited from contacting former patients or colleagues if you leave.

Consult with a healthcare attorney to ensure these clauses are enforceable in your state and negotiate modifications if they’re overly restrictive.

5. Review Termination Clauses

Termination clauses outline how and when your contract can end, either voluntarily or involuntarily. Understanding these terms is crucial to protecting yourself against unexpected job loss.

• Without Cause Termination: What notice period is required? A typical notice period is 60-90 days.
• For Cause Termination: Are the reasons for termination specific and reasonable?
• Severance Pay: Is severance provided if you’re terminated without cause?

A well-defined termination clause ensures clarity and security if the employment relationship ends.

6. Understand Malpractice Insurance and Tail Coverage

Malpractice insurance protects you from legal and financial risks related to patient care, and tail coverage ensures you remain protected after leaving a job.

• Type of Policy: Does the employer provide claims-made or occurrence-based malpractice insurance?
• Tail Coverage: If the policy is claims-made, who is responsible for purchasing tail coverage? This can be a significant expense, costing 1.5 to 2 times your annual premium.
• Coverage Limits: Ensure the policy meets state and specialty-specific requirements.

Clarify these details during contract negotiations to avoid unexpected liabilities.

7. Examine Career Advancement Opportunities

Your first job should support your long-term professional growth. Look for opportunities to advance your career through leadership roles, teaching, or research.

• Path to Partnership: If joining a private practice, what are the terms for partnership? Is there a buy-in requirement?
• Teaching and Research: If in an academic setting, are there opportunities for teaching or conducting research? Are these compensated or part of your base salary?

Ensure the role aligns with your career goals and provides room for advancement.

8. Seek Professional Guidance

Evaluating your first job offer is a complex process, and small oversights can lead to significant challenges later. Consulting with a healthcare attorney or contract review specialist can provide valuable insights and protect your interests.

A professional review can help you:

• Identify vague or unfavorable terms.
• Ensure compliance with state laws.
• Negotiate improvements to your compensation or contract terms.

Their expertise ensures you’re entering a fair and supportive employment agreement.

9. Negotiate With Confidence

Many residents feel hesitant to negotiate their first contract, but it’s an expected part of the hiring process. Employers often leave room for negotiation, and advocating for yourself can result in better terms.

• Know Your Worth: Use industry benchmarks to understand the market value of your specialty and location.
• Prioritize Your Needs: Focus on the areas that matter most to you, such as compensation, work-life balance, or career growth.
• Be Professional: Approach negotiations with confidence and respect, understanding that this is a collaborative process.

A well-negotiated contract ensures you start your career on the right foot.

Evaluating your first job offer and contract is a critical step in transitioning from residency to practice. By understanding the key components of a physician contract, asking the right questions, and seeking professional guidance, you can make informed decisions that set the foundation for a successful career.

Take the time to carefully review every detail, prioritize your needs, and don’t hesitate to negotiate for better terms. With preparation and confidence, you can secure a job offer that aligns with your goals, values, and aspirations.