All moves, med school to late career · Residents · Early career · reviewed October 27, 2026 · oldest source check October 21, 2026
The decision. Signing the first attending employment contract.
What changes
- Pay moves from a fixed salary to a formula: a guaranteed base, productivity pay (often per work RVU), bonuses, or a mix. When the guarantee ends, and what replaces it, matters as much as the starting number.Andwise clause library: compensation · checked October 21, 2026
- AMN, a recruiting firm, offered signing bonuses in 87% of the 1,293 physician and advanced-practitioner searches it ran from April 2025 to March 2026, averaging $49,306 for physicians. Relocation was offered in 68%, averaging $13,594. Where loan repayment was offered, 98% of searches required three or more years of service.AMN Healthcare, 2026 Review of Physician and Advanced Practitioner Recruiting Incentives · checked October 21, 2026
- In an MGMA poll of 304 groups in February 2026, 80% required repayment of a sign-on bonus if the physician left early, most prorated over one to three years.MGMA Stat, clawbacks on clinician sign-on bonuses more common (2026-02-05) · checked October 21, 2026
- In the Physicians Advocacy Institute's 2026 survey of 1,003 employed physicians, 52% reported a non-compete. In 30 of the 51 jurisdictions in Andwise's dataset, a statute voids physician non-competes or sets their limits.Physicians Advocacy Institute, 2026 Employed Physician Survey; Andwise: non-compete laws by state · checked October 21, 2026
- Tail coverage is priced as a multiple of the mature annual claims-made premium, typically 150% to 250%. Whether the employer or the physician pays it is set by the contract.Andwise: malpractice tail coverage costs by specialty · checked October 21, 2026
- PSLF counts a payment only while the borrower works full-time for a qualifying employer: a government organization or a 501(c)(3) nonprofit. A physician staffed into a nonprofit hospital by a for-profit group is employed by the group. Rules on which employers qualify are in litigation.34 CFR 685.219, Public Service Loan Forgiveness; CRS Legal Sidebar LSB11472, PSLF employer rule (updated 2026-08-31) · checked October 21, 2026
- In the same PAI survey, 33% of employed physicians reported a nondisclosure agreement, and 41% to 53% reported patient-volume targets in their compensation.Physicians Advocacy Institute, 2026 Employed Physician Survey · checked October 21, 2026
Not measured.
- No physician-specific data says how long offers stay open, or how often an offer is withdrawn after a counter.
Who is paid for what
How each party at this decision is paid, and what its role does not include. The page states payment structures only, not intentions.
Agency recruiter
Paid a placement fee by the hiring employer. The National Association of Physician Recruiters bars its members from taking fees from candidates.National Association of Physician Recruiters, ethical standards
Not part of its role Reviewing the contract on the physician's behalf.
The employer, including its in-house recruiters
Pays the physician through the contract's formula. In PAI's 2026 survey, 41% to 53% of employed physicians reported patient-volume targets in their compensation.Physicians Advocacy Institute, 2026 Employed Physician Survey
Not part of its role Explaining what the contract costs the physician on the way out.
Refinance lender
Earns interest on a private loan. Refinancing a federal loan with a private lender pays the federal loan off, and with it the federal repayment plans, deferment, forbearance and forgiveness, including PSLF.CFPB, consolidating or refinancing student loans; Andwise: refinancing a student loan, break-even
Not part of its role Comparing the refinance with federal plans and PSLF.
Malpractice carrier
Collects premiums, including a one-time tail premium of typically 150% to 250% of the mature annual premium when a claims-made policy ends.Andwise: malpractice tail coverage costs by specialty
Not part of its role Deciding who pays for tail; the contract decides that.
Costs that come later
What is agreed at this decision, and when its cost arrives.
- The non-compete's radius and lengthLands at Leaving the job, when the covenant starts runningNon-compete laws by state
- Who pays tail coverageLands at Leaving the jobTail coverage costs
- Signing-bonus and relocation repayment termsLands at Leaving before the commitment ends, when repayment comes from after-tax payBonus repayment after tax
- Loan-repayment vestingLands at Leaving within the service commitmentOffer comparison
- Guarantee length and the formula that follows itLands at The first year paid on the formulaWhen the salary guarantee ends
- The legal employer's tax statusLands at PSLF: payments made while employed by a for-profit employer do not countContract checker
Dates for a calendar
Contract dates come from the terms the contract checker read, saved in this browser only; a start date places them. Rule changes come from the site's feed of dated changes. The calendar file is built on this device.
What is fixed and what moves
Ratings are Andwise's reading of the evidence beside each one. No national data measures what negotiating changes.
- Signing bonus and relocation
- Offered in 87% of AMN's searches and varying widely in size between offers; wide variation is where room to move is most plausible.AMN Healthcare, 2026 Review of Physician and Advanced Practitioner Recruiting Incentives
- Bonus repayment (clawback)
- 80% of groups use clawbacks, most prorated; MGMA describes proration as the common form.MGMA Stat, clawbacks on clinician sign-on bonuses more common (2026-02-05)
- CME allowance, PTO and retirement
- CME was offered in 58% of AMN's searches, averaging $3,792; these benefits usually follow organization-wide policy.AMN Healthcare, 2026 Review of Physician and Advanced Practitioner Recruiting Incentives
- Non-compete
- Set or bounded by statute in 30 of 51 jurisdictions; elsewhere, courts apply general covenant law.Andwise: non-compete laws by state
- Termination notice
- The AMA recommends mutual without-cause termination with at least 90 days' notice and a 30-day cure period.AMA, physician contracting do's and don'ts
Deadlines, and who sets them
- Set by the other partyThe offer's expiry date
- Set by the program or a licensing bodyLicensing and credentialing before the start date. Examples, not a national norm: the Medical Board of California averaged 59 days from a complete application to first review (October 22, 2026); the AMA suggests allowing at least two months for a license; hospitals commonly ask for credentialing applications 90 to 120 days before the start dateMedical Board of California, application processing times; AMA, navigating state medical licensure (April 2026); Inova, centralized credentialing FAQs
Tools, in the order this decision uses them
Job posting decoder
Which terms a listing states and which it leaves out.
Contract checker
Quotes each clause with its page, in the browser.
Compare an employment offer
Hourly pay, tail and repayment exposure, call, practice limits.
Offer comparison
Two or three offers at 1, 3 and 5 years.
Non-compete laws by state
Each state's rule, with citations.
Tail coverage costs
Estimated exit cost by specialty.
Bonus repayment after tax
What repaying a signing bonus costs.
Compare repayment plans
Plan, payment and PSLF at the new salary.
Salary in two states after tax and housing
The same salary after state tax and practice rules.
Questions for a professional or the other party
Counsel
- Does the non-compete apply after a termination without cause?
- Which sites does the non-compete radius run from?
- Who pays tail coverage, and does that change with the reason for leaving?
The employer
- How long is the base salary guaranteed, and what formula replaces it?
- Which fee-schedule year sets the wRVU values?
- Is the employing entity a government organization or a 501(c)(3) nonprofit?
A CPA
- How is a repaid signing bonus treated for tax in the year it is repaid?