---
title: "From residency to the first attending contract"
canonical: "https://www.joinandwise.com/crossings/first-attending-contract"
checked: "2026-10-21"
claim: "andwise:crossing/first-attending-contract@2026-10-21"
license: "CC BY 4.0"
---

# From residency to the first attending contract

Signing the first attending contract switches on pay formulas, retention money, exit terms and PSLF employer rules. Most of their cost arrives years later, at the end of a guarantee or on the way out.

**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](https://www.joinandwise.com/contracts/clauses/compensation); checked 2026-10-21)
- 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](https://www.amnhealthcare.com/siteassets/amn-insights/physician/2026-review-of-physician--advanced-practitioner-recruiting-incentives.pdf); checked 2026-10-21)
- 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)](https://www.mgma.com/mgma-stat/clawbacks-on-clinician-sign-on-bonuses-more-common); checked 2026-10-21)
- 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](https://www.physiciansadvocacyinstitute.org/Portals/0/assets/docs/PAI-Research/PAI%202026%20Employed%20Physician%20Survey%20-%20final.pdf); [Andwise: non-compete laws by state](https://www.joinandwise.com/contracts/noncompete); checked 2026-10-21)
- 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](https://www.joinandwise.com/contracts/tail-coverage); checked 2026-10-21)
- 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](https://www.ecfr.gov/current/title-34/section-685.219); [CRS Legal Sidebar LSB11472, PSLF employer rule (updated 2026-08-31)](https://www.everycrsreport.com/reports/LSB11472.html); checked 2026-10-21)
- 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](https://www.physiciansadvocacyinstitute.org/Portals/0/assets/docs/PAI-Research/PAI%202026%20Employed%20Physician%20Survey%20-%20final.pdf); checked 2026-10-21)
- 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

- **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](https://www.napr.org/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](https://www.physiciansadvocacyinstitute.org/Portals/0/assets/docs/PAI-Research/PAI%202026%20Employed%20Physician%20Survey%20-%20final.pdf)) 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](https://www.consumerfinance.gov/ask-cfpb/should-i-consolidate-refinance-student-loans-en-561/); [Andwise: refinancing a student loan, break-even](https://www.joinandwise.com/loans/refinance)) 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](https://www.joinandwise.com/contracts/tail-coverage)) Not part of its role: Deciding who pays for tail; the contract decides that.

## Costs that come later

- The non-compete's radius and length → Leaving the job, when the covenant starts running — https://www.joinandwise.com/contracts/noncompete
- Who pays tail coverage → Leaving the job — https://www.joinandwise.com/contracts/tail-coverage
- Signing-bonus and relocation repayment terms → Leaving before the commitment ends, when repayment comes from after-tax pay — https://www.joinandwise.com/contracts/clawback
- Loan-repayment vesting → Leaving within the service commitment — https://www.joinandwise.com/contracts/compare
- Guarantee length and the formula that follows it → The first year paid on the formula — https://www.joinandwise.com/crossings/salary-guarantee-ends
- The legal employer's tax status → PSLF: payments made while employed by a for-profit employer do not count — https://www.joinandwise.com/contracts/check

## What is fixed and what moves

- Signing bonus and relocation: Often moves. 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](https://www.amnhealthcare.com/siteassets/amn-insights/physician/2026-review-of-physician--advanced-practitioner-recruiting-incentives.pdf))
- Bonus repayment (clawback): Sometimes moves. 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)](https://www.mgma.com/mgma-stat/clawbacks-on-clinician-sign-on-bonuses-more-common))
- CME allowance, PTO and retirement: Mostly fixed. 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](https://www.amnhealthcare.com/siteassets/amn-insights/physician/2026-review-of-physician--advanced-practitioner-recruiting-incentives.pdf))
- Non-compete: Set by law. Set or bounded by statute in 30 of 51 jurisdictions; elsewhere, courts apply general covenant law. ([Andwise: non-compete laws by state](https://www.joinandwise.com/contracts/noncompete))
- Termination notice: Sometimes moves. 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](https://www.ama-assn.org/medical-residents/transition-resident-attending/physician-contracting-do-s-and-don-ts-interviews))

## Deadlines

- The offer's expiry date — Set by the other party
- Licensing 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 date — Set by the program or a licensing body

## Tools

- [Job posting decoder](https://www.joinandwise.com/contracts/posting): Which terms a listing states and which it leaves out.
- [Contract checker](https://www.joinandwise.com/contracts/check): Quotes each clause with its page, in the browser.
- [Compare an employment offer](https://www.joinandwise.com/decide/offer): Hourly pay, tail and repayment exposure, call, practice limits.
- [Offer comparison](https://www.joinandwise.com/contracts/compare): Two or three offers at 1, 3 and 5 years.
- [Non-compete laws by state](https://www.joinandwise.com/contracts/noncompete): Each state's rule, with citations.
- [Tail coverage costs](https://www.joinandwise.com/contracts/tail-coverage): Estimated exit cost by specialty.
- [Bonus repayment after tax](https://www.joinandwise.com/contracts/clawback): What repaying a signing bonus costs.
- [Compare repayment plans](https://www.joinandwise.com/decide/loans): Plan, payment and PSLF at the new salary.
- [Salary in two states after tax and housing](https://www.joinandwise.com/decide/move): The same salary after state tax and practice rules.

## Questions

### 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?

## Sources

- [Andwise clause library: compensation](https://www.joinandwise.com/contracts/clauses/compensation)
- [AMN Healthcare, 2026 Review of Physician and Advanced Practitioner Recruiting Incentives](https://www.amnhealthcare.com/siteassets/amn-insights/physician/2026-review-of-physician--advanced-practitioner-recruiting-incentives.pdf)
- [MGMA Stat, clawbacks on clinician sign-on bonuses more common (2026-02-05)](https://www.mgma.com/mgma-stat/clawbacks-on-clinician-sign-on-bonuses-more-common)
- [Physicians Advocacy Institute, 2026 Employed Physician Survey](https://www.physiciansadvocacyinstitute.org/Portals/0/assets/docs/PAI-Research/PAI%202026%20Employed%20Physician%20Survey%20-%20final.pdf)
- [Andwise: non-compete laws by state](https://www.joinandwise.com/contracts/noncompete)
- [Andwise: malpractice tail coverage costs by specialty](https://www.joinandwise.com/contracts/tail-coverage)
- [34 CFR 685.219, Public Service Loan Forgiveness](https://www.ecfr.gov/current/title-34/section-685.219)
- [CRS Legal Sidebar LSB11472, PSLF employer rule (updated 2026-08-31)](https://www.everycrsreport.com/reports/LSB11472.html)
- [National Association of Physician Recruiters, ethical standards](https://www.napr.org/ethical-standards)
- [CFPB, consolidating or refinancing student loans](https://www.consumerfinance.gov/ask-cfpb/should-i-consolidate-refinance-student-loans-en-561/)
- [Andwise: refinancing a student loan, break-even](https://www.joinandwise.com/loans/refinance)
- [AMA, physician contracting do's and don'ts](https://www.ama-assn.org/medical-residents/transition-resident-attending/physician-contracting-do-s-and-don-ts-interviews)
- [Medical Board of California, application processing times](https://www.mbc.ca.gov/Licensing/Physicians-and-Surgeons/Apply/processing-times.aspx)
- [AMA, navigating state medical licensure (April 2026)](https://www.ama-assn.org/medical-residents/transition-resident-attending/navigating-state-medical-licensure)
- [Inova, centralized credentialing FAQs](https://www.inova.org/for-physicians/centralized-credentialing/faqs)

Reviewed 2026-10-27; oldest source check 2026-10-21. General information, not legal, tax or financial advice. The site describes what the law and rules say; it does not say whether a clause is enforceable or what you should do.