Understanding Your First Attending Contract

Your first attending contract sets your pay, your schedule, your exit terms and sometimes where you may practice later, so read it as a legal document and not as an offer letter. The single most useful step is to have an attorney experienced in physician employment contracts review it before you sign. This page explains the main terms so you can ask better questions. It is general information, not legal, tax or financial advice, and it does not list salary figures.

Get the process right first #

1. Ask for the full draft in writing, including exhibits, policies and any referenced handbook. The terms are often in the attachments.
2. Ask for time to review. A reasonable employer will allow it.
3. Negotiate before you sign. Many terms are negotiable, especially when you have other offers.
4. Get promises in writing. Verbal commitments about call, support staff, visa sponsorship or schedule are not enforceable if the contract says otherwise.
5. Keep a signed copy and any correspondence.

Compensation structure #

Ask how you are paid, and ask the employer to show how the formula works with examples.

Ask about:

• the start date for pay and for benefits,
• how pay changes after an initial period,
• whether any amounts are repayable,
• retirement contributions, health benefits and paid time off, and
• how expenses such as licensing fees, dues, CME and board fees are handled.

We do not give salary figures because they vary by specialty, region and year. Use published survey data and your own offers, and have an attorney or an experienced colleague help you read the terms, not just the number.

Call, schedule and duties #

• How much call is expected, what counts as call, and whether it is paid separately.
• Where you work, how many sites, and whether the employer can change them.
• Your duties and who sets your schedule.
• Support staff, space and equipment.
• Whether you are required to take on additional work, or are restricted from outside work.

Sign-on, relocation and clawbacks #

Signing bonuses and relocation payments often come with repayment terms. Ask:

• whether the money is a bonus or a loan, and how repayment works if you leave early,
• whether the repayment amount reduces over time, and
• what exceptions apply, such as termination without cause.

Read these clauses with the termination terms below, because the combination decides what leaving costs you.

Termination and notice #

• Whether either side can end the contract without cause, and with how much notice.
• What counts as "cause," who decides, and whether you can respond or cure.
• What happens to pay, benefits, accounts receivable and bonuses at termination.
• What obligations survive the contract, such as restrictive covenants and repayment terms.

Restrictive covenants #

A restrictive covenant, often called a non-compete, limits where or for whom you can work after you leave. Others may restrict soliciting patients or colleagues.

• State law decides. The Federal Trade Commission's rule on non-competes is not in effect and is not enforceable, according to the FTC's own page, which also notes that a district court order stopped it in August 2024 and that the agency took steps to dismiss its appeal in September 2025. That leaves state law. States differ: some ban or limit non-competes for physicians, others enforce them if reasonable, and several have changed their laws recently. We do not summarize states here. Ask your attorney what your state currently allows, and which state's law the contract chooses.
• Terms that matter include the radius, the duration, the activities covered, whether it applies if the employer ends your contract without cause, and whether a buyout is available. AMA guidance notes that the risk is tied to how the contract ends, and suggests limiting covenants where possible.
• Residents are treated differently. ACGME's Institutional Requirements say a Sponsoring Institution must have a policy stating that neither it nor its ACGME-accredited programs will require a resident or fellow to sign a non-competition guarantee or restrictive covenant. That rule protects residents and fellows, not attendings, so it does not apply to your first attending job.

Malpractice insurance and tail coverage #

• Is coverage occurrence-based or claims-made?
• Tail coverage protects you for claims filed after a claims-made policy ends. Ask who pays for it, when you leave for any reason, and whether the employer pays if it ends your contract without cause. AMA and other physician guides describe tail coverage as a cost that can be high, which is why it is negotiated.
• Limits of coverage, whether you have your own say over the carrier, and whether the employer will indemnify you.

Credentialing, licensure and board certification #

• Who pays for licenses, DEA registration, hospital privileges and dues.
• Whether you must become board certified within a period, and what happens if you do not. See board certification after residency.
• Whether the start date depends on credentialing and licensing timelines that are not within your control. See state licensure for IMGs.

Moonlighting and outside work #

Employers often restrict outside clinical work, and may claim ownership of income from it. If you want to keep teaching, consulting or locums work, negotiate it. For rules during training, see moonlighting during residency.

Terms that matter more for IMGs #

Visa sponsorship #

If you need a visa to start or continue, the contract should state who sponsors which status, who pays the filing and legal costs, and what happens if the filing is delayed or denied. If your start date depends on approval, say so in the contract. See H-1B cap-exempt employers for why employer type matters.

J-1 waiver obligations #

If you took a J-1 and are subject to the two-year home-country requirement, a waiver program may require a service commitment at a specific location. USCIS describes the Conrad 30 program as one such route, and its authorization has been tied to congressional action, so check the current page. See Conrad 30 and J-1 waiver options. The contract and the waiver terms must match, and many waiver agreements restrict changing employers or locations during the service period. Ask what happens if the employer ends your contract, closes or changes sites, and who covers legal costs.

Green card sponsorship #

If you want employer-sponsored permanent residence, ask when the employer will start, who pays, and whether it is guaranteed or discretionary. See green card paths for physicians.

Questions to bring to your attorney #

• What terms here are unusual or unfavorable for my specialty and state?
• Which clauses could I negotiate, and what is a realistic request?
• How is the non-compete likely to be treated in my state?
• How do termination, tail coverage and repayment terms interact?
• How does this contract fit my visa, waiver and green card plans?

This wiki gives general information and is not legal, tax or financial advice. A contract is a binding document, so have a qualified attorney review it.