From Residency to Practice: How to Evaluate Your First Physician Job Offer

After years of training, overnight shifts, and high-stakes exams, you’ve made it. You’re on the cusp of becoming an attending physician—and with that transition comes a milestone moment: your first job offer.

But not all offers are created equal.

Understanding the fine print, compensation structure, and legal implications of a physician contract is critical for setting yourself up for a sustainable, rewarding career. Unfortunately, many early-career doctors rush into accepting positions without fully evaluating the terms—often leading to burnout, financial regret, or limited career flexibility down the road.

This guide breaks down how to evaluate your first attending offer—from base salary vs. RVUs, to tail coverage, non-compete clauses, and relocation support—so you can make a confident, informed decision.

Why Your First Job Offer Matters

Your first job sets the tone for your professional future. It impacts:

• Your financial trajectory

• Your work-life balance and call expectations

• Your clinical autonomy and long-term growth

• Your geographic flexibility if/when you want to relocate

Whether you’re a PGY-3 considering primary care, or a gastroenterology fellow preparing for a highly specialized role, understanding how to compare physician offers is one of the most important career skills you can develop.

Key Elements of a Physician Job Offer to Review

1. Compensation Structure: Base Salary vs. RVUs

Understanding how you’re paid is essential—and RVUs (Relative Value Units) are a big part of that.

Base Salary

Many employers offer a guaranteed base salary for the first 1–3 years. This provides income stability while you ramp up your patient volume.

Pros:

• Predictable income

• Helpful in first job out of training

• No productivity pressure initially

Cons:

• May be lower than long-term RVU earning potential

• Might come with bonus thresholds or clawbacks

RVU-Based Compensation

After the initial salary period, many contracts shift to productivity-based compensation, typically using work RVUs (wRVUs). You’re paid based on services provided, not collections.

Key Questions:

• What is the RVU conversion rate (e.g., $/RVU)?

• Is there a threshold before RVUs kick in?

• Are bonuses offered for exceeding targets?

Tip: Use MGMA or AMGA benchmarks to compare wRVU compensation rates in your specialty and region.

2. Malpractice Coverage: Does It Include Tail Insurance?

All physicians need malpractice insurance, but tail coverage is what protects you after leaving a job.

• Occurrence policies: Cover you for any event that happened while the policy was active—no tail needed.

• Claims-made policies: Require tail coverage after you leave, often costing 100–200% of your annual premium.

Red Flag: If your contract doesn’t provide tail or doesn’t mention it, clarify who pays before signing.

3. Non-Compete Clauses (Restrictive Covenants)

A non-compete clause restricts where you can work after leaving your employer—often within a certain radius and time frame.

Examples:

• “You may not work within 30 miles of our location for 2 years post-employment.”

What to Look For:

• Duration (1 year is common; 2+ may be excessive)

• Geographic scope (too wide may limit job options)

• Specialty-specific? (general clauses may block unrelated roles)

Tip: States vary on how enforceable non-competes are. Check with a healthcare attorney.

4. Relocation Assistance and Signing Bonuses

Many employers offer relocation stipends (often $5,000–$15,000) and signing bonuses (from $10,000 to $50,000+) to attract physicians.

Watch for:

• Repayment clauses if you leave before 1–3 years

• Whether bonuses are taxed up front or spread over time

• How the relocation stipend is paid (reimbursement vs. lump sum)

5. Schedule and Call Requirements

Beyond compensation, your day-to-day life matters just as much:

• Inpatient vs. outpatient mix

• Weekend and holiday call expectations

• Night coverage structure (do you take your own call?)

• Average patients per day

• Support staff (MAs, scribes, RNs, APPs)

Red Flag: “Light call” with no definition can become 24/7 reality if you're the only physician.

6. Benefits and CME Allowance

Don’t overlook the value of your benefits package, including:

• Health, dental, vision coverage

• 401(k) or 403(b) with employer match

• Disability and life insurance

• CME allowance (usually $2,000–$5,000/year + 5–10 days off)

• Vacation and PTO policy (ask for the exact number of weeks)

Bonus: Questions to Ask Before Accepting a Job

• What is the average physician turnover rate at this practice?

• Are there opportunities for leadership or teaching?

• What are the top 3 reasons physicians leave this organization?

• What does success look like here in the first year?

• Can I speak to a physician who has been here for 3+ years?

Final Thought: This Is a Business Decision—Treat It Like One

You’ve worked too hard to accept your first job based on vague promises or flashy numbers. While mentorship and culture matter, your contract must also protect your financial future, lifestyle goals, and legal rights.

Consider hiring a physician-focused attorney to review your offer, and don’t be afraid to negotiate—especially on non-salary items like call burden, bonus structure, or contract length.

This is your first step into attending life. Make it a smart one.

Ready to Compare Physician Job Offers?

PracticeMatch helps new physicians navigate career decisions with:

• Verified jobs from top employers across all specialties

• Detailed compensation data and contract insights

• Free CV reviews and interview coaching

• Personalized job matching and recruiter connections

? Explore Physician Job Opportunities

Madison Tarrant - Director of Career Fair Operations. You can stay connected with me on LinkedIn for all of the latest PracticeMatch articles and upcoming events.