Your first attending contract will likely be the most important financial document you sign. The difference between a good contract and a bad one can be hundreds of thousands of dollars over a career. Here is what to watch for.
Compensation Section: The Most Important Part
This is where the money is, and where employers hide the most gotchas.
Base Salary vs. Total Compensation
Employers often advertise a high "total compensation" number that includes benefits, retirement matching, and stipends. Always ask for the base salary specifically. This is the number that matters for RVU calculations and future negotiations.
The RVU Details
If your compensation is RVU-based, get these details in writing:
- Conversion rate: How much do you get per RVU? ($40-$60 is common, but varies by specialty)
- Bonus threshold: How many RVUs must you generate before the bonus kicks in?
- Collar: Is there a minimum guarantee regardless of RVU production?
- Cap: Is there a maximum RVU beyond which you stop earning?
Guaranteed Salary Period
Most new attendings should negotiate a guaranteed salary for the first 1-2 years. This protects you if patient volume is lower than expected. Without this guarantee, you could end up earning far less than you planned.
Contract Length and Termination
Contract Duration
A 2-year contract is standard. Avoid 1-year contracts unless you are specifically looking for flexibility. Longer contracts benefit the employer, not you.
Termination Clauses
Look for:
- At-will termination: Can either party end the contract with notice?
- For-cause termination: What specific actions trigger termination?
- Non-compete: How long and how far does it restrict you? Some states limit enforceability.
- Non-solicitation: Can you take patients or staff with you?
Tail Coverage
If you are leaving, who pays for malpractice tail coverage? This can cost $50,000-$200,000. Get this in writing.
Benefits You Should Negotiate
These are often flexible andnegotiable, even when employers present them as fixed.
Signing Bonus
$10,000-$50,000 is common. This is often easier to negotiate than base salary because it is a one-time cost.
Relocation Assistance
$5,000-$15,000 is standard. Do not pay for this yourself.
Student Loan Repayment
Some employers offer $20,000-$50,000 per year toward loans. This is tax-free in some cases. Ask specifically.
CME Time and Budget
5-10 days per year plus $2,000-$5,000 for conferences and continuing education is standard.
Retirement Matching
403(b) or 401(k) matching varies widely. Some employers match 3-6% of salary. This is free money.
Red Flags to Watch For
These items should make you walk away or negotiate hard:
Vague RVU Language
If the contract does not specify the conversion rate, threshold, and collar in writing, you have no protection.
No Tail Coverage Mention
If the employer does not address who pays for tail coverage, assume you will. Get it in writing.
Excessive Non-Compete
A 2-year, 10-mile non-compete may be enforceable. A 5-year, 100-mile non-compete is not. Know your state laws.
Production-Only Compensation
Never sign a contract with no base salary and pure RVU production. What happens in your first month when you have no patients?
Gap in Duty Hours
Make sure the contract specifies your expected work hours. Some employers expect 50+ RVU-generating hours per week but only pay for production.
Automatic Renewal
Check if the contract automatically renews and how much notice is required to terminate.
What to Ask For
These items are reasonable to request:
- Higher base salary (compare to MGMA benchmarks)
- Signing bonus
- Relocation assistance
- Student loan repayment
- 2-year guaranteed salary
- CME time and budget
- tail coverage paid by employer
- Clear RVU conversion rate in writing
The Bottom Line
Never sign a physician contract without having it reviewed by a healthcare attorney. This costs $500-$2,000 and can save you hundreds of thousands.
Also, understand your RVU structure before you sign. Know what you will earn, what is expected of you, and what happens if you exceed or fall short of RVU targets. The numbers in your contract will determine your income for years.
Track your RVUs from day one. The data you gather will be invaluable for your next contract negotiation.
Know your worth. Track your RVUs.
RVU Tracker helps you log every encounter and understand your productivity. Use the data to negotiate your next contract with confidence.
Try RVU Tracker FreeNeed to look up RVU values for procedures? Use our free RVU Calculator.
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