Do I really need a lawyer for my first physician contract?

For the first one, yes. Physicians report paying $500 to $3,500, more if the attorney also negotiates.[12] Use a health care attorney licensed where you will practice, since restrictive covenant law is state-specific and has changed substantially since 2024.

Will the offer get pulled if I negotiate as a resident?

Very unlikely. Contract review data cited by the AMA puts employer offense under 5% of negotiations and withdrawn offers under 1%.[2] AMA guidance is not to accept a first offer and not to assume large employers refuse to negotiate.[3]

Is my non-compete enforceable now that the FTC rule is gone?

That depends on your state and your signature date. The 2024 FTC rule was blocked in August 2024 and the agency withdrew its appeal in September 2025, so there is no federal ban.[5] Texas caps physician non-competes at one year and five miles for agreements entered on or after September 1, 2025,[6] and Maryland bars them outright for direct-care providers earning $350,000 or less as of July 1, 2025.[7]

Who pays for tail coverage when I leave?

Whatever your contract says, which is why you have to find the sentence. Tail typically runs about 200% of the annual claims-made premium as a lump sum, so a $40,000 premium implies roughly $80,000.[8] Ask for employer-paid tail, or at minimum for the obligation to disappear if they terminate you without cause.

Do I have to pay back my signing bonus if I leave early?

Usually some of it. An MGMA poll conducted February 3, 2026 found 80% of medical groups use clawback provisions, commitment periods most often one to three years, repayment frequently prorated by time served.[9] Check whether the obligation survives an employer-initiated termination, because that term is often negotiable.

When should a final-year resident start looking and signing?

Timing varies by specialty and market, which is why the AMA declines to give one timeline.[14] Practically, leave runway for attorney review, a two to three round negotiation, and 60 to 180 days of credentialing before your intended start date.[11]

The most expensive first attending contract mistakes are almost never about the salary number. They are about the compensation exhibit that can be rewritten without your signature, the tail coverage nobody mentioned in the interview, and the assumption that a non-compete is automatically enforceable where you live. Salary is the one term residents actually scrutinize, which is exactly why it is rarely where they get hurt.

If you are a final-year resident or fellow reading one of these for the first time: you are being asked to sign a commercial agreement drafted entirely by the other side's lawyers, in a language nobody taught you, during the busiest year of your training. That is a structural mismatch, not a character flaw, and it is fixable.

The most common first attending contract mistakes have nothing to do with money

Ask a group of second-year attendings what they would redo, and the answers cluster in the same place. Not the base. The exit.

Some of this is just where the profession landed. Only 42.2% of physicians practiced in private practice in 2024, down from 60.1% in 2012, while direct hospital employment more than doubled.[1] Most residents graduating now sign with an organization that processes hundreds of these a year. You are reading yours once. Everything below is downstream of that asymmetry.

Mistake 1: Believing the phrase "this is our standard contract"

You will hear it, sometimes from a recruiter, sometimes from a physician leader who genuinely believes it.

The data says otherwise. Attorney Bryce Krieger, whose firm reviews physician agreements through an AMA partnership, reports that more than half the contracts they see arrive with the employer calling them "standard," and those same employers routinely make adjustments anyway.[2] Fewer than 5% of negotiations produce any employer offense, and fewer than 1% of offers are withdrawn because a candidate requested changes.[2]

Meanwhile at least three-quarters of physicians entering practice report apprehension about negotiating at all.[2] Put those numbers side by side. The fear is nearly universal. The consequence is nearly nonexistent.

AMA guidance is blunter than most residents expect: do not make the first offer, do not accept the first offer, and do not assume a large employer will not negotiate.[3] Declining to negotiate is the unusual move, and not in a good way.

Mistake 2: Reading the base salary and skipping the compensation exhibit

The salary lives in one sentence. What you earn in year three lives in an exhibit at the back, often labeled Schedule A, and frequently written so it can be rewritten.

Three questions matter more than the headline number:

How long is the guarantee? Most first contracts guarantee a base for a defined period, then move you to a productivity model. If you cannot name the date that transition happens and the threshold you must clear, you do not know what you signed.

What is the conversion rate, and against what benchmark? A dollars-per-wRVU figure means nothing without a specialty comparison.

Can the plan change without you? Residents almost never ask this one. An MGMA Stat poll of 258 medical groups conducted April 21, 2026 found 37% formally review their physician compensation methodology annually and another 38% review it every two to three years.[4] Three-quarters revisit the model on a schedule. If your agreement incorporates a compensation plan "as amended from time to time," you have agreed in advance to a formula you have not read.

Ask for the current plan as an attachment. Ask what happens if it is amended mid-term. An evasive answer is itself an answer.

Our physician employment contract guide covering every clause that matters goes deeper on the mechanics than a spoke article can.

Mistake 3: Assuming your non-compete is unenforceable because the FTC rule failed

This is the most common piece of misinformation circulating in resident lounges right now, and it costs people real money.

The actual sequence: the FTC issued a final rule in April 2024 that would have broadly banned non-competes, a federal court in Texas blocked it nationwide in August 2024, and in September 2025 the FTC withdrew its appeal and shifted to case-by-case enforcement instead of rulemaking.[5] There is no nationwide ban, and there never was one in force.

State law governs your restrictive covenant, and state law has moved a great deal, in different directions, on different timelines.

Texas shows how specific this has become. Senate Bill 1318 took effect September 1, 2025 for agreements entered or renewed on or after that date. It caps physician non-competes at one year, limits the restricted area to a five-mile radius from the physician's primary practice location at termination, caps the buyout at the physician's total annual salary and wages, voids the covenant entirely if the practitioner is terminated without good cause, and extends coverage to dentists, nurses, and physician assistants.[6]

Maryland took a different route. Since July 1, 2025, licensed providers delivering direct patient care who earn $350,000 or less cannot be bound by a non-compete at all. Above that threshold, the covenant is capped at one year and ten miles. Not retroactive.[7] Alabama, Arkansas, Delaware, Indiana, Louisiana, Massachusetts, New Mexico, and Pennsylvania also restrict or prohibit physician non-competes, with Tennessee and Virginia provisions effective July 1, 2026 and a broader Washington ban set for June 30, 2027.[5]

So the real question is whether yours is enforceable in your state, under the statute in effect on your signature date. Non-retroactivity cuts both ways: sign before a favorable law takes effect and you may not get its protection. Texas and Maryland have already enacted specific statutory limits, and other states continue to update their enforceability standards. A covenant nobody could ultimately enforce still works, because most physicians do not litigate. They relocate, or they stay.

Push on the trigger language. AMA guidance is that a restrictive covenant should not apply if the employer terminates you without cause.[10] That one sentence is worth more than most salary concessions.

This article is educational and is not legal advice. Contract terms vary by state and employer. Have any agreement reviewed by a licensed attorney before signing.

Mistake 4: Not finding out who pays for tail coverage

A claims-made policy covers claims reported while it is active. When you leave, that stops, and incidents from your time there can still surface. Tail closes the gap.

It is not a rounding error. Tail typically runs about 200% of the annual premium as a lump sum, so a $40,000 premium implies roughly $80,000 due at departure.[8] High-risk specialties pay more.

Sometimes the employer covers it outright. Sometimes it is prorated, forgiven over a vesting schedule, or shifted to you entirely if you resign. An unplanned tail obligation is a golden handcuff that arrives at the worst possible moment, usually the moment you have decided the job is not working.

Two lines to find: who bears the cost, and whether that changes depending on who ends it and why.

Mistake 5: Treating the signing bonus as money you already have

New attendings spend it. The bonus lands, the loan situation is what it is, and there is a house or a car or six years of deferred everything.

An MGMA Stat poll of 304 medical groups conducted February 3, 2026 found eight in ten (80%) use clawback or repayment provisions on signing bonuses if a physician or advanced practice provider leaves early. Only 16% had no clawback. Commitment periods most often ran one to three years, occasionally four or five depending on specialty or bonus size, and most groups prorated repayment by time served while some demanded the full amount back.[9]

For scale, AMN Healthcare's 2025 review of recruiting incentives, drawn from 1,420 search engagements, put the average physician signing bonus at $38,215, up 23% year over year, with relocation averaging $12,619 and CME $4,073.[13]

Find three things before you spend it: the commitment period, whether repayment is prorated or all-or-nothing, and whether the obligation survives if the employer terminates you without cause. That last one is negotiable more often than residents think.

Mistake 6: Accepting termination terms that are not symmetrical

Read the without-cause termination clause twice, once from each side of the table.

The AMA treats 90 days as the standard minimum notice and flags anything shorter. The right should also be reciprocal: if your employer can end things without cause on 90 days, so should you.[10] For-cause provisions deserve the same scrutiny. Ask for a cure period, typically 30 days, so a fixable problem is not a termination event, and negotiate your own for-cause grounds, including the employer failing to pay you on schedule.[10]

One clause residents skip entirely: what happens to patient notification and your access to a patient list when you leave. It generates disputes out of all proportion to the space it occupies.[10]

Mistake 7: Building your finances around the start date instead of the credentialing date

Your first paycheck is not tied to the date on page one. It is tied to when you are credentialed at the facility and enrolled with payers.

When I transitioned into my first post-residency role, the gap between my official start date and my first billable encounter stretched across weeks while commercial payer enrollment cleared—a frustrating delay I've seen play out for countless colleagues. Initial credentialing commonly runs 60 to 180 days end to end: hospital privileging 60 to 120 days, Medicare 60 to 90, Medicaid 45 to 90, commercial payer enrollment 90 to 120.[11] Late applications, or gaps that trigger verification requests, extend all of it.

Ask in writing when the credentialing packet goes out, who owns it internally, and what happens to your compensation if you are on payroll but cannot yet bill. Some contracts address this. Many do not.

Run your first contract past the red-flags checklist. Physicians' Copilot walks your agreement clause by clause, so the questions get asked while you still have leverage.

First physician contract review: a clause-by-clause reference

Clause	The question residents ask	The question that actually matters
Base compensation	Is the number competitive?	When does the guarantee end and what threshold replaces it?
Compensation exhibit	What is my $/wRVU?	Can the plan be amended without my consent during the term?
Non-compete	Is this even enforceable?	What does my state's statute say as of my signature date, and does the covenant survive a without-cause termination?
Malpractice	Am I covered?	Claims-made or occurrence, and who pays tail if I leave or if they let me go?
Signing bonus	When do I get it?	What is the commitment period, is repayment prorated, and does it survive employer termination?
Termination	How much notice?	Is notice reciprocal, is there a cure period, and do I have for-cause grounds of my own?
Call and coverage	How often is call?	Is the frequency defined in the contract or left to a policy that can change?
Start date	When do I begin?	When am I credentialed, enrolled, and actually able to generate revenue?
Benefits and CME	What is the allowance?	Is it stated in the agreement or in an employee handbook the employer can revise?

New attending contract review: a ten-step sequence before you sign

Get the complete package: every exhibit, schedule, policy, and compensation plan referenced by name. A contract pointing at documents you have not seen is not a contract you have read.
Read it once alone, start to finish, without a pen.
Read it again and mark every number, date, and named party. Those are the operative terms.
Look up your state's current physician non-compete statute and whether it reaches agreements signed on your date.
Identify who pays tail, under which departure scenarios.
Write out the bonus repayment schedule as dollars by month. Seeing the number changes how it feels.
Benchmark against specialty and geography, not against your co-residents.
Rank your asks. AMA advice is to request more items than you need so you have something to concede.[3]
Send it to a health care attorney licensed where you will practice.
Negotiate in writing, then confirm every agreed change appears in the final version. Verbal assurances do not survive personnel changes.

For the tactical layer, our physician contract negotiation playbook covers what to ask for and in what order, and our list of red flags in a physician employment contract covers the terms worth walking away from.

What a contract attorney actually costs, and why residents skip it anyway

Physicians report paying roughly $500 to $3,500, depending on complexity, local norms, and whether the attorney also negotiates.[12]

Set that against a tail obligation near $80,000, a prorated clawback on a $38,215 bonus, and a restriction that decides where your family lives for a year. Review is the cheapest line item in the transaction, and it is the one residents cut.

The reason is not money. It is time, plus a quiet worry about looking difficult in a year when everyone is still evaluating you. Name the worry, then look at the number again: fewer than 1% of offers get pulled over a request for changes.[2]

Key takeaways

The costliest first attending contract mistakes sit in the exit terms: tail coverage, non-compete triggers, bonus clawbacks, termination symmetry.
"This is our standard contract" is a posture, not a fact. More than half of reviewed contracts carry that claim and get changed anyway.[2]
The FTC non-compete rule is not in effect and the agency withdrew its appeal in September 2025. Your state statute, as of your signature date, governs.[5]
Eight in ten medical groups use signing bonus clawbacks, most prorated by time served.[9]
Credentialing and payer enrollment commonly take 60 to 180 days, so page one's start date is not when you begin generating revenue.[11].

Before you sign

You sign this once and live inside it for years. The version of you reading it in June of your final year is tired, relieved to have an offer, and inclined to trust that the institution has your interests at heart. Most institutions are not hostile. They are just represented, and you are not.

Get represented. Ask the boring questions. Then sign.

Run your first contract past the red-flags checklist. Physicians' Copilot walks you through the clauses that decide your exit terms, so you find the tail obligation and the clawback schedule now instead of in year two.