Signing Your First Attending Contract This Winter: Six Terms to Fix Before You Sign

The offer arrives in the fall of your final year, usually by email, usually with a note that the system would like it back within two weeks. It is the first contract most physicians ever negotiate, and it is negotiated at the worst possible moment: during interview season, between call shifts, with a recruiter who is friendly and a document that is not. This post walks through the six terms that matter most in a first attending agreement, why they matter more than the salary, and how to ask for changes without putting the offer at risk.

The calendar: when first contracts get signed and why the deadline is soft

Most physician employment agreements for a July start are signed the preceding fall and winter. Hospital systems and large groups recruit in cycles, which means the person sending you the agreement has sent dozens of them and has a list of terms the system will and will not change. A two-week deadline is meant to keep the recruiting pipeline moving, not to shut down negotiation. A short, polite request for an additional two weeks to have the agreement reviewed is routine, and a system that refuses it has told you something about how it will treat you later.

The timing matters for another reason. A resident who signs in November for a July start is bound for eight months before the first day of work. If something changes in that window, including a better offer, a family move, or a change in the practice, the termination and notice terms you signed in November are the ones that govern.

Term one: the compensation formula, not the salary

The offer letter states a salary. The agreement states how that salary is calculated, and the two are not the same thing. Most first attending agreements guarantee a base for a fixed period, often one to three years, and then shift to a productivity model built on work relative value units. The three numbers that decide what you are paid after the guarantee ends are the length of the guarantee, the wRVU threshold you must hit to keep the base, and the conversion factor that turns each wRVU above the threshold into dollars. If the agreement states the salary but refers to a compensation plan you have not seen for the rest, ask for the plan before you sign. A compensation term you cannot calculate from the documents in front of you is a term to fix.

Ask also who controls the data. The wRVU count comes from the employer's coding and billing, and a formula that lets the employer adjust it after the fact is a formula you cannot check. Quality and value bonuses deserve the same question: are the targets published, or discretionary?

Term two: tail coverage

Most employed physicians are insured under a claims-made malpractice policy, which covers claims filed while the policy is in force. When you leave, claims arising from your work there can still be filed, and covering them requires a tail, or extended reporting endorsement, whose premium can be substantial. The agreement decides who pays it. Some put it on the employer in every case, some put it on the physician, and many shift it depending on who ends the relationship and why. For a first attending, who may well leave the first job within a few years, tail coverage is one of the most expensive terms in the agreement and one of the most negotiable. The physician contract page explains the variations.

Term three: the without-cause notice period

Nearly every physician agreement lets either side end it without cause on notice, commonly 60, 90, or 180 days. Two questions. First, is the period the same for both sides? An agreement that lets the employer end the relationship on 60 days' notice while requiring 180 from you is one-sided and worth raising. Second, what is paid during the notice period, and does the non-compete, the tail obligation, or the bonus repayment change depending on who gave notice? The cause definition deserves a read too, because a termination labeled for cause can trigger repayment and forfeiture that a without-cause termination does not.

Term four: the non-compete radius and the buyout

Ohio enforces a physician non-compete that is reasonable in scope and duration, and narrows one that is too broad rather than voiding it. The term that matters most is the center point: a radius measured from your primary practice site is manageable, while a radius measured from every site where you ever provide services can take in most of the region, especially in a system with dozens of locations. Ask whether the covenant applies if the employer terminates you without cause, and whether a buyout is available. A first attending who may want to stay in the area after a first job that does not work out should treat this as the most important clause in the agreement after compensation.

Term five: signing bonus, relocation, and loan repayment

Signing bonuses and loan repayment are the terms residents like best and read least. Nearly all of them are structured as advances that are forgiven over time and repaid if you leave early, and the repayment schedule is where the detail lives. Ask that repayment be prorated by month of service rather than all or nothing, that it fall away entirely if the employer ends the agreement without cause, and that the forgiveness period match the guarantee period rather than running longer. A loan repayment program tied to a federal or state program has its own rules that sit on top of the agreement.

Term six: call, sites, and what the employer can change alone

The last set of terms is the one that changes the job after you start. Call frequency, practice locations, and clinical duties are sometimes fixed in the agreement and sometimes left to the employer's discretion, with language such as "as assigned" or "as determined by the department." Ask for the call expectation in writing, ask that your practice sites be listed, and ask whether the employer can reassign you to another site or service line without your agreement. Outside activities, moonlighting, expert work, and intellectual property are usually covered in the same section and deserve a read before you sign.

How to ask for changes

Send the proposed changes in writing, as specific language rather than general concerns, and send them to the recruiter or the physician liaison rather than to the department chair. Lead with the two or three terms that matter most to you, because a list of fifteen requests signals that you have not prioritized and tends to produce a form response. Large systems generally use standardized templates, so the open terms tend to be the ones the system treats as negotiable: start date, signing and relocation amounts, loan repayment, call expectations, the list of practice sites, the productivity threshold, and sometimes the non-compete radius and buyout. A written review identifies which of those apply to your draft and gives you the language to request. If you would rather the firm negotiate directly with the employer's counsel, that is a separate scope quoted separately.

What to send for a review

The agreement and everything it references: the compensation plan, the benefits summary, the bylaws or policies it incorporates, and any separate restrictive covenant. Name the employer, the specialty, and the date you have been asked to sign by. The physician contract review checklist lists each term, and the two-minute self-check flags which ones in your draft deserve attention.

The bottom line

The first attending contract is the one you will negotiate with the least experience and the most leverage, because the system has already decided it wants you. Ask for time, ask for the documents the agreement references, fix the six terms above in writing, and sign the version that says what you were told.

Frequently Asked Questions

Can I negotiate my first attending contract as a resident?

Yes. Systems expect it, and most have a short list of terms they routinely adjust for new attendings: start date, signing and relocation amounts, loan repayment, call expectations, the list of practice sites, and sometimes the productivity threshold and the non-compete radius. Ask in writing, as specific language, and lead with the terms that matter most to you.

How much time should I ask for before signing?

Two weeks beyond whatever the recruiter proposed is a reasonable request and is routinely granted. Use the time to gather every document the agreement references and to have it reviewed. A system that refuses any extension is telling you something worth knowing before you sign.

Is the salary in the offer letter guaranteed?

Only for the guarantee period stated in the agreement, which is often one to three years. After that, most agreements shift to a productivity model, and the wRVU threshold and the conversion factor decide what you earn. If the agreement refers to a compensation plan you have not seen, ask for it before you sign.

What does a physician contract review cost?

The firm reviews physician employment agreements on a flat fee starting at $1,750 for a single agreement of typical length, including a written analysis, proposed language, and a call. The exact fee is quoted in writing before any work begins, and direct negotiation with the employer is a separate scope quoted separately.