Your First Attending Contract: What New Physicians Need to Review Before Signing

Physician Contracts Counsel, PLLC

Finishing residency or fellowship is a full-time job in itself, which is exactly why so many new attendings sign their first employment contract without a close read. You've spent years being told what to do by an institution. This is the first contract where the terms are actually yours to negotiate, and most new grads don't realize how much room they have.

Here's what to look at closely before you sign your first attending contract.

Start date flexibility and credentialing timeline

Hospital credentialing and payer enrollment can take 60 to 120 days, sometimes longer. If your contract sets a start date that doesn't account for that lag, you could be on payroll before you're actually able to see patients and bill for it, or worse, without a clear plan for what you're doing and getting paid during that gap. Get the credentialing timeline and your compensation during that period spelled out in writing.

Loan repayment and forgiveness program eligibility

If you're carrying resident-level educational debt, confirm whether the employer offers loan repayment assistance, and just as important, whether the position qualifies for Public Service Loan Forgiveness. Nonprofit and government-affiliated hospitals often qualify, private practices generally don't. This single fact can be worth more than a base salary difference, so get it confirmed in writing rather than relying on a recruiter's verbal answer.

Signing bonus and relocation clawback terms

New attending offers often come with a signing bonus and relocation allowance, both of which typically come with a repayment obligation if you leave within a set period, commonly one to three years. Know the exact proration schedule. A bonus that looks generous on offer day can turn into a five-figure repayment bill if the job doesn't work out and you leave in year one.

Supervision requirements during your first year

Some employers build in a probationary or mentorship period with additional oversight, chart review, or restricted procedure privileges for new attendings. There's nothing wrong with this on its own, but it should have a defined end date and clear criteria for when full privileges kick in, not an open-ended "at the discretion of the department" clause.

Moonlighting restrictions

Many new attendings want to pick up locum shifts or moonlighting work to pay down debt faster. Check whether your contract restricts outside work entirely or just requires notice and approval. This is frequently negotiable even when the initial draft looks restrictive.

Non-compete scope for a first job

A broad non-compete is a bigger risk for a new attending than for someone later in their career, because you don't yet know if this job, this location, or this specialty focus is the right long-term fit. Push for the narrowest geographic and time scope you can get, especially if this is a training-adjacent first job rather than your intended long-term practice.

RVU ramp-up and productivity expectations

If part of your compensation is tied to RVU production, ask how quickly you're expected to reach full productivity. Building a patient panel from zero takes time, and a contract that measures you against an experienced attending's benchmarks in month three is setting you up to fail a metric that was never realistic for a new grad.

Why this is worth a review before you sign

You are, by definition, negotiating your very first attending contract without ever having done it before. Recruiters and hospital administrators negotiate these contracts constantly. That imbalance is exactly what a contract review is meant to correct, and it costs far less than living with unfavorable terms for the next several years.