A printable contract review checklist for new attending physicians. Organized by section: Compensation, Benefits, Restrictive Covenants, Termination, Malpractice, and Schedule.
Key Takeaways
- This checklist covers every critical item new attending physicians should verify before signing their first employment contract
- Organized by section: Compensation, Benefits, Restrictive Covenants, Termination, Malpractice, and Schedule
- Each item includes a brief explanation of what to look for and why it matters
- Print this checklist and go through it line by line with your contract in hand
Your first attending contract is the foundation of your medical career. The terms you accept now will affect your income, lifestyle, career flexibility, and financial security for years to come. But after 7-12 years of medical training, you are exhausted and eager to start earning. The temptation to sign quickly is real.
Do not rush. This checklist will take 2-3 hours to complete with your contract in hand. Those hours could be worth $50,000-$100,000 or more in identified negotiation opportunities and avoided financial traps. For a deep dive on any section, refer to our comprehensive Physician Contract Review Guide.
Section 1: Compensation
☐ Base salary amount is clearly stated
Verify the exact dollar figure and pay frequency (biweekly, monthly). Compare to specialty benchmarks — know what percentile your offer represents.
☐ Compensation model is defined (salary, productivity, hybrid)
If hybrid, know exactly what percentage is guaranteed vs. at-risk. A 60/40 split means 40% of your expected income depends on hitting production targets.
☐ Productivity metrics and thresholds are specified
If compensation includes RVU bonuses, verify the threshold, per-RVU rate, and whether thresholds reset annually. Check the threshold against national benchmarks — if it is above the 75th percentile, the bonus is functionally unreachable for a new attending.
☐ Bonus structure and calculation formula are in writing
Quality bonuses, production bonuses, and incentive payments should have a clear formula, not "discretionary" or "based on practice performance." If the bonus is worth $50,000, you need to know exactly how to earn it.
☐ Annual compensation review or adjustment is specified
Your contract should include an annual review with at least a cost-of-living adjustment. A flat salary over a 3-year contract loses 9-12% of purchasing power to inflation.
☐ Salary guarantee period is defined
New attendings should have a guaranteed base salary for at least 12-24 months while building a patient panel. If compensation shifts to pure productivity after 6 months, that is a red flag.
Section 2: Signing Bonus and Loan Repayment
☐ Signing bonus amount and payment timing are stated
Know when you receive the bonus (at signing, on start date, or after X days) and the gross vs. net amount. A $50,000 signing bonus nets approximately $30,000-$35,000 after taxes.
☐ Clawback/repayment terms are pro-rata, not cliff
Pro-rata forgiveness (repay proportional to remaining time) is fair. Cliff vesting (repay 100% if you leave before the full term) is punitive. Push for pro-rata.
☐ Tax gross-up is included (or you understand the tax impact)
Without a gross-up, you keep ~65% of the signing bonus but may owe back 100% if you leave early. Ask if the employer will gross up the bonus or structure repayment on a net basis.
☐ Student loan repayment terms are documented
If the employer offers loan repayment, verify: total amount, payment schedule, conditions (must stay employed?), and tax treatment. Employer loan repayment is taxable income to you.
☐ Relocation assistance amount and terms are stated
Know the dollar amount, what it covers (moving costs, temporary housing, travel), and whether it has a clawback provision.
Section 3: Benefits Package
☐ Health insurance — employer premium contribution and plan details
Know your out-of-pocket cost for premiums, the deductible, and whether dependents are covered. Employer health coverage is worth $15,000-$30,000/year.
☐ Retirement plan — type, employer match, and vesting schedule
A 401(k) with 4% match on a $300,000 salary = $12,000/year in free money. Check the vesting schedule — if contributions vest over 5 years and you leave after 2, you may forfeit 60%.
☐ PTO days are specified (vacation, sick, personal)
Standard is 3-4 weeks for new attendings. Know whether unused PTO rolls over or is forfeited. Understand if PTO is "accrued" (you may start with zero days available) vs. "front-loaded."
☐ CME allowance and CME time off are separate from PTO
CME days should not come out of your vacation time. Standard: $3,000-$5,000/year allowance plus 5-7 days of CME time. Procedural specialties may receive more.
☐ Disability insurance coverage is reviewed
Group disability policies are often insufficient — they typically cover 60% of base salary (not total compensation) and may not include own-occupation coverage. New attendings should strongly consider supplemental own-occupation disability insurance.
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Section 4: Restrictive Covenants
☐ Non-compete geographic radius is reasonable
Urban: 5-10 miles. Suburban: 10-15 miles. Rural: 15-25 miles. Anything beyond these ranges is aggressive. Map the restricted area to understand exactly where you cannot practice.
☐ Non-compete duration is reasonable
1-2 years is standard. 3+ years is excessive. Check your state's law — some states have banned or limited physician non-competes.
☐ Non-compete is measured from primary practice location only
If the radius is measured from every location where you provided services (including hospital rounds, satellite clinics, and call coverage), overlapping radii can cover an enormous area.
☐ Non-compete is waived if terminated without cause
If the employer fires you (not for misconduct), you should not also be restricted from practicing nearby. This is a critical negotiation point.
☐ Buyout clause exists
A buyout allows you to pay a specific amount to waive the non-compete. Having this option provides a financial exit even if the non-compete is otherwise enforced.
☐ Non-solicitation clause scope is reviewed
Non-solicitation clauses may prevent you from notifying your patients that you are leaving or where you are going. This can effectively destroy your patient relationships. Push for the right to send a departure notice.
Section 5: Termination and Exit
☐ Without-cause termination notice is equal for both parties
90-120 days notice for both you and the employer. Asymmetric periods (30 days for employer, 180 for you) are unfair.
☐ "Cause" definition is limited to objective, verifiable events
Acceptable "cause": loss of license, felony, DEA revocation. Unacceptable: subjective standards like "unsatisfactory conduct" or "failure to meet expectations." See contract red flags for details.
☐ Cure period exists for alleged breaches
You should have 30 days to fix any alleged breach before termination for cause. Without a cure period, a minor documentation error could be grounds for immediate termination.
☐ Post-termination compensation obligations are clear
Know what happens to unvested retirement contributions, unused PTO, pending bonuses, and signing bonus clawbacks upon termination. Get it all in writing.
☐ Assignment clause requires your consent
If the practice is acquired, your contract should not automatically transfer. You should have the right to consent to (or terminate upon) assignment.
Section 6: Malpractice Insurance
☐ Policy type is identified (occurrence vs. claims-made)
Occurrence-based = no tail needed (gold standard). Claims-made = tail coverage is essential. Know which type you have.
☐ Coverage limits are adequate for your specialty
Standard limits are $1M per occurrence / $3M aggregate. High-risk specialties (OB/GYN, neurosurgery) may need higher limits.
☐ Tail coverage responsibility is explicitly assigned
If claims-made, the contract must state who pays for tail. Ideal: employer pays in all circumstances. Acceptable: employer pays if they terminate without cause, vesting schedule for voluntary departures.
☐ Consent-to-settle clause exists
This prevents the insurer from settling a malpractice claim without your approval. Important for protecting your professional reputation and National Practitioner Data Bank record.
Section 7: Schedule and Duties
☐ Clinical hours/sessions per week are specified
Know exactly how many half-day clinic sessions, OR days, or hospital shifts are expected. "Full-time" is not a number.
☐ Call schedule frequency and compensation are defined
How often (1:3? 1:7?), what type (phone only vs. in-house), and is there additional pay? Call without additional compensation on top of a 40-hour clinical week can destroy your effective hourly rate.
☐ Practice location(s) are listed
The contract should name your primary practice location and any satellite sites. The employer should not be able to unilaterally relocate you.
☐ Administrative and documentation time is addressed
Chart completion, peer review, committee meetings — these take real time. Does the contract account for administrative hours, or is that all on top of your clinical schedule?
☐ Moonlighting and outside activities policy is clear
Can you do locum tenens work, expert witness consulting, or medical surveys on your own time? Some contracts prohibit all outside clinical work. Clarify upfront.
Your Next Steps
After completing this checklist, you should have a clear picture of your contract's strengths and weaknesses. Here is what to do next:
- Compile your findings — note every item where you checked "no" or found a concern
- Prioritize your negotiation points — pick the 3-5 items with the highest financial or career impact
- Benchmark your compensation — use SalaryDr's data to know exactly where your offer falls
- Read the negotiation guide — our 7-step negotiation framework will walk you through the process
- Consider professional help — a negotiation service or contract lawyer can maximize your contract value
Your first attending contract sets the trajectory for your entire career. Invest the time now to get it right.
Are You Being Paid What You’re Worth?
Physicians who negotiate earn an average of $43,000 more per year. SalaryDr’s physician-focused negotiation team has helped hundreds of doctors secure better compensation. Get a free negotiation assessment →
Frequently Asked Questions
How long should I take to review a physician employment contract?
At minimum, take 1-2 weeks. This gives you time to go through this checklist thoroughly, benchmark your compensation, consult with a professional reviewer, and prepare your negotiation strategy. Any employer that pressures you to sign in less than a week is not respecting the significance of the commitment.
What if my contract is missing some of these items entirely?
Silence in a contract typically benefits the employer. If an important term (like tail coverage, call compensation, or annual reviews) is not addressed, it should be added as an amendment before you sign. Verbal assurances that "we'll figure it out" are not enforceable.
Is this checklist relevant for fellowship-trained subspecialists?
Yes. Every item on this checklist applies regardless of specialty. Subspecialists may have additional considerations (research time, procedure-specific call, equipment needs) that should be addressed in the contract. The compensation benchmarks will vary by specialty — check your specific specialty data.
Should I use this checklist for a locum tenens contract?
The core compensation and malpractice sections apply to locum tenens contracts. Restrictive covenants, partnership track, and long-term benefits sections are less relevant for temporary assignments. Locum tenens contracts have their own unique considerations including hourly rate structures, travel reimbursement, and housing provisions.
What is the single most important thing on this checklist?
If we had to pick one item: verify that your total compensation (base + expected bonus + benefits value) is at or above the 50th percentile for your specialty and region. Being underpaid by $30,000-$50,000 per year compounds dramatically over a career and is often the hardest thing to fix after you have already signed.