7 Job Offer Red Flags New Physicians Ignore at Their Own Risk

The fastest way to burn out in your first attending job is to ignore the red flags hiding in your job offer.

Most new physicians obsess over salary and sign‑on bonuses. That is exactly how they get trapped. The real danger lives in the details: vague call expectations, opaque RVU targets, “standard” non‑competes, and rosy volume promises that never materialize.

I have watched brand‑new attendings walk into:

• 1:4 weekend call they never agreed to
• RVU quotas no one in the group actually met
• “Partnership tracks” that mysteriously reset every 2–3 years

And the worst part? Almost every one of them could have seen it coming if they knew what to look for in the offer.

Let me walk you through the seven job offer red flags new physicians ignore at their own risk.

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1. Vague Call Expectations and “Flexible Coverage”

If the contract is crystal clear about your salary but fuzzy about call, that is not an accident. That is strategy.

Common phrases that should set off alarms:

• “Call responsibilities as assigned by the group”
• “Reasonable call, shared equitably”
• “Anticipated call schedule to be 1:x but subject to change”
• “Flexibility in covering call depending on departmental needs”

Translation: “We will decide once you are locked in, and you will not like it.”

What this looks like in real life

I watched a new hospitalist sign with a community hospital that verbally promised “1:6 weekends.” The contract said “call and weekend coverage as determined by employer to meet clinical needs.” Six months in, two colleagues left. Suddenly he was 1:3, with “temporary” extra shifts that lasted over a year.

Another: a new OB/GYN was told “call is pretty light, about 1:5.” The contract? “Call responsibilities as assigned.” Once she started, she discovered:

• A second, unadvertised “backup call” pool
• Mandatory in‑house coverage for certain nights
• No additional compensation for extra call when partners were on vacation

How to protect yourself

Do not accept vague call language. At all. You want specifics in writing:

• Type of call:
  • In‑house vs home call
  • Primary vs backup
• Frequency:
  • Weekday call: “No more than 1:x”
  • Weekend call: “No more than 1:y”
• Post‑call expectations:
  • Are you seeing a full clinic after being up all night?
• Compensation for:
  • Extra call beyond baseline
  • Holiday call
  • Covering for vacancies

If they refuse to define call clearly “because it may change,” what they are really saying is: “We want maximum flexibility over your life, with minimum obligation on ours.”

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Common Hidden Call Escalation After Hire

Category	Value
Promised	4
Year 1 Actual	6
Year 2 Actual	7

(Bars represent average monthly call nights for several new attendings I have seen: promised vs reality.)

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2. Unrealistic RVU Targets and Opaque Productivity Models

New physicians consistently underestimate how dangerous bad compensation structures are. Salary is easy. RVUs and “productivity incentives” are where you get exploited.

Red flag phrases:

• “Bonus eligible for exceeding 6,500 RVUs annually” (with no data on current doc volumes)
• “Productivity‑based after year one” without a clear formula
• “RVU targets subject to change at employer discretion”
• “Compensation set according to fair market value” but no actual ranges or examples

The classic trap

Here is the pattern I have seen too many times:

1. Year 1: Guaranteed salary. Life feels fine.
2. Year 2: Salary tied to RVUs or collections. Suddenly the math matters.
3. You discover:
   • The clinic template only allows 12–15 patients per day
   • New patient referrals are mostly going to senior partners
   • Hospital support (MA, nursing, scheduling) is terrible, so throughput tanks

Yet your “target” is based on the top 75th percentile MGMA productivity for your specialty. On paper it looks “competitive.” In practice, almost no one locally hits it.

What you should demand

At minimum, you need these in writing or in a formal document:

• Exact RVU target for each year
• Dollar per RVU for:
  • Base compensation
  • Bonus tiers
• Whether targets can change unilaterally, and how

And you must insist on actual numbers from the practice, not just “MGMA benchmarks”:

• Average annual RVUs for each current physician (de‑identified)
• Average new‑patient volumes per month
• No‑show rates
• How long it took other physicians to build to target volumes

Item	Reasonable Offer	Red Flag Offer
Year 2 RVU target	4,500 with local data shared	7,000 “based on MGMA” only
RVU rate	$50 per RVU, fixed 3 years	“According to FMV” but no number stated
Data on partner RVUs	Provided, de‑identified	“We do not share specific numbers”
Change to targets	Requires mutual agreement	“At employer discretion”

If they resist sharing any productivity data “for confidentiality,” understand what they are really hiding: that new hires routinely miss targets and watch their pay fall after the guaranteed year.

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3. Toxic Non‑Compete Clauses and Geographic Traps

New physicians routinely sign away their geographic freedom for a slightly bigger sign‑on bonus. That is a mistake you will feel in 2–3 years when you want out.

Non‑compete and restrictive covenant red flags:

• Radius over 10–15 miles in dense urban areas
• Multiple hospitals or “any facility in which employer has privileges”
• Duration over 1–2 years
• Applies even if they terminate you without cause

I saw a new cardiologist locked into:

• A 50‑mile radius around every affiliated clinic location
• Two‑year non‑compete
• No carve‑out if the practice dissolved

His wife’s entire family lived in that city. When the group imploded, he had to choose: move states or sit on his hands.

How to evaluate non‑competes (and when to walk)

In a post‑residency job search, you cannot treat non‑competes as a formality. They are handcuffs.

Ask explicitly:

• What is the radius? From which point exactly?
• Is the restriction tied to:
  • A single primary practice location, or
  • Every site you ever touch?
• Does it apply if:
  • You are terminated without cause?
  • You decline to renew at the end of the term?

And then ask yourself bluntly:

• “If this job becomes toxic, can I still live near my support system and work elsewhere?”

If the honest answer is no, you are gambling your personal and family stability on a job you have never actually worked in. I have seen very few situations where that gamble was worth it.

Do not let anyone brush this off with “We never enforce it.” If it is in the contract, it exists to be enforced. If the group truly “never” uses it, they should have no objection to narrowing or removing it.

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4. Partnership Tracks That Never Really End

“Partnership after 2–3 years” might be the single most seductive line in private practice job offers. It is also one of the most abused.

Red flags around partnership:

• No written criteria. Only: “Subject to partner vote.”
• “Buy‑in to be determined at that time” with no current range.
• No transparency on current partner compensation vs associate compensation.
• History of frequent turnover at the 2–3 year mark.

I once reviewed an offer where every new hire was told “partnership at year 3.” After some digging, we discovered:

• In the last 10 years, only 1 of 6 associates actually made partner.
• The others “mutually agreed” to separate right before their partnership date.
• There was no objective metric; partners just “did not think they were ready.”

Questions you must ask (and not skip)

You should be asking, in writing and in person:

• How many partners vs non‑partners are currently in the group?
• In the last 10 years:
  • How many associates hired?
  • How many made partner?
  • How many left before that point? Why?
• What exactly is required for partnership?
  • RVU/production thresholds
  • Quality metrics
  • Citizenship or committee expectations
• What is the current partnership buy‑in range?
• What is the approximate income difference between partner and associate levels?

Associate-to-Partner Conversion in One Group

Category	Value
Made Partner	17
Left Before Partner	83

(In one real example I saw, only 1 of 6 associates over a decade actually became a partner. That pattern is not an accident.)

If everything about partnership is hand‑wavy and “we will discuss when you get there,” assume you will never actually “get there” under terms that make sense for you.

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5. Toxic Culture Hiding Behind Polite Language

You will not see “We burn people out” printed in a contract. Culture red flags are subtle, but they show up in patterns if you look.

What I pay attention to during the process:

• How quickly do they respond to your questions about workload and support?
• Do they dodge specifics about staffing, turnover, or leadership changes?
• Does anyone bad‑mouth former physicians as “not a team player” without explanation?
• How do junior physicians talk when senior partners are not in the room?

Concrete warning signs

During site visits and calls, watch for these:

• No protected time for:
  • CME
  • Administrative duties
  • Teaching, if “teaching” was a selling point
• Repeated mentions of “we all pitch in when needed” but no boundaries
• “Our doctors are available to patients 24/7” with no clear after‑hours system
• High MA / nurse turnover, blamed on “work ethic” rather than workload

I remember sitting in a group lunch with a candidate where a senior partner said, half joking:

• “We tell new hires it is a 4‑day workweek, but everyone ends up here six days once they see the volume.”
  People laughed. The candidate smiled politely. Two years later, that same candidate was texting me at 9 p.m. from the office.

How you can test culture before signing

You cannot rely only on the people the group chooses to show you. You need independent data points:

• Ask to speak with:
  • The newest hire
  • Someone who joined 3–5 years ago and stayed
• Ask explicitly:
  • “What surprised you in the first 6–12 months?”
  • “What do people complain about here that leadership does not fix?”
• Check:
  • Online reviews from staff and patients (glassdoor, indeed, etc.)
  • Recent local news on the hospital or system

If every answer feels rehearsed and relentlessly positive, that is not culture. That is marketing.

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6. “Standard” Contract Language You Are Told Not to Question

The phrase “This is our standard contract” has pressured more new physicians into bad deals than any other line.

Here is what usually hides in “standard language”:

• “For cause” definitions that are broad and one‑sided
• “Without cause” termination with short notice for them, long notice for you
• Mandatory arbitration in a forum convenient only for the employer
• Unilateral rights for the employer to change your work location or duties

I reviewed a contract where the employer could:

• Reassign the physician to any site within a 60‑mile radius
• Change their duties “to any clinical services reasonably consistent with training”
• Cut compensation if the doc refused additional locations

All buried under “standard employment terms.”

Pay brutal attention to these sections

Do not gloss over:

• Term and termination
• Duties and responsibilities
• Place of work / assignment
• Amendments and modification

Ask yourself:

• Can they reduce my salary unilaterally?
• Can they add clinics or hospitals without additional pay?
• Can they move me to only nights, or only an unpopular location?
• How fast can they fire me without cause, and what severance (if any) do I get?

Physician Job Offer Risk Points

Step	Description
Step 1	Offer Received
Step 2	Compensation Section
Step 3	Call and Schedule
Step 4	Non compete
Step 5	Termination Clauses
Step 6	High Risk
Step 7	Lower Risk
Step 8	Clear and detailed?
Step 9	Specific limits?
Step 10	Reasonable radius?
Step 11	Balanced rights?

If the employer refuses to modify obviously one‑sided provisions “because legal will not change it for anyone,” that tells you exactly how they will treat you once you are on payroll.

You are not a replaceable MA. You are a physician revenue engine. If they are not willing to individualize your contract at all, do not expect much individual consideration once you work there.

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7. Rushing You to Sign and Minimizing Legal Review

The last red flag is not in the words. It is in the pace.

Pressure tactics I see constantly:

• “We need your answer in 48–72 hours.”
• “Recruiting season is competitive, we cannot hold this spot.”
• “Everyone signs the standard contract; you do not need a lawyer.”
• “Legal review will just slow this down and you might lose the offer.”

This is nonsense. And they know it.

Hospitals and groups delay routine things for weeks all the time—credentialing, committee decisions, payor enrollment. But somehow, your decision about your first attending job must be made over one weekend?

What you absolutely must do

You are making a multi‑year life decision. Treat it like one.

• Have the contract reviewed by:
  • A health‑care / physician contract attorney
  • Ideally someone who has seen many offers in your region and specialty
• Get a second opinion from:
  • A trusted senior physician, mentor, or fellowship director
• Take the time to:
  • Draft questions
  • Ask for revisions
  • Walk away if they refuse to negotiate anything meaningful

You do not need to get everything you ask for. But if they become defensive or offended that you even want an attorney to look at it, that is an enormous character red flag for the organization.

Because if they are this controlling when you are still a free agent, what will they be like when you are dependent on them for your paycheck, malpractice coverage, and tail?

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Putting It All Together: A Simple Risk Check

When you receive a job offer, pause the excitement and do a quick hard‑nosed risk check in four domains:

Domain	Safe-ish Sign	Serious Red Flag
Schedule/Call	Specific limits in writing	“As assigned” or “reasonable” only
Compensation	Clear RVU data and formulas	Targets with no local data, vague “FMV” language
Non-compete	Narrow radius, short duration, carve-outs	Large radius, multiple sites, applies even if fired
Control/Legal	Some negotiated changes allowed	“Standard contract only, no attorney needed”

If you see more red in that table than green, stop telling yourself “I can make it work.” That is residency thinking. As an attending, no one is coming to rescue you from a bad job.

You are your own protection now.

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The Bottom Line

Three things I want you to remember:

1. Vague language is not a minor annoyance; it is a deliberate power move. If something is not written clearly—call, RVUs, location, partnership—it does not exist in your favor.
2. “Standard contract” and “trust us, we never enforce that” are the two biggest lies in physician employment. If it is in writing, assume it will be used when it benefits them.
3. The only real leverage you ever have is before you sign. Use it. Ask hard questions, insist on specificity, get legal review, and walk away from offers that feel wrong—because once you are in, getting out will cost you far more than you think.