Which Benefits Matter Most in a Physician Contract? A Prioritization Guide

Most physicians obsess over salary and completely misjudge which benefits actually matter in a contract.

If you’re finishing residency or fellowship and staring at your first real offer, here’s the blunt truth: the wrong benefit structure can cost you more than a $50–100k pay cut over just a few years. And you won’t realize it until you’re stuck, burned out, or paying a massive tail bill.

This guide is the prioritization framework I wish every new attending had on day one.

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The Short List: What Actually Matters Most

Let’s cut the noise. These are the benefits that truly move the needle, in rough order of priority for most physicians:

1. Malpractice coverage (claims-made vs occurrence + tail)
2. Time off (PTO/CME) and call structure
3. Health, disability, and life insurance
4. Retirement and match
5. CME money and support for professional development
6. Loan repayment / sign‑on vs retention bonuses
7. Relocation and other one‑time perks

Everything else? Nice‑to‑have, not decision‑making level.

We’ll walk through how to rank these based on your situation and what’s often overhyped.

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#1 Malpractice Coverage: Non‑Negotiable Core

If you only deeply understand one benefit before signing, let it be malpractice.

Claims-made vs occurrence

Here’s the practical difference:

• Occurrence policy
  You’re covered for claims that occurred during the period you worked, even if they’re filed years later. Simple. No tail needed.

• Claims-made policy
  You’re covered only if the claim is made while the policy is active. Once you leave and that policy ends, anything filed afterward is your problem unless someone pays for tail coverage.

Feature	Claims-Made	Occurrence
Needs tail coverage?	Yes	No
Employer cost	Lower annually	Higher annually
Your risk if you leave	High without tail	Minimal
Common in	Private groups	Hospitals, large orgs

The key question to ask directly:
“Who pays for tail if I leave, and under what circumstances?”

Tail for many specialties is not pocket change. I’ve seen:

• Primary care physician: $25–40k
• OB/GYN: $80–150k
• Surgery: $60–120k
• EM: $40–80k

If the contract says “physician responsible for tail,” that’s effectively a giant balloon payment scheduled for your future. Factor that into your total compensation. A “higher salary” with you paying your own tail is often a bad deal.

Priority rule:
I’d take slightly lower salary with paid tail/occurrence coverage over higher salary with you fully on the hook for tail, almost every time.

Red flags and what to push for

Watch for:

• Tail only paid if you stay X years (3–5+)
• Tail not paid if you initiate termination (even for good reason)
• Vague language like “tail coverage may be negotiated at time of separation”

What to negotiate:

• Employer pays 100% of tail after 2–3 years of service, regardless of who initiates termination (except for extreme cause)
• If they refuse, push for:
  • A vesting schedule (e.g., 25% per year)
  • Higher guaranteed salary explicitly justified as “to offset tail responsibility”

If the malpractice setup is terrible, I don’t care how shiny the rest looks. This is a top‑tier deal breaker.

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#2 Time Off, Call, and Schedule: Your Real Quality of Life

Most new attendings underestimate how much time and call structure matter until they’re 9 months in and exhausted.

You’re not just choosing money. You’re choosing a life.

Paid Time Off (PTO) and CME days

Combination of:

• Vacation
• Sick days (sometimes carved out)
• CME days
• Holidays (sometimes included in PTO, sometimes separate)

Average ranges for attendings:

• PTO: 3–6 weeks
• CME days: 3–10 days per year

Ask very specific questions:

• “How many total days away from clinical duties per year, including vacation, CME, and holidays?”
• “Are clinic cancellations for CME counted against my productivity targets (RVUs)?”
• “Is PTO use subject to RVU clawbacks or expectations to ‘make up’ time?”

Here’s why it matters: A “great” salary can be torpedoed if taking vacation means you miss RVU targets and lose your bonus.

Call requirements

Call is one of the most abused, underpriced parts of physician work.

Things to clarify clearly:

• Is call home, in-house, or Q24 backup?
• Average nights/month? Weekends/year?
• Post‑call expectations? Clinic the next morning?
• Is call paid separately or “included” in your base?
• What’s the backup process when things are insane?

I’ve seen people take $15–20k more in base salary in exchange for call that effectively destroyed their sanity. That’s not a win.

If call is heavy, it should be:

• Explicitly described in the contract or an attached schedule
• Paid (stipend or extra pay per shift)
• Protected from quietly escalating without compensation

If you have kids, a partner with a demanding job, or you’re planning a family soon, call structure may outrank a lot of other benefits.

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#3 Health, Disability, and Life Insurance: Protecting Future You

These benefits aren’t sexy, but when something goes wrong, they’re everything.

Health insurance

You already know to ask:

• Monthly premium
• Deductible
• Out‑of‑pocket max
• Network (do your own doctors/hospital accept it?)

But don’t stop there. Ask HR for the actual plan summary PDFs and compare. Use them like price tags.

Annual Out-of-Pocket Exposure (Single Coverage)

Category	Value
Plan A	4500
Plan B	8000
Plan C	12000

Those differences are real money. A slightly higher salary with terrible health coverage is a bad trade, especially if you or your dependents have ongoing medical needs.

Disability insurance

This is where many first‑year attendings get burned.

Ask:

• Is long‑term disability provided? At what % of income (usually 50–60%)?
• Is it own-occupation coverage? (You want this.)
• Is employer‑provided coverage taxable or post‑tax?

Employer plans are usually bare minimum. Often, you’ll still want your own private “own‑occupation” policy, especially early in your career. But if they offer a solid base, that’s real value.

Life insurance

Most employers throw in 1x salary. That’s fine but not life‑changing. It’s a nice add‑on, not a deciding factor. You should assume you’ll get your own term policy if you have dependents or debts anyway.

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#4 Retirement Plans and Match: Compounding vs Illusion

Retirement benefits are long‑term leverage. But they’re not all created equal.

Key questions:

• What type of plan(s)? 401(k), 403(b), 457(b), pension?
• What’s the employer match formula and cap?
• Vesting schedule? (Immediate vs graded over years)
• Is there a profit‑sharing component?

Feature	Job A	Job B
Match	4% up to 4%	8% up to 8%
Vesting	3-year graded	Immediate
Profit sharing	None	Up to 5%
Max employer	4%	13%

Over 5–10 years, that employer contribution difference can be six figures.

Still, for most early‑career physicians, I’d rank:

1. Malpractice
2. Schedule/call
3. Insurance
4. Retirement

Why? Because you can always increase your own contributions at the next job, but clawing your way out of burnout or a terrible tail situation is harder.

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#5 CME, Professional Development, and License Support

This one’s simple but meaningful.

Standard ranges:

• CME money: $2,000–$5,000/year (some specialties higher)
• CME days: 3–10 days/year
• License/DEA/board fees: often reimbursed or directly covered

Ask:

• “What’s the annual CME allowance and how can it be used?” (Courses, travel, books, online subscriptions?)
• “Do you pay for state license, DEA, board certification, and renewals?”
• “Any restrictions on which conferences I can attend?”

If there’s a big gap between offers, this can easily be worth several thousand a year. It’s not at the very top of the priority list, but between two similar offers, this can be a tie‑breaker.

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#6 Loan Repayment, Sign‑On, and Retention Bonuses

Here’s where people get seduced by big numbers and miss the fine print.

Loan repayment

Two flavors:

• True loan repayment: Employer pays directly to your lender or reimburses documented payments. Often tied to service commitments (e.g., 3–5 years).
• “Forgivable” sign‑on or retention bonus: They call it loan help, but it’s really a bonus that’s forgiven over time.

Questions to ask:

• Who receives the money, me or my lender?
• Over how many years is it paid?
• What happens if I leave early? (Clawback? Pro‑rated?)
• Is this on top of salary or baked into it?

Sign‑on bonus

Standard pitfalls:

• Payable after you start, sometimes after you finish a probation period
• Repayable if you leave before X years
• Taxed like regular income (so that “$50k” feels like $30k in your pocket)

Sign‑ons are fine. Just don’t confuse a big one‑time check with long‑term comp and benefits. Over a 3‑year span, a strong base + sane call + paid tail beats a fat sign‑on almost every time.

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#7 Relocation and One‑Time Perks

Relocation is nice, not decisive.

Typical:

• $5,000–$15,000 for relocation
• Sometimes structured as reimbursement (save receipts)
• Rarely: temporary housing, help with closing costs, etc.

Ask:

• Is it a flat stipend or reimbursement‑only?
• Any minimum distance requirement?
• Clawback if I leave early?

These perks don’t move the long‑term needle. They just smooth the first 6–12 months.

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How to Prioritize for Your Situation

Here’s a simple decision framework that works for most new attendings:

Physician Contract Benefit Prioritization

Step	Description
Step 1	Start
Step 2	Prioritize malpractice and tail
Step 3	Prioritize schedule, PTO, call
Step 4	Prioritize health and disability
Step 5	Prioritize retirement and CME
Step 6	Then compare salary and bonuses
Step 7	High risk specialty or litigious state
Step 8	Family or lifestyle top priority
Step 9	Have dependents

Rough ranking templates:

• High‑risk specialty (OB, surgery, EM, anesthesia)

  1. Malpractice/tail
  2. Call/schedule
  3. Insurance
  4. Salary
  5. Retirement/loan help

• Primary care / lower‑risk outpatient

  1. Call/schedule
  2. Malpractice (still essential, but often cheaper)
  3. Health/disability
  4. Retirement
  5. Salary/bonuses

• Heavy student loans, minimal family obligations

  1. Base salary and stability
  2. Loan repayment (real, not fluff)
  3. Malpractice
  4. Retirement match
  5. CME / future career options

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Benefits That Are Overrated or Easy To Fix Later

Some things candidates obsess over that usually don’t deserve it:

• Parking fees – annoying, yes. But not how you choose between two jobs.
• Gym memberships / wellness “perks” – nice, not worth sacrificing real benefits.
• Scrub allowance / phone stipend – these are $20–100/month issues, not $20,000/year issues.
• Food in the physician lounge – you’ll stop caring 3 months in.

You can always fix the small stuff later with a little extra salary or a side gig. You cannot easily fix a toxic call schedule, a bad malpractice situation, or weak disability coverage after the fact.

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Quick Reality Check Before You Sign

Before you send back a signed contract, literally sit down and write out:

1. What must be true about this job for me not to regret it in 2 years?
2. Does this contract structurally support that? Or fight it?
3. If the relationship ends, what am I on the hook for? Tail? Bonus clawback? Relocation repayment?

If you’re not sure you’re reading it correctly, spend a few hundred dollars on a physician contract attorney. That’s not paranoia; that’s smart. I’ve watched that consultation save people from five‑figure mistakes many times.

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FAQs

1. If I have to choose, is higher salary or better benefits more important?
In your first attending job, better structural benefits (malpractice, schedule, insurance, reasonable call) usually beat a higher salary. A $20–30k salary bump can be wiped out by unpaid tail, constant call, or burnout that forces you to leave early. Once the big rocks are solid, then you push salary.

2. How bad is it really if I have to pay my own malpractice tail?
It can be brutal. Think $40–150k depending on specialty and location, due at the worst possible time—when you’re leaving a job and possibly relocating. If you absolutely must accept tail responsibility, negotiate salary and sign‑on with that cost explicitly in mind and plan to save aggressively.

3. How much PTO should I aim for as a new attending?
Bare minimum I like to see is 4 weeks PTO plus some CME days. If a job offers under 3 weeks total away from clinical duties, that’s a quality‑of‑life red flag. More important than the raw number is whether taking PTO tanks your RVUs or bonus.

4. Are loan repayment programs worth prioritizing?
Only if they’re real and clearly structured. True loan repayment paid to your lender in exchange for a multi‑year commitment can be powerful. But “loan bonuses” that are just taxable sign‑ons with clawbacks are fluff. Don’t let a shiny $50k “loan bonus” distract you from bad malpractice or terrible call.

5. What’s an acceptable retirement match for a physician job?
A common range is 3–6% of your salary as an employer match, sometimes with additional profit sharing. Anything 8%+ with immediate vesting is excellent. But if you’re early in your career, I still wouldn’t put retirement ahead of malpractice, call, and health/disability.

6. How much should I care about CME money and days?
Moderate priority. You can always skip an expensive conference, but a decent CME package (say, $3–5k/year and 5+ days) adds real professional value and helps you maintain certifications without self‑funding everything. Between similar offers, stronger CME support is a legitimate tiebreaker.

7. Is it ever okay to accept a contract without tail coverage paid by the employer?
Sometimes, but only with eyes wide open. If the job is otherwise outstanding and you’re well‑compensated, you can treat tail as a known future liability and plan for it. But you should either: negotiate higher guaranteed compensation to offset it or ensure the tail cost is clearly estimated upfront. If you’re in a high‑risk specialty, I’d be very cautious about this.

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Bottom line:
Focus on benefits that change your risk and your life: malpractice structure, schedule/call, core insurance, and retirement. Don’t let shiny sign‑ons or tiny perks distract you from those. And never sign a contract where you don’t fully understand what happens the day you decide to leave.