Physicians leaving residency tend to judge their first job offer by its base salary, while the contract terms that shape their earnings after the first year or two get far less scrutiny, according to a Sept. 29 report from the American Medical Association.
Ryan Mire, MD, an internist in private practice in Tennessee and a physician educator for Resolve, a firm that reviews and negotiates physician employment contracts, told the AMA that the jump in pay after training can make an offer look better than it is.
“You’ve gone from a five-digit salary to a six-digit salary, and it really sounds like a huge jump, going from $60,000 in residency to now, just say $200,000,” Dr. Mire said. “You’re pleased with that, and you become very satisfied that that’s a good salary. But what you’re not thinking about is what happens down the road.”
Debt adds to the pull of a large starting number. The average medical school graduate carried $216,659 in educational debt in 2025, according to the Education Data Initiative, while the average U.S. intern earns about $68,000, according to AMA data.
The first year of a physician’s salary is typically guaranteed, and sometimes the first two, Dr. Mire said. After that, compensation often shifts to a productivity model tied to relative value units, along with call coverage and weekend rotation requirements. He said most first-year physicians focus on the initial figure and have trouble seeing how that productivity model will affect their pay two years out.
Resolve reviewed more than 4,000 physician contracts across all 50 states and 116 specialties and subspecialties for its report, and found that the biggest offers often carry the steepest targets.
“Higher base pay is often paired with higher performance expectations. Sometimes these expectations are unrealistic,” the report said.
Physician shortages are pushing productivity expectations higher, the AMA reported, though some organizations offset those demands by paying for call separately or adding support staff.
Those mismatches may help explain early-career turnover. About 54% of physicians change their practice setting and location within five years of their first job, Dr. Mire said.
“That number is striking to me because it tells me that after five years, a lot of physicians realized that they signed with a group that either wasn’t what they were looking for or the contract stipulations were not what they intended it to be,” he said.
Other data points the same direction. Nearly 60% of physicians leave their first post-training job within three years, and more than 25% consider leaving within the first year, according to a report from Jackson Physician Search and the Medical Group Management Association.
Partnership tracks are another area where early-career physicians often lack a clear picture, Dr. Mire said, particularly those who have not worked under that employment model before.
“There are buy-ins to partnership, there are stipulations to partnership, there is equity to partnership that you would really want to understand,” he said.
His advice is to work through the full contract before signing, not just the salary line.
“Understanding all of that on the front end, it really empowers you to make better decisions so you’re not in that 54% who will change [their job] in five years,” Dr. Mire said.
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