Emerging from residency or fellowship training shouldering a heavy burden of medical student-loan debt, many new physicians eagerly look for the salary figure in their first employment contract.
But in focusing too much on that one number, residents and fellows may miss important details related to productivity measurements that will have an outsized impact on their long-term compensation, said Ryan Mire, MD, MACP. He is a physician educator for Resolve, a contract review and negotiation firm specializing in physician employment.
“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,” said Dr. Mire, an internist in private practice in Tennessee, in an AMA webinar on the topic. “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.”
A report on physician salary data (email required) recently released by Resolve draws from more than 4,000 physician contracts that their experts reviewed, coming from all 50 states and in 116 specialties and subspecialties, to examine the ways that productivity measurements can change your experience in early career.
Physicians in any stage of their careers can leverage the report data to help them assess where they may be leaving money on the table. That is particularly those seeking their first positions after the end of residency or fellowship training, when a missed opportunity for higher compensation has more years to compound.
The AMA has teamed up with Resolve to provide AMA members an exclusive discount on services that include custom contract review. Resolve offers personalized legal expertise to help physicians secure the best employment contract terms, no matter where they are in their careers. Ready to access your AMA-member Resolve discount? Learn more now.
Short-term vs. long-term compensation
It’s only natural for early-career physicians to make salary an important factor in selecting a first job out of training. The Education Data Initiative estimates that in 2025, physicians graduated from medical school with an average of $216,659 in educational loan debt. And repayment during residency or fellowship can be tricky, with the average salary of an intern in the U.S. being about $68,000.
“Your first year is a guaranteed salary, and sometimes it's two years that you’ll have a guaranteed salary,” said Dr. Mire, an AMA member. “Most first-year physicians focus in on that initial number and it's hard for them to see two years down the road how that productivity model is” going to affect your compensation.
And employers are demanding more in terms of productivity, Resolve says in the report, seeking higher relative value unit (RVU) targets, increased call-coverage frequency and broader participation in weekend and holiday rotations.
“While organizations try to remain mindful of physician burnout, sustained access challenges and demand growth have pushed median and upper‑quartile RVU targets higher, particularly in inpatient‑heavy and procedure‑driven roles,” it says.
Does turnover tell the tale?
Early-career physicians may not be prepared for the type of workload that their new employment contracts demand and might be surprised by the way their compensation changes after a guaranteed salary ends. Dr. Mire said strong evidence to support that comes from physician turnover statistics.
“About 54% of physicians will change their practice setting and location within five years of their first job,” he added. “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.”
And a report from Jackson Physician Search and the Medical Group Management Association shows that nearly 60% of physicians will leave their first post-training jobs within three years. More than 25% said they considered leaving within just one year.
“Higher base pay is often paired with higher performance expectations,” the Resolve report says. “Sometimes these expectations are unrealistic.”
Dr. Mire said that the economic complexities of partnership opportunities can also be confusing for physicians who have never encountered the 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, and not just focus on that first-year guaranteed salary, because the partnership stipulations may not be what you’re looking for three to five years down the road,” he said. “Understanding that on the front end may actually save you from having to change a practice.”
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Shortages are affecting productivity
As many healthcare organizations deal with a shortage of physicians, especially in rural areas and in some specialties, a growing number are increasing their demands for physician productivity.
The news for physician job seekers isn’t all bad, though. To balance increased workload requirements, more healthcare organizations are compensating call separately, for example, and offering support from other healthcare professionals, Resolve experts said.
“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. “You can sign with a practice that’s going to be one where you can both commit to each other for the long term.”
With so much of a physician’s compensation and earning potential tied up in factors that require careful negotiation, it’s more important than ever to have experienced professionals review any employment contract before you sign.
AMA members receive a 20% discount on all Resolve services. With Resolve, you get:
- Custom contract review for any type of employment contract.
- Access to experienced attorneys who can negotiate on your behalf.
- Real-time, comprehensive compensation data and benchmarks to help you understand your worth.
- An instant contract-review option, powered by Resolve’s attorney-trained AI model.
- Free tools such as a contract scorecard to give a quick overview of where your contract stands.
Ready to access your AMA-member Resolve discount? Learn more now.
And if you’re seeking your first physician job after residency, get your cheat sheet now from the AMA.
