What should a pediatrician check in a first contract at a children's hospital?

Five things, in the order they cost you money when they are wrong. One: the FTE split, in writing, with the session counts that define the clinical fraction, because your pay per clinical hour is the salary divided by that fraction. Two: call, its frequency, its cap, and whether a stipend or comp time attaches, because unpaid call is the hardest hours of the job priced at zero. Three: the employer's Public Service Loan Forgiveness status, confirmed in writing, because your loan plan rides on it. Four: the band review process and the date of its last market adjustment, because the band is your raise mechanism for years. Five: the exit terms, notice, signing money repayment, moonlighting rights, and who pays the tail on a claims made malpractice policy.

Part of the pediatrics hub.

Why these five, in this order

The split comes first because it silently reprices everything else. Two offers at the same salary, an average starting point of $258,000 (AMN), are different jobs if one defines 0.8 clinical FTE and the other runs you at 1.0: divide $258,000 by 0.8 and a full clinical load prices at $322,500, which is the number to compare across offers and the number that tells you what schedule creep costs. Call comes second because children's hospital call is heavy, frequent, and in many offers entirely unpriced: nights named in the duties with no stipend, no comp time, and no cap are coverage the hospital would otherwise buy at locum prices, donated by you. Get the stipend or the comp time, and a rate for call beyond the stated frequency, into the document.

Forgiveness status comes third because it is binary and enormous. Children's hospitals are overwhelmingly government or 501(c)(3) nonprofit employers, the qualifying kinds, and most pediatricians build their loan plan on that fact, minimums and certification toward cancellation at payment 120 on a median balance of $200,000 (AAMC). Verify this employer's status in writing before you sign, because discovering a non qualifying structure after the first year costs a year of count you cannot buy back. The band review is fourth because it compounds: a band adjusted against market data on a schedule is a rising floor under a salary that starts lowest in medicine, while a frozen band is a real pay cut every year nobody has to announce.

Price the bonus and the call terms with the same care as the base. The average incentive bonus for pediatricians is $26,000, the second lowest among the specialties surveyed, and only psychiatry sits lower at $24,000. That $2,000 difference is small beside a starting salary of $258,000, which is exactly the point: at this pay level, bonus language should be read for how the amount is earned and when it is paid, not treated as a sum that will rescue a weak base or an unpriced call schedule. A bonus that depends on measures outside your control, or that is paid long after the year it rewards, is worth less than the same $26,000 stated plainly, and a contract should say which of those forms the figure in front of you actually takes before you sign.

The exit terms nobody reads first

The fifth check reads like pessimism and is actually arithmetic. Notice periods in academic contracts can run long, and a long notice period at departure is a season of income timing you cannot control. Signing money with a clawback is a loan against staying; know its schedule before you spend it, and spend it the boring way, reserves first. Moonlighting rights are the one income lever this salary leaves open, and a blanket ban in the fine print removes it; get the policy stated, even if you never use it. Malpractice shape decides the tail: occurrence coverage walks away clean, claims made coverage bills you at exit unless the contract assigns the tail to the employer. Read those clauses with the same care as the salary line, because they are salary lines, dated later. The full contracts treatment, with the red flags list, is on the contracts page.

Return to the clinical fraction once more when you compare a second year to a first. If the salary stays at $258,000 while the clinical fraction rises from 0.8 to 1.0, the pay for the same clinical load falls from the $322,500 full load equivalent in the first year to $258,000 in the second, a change of $64,500 in equivalent terms with no change in the headline number. Contracts that leave the fraction to be set later, or that allow session counts to be raised by policy rather than by amendment, hand that change to the employer after signing. Pin the fraction, the session count, and the process for changing either one in the document itself, and treat any later increase in sessions without an increase in pay as the pay cut the arithmetic shows it to be, whether or not the salary line itself ever moves.

Follow up questions

How do I compare two offers at the same salary?

Divide by the clinical fraction. An offer at $258,000 defined as 0.8 clinical FTE prices a full clinical load at $322,500, and that is the number to compare across offers, because the split silently reprices every other term in the document.

What should I confirm about forgiveness before signing?

The employer's Public Service Loan Forgiveness status, in writing. Children's hospitals are overwhelmingly government or 501(c)(3) nonprofit employers, but the count runs on this employer, and a non qualifying structure discovered after the first year costs a year of count you cannot buy back.

Why do the exit terms deserve salary level attention?

Because they are salary lines dated later. Notice length controls a season of income timing, a signing money clawback is a loan against staying, a moonlighting ban removes the one income lever this salary leaves open, and a claims made policy bills you for the tail at exit unless the contract assigns it to the employer.

Related questions

• Private practice partnership or hospital employed: which is better for a pediatrician?
• Is PSLF at a nonprofit children's hospital the best loan strategy for a pediatrician?
• Can I moonlight in urgent care during a pediatrics fellowship, and is it worth it?

Sources

AMN Healthcare, 2025 Review of Physician and Advanced Practitioner Recruiting Incentives (pediatrics average starting salary of $258,000, accessed October 2026)

Association of American Medical Colleges (median education debt of $200,000 for the class of 2025, accessed October 2026)

Federal Student Aid, Public Service Loan Forgiveness (qualifying employers are government agencies and 501(c)(3) nonprofits, accessed October 2026)

Takeaways

• Check five things in order: the FTE split, call and its price, forgiveness status in writing, the band review process, and the exit terms.
• Price offers per clinical hour, not per headline salary; the same $258,000 is a different job at 0.8 and at 1.0 clinical FTE.
• Unpaid call is coverage the hospital would otherwise buy, donated by you; get the stipend, the comp time, or the overflow rate into the document.
• Read the tail, the clawback, the notice period, and the moonlighting policy with the same care as the salary line.