I want to leave after one year. What will it actually cost me: tail, clawbacks, vesting?

Add it in four lines before you resign, because each line was written into your contract at signing and each one bills you on the way out. Line one is the sign on clawback: the unearned portion of your bonus, repaid on the schedule your contract states. Line two is the tail: if your malpractice coverage is claims made and the contract puts the tail on you, the exit carries that bill too. Line three is vesting: employer retirement contributions you have not yet vested in stay behind. Line four is forgiveness: if you are counting toward Public Service Loan Forgiveness, a year of qualifying payments is stranded if the next employer does not qualify. None of these lines is a reason to stay in the wrong job. All four are reasons to leave on the cheapest date rather than the angriest one, and the difference between those dates is often five figures.

Part of the internal medicine hub.

Line one and two: the clawback and the tail

The clawback is arithmetic, and your contract states the formula. Read whether repayment is prorated or all or nothing, and whether the clock started on your sign date or your start date. For example, a bonus of $50,000 forgiven evenly over a two year clawback leaves half unearned at the end of year one, so leaving then means repaying $25,000, because half of $50,000 is $25,000. The same bonus forgiven in a lump at the second anniversary means repaying all $50,000 at the same exit date. That example is illustrative; your contract's formula is the one that bills you, so read the formula, not the memory of the recruiter's summary. Some contracts also claw back relocation and loan repayment on their own schedules, so list every forgiveness schedule in the document, not just the bonus.

The tail is the second line, and it is structural rather than arithmetic until you get the quote: on a claims made policy, leaving ends your coverage for claims filed later over your entire tenure unless the tail is bought. If the contract makes the employer pay it after a stated tenure, or when they terminate without cause, your line two may be zero. If it makes you pay in all cases, get the actual price from the carrier before you set your exit date, because it is a single payment due at departure. The tail question in this bank works the clause itself. Add the noncompete's cost as a shadow line: if it pushes you outside your metro for its duration, price the commute, the locums bridge, or the idle months honestly. The noncompete question covers how that price gets set.

Line three and four: vesting and forgiveness

Vesting is the quiet line. Your own deferrals are always yours: the 2026 limit is $24,500 each for a 403(b) and a governmental 457(b), and every dollar you deferred walks with you. The employer's match and contributions are different: they vest on the schedule in the plan document, and leaving before a vesting milestone forfeits the unvested share. Read the milestone dates before you choose your exit date. Leaving three weeks before a cliff vesting date can cost more than a month of salary, and the fix is often nothing more heroic than a calendar.

Forgiveness is the line physicians forget until the servicer reminds them. Public Service Loan Forgiveness cancels the remaining balance after 120 qualifying monthly payments made while working full time for a qualifying employer, a government agency or a 501(c)(3) nonprofit. A hospitalist who leaves a qualifying hospital for a for profit group stops the count where it stands; the payments made are not erased, but they stop growing, and if the new job never qualifies, the forgiveness those payments were marching toward never arrives. On a balance near the class of 2025 median education debt of $200,000, the stranded value of a broken forgiveness track routinely outweighs the other three lines combined. If the next job also qualifies, line four is zero and the count continues uninterrupted. Check the next employer's status before the offer letter, not after the resignation letter.

Leave on the cheapest date

With the four lines priced, the decision usually makes itself. Sometimes the total is small and the right move is to pay it and go. Sometimes one line dominates: the clawback anniversary is six weeks away, the vesting cliff is next quarter, the tail trigger flips at two years of service. Employers set those dates hoping you will not do this math; the dates are the negotiation you already lost or won at signing, collected at exit. If the total is large, that is not a trap, it is a price, and prices can be negotiated at the next signing: a new employer that wants you can cover a clawback repayment or a tail as a sign on, which is one more reason the negotiation question in this bank starts with the lines around the salary. Price the exit, pick the date, and leave like a professional who read the contract twice: once before signing, and once before resigning.