How do I compare first attending offers as an OB/GYN resident?

Compare offers on total value across five lines, never on headline salary alone. In OB/GYN, the salary is only one of five prices in the offer. The five lines are pay, call, malpractice premium, tail responsibility, and loan eligibility, with region running underneath all of them. The anchors for pay are sourced: an average starting salary of $374,000 for obstetrics and gynecology in the AMN Healthcare 2026 review, average compensation of $390,000 in the Medscape Physician Compensation Report 2026, and average total compensation of $420,859 in the Doximity Physician Compensation Report 2026. An offer well above or below those anchors is telling you something about its other lines, usually call load, premium geography, or both. The resident who reads all five lines signs the offer she meant to sign. The resident who reads one line discovers the other four during her first year, when discovery is expensive.

Part of the OB/GYN hub.

Line one and two: pay, priced against region and call

Call is the specialty's second currency, and it must be priced as its own line. Ask how many call nights the salary assumes, whether call is paid separately or folded into salary, what backup exists, and what happens to pay if call exceeds the assumption. Two offers at the same salary with different call loads are different offers. A laborist comparison makes the point concrete: the Vanderbilt University Medical Center laborist posting offers $370,000 base salary for fourteen 12 hour shifts a month with no call, and Public Service Loan Forgiveness eligibility. The Sutter Medical Group hospitalist posting in Davis, California, offers $429,000 at 1.0 FTE of 24 hour shifts. Those are postings, not averages, and they show the trade plainly: shift work with no call from home is a different product from traditional practice at a similar headline, and neither is better until you price the life each one buys and sells.

Lines three and four: the premium and the tail

Malpractice geography can outweigh salary geography in this specialty. For $1M/$3M policies, the AMA exhibit prices OB/GYN premiums at $243,988 in Florida, Miami Dade; $207,907 in Illinois, Cook, Madison, and St. Clair counties; $176,358 in New York, Nassau and Suffolk counties; $159,537 in Connecticut; $135,974 in Pennsylvania, Philadelphia; $134,901 in the District of Columbia; $94,640 in New Jersey; and $49,804 in California, Los Angeles and Orange counties. In an employed role the system usually carries the premium. In a private group the premium is overhead your compensation helps fund. Either way, ask who pays, in writing, and whether the amount comes out of a compensation pool you share in. The same physician, with the same skills, is priced almost five times higher in Miami Dade than in Los Angeles and Orange County on this line alone: $243,988 divided by $49,804 is about 4.9 times.

Tail is the exit price of a claims made policy, commonly 150 to 200 percent of the mature annual premium, due as one lump sum when the policy terminates, generally billed within about two months of cancellation. Shown arithmetic makes the offer line real. In Florida, $243,988 times 1.5 equals $365,982, and times 2 equals $487,976. In California, $49,804 times 1.5 equals $74,706, and times 2 equals $99,608. If your contract says you pay the tail, a Florida offer carries a potential exit bill near or above a full year of starting salary, while a California offer carries one near a quarter of it. Heidi, the new attending case in this specialty, signed with tail covered by the employer on a claims made policy, at about $320,000 in her first year. That single contract line is worth more than many salary negotiations ever win. Read who pays the tail, what triggers it, and whether retirement, disability, or death change the answer, before you sign anything.

Line five: loan eligibility, and the whole offer test

If you carry federal loans on the forgiveness track, the employer line can outweigh a salary gap. Public Service Loan Forgiveness needs 120 qualifying payments while working full time for a government or 501(c)(3) nonprofit employer, and eligibility follows the employer that pays you, not the building. A resident who banked up to 48 payments in four training years needs six more qualifying years. A higher paying offer from a non qualifying employer pauses the count for every year you stay, while interest and time move. Price the remaining forgiveness value against the salary gap, year by year, before deciding the private offer pays more. Heidi carries about $280,000 with 24 payments banked, so her household math treats employer eligibility as real money, because for her balance it plainly is.

Follow up questions

An offer pays much more in a high premium state. Is it really more?

Only if someone else carries the premium and the tail. A salary premium that compensates a group for a $243,988 Florida premium environment may never reach your household if the premium comes out of shared overhead, and a tail you owe personally, at $365,982 to $487,976 on the shown arithmetic, can erase years of salary advantage in one exit bill. Ask for the premium and tail terms in writing, then rerun the comparison. Employed offers in high premium states, where the system carries both lines, can be strong. Private offers in the same states need the closest reading of any offers in the specialty.

What should I get reviewed before I sign?

Have an attorney review the full contract before signing, as Heidi did, and give that review a specific list: tail responsibility and triggers, restrictive covenants and their geography, call assumptions and what happens when call exceeds them, how the production bonus is calculated and when it is paid, what the signing money requires you to repay if you leave early, and who the legal employer is for loan purposes. A review without that list finds generic issues. A review with that list prices the five lines this page is built on, while changes are still possible.

Related questions

• Is an OB/GYN fellowship worth it financially?
• Should an OB/GYN resident take a stipend or an early sign on bonus?
• What should an OB/GYN check on tail coverage and restrictive covenants?

Sources

AMN Healthcare, 2026 Review of Physician and Advanced Practitioner Recruiting Incentives (average starting salary of $374,000, regional average offers, and signing bonuses in 87 percent of searches averaging $49,306, accessed October 2026)

Medscape Physician Compensation Report 2026 (OB/GYN average compensation of $390,000, accessed October 2026)

AMA Policy Research Perspectives, Medical Liability Monitor premiums (OB/GYN premiums by market for $1M/$3M policies, accessed October 2026)

Physician Side Gigs, malpractice tail insurance guide (tail commonly 150 to 200 percent of the mature annual premium as a lump sum, accessed October 2026)

Financial Fellowship, Heidi and Spencer case (first year attending at about $320,000, claims made policy with tail covered by the employer, contract reviewed by an attorney, accessed October 2026)

Takeaways

• Score every offer on five lines: pay, call, premium, tail, and loan eligibility, against its regional anchor, starting from the $374,000 starting average.
• Premium geography is decisive in this specialty: $243,988 in Miami Dade against $49,804 in Los Angeles and Orange County, about 4.9 times on the same skills.
• A tail you pay personally runs $365,982 to $487,976 in Florida and $74,706 to $99,608 in California on the shown arithmetic. Who pays it can outweigh the salary.
• Get the contract reviewed against a specific list before signing. Heidi's tail covered by her employer is the line that proves the review pays.