OB/GYN Contracts and Income: Call Pay, Production, and Clauses That Follow

Start with the structure, because the structure decides who carries risk before any number in the offer means anything. Hospital employment pays a salary with a benefits package, and the system carries the malpractice premium and usually the tail. The floor is the firmest of the three and the ceiling is the flattest, and because the large systems are usually nonprofit organizations, the structure often keeps Public Service Loan Forgiveness running, which the student loans page prices in full. A private group pays production: collections on your clinic, your deliveries, and your surgery, minus your share of overhead. The ceiling is the highest of the three, the income moves with your panel and your call burden, and the malpractice premium is the largest single overhead line in the specialty. The laborist structure pays for time: scheduled shifts on labor and delivery, no panel to build, no call from home, and coverage carried by the hospital.

The laborist shape is best read in named postings, never as an average. Vanderbilt University Medical Center posts a laborist role at a $370,000 base salary for fourteen 12 hour shifts a month, with no call, and the posting notes Public Service Loan Forgiveness eligibility. Sutter Medical Group in Davis, California posts an OB/GYN hospitalist role at $429,000 at 1.0 FTE of 24 hour shifts. Those are two employer postings, not survey data: a defined block of hours, a defined price, and liability carried by the institution. The career length comparison is worked in How does laborist shift pay compare with private practice over a career? The choice between employment and a group is worked in Should I take a hospital employed OB/GYN job or join a private group? and the whole specialty map sits on the OB/GYN hub.

Verify your own offer against the published regional table instead of a rumor. AMN Healthcare, in its 2026 Review of Physician and Advanced Practitioner Recruiting Incentives, reports an average starting salary for obstetrics and gynecology of $374,000 across 1,293 permanent searches run from April 1, 2025 to March 31, 2026. The same review reports average offer salaries by region, and the spread is the lesson: an offer that looks strong in one region can sit below the regional line in another.

Verify five things in writing before you sign. First, where your base sits against the regional average for your region. Second, whether call is paid as a separate line or folded into the salary, and the frequency the salary assumes. Third, the actual malpractice premium for your market and who pays it, because the premium runs from $49,804 in California to $243,988 in Florida in Miami Dade in the AMA exhibit, a spread wider than most salary gaps. Fourth, the production formula and its deductions. Fifth, the exit terms: the clawback schedule, the covenant, and who pays the tail. A recruiter summary is not a verification. The contract text is.

Call is the second income inside the first one, and the contract either prices it in the open or hides it inside the salary. Priced call appears as its own line: a rate per shift, per night, or per hour of coverage, sometimes tiered for in house call against home call, with the expected frequency stated. Folded call disappears: the contract says call is included, the salary is the salary, and the number of nights is whatever the group and the census make it. Run the comparison with arithmetic, not impressions. Count the expected call nights in a year under each offer, including backup call where it is real. Under the priced offer, multiply the nights by the rate and add the result to the base. Under the folded offer, ask what call load the salary assumed, and price every night above that load using the logic of the priced offer. Across a three or four year term the difference compounds, one schedule at a time, and it is a common reason two offers with the same salary pay very differently.

Two details decide whether priced call stays priced. The rate belongs in the contract text, with the frequency and the split between in house and home call defined, because a rate without a definition invites reclassification later. The excess call clause matters just as much: call above the contracted frequency should pay at a stated rate rather than dissolving into included. The negotiation is easiest before signing. After signing, the call schedule is just your life. The full worked comparison lives in How do I compare paid call against call folded into an OB/GYN salary?

A production bonus is worth only what its formula leaves after thresholds, deductions, and timing have taken their shares. Read four terms in order. The unit: collections, charges, or work RVUs, because each one pays a different version of the same year, and OB/GYN work mixes clinic visits, deliveries, and surgery in proportions that favor different units. The threshold: the production level you must reach before any bonus pays at all, and whether the base salary was set assuming you would clear it. The rate: what each unit above the threshold pays, and whether the rate steps up at higher tiers or stays flat. The deductions: whether the malpractice premium, call costs, or overhead are subtracted before your production is counted, because a generous rate applied after a large deduction can pay less than a modest rate applied to the gross figure. Timing matters too: a bonus measured and paid once a year, with a reconciliation that can claw money back, is a different income from one paid quarterly with no true up.

Ask for the actual production of the physicians you would join, in writing, for the last full year. A formula with no volume data is a promise with no denominator. Price a conservative year, an expected year, and a busy year under the exact formula, and compare those totals against the salary offers on your table, with call priced separately in both. The valuation method is worked step by step in How should I value a production bonus in an OB/GYN offer?

A sign on payment is presented as a gift and written as a loan, and the clawback schedule is the part of the contract that proves it. AMN Healthcare reports that signing bonuses were offered in 87 percent of all physician searches in its 2026 review, averaging $49,306 across specialties. Prevalence does not make the terms harmless. The standard structure pays the bonus at signing or at start, then forgives it in slices across the term. Leave before the schedule finishes and the unforgiven share is due back, often alongside a tail bill if your coverage was claims made. Read the two clauses together, because they collect at the same moment, and the household that spent the bonus as income has no reserve for either.

Three questions settle the value of any sign on offer. Over what period is it forgiven, and is forgiveness steady across the term or weighted to the end. What events forgive it early, such as termination without cause, a group sale, or disability, and what events do not. And is a higher salary available instead, because salary compounds into raises, retirement contributions, and the next negotiation, while a bonus pays once and then asks to be repaid. That trade is worked directly in Is a signing bonus better than a higher starting salary for an OB/GYN? Hold the unforgiven balance inside your reserve plan until the schedule clears it.

The last read is the exit, because restrictive covenants and the tail clause decide where you can work next and what leaving costs. A restrictive covenant in OB/GYN usually pairs a distance limit with a time limit: you agree not to practice within a stated area for a stated period after you leave. An OB/GYN panel follows the physician, so a covenant here can separate you from patients who chose you across years of pregnancies and surgeries. Read the radius, the duration, the locations it covers, and the events that release you from it, such as termination without cause. Ask whether the covenant can be bought out, and at what price, and get that price in the text if it exists.

The tail clause sits beside the covenant and collects in cash. If your coverage is claims made, leaving without tail coverage leaves your prior years unanswered, and who pays for the tail on resignation, on termination, on retirement, and on disability is a six figure contract term in a high premium market. This page gives the clause its contract weight only. The full mechanics, the premium table by market, the arithmetic at the common 150 to 200 percent of the mature premium, and the state funds that change the shape live on the malpractice and tail coverage page. The contract checklist itself is worked in What should an OB/GYN check on tail coverage and restrictive covenants? Sign nothing until both clauses have been read by an attorney who works for you alone.

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

Doximity Physician Compensation Report 2026 (OB/GYN average total compensation of $420,859, published August 25, 2026, accessed October 2026)

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

American Medical Association, Policy Research Perspectives, medical liability premiums (OB/GYN premiums of $49,804 in California and $243,988 in Florida in Miami Dade, accessed October 2026)

Vanderbilt University Medical Center laborist posting ($370,000 base salary, fourteen 12 hour shifts a month, no call, Public Service Loan Forgiveness eligible, accessed October 2026) and Sutter Medical Group OB/GYN hospitalist posting ($429,000 at 1.0 FTE of 24 hour shifts, accessed October 2026)

Ryan Inman is a retired financial planner who worked with about 500 physician families. He created the Financial Residency podcast (about 3 million downloads) and is no longer affiliated with it. Financial Fellowship is his sole focus. This guide is educational. Last updated October 2026.