New Attending OB/GYN: The Contract, the Premium, the First Year Order

The coverage problem in this specialty is physical. The work is procedural and physical at the same time: deliveries at any hour, surgery on a schedule and in emergencies, and call that asks a body to perform on broken sleep for decades. An injury to a hand, a back, or a shoulder does not reduce that income gradually. It ends the deliveries and the surgery, and those are the income. Size an individual own occupation disability policy to attending income inside the first ninety days, targeting the 60 to 70 percent of pre disability income that carriers will issue in total coverage (Medical Economics), with the benefit period running to retirement age.

This section is built around Jimmy Turner, MD, the physician behind Money Meets Medicine and the disability voice this site trusts. His frame for new attendings is simple: the group policy is not your policy. Group coverage is capped, tied to the job, and gone when the employment is. The individual policy follows you from job to job, and the resident policy you placed in training, if you placed one, now gets exercised: raise the benefit to attending income on the increase right you bought, without a new medical exam. If you did not place one in training, this is the quarter to fix that. Read Jimmy and the assessment path at the Jimmy Turner page, and the definition itself at own occupation disability.

The case on this page shows the gap in a real household. Heidi, the new attending in the spotlight below, carries group only disability coverage in her first attending year, with a two year old at home and a household that runs on her procedural income. Her contract was reviewed by an attorney, her cards are at zero, and her employer carries her malpractice tail. The disability layer was simply never rebuilt at attending scale.

Term life follows the same logic, sized to the household rather than the group maximum, and the umbrella policy goes on once the attending income makes you worth suing. The full build is on the insurance topic page and in the protection stack framework.

The $390,000 average is the least informative number in this hub. The specialty pays three different ways, and the averages blend all of them. The hospital employed physician takes a salary and coverage carried by the system. The private group physician takes production pay and an ownership path, and the premium becomes a practice cost that lands on the partners. The laborist takes pay by the shift, with no call from home and coverage carried by the hospital, and gives up the panel and the ownership upside in exchange. Posted examples show that third model: a Vanderbilt University Medical Center laborist posting offers a $370,000 base salary for fourteen 12 hour shifts a month, with no call and Public Service Loan Forgiveness eligibility (DocCafe posting, accessed October 2026), and a Sutter Medical Group posting in Davis, California, prices $429,000 at 1.0 FTE of 24 hour shifts (Health eCareers posting, accessed October 2026).

The premium is why the structure read matters here. For $1,000,000 and $3,000,000 policies, reported OB/GYN premiums run $243,988 in Florida (Miami Dade) and $49,804 in California (Los Angeles, Orange), with liability premiums up for the seventh consecutive year (AMA Policy Research Perspectives, data through 2025). The average starting salary is $374,000 (AMN Healthcare). A salary read without its premium is missing its largest cost: in Miami Dade the premium alone is about 63 percent of the specialty average compensation, because $243,988 divided by $390,000 is about 0.63, while in California it is about 13 percent, because $49,804 divided by $390,000 is about 0.13.

Call gets its own line in the read. A contract that pays for call states a rate and a frequency, and both can be counted, compared, and renegotiated. A contract that folds call into salary at an unstated rate has priced your nights at whatever the census decides, and the effective rate falls every time the panel grows. Production gets the same discipline: a production bonus is worth the formula and the threshold in the document, not the number in the offer letter.

One clause gets read before any of the money. If the malpractice policy is claims made, know today who pays the tail when you leave, because tail coverage commonly prices at 150 to 200 percent of the mature annual premium as a one time lump sum. Against the Florida premium, that is $243,988 times 1.5, which is $365,982, up to $243,988 times 2, which is $487,976. Against the California premium, it is $74,706 to $99,608 by the same math. And read the restrictive covenant against a map of where else you could work. The depth lives on the contracts and income topic page. This section links there. It does not copy it.

Compare net to net, never gross to gross. That is the rule the whole first year runs on. The attending gross looks enormous next to the resident gross, and the comparison lies: taxes and the lifestyle the gross invites take their cut before the money is yours. The Double Up Rule frames the jump honestly. You lived on the net of a resident salary; as a new attending you live on double that net, a resident net of $65,000 becomes a $130,000 lifestyle, and every dollar above it flows the waterfall. You may not leave the rule until you reach the taxable account at its end.

1. Capture the full employer match, and nothing past it. The match is a guaranteed return, and nothing else in the order outranks it.
2. One month of reserves, sized at the new lifestyle. The reserve is priced at the attending month, not the resident one.
3. Credit cards to zero. Nothing else gets a dollar until consumer debt is gone.
4. Coverage. Disability above all, sized to attending income, plus term life, plus umbrella, per the disability section above.
5. The student loan plan runs in parallel. Public Service Loan Forgiveness means minimums and recertify, never a dollar extra. Forgiveness follows 120 qualifying monthly payments made while working full time for a government or 501(c)(3) nonprofit employer (Federal Student Aid), and eligibility follows the employer that pays you, not the building you work in, with one narrow exception where state law bars the hospital from employing physicians directly, as in California and Texas.
6. Backdoor Roth IRA, $7,500, before debt above 7 percent. The space is tiny, it closes every year, and tax free compounding is scarce at attending income.
7. Max retirement. Health savings account first inside the tier, at $4,400 self only or $8,750 family for 2026, then the 401(k) or 403(b) to the $24,500 elective deferral limit, then a governmental 457(b) where one is offered, then mega backdoor last where the plan allows.
8. Add two more months of reserves, three in total.
9. Extinguish remaining debt above 7 percent. Forgiveness track loans are excluded; they are on the parallel plan, not this one.
10. Finish the reserve before the first taxable dollar. Six months of expenses on W2 income, up to twelve months on 1099 or sporadic income. The endpoint is set by employment type only, never by specialty.
11. Taxable brokerage, alongside written goals. Reaching this step is the exit from the Double Up Rule into established attending life.

Heidi and Spencer, the household in the spotlight below, show the order meeting a real first year, at about $400,000 of household income. The credit cards are already at zero, so step three is done on arrival. The emergency fund holds about $35,000, about three months, so the work is the climb toward the step ten finish. About $280,000 of student debt runs on the forgiveness track in parallel, with 24 of 120 payments made: minimums and recertification only. About $25,000 of car loans waits for its turn at step nine if its rate clears 7 percent. The sign on bonus, if your contract carries one, runs through the same order rather than around it. The three bucket framework is the map underneath all of it: bucket one is the Safety Net you finish at step ten, bucket two is the Wealth Engine of retirement accounts, and bucket three is the Accelerator that only opens once the first two are funded.

The depth lives at the generic level. These are links, not copies. The contract comparison is on the contracts and income topic page. Loans are worked on the student loans topic page. Coverage is on the insurance topic page, and the premium and tail system is on the malpractice topic page. Retirement is on the retirement topic page, ownership on the ownership topic page, and documents on the estate planning topic page.

The pattern this stage signs is a claims made policy with the tail following the physician. The contract looks complete, the salary is right, and the malpractice clause leaves the tail premium with you at exit, where it arrives as a six figure lump sum in the gap between jobs, in the specialty where a delivery can become a claim nearly two decades later because in many states the malpractice clock for a child does not start running until the patient turns 18 (Physician Side Gigs). It belongs in the signed document: who pays, in what share, on what trigger. Call folded into salary at an unstated rate is unpriced call, and it grows with the census while the salary stays flat. And Heidi and Spencer carry the household version: group only disability and no umbrella policy, with a two year old at home.

Laborist instead of traditional practice: the schedule ends at the door, there is no call from home and no panel, and coverage is carried by the hospital, so price the shift rate against what the model gives up in ownership. Start with laborist work compared with private practice over a career.

Planning part time: price the call and the clinic load first and build the waterfall at the part time net.

Two physician household: run one waterfall for the household, coverage on both incomes, and the loan plans read together.

A move to a patient compensation fund state: the premium and the tail change shape, because a fund pays the layer above the provider up to a cap. Indiana caps total recovery at $1,800,000, with a provider liable for no more than $500,000, and the Fund pays the layer above the provider up to the cap (Indiana Code section 34-18-14-3). Read what a patient compensation fund changes before you price the move on salary alone.

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

AMN Healthcare, 2026 Review of Physician and Advanced Practitioner Recruiting Incentives (average starting salary of $374,000, accessed October 2026)

American Medical Association, Policy Research Perspectives, medical liability premiums ($243,988 in Florida (Miami Dade) and $49,804 in California (Los Angeles, Orange) through 2025, premiums up for the seventh consecutive year, accessed October 2026)

Physician Side Gigs, malpractice tail insurance coverage (tail at 150 to 200 percent of the mature annual premium, and the child clock, accessed October 2026)

Federal Student Aid, Public Service Loan Forgiveness (120 qualifying payments at a qualifying employer, accessed October 2026)

Internal Revenue Service, Notice 2025-67 and Revenue Procedure 2025-19 (2026 limits: deferral $24,500, IRA $7,500, HSA $4,400 self only and $8,750 family, accessed October 2026)

Medical Economics (disability carriers issue coverage totaling about 60 to 70 percent of pre disability income, 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.