What Medical Residents Should Know Before Entering the Physician Job Market

Match Day is almost here.

After years of medical school, thousands of clinical hours, and a match process that feels like it consumes your entire final year, you are days away from finding out where you are going. However match week unfolds, one thing is already true: the decisions you make over the next three to seven years of residency will shape the job search that follows more than most residents anticipate.

The job market you will enter as an attending is already forming around you, and understanding it now, even in broad strokes, gives you a meaningful advantage when the time comes.

Here is what the landscape looks like, and what it means for where you are headed.

Physician demand is outpacing supply, and that gap is only widening. The Association of American Medical Colleges (AAMC) projects a shortage of more than 86,000 physicians by 2036, driven by an aging population, increasing chronic disease burden, and a physician workforce that is itself aging toward retirement. That context is favorable for anyone entering practice.

But the shortage does not fall evenly across specialties. The AAMC's most recent projections break it down this way: primary care faces a shortfall of between 17,800 and 48,000 physicians, surgical specialties between 15,800 and 30,200, and other non-primary care specialties between 10,300 and 35,600.

Loading table...

Psychiatry sits among the most persistently underserved fields, particularly child and adolescent psychiatry, where demand has outpaced supply for years with no near-term correction in sight. Neurology and urology are similarly constrained, and vascular surgery has one of the highest projected demand growth rates of any specialty.

Geography compounds all of it. Some specialties face shortages that are severe nationally but particularly acute in rural and underserved markets. Your specialty and your willingness to consider geography will likely matter more to your job search than your residency program ranking.

The takeaway: knowing the demand profile of your specialty early, not the week you start sending out applications, lets you think strategically about your final year of training and where you focus your job search energy.

This isn't a rule, but it's a pattern that holds true more often than not. According to the AAMC, 55.7% of physicians who completed residency training between 2015 and 2024 are practicing in the state where they trained. That number shifts considerably by specialty. Family medicine and psychiatry residents stay at rates of 66% or higher, while surgical subspecialties like plastic surgery and colon and rectal surgery see more than half their graduates relocate after training.

If you already know you want to practice somewhere specific, it's worth thinking now about how to build connections in that region during training. If geography is flexible for you, that's a genuine asset. Physicians willing to consider a broader range of markets, particularly rural communities and underserved areas, often find more competitive compensation packages, faster hiring timelines, and greater practice autonomy than their peers seeking positions in saturated urban markets.

Most residents spend years developing clinical expertise and almost no time thinking about the business structure they are walking into. The gap between clinical preparation and business literacy tends to show up fast once you start receiving offer letters, and understanding the basic differences now will help you ask better questions.

There are three primary employment models worth understanding.

Hospital employment is the most common choice for new graduates. It offers a predictable salary, comprehensive benefits, and a lower administrative burden since the hospital absorbs the business risk. The tradeoff is control. Hospital-employed physicians often have less say over scheduling, patient volume, and clinical protocols, and productivity expectations tied to wRVU targets can create the kind of pressure many residents enter employment hoping to avoid.

Private practice offers the highest long-term earning potential and the greatest clinical autonomy, but it requires a business mindset and typically involves a lower income floor during the ramp-up period. For residents who prioritize independence and have some tolerance for early financial variability, it is worth serious consideration.

Locum Tenens has evolved from a stopgap into a deliberate career choice for many physicians. It offers schedule flexibility, geographic variety, and competitive compensation. For residents who want to explore different practice settings or regions before committing to a permanent role, it can be a useful bridge, and in some cases, a longer-term path.

The right model depends on what you actually value, not just what pays most at the start. Autonomy, stability, schedule flexibility, and long-term earning potential pull in different directions depending on which model you choose.

Most residents enter the job market having spent years developing clinical expertise and almost no time learning how physician employment agreements actually work. The gap between clinical preparation and business literacy tends to show up fast once offer letters start arriving. Understanding what a competitive offer looks like, and knowing which contract terms carry the most risk, puts you in a significantly stronger position before you ever sit down to negotiate.

Physician compensation varies significantly by specialty, geography, and practice model, but a few benchmarks are worth knowing before you reach the negotiation stage.

Procedural and surgical specialties continue to command the highest salaries. Orthopedic surgery, interventional cardiology, and gastroenterology consistently sit at the top of starting salary ranges, while primary care and pediatrics sit at the lower end of the spectrum. That gap reflects both supply and demand dynamics and the fee structures tied to procedural versus cognitive work. Notably, psychiatry and family medicine are seeing faster compensation growth than many other specialties due to persistent shortages and federal incentive programs.

Incentive Package: Signing Bonuses, Relocation, and Loan Repayment

Beyond base salary, the incentive package is where offer negotiations often have the most room to move. Signing bonuses have become standard across most specialties and markets, and when relocation assistance and continuing medical education allowances are factored in, total recruitment packages often approach or exceed $60,000 on top of base compensation.

Employer-offered loan repayment assistance is also increasingly part of physician offer packages, with common structures ranging from $10,000 to $30,000 per year over a three-to-five-year period. With the average medical school graduate in the class of 2025 carrying $223,130 in education debt, it is worth asking about loan repayment as part of your negotiation, not just base salary.

Compensation structures, wRVU productivity benchmarks, non-compete clauses, tail insurance, call obligations, sign-on bonus repayment terms, and partnership tracks are all negotiable, and all carry significant financial and professional consequences. Physicians who enter contract negotiations underprepared often leave significant compensation on the table, sometimes hundreds of thousands of dollars over the life of the agreement.

Three areas deserve particular attention before you sign anything.

Physician Non-Compete Clauses

Non-compete clauses govern where you can practice if you leave. Most contracts include a geographic radius and a time restriction, and what those terms actually mean depends heavily on where you are practicing. A ten-mile restriction in a rural area effectively locks you out of an entire region. A ten-mile restriction in a dense urban market may have little practical impact. Know the radius, understand the duration, and think through what it would actually mean for your options if the role doesn't work out.

Physician Tail Coverage

Tail coverage is one of the most overlooked financial risks in a first contract. Most hospital employment agreements use claims-made malpractice policies, which only cover claims reported while the policy is active. When you leave a job covered by a claims-made policy, you need tail coverage to protect against future claims from incidents that occurred during your employment. That coverage often comes as a lump-sum payment required within 30 to 60 days of departure, and depending on your specialty, it can run anywhere from $12,000 to well over $100,000. Understanding who is responsible for tail coverage before you sign, and negotiating for employer-paid tail if possible, is one of the highest-value contract conversations you can have.

Termination Clauses

Termination clauses determine how and under what circumstances either party can exit the agreement. Pay close attention to whether the termination-without-cause provision is mutual, what constitutes cause for immediate termination, and whether bonus or relocation repayment is triggered by certain types of departure. Vague language around conduct or policy violations can give employers significant discretionary power that most residents don't anticipate until they need to leave.

You don't need to become a contract attorney. You do need to know enough to ask the right questions and have the right people in your corner when it matters.

The physician job market moves more slowly than most people expect, and the search timeline varies by specialty, geography, and how competitive or specific your requirements are. A general framework worth keeping in mind:

In your second-to-last year of training, the focus should be on defining what you actually want. Think through your non-negotiables around call schedules, geography, practice model, and compensation floor. Start building your CV and identifying the regions or systems you want to target.

In the first half of your final year, start connecting with recruiters, begin light outreach, and initiate state licensure if you're considering practicing outside your training state. Licensing can take 90 days or more and is a common source of avoidable delay. 

In the middle months of your final year, move into active interviews. Plan for three to six phone interviews with potential employers, follow those with on-site visits for your front-runners, and be prepared to negotiate.

In the final stretch before graduation, close. Sign your contract, complete credentialing, and begin relocation planning.

The table below outlines a general framework for how to think about the search at each stage of training.

Loading table...

Starting your search in the final year of training is not too early. Starting it six months before graduation is tight. Waiting until graduation to begin is a position most physicians who do it wish they had avoided.

Many physicians don't encounter locums work until a gap opens in their career or a staffing need arises unexpectedly. But understanding how locum tenens works before you complete training gives you options that pure permanent placement candidates don't have.

Some physicians use locum tenens immediately after residency to explore different practice settings, geographies, or patient populations before committing to a permanent role. Others use it to supplement income while searching for the right permanent opportunity. In both cases, working across different healthcare environments can inform your permanent placement decision in ways that reading job descriptions simply cannot.

Learning how locum tenens works before you need it, including the compensation structure, assignment process, and licensing requirements, means you can move quickly if the right opportunity comes up.

The short answer is earlier than you think. A recruiter who specializes in physician placement can help you understand what demand looks like for your specialty and target geography, facilitate communication with potential employers, and provide guidance during contract negotiations to make sure your interests are represented. That support is hard to replicate on your own, particularly during the final stretch of training when time is limited.

At CI Health Group, we work with residents and fellows who are beginning to think about life after training, as well as physicians who are mid-search and need a focused, experienced partner to help them find the right fit. If you're curious about what the job market looks like for your specialty and want to talk through where to start, we're glad to have that conversation.

Explore open positions or connect with a CI Health Group recruiter to talk through your options.