My fiancée is an anesthesiologist. After years of training, she finally had her first attending offer.

We sat down to read it together. Three hours later we were more confused and more anxious than when we started.

Here's what I've learned since: the salary is almost never where the real risk lives. It's in the clauses in the physician contracts that no one tells you to look at. The ones that don't just affects her career but they affect both of your lives.

**1. The call schedule with no ceiling**

The contract mentioned call obligations but never defined a maximum. Seemed fine with the current group size. But if two people leave or someone goes on parental leave, nothing stops that schedule from swallowing every other weekend. We only caught this because we thought to ask. It wasn't volunteered.

**2. The automatic renewal clause**

Miss a 90-day notification window and the contract rolls over for another full term. No reminder. No flag from the employer. Life gets busy and you've accidentally recommitted to another year without realizing it.

**3. The assignment clause**

This one is buried and almost nobody talks about it. Many hospital contracts allow the employer to transfer your contract to a completely different entity — different location, different conditions — without your consent. A friend had her employer lose a hospital contract mid-year. She was expected to start somewhere completely different after she'd already signed a lease near where she planned to work. That clause is how it happened.

**4. The non-compete radius**

People think of this as "if I leave, I find another job nearby." What they miss is it also kicks in when the employer exits. Combined with an assignment clause situation, your options in your own city can evaporate fast. Some contracts prohibit practicing within 60 miles for two years. In a dense metro, that's effectively a forced relocation.

**5. The without-cause termination window**

Some contracts give the employer 30 days to let someone go, no explanation needed. That's not enough time to find a role, negotiate terms, sort out logistics — especially with a house or kids in school. Add a non-compete and you may not even be able to practice locally while you figure it out.

**6. Tail coverage**

If your partner leaves a job with a claims-made malpractice policy, someone has to buy "tail" coverage — insurance that covers claims filed after they leave. If the contract says that's on them, you're looking at $20,000–$50,000 out of pocket. Right when you're already managing a job transition. Most people don't see this coming.

**7. The sign-on bonus clawback**

Sign-on bonuses feel like a win. They often come with a repayment clause requiring full payback if you leave before year two or three - even if the role wasn't what was described. A couple we know put the bonus toward a down payment for their home. The job wasn't what was promised and leaving meant writing a five-figure check.

The clauses aren’t hidden. The consequences are.

We pieced this together after spending thousands of dollars and hours of our time on Reddit threads, WCI, lawyers, and colleagues who'd been through it. It worked. It shouldn't have to be that hard.

If you're in this moment now, or someone you know is, I built ClauseMD - a tool that does this analysis automatically.

What I wish someone had warned us about before my partner signed her first attending contract