I sent a lot of these offers in twenty years on the hiring side, so I know what the tells look like from behind the desk. Start with this one, which has saved more physicians than any single piece of contract advice: a good job can wait a week. If an offer comes with an exploding deadline, sign by Friday or we move on, that urgency is information, and it's rarely about you. A healthy group knows a physician they want is worth waiting a few days for, and a place that needs you to decide before you've had time to think is telling you how it will treat your time once you're inside, and it's usually the first of several tells.
The exploding offer is the loudest one. Pressure to sign fast is almost never in your interest and almost always in theirs, because a rushed decision is a decision made in their favor. "I'll get back to you next week" has never cost anyone the right job, and it has saved plenty of people from the wrong one.
Then there's the number that's too good. If the comp sits noticeably above what everyone else in that market pays, don't just enjoy the flattery, ask why. Sometimes there's a clean answer, like a real shortage or a hard location or a genuine premium, and sometimes the answer is that the call is brutal, the turnover is high, and the money is hazard pay they'd rather not explain. A number that's out of line with its market is a question, not a gift.
Watch how they handle "why is this seat open." A confident group answers plainly, with something like "someone retired" or "we're growing" or "we added a service line," and a struggling one gets abstract or vague or changes the subject. The same goes for access. If you ask to talk to the physicians actually doing the job and you get one carefully chosen ambassador and a lot of reasons the others are busy, you've learned something the brochure worked hard to hide.
Read the income projection like a skeptic, too. A lot of offers come with a rosy pro-forma showing what you'll "make," and the fine print is that it assumes production most new attendings can't hit in year one, sometimes the 90th percentile of a busy veteran with a full referral base. Ask what the number looks like at realistic first-year volume, and watch whether they've even thought about it.
And then the classics that never go out of style. There's vague call and coverage language, the "as reasonably required" kind that turns into every third night once you're on staff. There's the line that a clause is "standard" and "non-negotiable," which is true of exactly no clause ever written. And there's turnover, the quiet one, which you surface by asking how many people have left in the last two years and why, and by noticing whether anyone will give you a straight number.
Put it together and the pattern is simple. Almost every red flag is a place where a healthy organization stays comfortable and an unhealthy one gets evasive, rushed, or defensive. You're not looking for a perfect job, because there isn't one. You're looking for a group that stays calm and specific when you ask the uncomfortable questions, because that composure is the best single predictor of what it'll be like to work there when something actually goes wrong. So take the week, and ask the questions that make a nervous employer squirm. The right one won't mind, and the wrong one will tell on itself, if you give it enough room and a little time.