You Can't Just Start Monday: The 90-Day Gap Nobody Warns You About

Resign Friday, start Monday isn't a thing. What has to clear before you can see a patient or bill a dollar, and how to keep the gap from costing you a quarter.

How long does physician credentialing take?

Longer than anyone plans for. Three separate approvals have to land before you can see patients and bill: credentialing at the hospital, privileging for your specific scope, and enrollment with each payer. They run on their own timelines, not your start date, and an employer can grant you privileges while an insurer still won't let you bill.

I moved a lot of physicians in and out of jobs over twenty years, and this is the part that blindsided almost every one of them.

Physicians picture leaving a job as one clean step. Resign Friday, start Monday. Then they hit the least glamorous and most underestimated fact in medicine, which is that you cannot simply show up and start seeing patients.

Why it matters: This is the gap that turns a good career move into a lean quarter. Not the salary you negotiated, not the contract terms you worried over. The weeks between your last paycheck at the old place and your first real one at the new place, which nobody puts on the calendar because nobody tells you it exists.

Start the clock the day the offer is real

Not the day you sign. The day it's real.

Ask the new employer's medical staff office to begin credentialing, and ask specifically how long enrollment with the major payers runs in that market. Those are two different questions with two different answers.

A hospital can grant you privileges and you still can't bill a given insurer until that insurer says so. That distinction is the single most common way a smooth transition turns into an unpaid one, and it's entirely avoidable with a calendar and some polite nagging.

Read the exit clauses before you say a word

Before you give notice. Not after.

The notice period. Whatever your contract says, plus whatever you owe the people covering for you.

The clawback. If your signing bonus or relocation money forgives on a schedule, leaving early may mean writing part of it back. You want that number in front of you before the conversation, not in a letter afterward.

The non-compete. The day you resign is the day it kicks in, so know the radius, the duration, and whether it even applies when you're the one leaving voluntarily. The answer changes where you're allowed to work next.

The tail. If your malpractice coverage is claims-made, someone has to buy the policy covering claims filed after you're gone. If your contract is silent on who, assume the bill is yours until proven otherwise. That isn't a reason to stay. It's a reason to price it, the same way you'd price movers.

Resign like someone who knows the village is small

Medicine is a village. Your references live at the place you're leaving, and the profession has a long memory.

Resign in person where you can. Give at least the notice your contract requires and ideally a little more. Expect a counteroffer inside seventy-two hours, and decide what you'll say before it arrives. Resist the very human urge to finally tell everyone exactly what you thought of the place.

A clean exit is worth more over a career than the momentary satisfaction of an honest exit interview. The colleague you part with graciously today is the one who refers you a partner, or vouches for you to a group, five years from now.

Your patients are part of this too. Depending on your specialty and your contract, there are real limits on how they get notified, who's allowed to tell them where you've gone, and what you can say on the way out. Some of that is governed by your agreement and some by state rules, so check rather than assume. The goal is continuity of care that reflects well on you, not a scramble that reflects badly.

The move checklist

Six things, in roughly this order:

1. Start credentialing the day the offer is real. Ask for the hospital timeline and the payer enrollment timeline separately.
2. Read your current contract before you give notice. Notice period, clawback schedule, non-compete, tail obligation.
3. Price the exit. Unforgiven bonus plus tail premium plus any unpaid weeks. That's your real cost of moving, and it belongs in the negotiation for the new job.
4. Give notice in person, and generously. Contract minimum is a floor, not a target.
5. Ask what you're allowed to tell patients, before you tell any of them anything.
6. Budget for the gap. Assume you will be between real paychecks longer than anyone promised.

The bottom line

None of this is a reason to stay in a job that isn't working. It's the opposite.

The physicians who move well treat the logistics with the same rigor they'd bring to a discharge plan. Start the clock early, read the clauses before you talk, price the tail and the clawback, protect the relationships, mind the patients.

Do that and the ninety-day gap becomes something you planned for instead of something that happened to you. The exit isn't an emergency. It's a procedure, and you already know how to run a procedure.

None of this is legal advice, and physician contracts vary by state. Have a contract attorney read yours before you act on any of it.

Questions physicians ask about changing jobs

Can I see patients before payer enrollment is complete?

Sometimes, but you may not get paid for it. Hospital privileges and payer enrollment are separate approvals. Some employers will let you start seeing patients on privileges alone and hold the claims, billing retroactively once enrollment lands, but that depends on the payer and the contract. Ask specifically what happens to visits performed before enrollment, and get the answer in writing.

What is a tail policy and who pays for it?

If your malpractice coverage is claims-made, it only covers claims filed while the policy is active. A tail policy extends that coverage to claims filed after you leave. Whether you or your employer pays should be stated in your contract, and when it isn't, the default is usually you. It can be a meaningful amount, so find out before you resign.

Does a non-compete apply if I resign voluntarily?

Usually yes, and often the enforceability turns on who terminated and why. Some agreements carve out termination without cause; most do not carve out voluntary resignation. The radius, duration and definition of competing practice vary enormously between agreements that look nearly identical on the page.

Do I have to repay my signing bonus if I leave early?

If it forgives on a schedule, probably a portion of it. Most physician signing and relocation payments forgive over two to four years, so leaving in year two typically means repaying whatever hasn't vested. Read the forgiveness schedule and calculate the exact figure before you give notice.

Can I tell my patients where I'm going?

It depends on your contract and your state. Some agreements restrict soliciting patients; some states have patient-notification requirements that override those restrictions. These two can conflict, which is exactly why it's worth asking rather than assuming either way.