Physician Employer Guides (2026): Kaiser, VA, Mayo, HCA, UC and More Compared

Decision path

Start here

Pick the line that describes you, and read in that order.

1. Resident or fellow with federal loans, choosing a first job. Settle PSLF first, because it can be worth more than any retirement plan: check whether the employer qualifies, then run PSLF vs. refinancing. If the VA or an FQHC is on your list, read the VA guide (EDRP) and the FQHC playbook (NHSC) next.
2. Holding an academic offer. You face a retirement election with a deadline, often irrevocable. Go straight to your system: UC (90 days), UT System (90 days), University of Iowa (60 days) or Florida's state universities (choose a provider right away). The deadlines table below has all four.
3. Holding a health-system offer. Find out how pay is set and when the deferred money vests. Salaried: Mayo Clinic, Cleveland Clinic, Kaiser (and its pay by region). Production-leaning: HCA. Texas nonprofit: Baylor Scott & White.
4. Comparing two offers. Use the offer comparison on this page, then the contract analyzer and our contract negotiation guide.
5. Already employed, facing open enrollment. Read the open enrollment guide for the HSA, 403(b), 457(b) and disability elections, and the contribution limits guide.
6. Thinking about leaving. Check your vesting dates in the vesting table, HCA's December 31 match rule, your tail coverage and your non-compete before you give notice.

The comparison

Every employer side by side

Each cell below comes from that employer's guide on this site, which carries the sources. Pay figures are deliberately left out where an employer doesn't publish them; the guides explain what the self-reported data shows.

Computed from each formula

What the pensions actually pay

A pension formula only means something once you put a salary through it, and the cap is what changes the answer. The table runs each plan's formula for 30 years of service at two salaries, assuming you retire at the plan's full-benefit age (65 for UC's 2.5% factor, 62 for the VA's 1.1% tier) and that the salary shown counts in full.

Three things stand out. First, at $300,000 the UC pension already sees only 53% of the salary, and at $450,000 it sees 36%, which is why the UC guide leans toward Savings Choice for physicians who might move. Second, the IRS limit flattens every other plan above $360,000: going from $300,000 to $450,000 adds only $41,400 a year to a TRS pension. Third, the formulas assume the pay counts. At UC, the Y and Z parts of a clinician's pay often don't, and IPERS excludes bonuses, so a productivity-heavy package can produce a much smaller pension than the table shows.

The 25× column is the 4% rule run backward: the savings you would need to draw the same income. It ignores the pension's inflation adjustments (where they exist), survivor options and the fact that it stops at death, so treat it as a sense of scale. The VA guide also shows a more conservative annuity-price comparison, and Physician Net Worth at Retirement shows how a pension changes the savings target.

Computed on a $300,000 salary

What you keep if you leave after 4 years

Academic medicine is mobile: an AAMC analysis cited in our UC guide found that more than half of clinical faculty leave their institution within 10 years. So the most useful question about a retirement package is often not what it pays at 30 years but what you walk away with at four. The table uses each employer's contribution formula on a flat $300,000 salary, counting contributions only (no investment growth).

The spread is the point. After 4 years, the same physician leaves Kaiser, UC's Pension Choice, TRS or IPERS with only their own contributions, while the same four years under University of Iowa (TIAA) leave $119,359 of employer money in their account. Neither is a bad plan. The pensions pay off for people who stay; the immediately vested accounts pay off for people who don't. Before you elect, write down an honest guess of how long you'll stay, then read the row that matches it.

Two traps the table can't show. HCA pays its match once a year, and only if you're employed on December 31 and were paid for at least 1,000 hours, so leaving in November forfeits the whole year's match on top of any unvested balance. And Kaiser's and the VA's 5-year cliffs mean the fifth year is worth far more than its salary: our Kaiser guide calls the first five years “the exposure window” for exactly this reason.

Framework and worked example

How to compare two offers

Salary is one of five lines. Price each offer as a year of total compensation, then add the one-time items separately:

1. Salary at realistic volume. For a production offer, use the year-one and year-three pay you'd earn at typical volume for that facility, not the base or the top-quartile figure. For a salaried offer, the number is the number.
2. Employer retirement money you will actually vest in. Match, automatic and supplemental contributions, counted only if you expect to stay past vesting.
3. Pension accrual, net of what you pay in. A year of service adds to a lifetime income stream. Count its value, and subtract any required employee contribution such as FERS's 4.4% or TRS's 8.25%.
4. Loan benefits. PSLF eligibility, EDRP, NHSC and state programs, and forgivable loans. Gross up tax-free benefits to compare them with salary, and read every clawback.
5. Malpractice and tail. Who pays the premium, whether the policy is claims-made, and who pays the tail when you leave.

Worked example: a VA offer against a for-profit offer

Our VA guide prices a scenario debated on the White Coat Investor forum: a hospitalist with a $310,000 VA offer and a $350,000 private offer. We give the private offer HCA's published 401(k) schedule and put both jobs in Texas. The physician is single, defers $24,500 pre-tax at either job, and carries $300,000 of federal Direct Loans with 3 qualifying years from residency. The VA position is assumed EDRP-eligible, which you must confirm in writing for a real offer.

How each line was built:

• Retirement. The TSP adds 1% automatically and matches up to 4%, so 5% of $310,000. HCA matches 100% of 3% of pay in years 0–4. Both are within the $360,000 compensation limit.
• Pension. Each VA year adds $3,100 a year of lifetime income from retirement ($3,410 at the 1.1% tier). The VA guide values a year of that accrual at roughly $15,000 to $25,000; we use the low end, and subtract the 4.4% you pay toward it, which comes out of after-tax pay.
• Loans. Under the RAP plan our PSLF calculator models, the payment is $2,379 a month ($28,550 a year). EDRP reimburses payments you make, up to $40,000 a year, so it covers all $28,550. That money is tax-free; at this physician's 37% marginal rate (federal plus Medicare), matching it with salary takes $45,571.

What the table says. With EDRP, the VA offer is worth $11,931 a year more than the for-profit offer despite paying $40,000 less. Without EDRP, the for-profit offer leads by $33,640 a year, and the take-home row shows why the VA can feel tighter month to month. That swing is why EDRP eligibility belongs in the offer letter, not in a recruiter's email.

The items that don't fit in one year:

• PSLF. With 84 payments left, the PSLF model forgives about $100,150 tax-free at year 10 if the physician stays in qualifying work (the VA or any other qualifying employer). The model subtracts remaining payments from today's balance and ignores interest, so with interest accruing the real forgiveness is usually larger. The for-profit job generally doesn't count toward PSLF at all.
• EDRP over five years. $142,750 of loan payments refunded tax-free, with no clawback if the physician leaves early, per the VA guide.
• Tail. The VA never needs one. If the for-profit contract makes the physician buy tail on departure, at 150% to 300% of an internist's $8,274 premium (the lowest AMA-reported premium in our tail cost guide), that is $12,411 to $24,822 once. For a surgeon or OB/GYN it can reach six figures.
• Vesting. The FERS pension needs 5 years; HCA's match is 60% vested at year 4 and fully vested at 6. A physician who expects to leave in three years should drop the pension line from the VA column.

Change the inputs and the answer moves. A proceduralist with a $300,000 salary gap can't close it with this stack, as the VA guide says plainly; a physician with no federal loans loses the PSLF and EDRP lines entirely. Run your own numbers with the contract analyzer, the PSLF calculator and the take-home pay calculator.

Deadlines

The elections and deadlines you can miss

Several of these employers ask for a permanent decision in your first weeks, often before orientation has explained it. The defaults matter, because doing nothing is a choice.

Two more apply almost everywhere. Certify PSLF employment from your first month if you carry federal loans, and at every job change. And at a private nonprofit, a 457(b) stays the employer's property until it's paid to you, so read the plan's payout rules before you raise the election; the open enrollment guide walks through that tradeoff.

Malpractice

Who pays malpractice and tail

Malpractice rarely shows up in the salary line, but tail can cost a year's savings when you leave. Our tail cost guide shows that tail is priced as a multiple of your final claims-made premium, with brokers planning on 150% to 300%. Where the series' employers stand:

• The VA and FQHCs: Federal Tort Claims Act coverage. Claims run against the United States, so there are no premiums and no tail, ever. It covers only work within the job; any moonlighting needs its own policy.
• Kaiser: malpractice coverage including tail, per our Kaiser pay guide.
• Cleveland Clinic: institution-provided, per its recruitment materials.
• HCA and Baylor Scott & White: typically provided for employed physicians; confirm tail terms, especially if you're contracted through a group or work PRN.
• Mayo Clinic and the university systems: our guides don't document the terms. Ask whether coverage is provided and whether you owe anything for tail if you leave.

Read claims-made vs. occurrence before you sign anything that leaves tail to you.

The deep dives

Employer by employer

Kaiser Permanente (TPMG and SCPMG)

Best for: physicians who want the strongest total retirement stack in private medicine and plan to stay past year 5.

The most-searched physician employer in America, and the most misunderstood. In Southern California, “making partner” means becoming a true K-1 partner for a nominal buy-in (physician-reported around $2,500). In Northern California there are no partners: you become a shareholder of a corporation, buying real stock (physician-reported at roughly $140,000–$150,000 in recent years).

Underneath both is a genuine pension (2% of pay per year for 20 years, then 1%), an automatic employer contribution that works out to $26,775 a year at the 2026 caps, and a 401(k) with full Mega Backdoor Roth capability, so a capped TPMG physician can fill the whole $72,000 limit. The catch: everything meaningful vests at 5 years, so Kaiser as a two-year stepping stone is a below-market deal by design. Pay varies more by region than most people expect; the regional pay guide lists posted ranges for 12 specialties across the Permanente groups, including the Northwest's 21% retirement contribution and Hawaii's retiree medical.

Read the full Kaiser guide

The Department of Veterans Affairs

Best for: physicians with large federal loan balances, and cognitive specialties where the salary gap is small.

The VA's sticker salary understates the real package more than any employer in this series. The FERS pension counts Title 38 market pay toward your high-3 (38 U.S.C. § 7431 treats it as pay for retirement purposes, the detail almost every projection gets wrong). EDRP pays up to $200,000 in loan repayment ($40,000 a year over five years), tax-free, with no clawback if you leave early. VA employment is automatically PSLF-qualifying, and EDRP reimburses the same payments PSLF counts.

And the sleeper: you never buy malpractice insurance or a tail. Under 38 U.S.C. § 7316, a malpractice claim runs against the United States instead of you. The catch: total compensation caps at the President's salary ($400,000), so the gap versus private practice widens as specialty income rises, and the TSP has no after-tax option for a Mega Backdoor Roth.

Read the full VA guide

University of California

Best for: understanding the one decision new UC physicians can never undo.

Every new UCSF, UCLA, UC Davis, UC San Diego and UC Irvine physician gets 90 days to choose: Pension Choice or Savings Choice. Do nothing, and you're defaulted into the pension — irrevocably, per UC's Retirement Choice rules.

Here's why the generic UC advice fails physicians: the pension formula counts only $159,773 of salary (the PEPRA cap for the plan year starting July 1, 2026), and under the Health Sciences Compensation Plan much of a physician's clinical pay was never pension-eligible to begin with. For most mobile physicians, Savings Choice — 8% employer money, 1-year vesting and a later option to switch into the pension — is the asymmetric play. UC also lets you fund a 403(b) and a 457(b) at the same time ($49,000 in 2026) and supports the Mega Backdoor Roth.

Read the full UC guide

The UT System

Best for: faculty at MD Anderson, UT Southwestern, UTMB and the other UT institutions facing the 90-day TRS-or-ORP election.

TRS is the richest formula in the series (2.3% a year, up to 80.5%) and counts pay up to $360,000, but it vests at 5 years and its portability outside Texas public higher education is essentially zero. ORP is a 403(b) with an 8.5% UT contribution (6.6% state plus a 1.9% UT supplement) that vests after a year and a day. The Texas wrinkles: no state income tax, ORP service earns Social Security credit while TRS service generally doesn't, and MD Anderson pays 100% of retiree medical premiums for qualifying retirees, worth $200,000–$300,000 or more over a decade of pre-Medicare retirement per the guide's estimate.

Read the full UT System guide

IPERS (Iowa public physicians)

Best for: UIHC and Carver faculty, county hospital physicians, and anyone facing Iowa's 60-day IPERS-vs-TIAA election.

Iowa's state pension counts compensation up to the IRS limit of $360,000, more than double UC's cap, and pays up to 65% of your high-5 average at 35 years. The Rule of 88 allows unreduced early retirement, and Iowa now excludes retirement income from state tax.

The catch: a 7-year vesting cliff (the longest in this series), bonuses excluded from covered wages, and an early-career election most physicians make before understanding it (at the University of Iowa, 60 days to choose IPERS or TIAA, with IPERS as the default). TIAA vests immediately.

Read the full IPERS guide

Florida's state universities (SUSORP)

Best for: College of Medicine faculty at UF, USF, FSU, UCF and FIU, who discover at onboarding that the FRS pension-vs-investment choice doesn't apply to them.

Florida law puts medical faculty in SUSORP, a defined contribution plan: 3% from you, about 5.14% from the employer, vested immediately, with no loans or hardship withdrawals. The decision you do make is which of four providers holds the account, and fees differ. UF's clinical faculty also get a second, identical plan (the AEF 403(b)), roughly doubling the employer contribution; ask other schools whether they have one.

Read the full SUSORP guide

Community health centers (FQHCs)

Best for: primary care and behavioral health physicians with meaningful federal loans.

Three federal benefits stack at an FQHC: FTCA malpractice coverage (no premiums, no tail), PSLF-qualifying employment, and NHSC loan repayment of up to $75,000 for a two-year full-time primary care commitment, with continuation contracts up to $35,000 a year. Salaries run roughly 8%–15% below private practice in primary care; the playbook's six-year example captures about $205,000 of non-salary benefits before PSLF forgiveness.

Read the FQHC playbook

Mayo Clinic and Cleveland Clinic

Best for: physicians who value predictability over productivity upside and want a pure salaried model.

Two of American medicine's most prestigious institutions independently concluded that productivity-based pay creates bad incentives, and both pay a straight salary with no wRVU bonus. Their retirement plans differ. Mayo offers a pension at no cost to employees (a Stable Lump Sum formula for anyone eligible since 2023, vesting after three years for most participants) plus a match of $0.50 to $1.00 per dollar on the first 4% of pay. Cleveland Clinic offers an account-based Investment Pension Plan that starts at 2.5% of salary and rises to 5.5% with service, vesting at 3 years, plus a 50% match on the first 6%. Mayo's Minnesota job postings now show its salary band ($217,500 to $533,750 starting base); Cleveland Clinic publishes none.

Read the Mayo Clinic guide · Read the Cleveland Clinic guide

HCA Healthcare and Baylor Scott & White

Best for: Texas and Florida physicians weighing the two giants, where the deciding line is often tax status, not salary.

HCA, the largest for-profit hospital operator, pays on production-leaning models and offers one of the best 401(k) matches in healthcare: 100% of 3% of pay in the first four years, rising to 9% after 25. It pays the match only to people employed on December 31, and HCA employment generally doesn't count for PSLF. Baylor Scott & White, the largest nonprofit system in Texas, matches dollar for dollar up to 5% of base pay with 3-year vesting, and employee reports describe below-market base pay, but its employment generally qualifies for PSLF, which our guides value at $200,000–$400,000 for a physician with $250,000–$400,000 in federal loans.

Read the HCA guide · Read the Baylor Scott & White guide

Checklist

How to read any employer's package

The guides above share one framework. Apply it to any offer, including employers this series doesn't cover yet:

1. Find the vesting cliff. Every deferred benefit has one: 3 years at Mayo, Cleveland Clinic and Baylor Scott & White, 5 at Kaiser, the VA's pension, UC's pension and TRS, 6 for HCA's full match, 7 at IPERS. If your realistic tenure is shorter, price the package without the deferred benefits, because you won't keep them.
2. Find the compensation cap. Pensions never count all of a physician's income. The question is which cap applies: the IRS limit ($360,000 for Kaiser, TRS and IPERS), the VA's $400,000 pay cap, or something far lower (UC's $159,773). The cap decides whether the pension replaces half your income or less than a fifth of it.
3. Find what counts as pay. UC's pension mostly sees the scale-based X component, IPERS excludes bonuses, and the VA counts market pay but not the Physician Comparability Allowance. Ask HR in writing which pay elements count.
4. Ask what the salary gap buys. A below-market salary with a pension, retiree health and loan benefits can beat a higher salary with none, if you stay past vesting. Our contract negotiation guide covers how to run this comparison on paper before signing.
5. Check PSLF status. The VA qualifies automatically, and UC, the UT System, Iowa and Florida's universities are government employers too. Kaiser physicians in California may qualify under the PSLF contractor provision that took effect July 1, 2023, for positions state law bars a qualifying employer from filling with a direct employee. For any physician carrying federal loans, the PSLF math can outweigh the entire pension-vs-DC question.
6. Stress-test the promise. Pensions and deferred comp are only as good as the entity behind them. Government backing (VA, IPERS, UC, TRS) differs structurally from corporate backing, and nonqualified deferred comp anywhere makes you an unsecured creditor. Our hospital bankruptcy guide covers the due diligence.

Directory

Every guide in this topic

Health systems

• Kaiser Permanente physician finances: TPMG vs. SCPMG, the shareholder buy-in, the three-layer retirement stack and PSLF.
• Kaiser Permanente salary by region: posted pay for 12 specialties across the Permanente groups, signing money and take-home against local housing.
• Mayo Clinic salary and benefits: the step-based salary, posted Minnesota pay band, no-cost pension and 4% match.
• Cleveland Clinic salary and benefits: the salaried model, the tenure-scaling Investment Pension Plan and what the salary data can and can't tell you.
• HCA Healthcare pay and benefits: production pay, the 3%-to-9% match and its December 31 rule, the ESPP and the PSLF problem.
• Baylor Scott & White pay and benefits: PSLF eligibility, the 5% match, the Tier 1 health plan network and the 2026 Medicaid exit.

Federal and community employers

• VA physician pension, pay and benefits: Title 38 pay, the FERS high-3 detail, EDRP plus PSLF and FTCA malpractice.
• The FQHC physician playbook: FTCA malpractice, PSLF and NHSC loan repayment, with the stacking math.

Public universities and state plans

• UC Pension Choice vs. Savings Choice: the irrevocable 90-day election, the PEPRA cap and the HSCP pay rules.
• UT System TRS vs. ORP: the 90-day election, contribution rates, vesting and MD Anderson's retiree medical.
• IPERS for Iowa physicians: the formula, the $360,000 cap, the bonus exclusion and the 60-day IPERS-vs-TIAA choice.
• SUSORP for Florida physicians: the mandatory plan, choosing a provider and UF's second plan.
• California physician finance: the state's taxes, entity rules and pension caps in one place.

Benefits elections and retirement accounts

• Open enrollment for physicians: HDHP vs. PPO, the 2027 HSA limits, 403(b) and 457(b) elections, group disability and life.
• Retirement contribution limits: every current limit and which ones stack when you have several plans.
• The Mega Backdoor Roth: how after-tax 401(k) contributions fill the $72,000 limit, and which employer plans allow it.
• Tax planning for physicians: retirement accounts, the HSA, the backdoor Roth and other sourced strategies.
• Group vs. individual disability: why the employer policy isn't enough on its own.
• Physician net worth at retirement: what doctors actually have, and how a pension changes the target.

Contracts, negotiation and leaving

• Physician contract negotiation: leverage, preparation and the 15 terms to negotiate.
• Contract red flags: ten clauses never to sign without negotiating.
• Salary negotiation: market data and language that works.
• Signing bonuses: repayment terms, forgivable loans and the tax trap.
• What is a wRVU?: how production pay turns into a paycheck.
• Partnership buy-ins: what a fair buy-in costs and which terms to check.
• Physician non-competes: the 2026 state rules and how to get out of one.
• Tail coverage explained: when you need it and who should pay.
• How much tail coverage costs: carrier pricing, AMA-reported premiums and the arithmetic.
• Claims-made vs. occurrence: the policy type that decides whether you owe tail.
• Hospital bankruptcy: what happens to pay, the 403(b), the pension and tail when an employer fails.
• Private equity deals in 2026: what the slowdown means if you're employed or weighing an offer.
• Contract review services compared: the services that review physician contracts, compared.

Student loans and PSLF

• Does my hospital qualify for PSLF?: why the paycheck, not the building, decides, and how to check in 60 seconds.
• Public Service Loan Forgiveness: the rules, forms and pitfalls.
• PSLF vs. refinancing: the 2026 math by scenario.
• Physician student loan forgiveness: every program and how they stack.
• State loan repayment programs: the map, including Iowa's, Florida's and California's programs.

Calculators

• Contract analyzer: compare an offer's salary, wRVU bonus and terms with benchmarks.
• Pay benchmark: where an offer sits against your specialty's pay.
• PSLF calculator: projected forgiveness against refinancing.
• IDR comparison: RAP vs. IBR payments.
• Retirement savings: whether you're on track, with or without a pension.
• Career path calculator: lifetime earnings in private practice, academics or locums.
• Take-home pay calculator: after-tax pay by state.

New deep dives land in the monthly newsletter first.

Frequently asked questions

Update log

• October 2026: Rebuilt the hub to cover all eleven employers in the series. Added the side-by-side table, pension results computed from each formula, the four-year vesting table, the offer comparison framework with a worked VA-vs.-for-profit example (computed with our take-home and PSLF models), the elections table, a malpractice and tail section and a full directory. Corrected the takeaway that every pension has a 5-to-7-year cliff (Mayo's vests at three years for most participants).
• September 2026: Headline figures checked against the primary sources listed below.
• August 2026: First published.

Methodology and sources

Every rate, formula and vesting rule on this page is the one stated in that employer's guide on MedMoneyGuide, which carries its own full source list; where a guide labels a figure as physician-reported or unverified, so does this page. Dollar results (the pension table, the four-year vesting table, Kaiser's Plan 2 contribution and the worked example) are computed in the page's code from those inputs and the 2026 federal limits, using our shared take-home model for taxes and our PSLF calculator's model for loan payments and forgiveness. Salaries in the worked example are a scenario from the VA guide, not quotes. Pension values use the 4% rule as a measure of scale, not a valuation.

1. 38 U.S.C. § 7431, Pay (compensation cap and treatment of market pay for retirement) and 38 U.S.C. § 7316 (malpractice remedy against the United States), Office of the Law Revision Counsel. Accessed September 27, 2026.
2. Education Debt Reduction Program, VA Careers, U.S. Department of Veterans Affairs. Accessed September 27, 2026.
3. FERS Eligibility, U.S. Office of Personnel Management. Accessed September 27, 2026.
4. UC Retirement Choice Program, University of California (UCnet). Accessed September 27, 2026.
5. IPERS: Regular Members' Retirement Benefit Calculation, Vested Members, and Retiring Members, Iowa Public Employees' Retirement System; Iowa Administrative Code 495, Chapter 6 (Covered Wages). Accessed September 27, 2026.
6. Retirement, University of Iowa Human Resources. Accessed September 27, 2026.
7. Benefits, Mayo Clinic Jobs. Accessed September 27, 2026.
8. Benefits summary, Cleveland Clinic Office of Physician and Advanced Practice Recruitment. Accessed September 27, 2026.
9. COLA increases for dollar limitations on benefits and contributions ($360,000 compensation limit; $72,000 defined contribution limit for 2026), Internal Revenue Service. Accessed September 27, 2026.
10. 34 CFR 685.219, Public Service Loan Forgiveness Program, Electronic Code of Federal Regulations. Accessed September 27, 2026.
11. Understanding the TPMG physician retirement plan options, Capital Advantage (Kaiser pension and Plan 2 formulas), as cited in our Kaiser guide.
12. Optional Retirement Program, University of Texas System, and Teacher Retirement System of Texas, as cited in our UT System guide.
13. Section 121.35, Florida Statutes and SUSORP, University of Florida Human Resources, as cited in our SUSORP guide.
14. NHSC Loan Repayment Program, HRSA, as cited in our FQHC guide.
15. Mayo Clinic pension plan summary (MC 5500-82), as cited in our Mayo Clinic guide.
16. Benefits, Cleveland Clinic Careers, as cited in our Cleveland Clinic guide.
17. HCA Healthcare Benefits Brochure 2026 (401(k) match, year-end rule and vesting), as cited in our HCA guide.
18. Retirement Savings Plan, Baylor Scott & White Health, as cited in our Baylor Scott & White guide.
19. Public Service Loan Forgiveness, Federal Student Aid, U.S. Department of Education.