As a resident or fellow pursuing a post-training career opportunity, compensation packages are going to be a key factor—perhaps, even, the key factor—in determining where one begins working as a practicing physician. A signing or commencement bonus is likely to be part of that package.
During the 12-month period from April 1, 2023, to March 31, 2024, the average signing bonus for physicians was $31,473. That data comes from AMN Healthcare’s 2024 Review of Physician and Advanced Practitioner Recruiting Incentives, which is based on a sample of the more than 2,100 permanent physician and nonphysician provider search engagements that the company’s AMN Healthcare’s Physician Solutions division conducted.
Leah Grant, president of the AMN Healthcare Physician Solutions division, said much has changed in just the last few years.
“This is the year of new,” Grant said. “I don't know if it's because we're coming out of COVID or we're just in a different health care landscape, but we're seeing big increases in starting salaries. We’re also seeing signing bonus amounts and terms changing.”
One big change: When you get paid
Just five years ago, physicians typically did not see any of their signing bonus until they started work. Physicians now can expect many employers to give them at least some of it immediately.
“The biggest difference is they're no longer waiting on you to start,” Grant said. “Some now pay out the moment you sign the contract. About half of the signing bonuses we see today are extended then.”
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Another: City jobs have caught up
For many years, the cost of living was a factor in signing bonuses, but not in the way one may think. Typically, areas with lower cost of living were less desirable to physicians in the job market, so those opportunities needed to offer more competitive incentives.
“That’s no longer the case,” Grant said. “Your major metropolitan areas are now offering extremely competitive signing bonuses. What they've started to do is tie it to retention. They may give you $150,000–$75,000 when you sign the contract and the remainder on the day you start, but what they will say you have to commit to X number of years. They don’t want to see you leave after just one year. So while your rural employer often won’t tie the signing bonus to an aggressive retention plan, your major metro employer often will.”
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Big variations by specialty
The average signing bonus, $31,473, was down considerably from the year before, $37,473, although it was largely unchanged from 2021–2022, when it was $31,000.
There was a wide variety in signing bonuses by specialty. In 2023–2024, AMN Healthcare Physician Solutions’ four most requested specialties offered the following average signing bonuses:
- Family medicine: $30,013.
- Ob-gyn: $38,281.
- Internal medicine: $32,205.
- Gastroenterology: $46,040.
In addition, the highest average signing bonus has been highly volatile. The five previous reviews found it had jumped around in prior years, ranging from $100,000 to $570,000 in 2022–2023. In the most recent review, it was down again, to $325,000.
The lowest signing bonus has been similarly in flux. This year’s lowest was $3,000, up from $500 last year, which was down from $5,000 the year before.
Expect differences by practice type
It’s important to understand that signing bonuses are also influenced by the practice setting.
“For a private practice, a signing bonus is often coming from the revenue that physician or practice is going to generate. So we do typically see that hospitals, health systems, urgent care centers and retail clinics—especially those backed by private equity groups—are in a position to offer a larger signing bonus, simply because they can afford it,” Grant said.
With the physician employment market experiencing so much change, Grant advised residents and fellows to start thinking about signing bonuses and other compensation-related issues before they are in their final year.
“Do your due diligence—that’s critical. You went to medical school and residency to be educated on how to diagnose and treat patients. So why take a job and not be educated on the market?” she said. “And finally, don't be afraid to negotiate. With education comes the ability to speak fluently about what's out there.”
The AMA Transitioning to Practice series has guidance and resources on deciding where to practice, negotiating an employment contract, managing work-life balance, and other essential tips about starting in practice.
