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Sign-On Bonuses & The Bigger Picture

Apr 28, 2025

This Week’s Real-Life Lesson: Sign-On Bonuses

Not long ago, I found myself having coffee with a young doctor about to step into the marketplace for the very first time. He was smart, ambitious, and had built a job-stacking strategy that involved three different part-time contracts. One of these was with a remote hospital offering a tantalizing sign-on bonus. He was planning to work there one day a week.

Naturally, he asked: "How would working only part-time affect the size of my sign-on bonus?"

It was a fantastic question—one that opened a door to a much bigger conversation about what sign-on bonuses really mean, especially for independent physicians.

And today, I want to share that conversation with you.

What Are Physician Sign-On Bonuses Anyway?

At face value, a sign-on bonus is a financial incentive to get a doctor to sign a contract. It can come in a few different flavors:

Advances or Forgivable Loans: Paid upfront, but only forgiven after a set number of years.
Retention Bonuses: Paid out slowly over 1-3 years if you stay.
Lump Sums: A big check up front—often with repayment clauses if you leave early.
Stipends: Offered while still in training, locking you in early.

For full-time employed doctors, these bonuses feel like a windfall.

For independent physicians like us, they should be treated with caution.

At best, they are temporary financial boosts.

At worst, they are golden handcuffs.

The Average Physician Sign-On Bonus in 2024

According to the AMA, here's where the numbers land:

Average bonus: $30,395
Median bonus: $20,000
Range: $1,000 to $300,000 (specialty dependent)

Variations by Specialty

Sign-on bonuses varied significantly across specialties, often correlating with the demand and competitiveness of each field:

Urology: Average bonus of $45,000, with reported ranges between $10,000 and $180,000.
Cardiology: Average of $41,000, ranging from $1,000 to $150,000.
Orthopedic Surgery: Average of $41,000, with bonuses between $10,000 and $125,000.
Gastroenterology: Average of $40,000, ranging from $5,000 to $250,000.
Anesthesiology: Average of $39,000, with a broad range from $1,000 to $300,000, the highest reported across all specialties.
Emergency Medicine: Average of $36,000, with bonuses between $3,000 and $150,000.
Family Medicine: Average of $35,000, ranging from $2,000 to $250,000.
Internal Medicine: Average of $25,000, with bonuses between $5,000 and $100,000.
Pediatrics: Average of $20,000, with a range from $1,200 to $200,000.

Influencing Factors

Several elements influenced the size and structure of sign-on bonuses:

Practice Setting: Hospitals, health systems, and organizations backed by private equity were more likely to offer substantial signing bonuses compared to private practices, which often have limited financial flexibility.
Geographic Location: Historically, rural areas offered higher bonuses to attract physicians. However, in 2024, urban centers also began offering competitive bonuses, often tied to retention agreements requiring multi-year commitments.
Timing of Payment: A notable shift has occurred wherein many employers have begun disbursing a portion of the signing bonus upon contract signing, rather than waiting until the physician's start date. This change aims to secure commitments in a competitive hiring landscape.

Considerations and Caveats

While sign-on bonuses can be enticing, it's essential to approach them with a comprehensive understanding:

Tax Implications: Bonuses are typically taxed at higher rates, reducing the net amount received. Signing bonuses are generally considered ordinary income and you’ll owe federal, state, and local income taxes on them. Many employers will withhold the taxes from you in the sign on bonus check, similar to how they would with your first attending paycheck. However, especially if you are not yet formally employed, they may instead write you a check for the gross amount, leaving you responsible for paying the taxes on your own. Physician Side Gig
Repayment Clauses: Many contracts include provisions requiring repayment of the bonus if the physician leaves before a specified period.
One-Time Payment: Unlike salary increases, a signing bonus is a one-time payment. Prioritizing long-term compensation and benefits may offer more substantial financial advantages over time.

Free Contract Review Guide

You can also learn more about the physician contracts in one of my free PEA resources

👉 What You Need to Know About Physician Employment Contracts.

So, What Happens If You Work Part-Time?

Back to our young doctor’s question about working part time and sign on bonuses.

Here’s the truth I shared with my PEA member:

👉 The bonus will almost certainly be prorated.

In other words, if the hospital is offering a $20,000 sign-on bonus for a full-time (40-hour week) physician, and you're only committing to one day a week (roughly 20% FTE), your bonus would likely shrink to 20% of that full-time amount—around $4,000.

Important Tip: Always read the fine print. Some institutions don't automatically prorate—others simply deny part-timers bonuses altogether.

Independent Doctor Considerations About Sign-On Bonuses

This brings us to the bigger entrepreneurial insight:

1. W-2 Sign-On Bonuses Are Tiny Compared to Ownership Benefits

The financial incentives to sign on as a W-2 employee are real, and you might pocket $20K now… But by negotiating to receive your compensation and bonus as 1099 income through your micro-corporation, you open a lifetime of benefits:

Strategic tax planning
Diversified income streams
Business deductions that could save you tens of thousands each year

👉 learn more in our free e-book: Tax Deduction Guide for Micro-Business Owners

2. Golden Handcuffs Are Real

Sign-on bonuses usually come attached to retention clauses. Break your contract early? You may owe back that money—and then some.

3. You Can Create Your Own “Bonuses”

Self-employed physicians can:

Maximize deductions
Build retirement funds faster
Write off business expenses
Create their own sign-on bonus—through strategic planning and wealth accumulation.

Real-Life Case Study: Dr. Rapid’s Transformation

Take Dr. Rapid, a former tenured hospitalist who left her employed position feeling burnt out and boxed in. Instead of chasing another employer bonus, she:

Started a micro-corporation with PEA’s 10 Step Guide
Began stacking telehealth, legal consulting, and locums work.
Prepared to launch her cash-only obesity clinic.

Within 18 months, her net income tripled compared to her employed salary—without signing a single bonus clause.

Stories like Dr. Rapid’s aren’t rare anymore—they're happening every day inside the PEA-SimpliMD movement. If you’re feeling the pull toward something greater, start now with our free guides, built just for independent-minded clinicians:

✅ 100% free.

✅ 100% focused on helping you take back control.

👉 Explore the Free PEA Resource Vault

Is This Deductible?

🧾 That “strategic beach retreat” you planned for reviewing your new contract and how it intersects with your micro-business development?

👉 Yes. With proper documentation, it could be deductible!

Learn How With the PEA Builder Membership →

Join the Movement 🚀

Thousands of clinicians are breaking free through micro-business ownership. Ready to join them?

👉 Become a PEA Explorer Member Today

✨ Bonus: When you join, you’ll get free access to my resource vault, including e-books like:

These aren't just e-books. They're the blueprints for your new entrepreneurial life.

Closing Thoughts:

Don't Trade Your Freedom for a One-Time Check

Sign-on bonuses are a shiny object—but don’t lose sight of the bigger picture. Your ability to build, own, and control your career will always outweigh a temporary financial perk.

When you build your own independent brand through micro-business ownership, the rewards—financial, emotional, and professional—keep coming for life.

If you're ready to stop playing the hospital's game and start building your own, your first step is simple:

👉 Schedule your Micro-Business Consult for just $199 and get your PEA-SimpliMD Explorer membership thrown in.

This is the future of medicine—and it's yours for the taking.