With today’s wild and woolly job market, emergency physician candidates are experiencing an unprecedented variety of items tossed at them, from huge sign-on bonuses to free dry cleaning. It’s especially difficult to sort through all of it and make sense of what has value. What is a sign-on bonus really worth in the long run – or loan payback, hourly salary, bonuses, pensions, retirement, and of course the now popular RVU incentive? These days, I find younger physicians, particularly those just coming out of residency, are more susceptible to fabulous front money and less impressed with the long-term gains. That can be a big mistake. Let’s look at each category.

Sign-on bonus

Ah, the wonderful world of short-term bribery … to be honest, that’s what sign-on bonuses are, a bribe to get you to take one job over another. I have nothing against financial gain, being a devoted capitalist from way back, but I like a big bang for my buck.

A $30K sign-on paid when you sign a contract sounds really juicy, doesn’t it? But what if I told you that the average physician blows these dollars long before starting the job and, all too often, figure out in a few months that oops, the chunk of change was nice but the job really sucks! The scenario draws from the same pool of psychology as lottery winnings … found money blown on unimportant frivolities leading to bankruptcy. You know the story.

What I’m starting to see now is a sign-on bonus structure that is spread out over time, rewarding longevity. It’s more of a “Thank you” than a “Please,” and far more valuable in the long run. If you perform well, your value goes up, as does your retention bonus.

Loan payback

With the average grad coming out of residency with an educational debt in $300-$350,000 range, that’s a heck of a big millstone hanging around the neck. Asking employers to help with that used to be a Federal or State Underserved Area perk. But these days, emergency medicine residents are adding it to their must-have lists. Certainly having an employer tell you it will take a third of that debt off your hands is a high-value compensation item, but it all depends on how it is structured.

No one except a desperate lunatic is going to offer $100K in loan payback for signing a 1-year contract. This is strictly a time equals money deal. Expect an average of $20K-$25K a year scenario where you must work 4 or 5 years to realize the full value. And here’s the rub. You’d best be real sure you are going to be happy in the job, because 5years is a long time to be miserable at work! Try to get a pro-rated application of the loan payback, so that if you do decide to leave before the full-time commitment is up, you don’t lose what you have earned to that point.