A physician signing bonus in 2026 usually lands between $20,000 and $50,000, but the physician signing bonus by specialty spread is far wider than that suggests. AMN Healthcare's most recent recruiting review puts the average at $38,215 across all specialties [1]. Physician-reported data puts the median closer to $20,000 [6]. Both are accurate. They measure different populations, and knowing which one sits behind your recruiter's number changes what you should ask for.
If you are finishing residency, you have already been contacted more times than you can count. The offer letters arrive with a bolded figure near the bottom, and that is the figure you remember on the drive home. It is also the term carrying the most fine print.
What the national numbers actually say
AMN Healthcare's Physician Solutions division, formerly Merritt Hawkins, has published a recruiting incentive review every year for more than three decades. It is the closest thing the market has to a running record of what employers put on the table. The 2025 edition draws on 1,420 permanent search engagements conducted between April 1, 2024 and March 31, 2025 [1][2]. It reports an average physician signing bonus of $38,215, against $12,869 for nurse practitioners and physician assistants [1]. The reported low was $5,000. The high was $250,000 [2].
That average was $31,473 in the prior review [4]. Two years before that it was $37,473, and in 2020 it was $29,656 [4]. The trend line is not smooth, and anyone telling you signing bonuses climb every year has not looked at the series.
One caution on that headline figure. AMN's own summary lists $38,215 [1]. Becker's reported $38,125 [2]. The AMA reported $38,315 [3]. Three outlets, three numbers, one underlying report. We use AMN's figure because it comes from the publisher. If you see a slightly different number elsewhere, that is why.
The more useful shift is not the average at all. In the 2024 review, 51 percent of AMN's search engagements included a signing bonus, down from 63 percent the year before [4]. In the 2025 review, close to three quarters did [2]. Employers did not just raise the number. They started offering it to nearly everyone. A bonus almost every competing offer includes has stopped being a differentiator and become table stakes.
Physician signing bonus by specialty: the 2026 benchmark table
The table below draws on two vantage points on purpose. The first two columns come from a physician-reported compensation database of more than 6,000 data points collected between mid-2023 and mid-2024 [6]. The third comes from AMN's recruiter-side data for its five most requested searches in the same era [4][5]. Different populations, different windows, and that gap is the useful part.
Physician-reported figures reflect only the 41 percent of respondents who received a signing bonus; $0 contributions were removed before averaging [6]. AMN figures reflect employer offers during active searches, not what was signed [4]. Ordered by physician-reported average.
The two sides diverge inside the same specialty, and not always in the same direction. Internal medicine runs $32,205 on the recruiter side against a $25,000 physician-reported average, while family medicine runs $30,013 against $35,000 [4][6]. Recruiter data captures what was advertised at the top of a search. Physician-reported data captures what people signed, including everyone who took less to end up in the right city, or close to a parent who needs them.
Signing bonuses track base pay, so this ranking will look familiar if you have spent time with compensation benchmarks by specialty and state.
Hospitalist signing bonus figures
Hospital medicine deserves its own paragraph because it is now the single most searched physician specialty in the country. AAPPR's benchmarking report put hospital medicine at 10.8 percent of all physician searches, just ahead of family medicine at 10.6 percent [8]. Physician-reported data puts the hospitalist average at $25,000 with a median of $20,000, across a range of $2,500 to $200,000 [6]. The split inside that group is worth knowing: internal medicine hospitalists averaged $26,000, family medicine hospitalists $21,000, and pediatric hospitalists $18,000 [6].
【MARKET BOARD DATA: Internal Medicine / Hospitalist Baseline $25,000 (as of Sept 2026) 】
Why the average is the wrong number to anchor on
In the physician-reported dataset, the all-specialty mean is $30,395 and the median is $20,000 [6]. That is not measurement noise. Reported bonuses ran from $1,000 to $300,000, and a small cluster of very large retention packages pulls the mean more than 50 percent above the median [6].
There is a second problem, and it quietly distorts every published average. These figures are calculated among physicians who received something. In that same dataset, 12 percent said outright they got no signing bonus, and another 47 percent left the field blank [6]. So the honest reading of any published average is: among physicians who received one, the average was X. Comparing your offer to that number means comparing yourself to a filtered group.
For a single offer, the median is the better anchor. Ask for the median in your specialty and state over the last twelve months. A recruiter will either answer or decline, and both tell you something about the search you are walking into.
What actually moves your number
Specialty explains less of the variation than most physicians assume. Four things explain more.
Practice setting. Hospitals and health systems carry a dedicated recruitment budget line and pay the largest bonuses. Academic departments mostly do not compete on this term. Private groups often pair a smaller bonus with a shorter partnership track, which is worth more across five years and looks worse on day one.
How long the seat has been empty. AAPPR reported a median time to fill of 118 days for physician searches, with nearly half still open at year end [8]. A position posted eleven months ago carries a different internal budget conversation than one posted in March.
Geography. The same specialty in two markets 300 miles apart can differ by tens of thousands of dollars, driven by call burden, payer mix, and how many candidates the employer has already lost to someone else.
Whether a hospital is recruiting a physician not yet on its medical staff. Those arrangements sit inside a specific Stark Law recruitment exception [13], which is why hospital offers so often arrive bundled with relocation requirements, community service commitments, and repayment language. That is the employer's compliance obligation rather than yours, but it explains why a few of those terms genuinely will not move.
Demand is not evenly distributed either. Our read on the 2026 physician job market covers where the openings concentrate by specialty and region.
Public benchmarks tell you what was offered two years ago. To see what is on the table right now, compare signing bonuses on the market board by specialty and state.
Read the payback terms before you read the number
Most signing bonuses are not gifts. They are advances. MGMA's 2025 compensation report, built on 2024 data from more than 220,000 providers, found that practices increasingly offer signing and starting bonuses and that most now attach full or prorated payback clauses [7]. Many are papered as forgivable loans with a promissory note, forgiven over a set term, commonly one twenty-fourth per month across two years [12].
There is a reason employers reach for this lever. MGMA's 2026 report found work RVUs falling in 16 of 23 specialties and total encounters falling in all 23, while compensation kept rising [11]. When margins tighten, a one-time bonus is easier to approve than a permanent increase to base, because it does not compound.
Run the arithmetic before you sign. A $40,000 bonus forgiven monthly across 24 months leaves you owing $10,000 if you resign at month 18. The same $40,000 with a single cliff at 24 months leaves you owing the entire $40,000 if you resign at month 23. Identical headline figure. Very different exposure, and the difference shows up at the worst possible moment, when you have already given notice and the next paycheck has not started.
Six questions to put to the employer in writing:
What triggers repayment? Resignation only, termination for cause, or any separation?
Is forgiveness prorated, and at what interval: monthly, quarterly, or annually?
Does interest accrue, and from what date?
Is there a carve out if the employer terminates you without cause, or closes the site?
Can the employer offset repayment against your final paycheck or an earned production bonus?
How many days after separation is repayment due?
The interval in question two is the cheapest term to negotiate and the most commonly overlooked. Moving from annual to monthly proration on a three year term is worth as much as eleven months of forgiveness and costs the employer close to nothing.
This article is educational and is not legal advice. Contract terms vary by state and employer. Have any agreement reviewed by a licensed attorney before signing.
How signing bonuses are taxed, and the part people get backwards
There are two tax issues here. The second one is worse than the first, and almost nobody warns you about it.
The first is withholding. The IRS treats a signing bonus as supplemental wages. For 2026, employers may withhold federal income tax at a flat 22 percent, rising to 37 percent on cumulative supplemental wages above $1 million [9]. Social Security and Medicare come out on top of that, so a $40,000 bonus can hit your account as roughly $28,000. Most physicians read that as a 30 percent tax. It is not a tax rate. It is a withholding rate, and the liability is settled on your return. The part that gets reported backwards: for an attending in the 32 or 35 percent bracket, the flat 22 percent under-withholds. The shortfall does not disappear. It shows up in April.
The second issue is repayment. If you repay a bonus in a later tax year, you repay the gross amount, not the net that reached your account. IRS Publication 525 lets a repayment over $3,000 be taken as an itemized deduction in the year of repayment or as a credit under the claim of right rules, whichever produces less tax. A repayment of $3,000 or less of wage income gets no deduction at all under current law. Social Security and Medicare on the original payment are recovered separately, usually through a corrected W-2 [10].
If the bonus is a forgivable loan, the timing flips in your favor. You generally recognize income as the loan is forgiven rather than when the cash arrives [12], which spreads the liability across the term. Ask which structure you are being offered, in writing, and hold back part of the money until you know.
This article is educational and is not tax or financial advice. Consult a CPA or licensed financial advisor about your specific situation.
Putting these numbers to work
Anchor on the median in your specialty and market rather than the national average, and be ready to say where your number came from. Then negotiate structure before size. Employers defend the headline figure because it gets compared internally and documented for fair market value purposes. They are usually more flexible on forgiveness interval, term length, payment timing, and termination carve outs, and that is where the money you keep actually sits. For the exact language, our scripts for negotiating physician salary, PTO, and signing bonus cover the conversation line by line.
One more thing, and it is the part that gets lost when the number is large. A signing bonus is a one-time payment against a decision that will shape the next several years of your clinical life, your call schedule, and your evenings. Six months into a job that does not fit, nobody remembers the wire transfer.
Key takeaways
AMN's most recent review puts the average physician signing bonus at $38,215; physician-reported data puts the median near $20,000. For a single offer, use the median.
The share of searches including a signing bonus jumped from 51 percent to roughly three quarters in one year. It is now standard, which means it no longer separates a good offer from an average one.
Setting, time to fill, and geography explain more of the variation than specialty does.
Most bonuses are advances with repayment terms attached. The forgiveness interval, monthly versus annual, is the cheapest term to negotiate and the one most often missed.
The 22 percent flat withholding on supplemental wages is not your tax rate. For most attendings it under-withholds, and the balance is due in April.
Compare signing bonuses on the market board alongside base salary and $/wRVU benchmarks in your specialty and state before you counter.
REFERENCES
[1] AMN Healthcare. 2025 Review of Physician and Advanced Practitioner Recruiting Incentives (report summary and key findings). AMN Healthcare. Published August 12, 2025. https://www.amnhealthcare.com/amn-insights/physician/whitepapers/2025-review-of-physician-and-advanced-practitioner-recruiting-incentives/ Accessed August 27, 2026.
[2] Cortigiano C. How much are physician signing bonuses? Becker's ASC Review. Published July 20, 2026. https://www.beckersasc.com/asc-news/how-much-are-physician-signing-bonuses/ Accessed August 27, 2026.
[3] Smith TM. Physician employers offer big signing bonuses, but there's a catch. American Medical Association. Published August 2025. https://www.ama-assn.org/medical-residents/transition-resident-attending/physician-employers-offer-big-signing-bonuses-there Accessed August 27, 2026.
[4] AMN Healthcare. 2024 Review of Physician and Advanced Practitioner Recruiting Incentives (full report, PDF). AMN Healthcare Center for Workforce Research. Published August 2024. https://www.amnhealthcare.com/siteassets/amn-insights/physician/incentive-review-2024-final.pdf Accessed August 27, 2026.
[5] Smith TM. Should you expect a signing bonus in your first job after residency? American Medical Association. Published December 10, 2024. https://www.ama-assn.org/medical-residents/transition-resident-attending/should-you-expect-signing-bonus-your-first-job Accessed August 27, 2026.
[6] Mehta N. Average Physician Sign On Bonus Amounts by Specialty. Physician Side Gigs. Published November 16, 2024; updated March 20, 2025. https://www.physiciansidegigs.com/average-physician-sign-on-bonus Accessed August 27, 2026.
[7] Medical Group Management Association. 2025 MGMA Provider Compensation and Productivity Data Report (2024 data, more than 220,000 providers). Published June 10, 2025. https://www.mgma.com/2025-provider-compensation Accessed August 27, 2026.
[8] Association for Advancing Physician and Provider Recruitment. Physician Recruitment Teams Face Consistent Demand and Lengthy Search Times, According to AAPPR Report. Published September 10, 2025. https://aappr.org/2025/09/10/physician-recruitment-teams-face-consistent-demand-and-lengthy-search-times-according-to-aappr-report/ Accessed August 27, 2026.
[9] Internal Revenue Service. Publication 15 (2026), (Circular E), Employer's Tax Guide, Section 7: Supplemental Wages. IRS. Revised for 2026. https://www.irs.gov/publications/p15 Accessed August 27, 2026.
[10] Internal Revenue Service. Publication 525, Taxable and Nontaxable Income: Repayments. IRS. https://www.irs.gov/publications/p525 Accessed August 27, 2026.
[11] Medical Group Management Association. 2026 MGMA Provider Compensation and Productivity Data Report (2025 data). Published July 2026. https://www.mgma.com/2026-provider-compensation Accessed August 27, 2026.
[12] Physician Agreements Health Law. Physician Sign-On Bonus and Relocation Allowance. Published January 15, 2026. https://pahealthlaw.com/physician-sign-on-bonus-relocation-allowance/ Accessed August 27, 2026.
[13] Exceptions to the referral prohibition related to compensation arrangements: physician recruitment. 42 CFR 411.357(e). Electronic Code of Federal Regulations. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-411/subpart-J/section-411.357 Accessed August 27, 2026.
FAQs
AMN Healthcare's most recent review, covering April 2024 through March 2025, reports an average of $38,215 across all specialties, with a low of $5,000 and a high of $250,000 [1][2]. Physician-reported data from a comparable period puts the median near $20,000 [6]. The average is inflated by a handful of very large retention packages, so the median is the better reference point for a single offer.