12 compensation types beyond salary to negotiate in your contract

By Altelisha "Lisha" Taylor, MD, MPH
Published October 27, 2023

Key Takeaways

  • New hires may be able to get certain bonuses, such as a sign-on bonus or a relocation bonus, when they sign the employment contract.

  • Existing employees may be eligible for other types of payment, such as retention bonuses and productivity bonuses. 

  • Every physician should ask about other forms of compensation when negotiating an employment contract, including opportunities for a retirement match, paid time off, and additional payment for extra duties.

While salary is a meaningful component of take-home pay, there are other forms of compensation physicians should ask about before starting a new job or renegotiating an employment contract.

Here are 12 alternative types of compensation to consider.

Sign-on bonus

This is a one-time bonus given when you are first hired. Organizations offer sign-on bonuses for two main reasons: 

  1. To reward you for signing with them over another organization who is interested in hiring you

  2. To incentivize you to stay at the organization long-term

The amount of the bonus can vary from $0 to $100,000 and beyond, depending on your speciality, location, expertise, and structure of the practice.

If you are eligible for a sign-on bonus, be sure to see how it’s structured—many jobs require you to repay a portion of the bonus if you leave the job within the first 2 to 4 years. 

Relocation bonus 

This is extra money you may be given when you are hired at an organization in a different location. It’s meant to cover moving costs. Some organizations give everyone the same amount, others offer a percentage of your base salary. 

Keep in mind this bonus is usually given retroactively. You may have to pay the moving costs up front, then submit receipts for reimbursement afterwards. 

Student loan assistance

Some organizations will help cover part of your student loan repayment costs. It is offered as another recruiting tool to incentivize you to sign with the organization over others. 

Typically, the money is offered for a certain number of years based on the length of your contract. Many doctors don’t get this bonus at all, and others can get up to $50,000 per year. Be sure to ask about it at your job. 

Retention bonus 

You may be offered this additional money as an incentive to continue working at the organization each year. It can cost up to $250,000 to recruit and train a new physician, so some organizations will offer you a retention bonus to encourage you to stay. 

While retention bonuses may not be given to everyone, I’ve seen them offered as a way to temporarily increase compensation for new physicians during the first few years when they are paid a set salary and have not yet become productive. I’ve also heard of them being offered as a reward to experienced physicians who have been at the organization a long time and may be getting higher offers to work elsewhere. 

Related: From residency to retirement: How compensation changes over a physician’s career

Productivity bonus 

This compensation can come after reaching a certain productivity threshold, usually calculated in work relative value units (wRVUs).

While some jobs may only pay based on productivity, or only provide a set salary, some jobs may give you both. For example, they may give you a base salary and then provide you with productivity bonuses once you reach certain milestones or thresholds. 

Mid-level collaboration stipend 

As a physician, you may be asked to work with a physician assistant or nurse practitioner. Some jobs will ask you to be available for questions and “collaborate” with these providers. Other jobs will require you to review a portion of their charts and allow them to use your license for billing. 

If you are supervising or asked to be available to mid-level providers, be sure you are compensated for the added work. 

"Working with these providers will increase your liability and require more of your time, and you should be compensated for it."

Lisha Taylor, MD, MPH

Some jobs will pay you a flat rate for the year, a stipend each month, or give you a percentage of the billing. 

Cost of living adjustment 

This is an increase to your existing compensation to account for inflation. As everything tends to get more expensive over time, jobs may offer an increase to your compensation so you can maintain the same standard of living in the midst of increasing costs. 

In other words, if rent, gas, food, and travel is 3% more expensive from year to year, then a job may offer a 3% increase to your pay each year to account for that.

While it is common for staff workers and folks in administration to get a cost of living adjustment each year, it is not as common for attending physicians, but might be something you can negotiate in your contract.

On-call bonus 

Some jobs may require you to be on-call as a part of your yearly salary. Other jobs may offer you additional pay for being on-call, especially if it requires you to go to the hospital and evaluate potential emergencies in person. 

If you are in a surgical field, you may be paid a portion of the wRVUs the hospital generates from the procedures you do. Other physicians may be paid a flat rate or stipend for the times they are on call.

Related: Physician compensation 2023: The good, the bad, and the ugly

Teaching stipend 

If you work at an academic institution, you may be asked to work with learners. They may want you to teach medical students, give lectures to residents, or allow fellows to rotate with you in the clinic. While some doctors say yes, others decline or ask for added compensation. 

Added teaching responsibilities may make you less productive. One way to make up for this decrease in efficiency is to get a stipend from the medical school (from a portion of the students’ tuition payment).

I’ve found that doctors hired within academic institutions typically don’t get extra pay for this, but doctors in larger health systems or private practice groups usually are offered some sort of payment, either from the medical school or directly from the state.  

Paid time off 

One overlooked form of added compensation is paid time off (PTO). While some jobs separate vacation days, sick days, and holidays, other jobs lump it all together into one PTO category. Some doctors get 3 to 4 weeks of paid vacation in addition to sick time. Others only get a limited number of days off before they have to take unpaid leave. 

Make sure to ask questions about your organization’s PTO policy, especially regarding parental leave for the birth or adoption of a child.

"Oftentimes, if an organization cannot increase your salary or compensation, they may be willing to give you more PTO instead."

Lisha Taylor, MD, MPH

CME allowance 

This is a yearly allowance given to cover the costs of continual medical education (CME). It is used to cover the expenses of medical conferences, memberships, courses, and books that enhance your medical knowledge and allow you meet your specialty’s CME requirement to remain board certified. This amount can vary. I’ve seen as low as $500 and as high as $7,000 yearly.

Retirement match 

This is money given to incentivize you to contribute to your workplace retirement account. Usually jobs will offer to match your contributions up to a certain percentage of your salary. For example, if the match is 5% and your salary is $300,000 per year, and if you contribute 5% ($15,000) a year into the account, your job will provide an additional 5% ($15,000) to the account, so you have $30,000 invested in the account each year. 

Contributing to work retirement accounts can be one of the biggest sources of added compensation.

What this means for you

There are other types of compensation you should ask about in addition to salary. Some types of compensation are only offered to new hires, such as a sign-on bonus, and some may be offered once you’ve been at the organization for a certain length of time, such as productivity incentives. Regardless of when you were hired, every physician should ask about a retirement match, paid time off, a CME allowance, and extra money for additional duties, such as supervising mid-levels or teaching learners. 

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