ST LOUIS, MO - Did you know the autograph of your typical emergency department physician is worth more than an authentic autograph from George Washington and Abraham Lincoln – combined?!

Amazingly, it’s true. According to eBay, a genuine autograph of George Washington (on a routine document or letter) is worth approximately $7000; an authenticated signature of Abraham Lincoln (again, on a routine government document) is $4000. But the value of the autograph of an average emergency medicine physician on an employment contract can be worth approximately $20,000 – to the physician.

That’s because these “autographs” trigger signing bonuses which are used by hospitals and practice groups to entice a particular physician to work for them rather than someone else. Long a staple of contracts negotiated by professional athletes, signing bonuses are becoming more common in the emergency medicine jobs recruitment world as well. Jason Kendall, Operations Manager at KPS Physician Staffing in St. Louis Mo., says he’s seen some signing bonuses as high as $50,000 but that’s fairly unusual. A more typical number is $20,000, he says.

“For EM jobs, the signing bonus can be structured in different ways,” Kendall explains. “The physician may get half upon the actual signing, and the other half on their first day of work, for example. Or they could get it all upfront; it just depends. But regardless of how it’s structured, we are definitely seeing more sweeteners added to contracts for physicians who sign on the dotted line by a particular day.”

The actual amount of the signing bonus is also dependent on other aspects of the employment contract. For example, if the EM physician has a family and lives in another city, he or she will need a healthy relocation reimbursement. That could dramatically lower – or eliminate – the signing bonus, Kendall points out. Some hospitals offer medical education student loan forgiveness if the physician agrees to work for the hospital for a specified period of time – say, 3-5 years, for example. That could also affect the signing bonus.

Signing bonuses are more common in rural areas, Kendall says, because typically these hospitals have to work harder to attract physician talent than, say, a hospital in New York or San Francisco. “A lot of it has to do with location – the desirability of a certain metro area,” he says. “Obviously it doesn’t take much persuasion to make ER jobs in San Francisco sound attractive.

In 2011, 88 percent of physicians were paid to put their “John Hancock” on an employment contract– up from 73 percent in 2010. Although the housing market remains sluggish, the percentage of relocations increased in 2011, as compared to 2010. Of the physicians placed in 2011, 93% moved to a new community for their new job.

Continuing a trend, hospitals are increasingly employing physicians directly. Among the physicians placed in 2011, 83% were employment agreements with the hospital itself, as opposed to “recruiting agreements” consisting of a forgivable loan to start a physician-owned private practice. Less than 5% of physicians were placed in solo practices.

While direct employment of physicians by hospitals has ebbed and flowed in past decades, it is becoming more common once again because of healthcare reform.