What is inside your first year number, and which pieces vanish in year two?

Your first year number has five pieces: base guarantee, sign on bonus, stipend, call pay, and a productivity kicker. Only the base usually survives into year two. Price all five separately, because the stipend and call pay are different lines with different rules, and the bonus is money with strings attached.

Anesthesiology New Attending hub

The five pieces

Base guarantee. This is the headline salary, the number on the offer letter. Illustrative range for a new attending anesthesiologist: $425,000 to $550,000, higher in hard to staff markets. It is usually guaranteed for one to two years, then your pay resets to a formula. This is the only piece that repeats, so it carries the most weight.

Sign on bonus. Illustrative range in anesthesia: $25,000 to $100,000, sometimes $150,000 or more for brutal call or rural sites. Paid at or near your start date. It is not a gift. It comes as a promissory note that forgives over 24 to 36 months, and if you leave early you repay the unforgiven balance. This piece vanishes completely in year two.

Residency stipend. Paid during the last months of training, after you sign but before you start. Illustrative: $2,000 to $3,000 per month for 4 to 6 months. It fills the gap between signing and your first paycheck. It is frequently folded into the same promissory note as the sign on bonus, which means the same clawback clock applies. Also vanishes after year one.

Call pay. Compensation for call beyond what the base schedule assumes. Two common structures: baked into the base, or paid per call day. Illustrative per call rates: $1,000 to $1,500 per extra call day, or a flat annual call stipend of $15,000 to $25,000. When call is baked into the base, you get paid the same whether call is light or heavy. Per call pay rewards the actual work. This piece resets whenever the schedule changes.

Productivity kicker. A bonus paid above a production threshold, usually measured in anesthesia units or collections. Illustrative: a threshold of 12,000 units per year with $50 to $65 per unit above threshold. New attendings often miss the threshold in year one because ramp up is slow and rooms are not full on day one. Price this piece at zero until you see the threshold and the per unit rate in writing.

A sample first year package

All numbers below are illustrative, not a quote. This is what the five pieces look like stacked together:

The kicker row is $0 here because this page prices the kicker at zero until you see the threshold and the per unit rate in writing.

That $554,400 headline is a $475,000 job with $79,400 of one time and conditional money on top. In year two, the bonus and the stipend are gone. That is $65,000 of the headline that will never repeat.

The question that decides the offer

Ask this before you sign: what does my pay look like in year two if the bonus, the stipend, and the kicker all pay zero? If the base plus the written post guarantee formula still works for your life, the offer works. If the offer only wins because of one time money, it does not win. It just pays you to ignore the math.

Then get the post guarantee formula in writing. The formula after the guarantee is often unit based or collections based, and you need the conversion factor now: dollars per unit, collections percentage, and the threshold. A $475,000 guarantee that resets to a formula paying $420,000 at your realistic production is a pay cut scheduled for month 13.