As the new year for interns begins, senior residents and fellows are coming to the end of their training and starting their job search. This can be an overwhelming time of uncertainty, to consider where to work, type of work, and compensation at work. While the first two things are often discussed with family, friends, and mentors, the last one is still, unfortunately, a bit taboo. Here are five tips to unapologetically get the conversation started and to bravely enter into contract negotiations for the first job. Click here to get a worksheet to keep track of each step.
1. Know your worth
Know your strengths, accomplishments, and interests. Honing in on your skills and your value will help you take notice of gaps in the hospital or company you are interested in and allow you to confidently offer to fill those gaps with you. Making your strengths and interests known to mentors and recruiters and practicing physician friends could help get you a lead because they will think of you when they hear of an opportunity that might be a good fit. First, convince yourself of your worth, then talk to those in your support network about your worth, and it will be a breeze to convince potential employers.
Know your worth by talking to other doctors in your specialty about their worth, their salary and bonus formulas. Will you have the same duties or more responsibilities than a colleague, but are offered less money? The reality is that on average and across all specialties, women and minorities are paid less. Studies show that the gender gap even starts fresh out of residency and in early career physicians. If we make it the norm to ask and share salary numbers and contract offers, then maybe we can whittle away at these gaps. There is so much at stake even from the beginning, because how much you make with your first job can determine your salary with every new promotion and job transition. Start high; end high. You are worth the ask.
2. Know the salary data
Doximity has published physician salary information using data from 65,000 US doctors representing 40 specialties. MedScape has been publishing data, using their database of 20,000 US doctors representing 29 specialties. Both are free and rely on self-reported information on salary, hours, location, and other details such as job challenges, benefits, gender, ethnicity, and geographic location. The veterans affairs (VA) and the federal government (search “medical officer”) also provide their own free salary databases. The Medical Group Management Association (MGMA) has also been keeping track of salaries and RVUs (a measure of productivity) for physicians through surveys filled out by practice administrators. The MGMA data is very complete but also very costly, so ask around and your residency’s hospital or someone who knows someone may be willing to share it.
Use these numbers to map out your target $/RVU and salary range — which may vary by location if your job search spans more than one region. Also, ask for information about the bonus incentive formula, often RVU or patient visit based, and the pay ladder for promotions, which will reveal opportunities for income increases. Footnote where you found the data in case you need to reference it. Basing the negotiations on objective information from powerful databases will empower you to advocate for yourself. Don’t feel intimidated when trying to negotiate a higher salary with human resources or the practice owner. Let the numbers speak.
3. Know your BATNA
BATNA stands for best alternative to a negotiated agreement. This is a negotiation technique to get the best deal possible if your desired changes to a contract are not accepted. What can you ask for that is of minimal or no cost to the practice? Consider non-salary benefits that might be important to you: administrative time, research time and funding, vacation time, continuing education money, sign-on bonus, clinical titles, restrictive covenant (the number of years a doctor is restricted from working within a set mileage from the practice). For example, asking for a title won’t cost the department anything, but that might lend the junior physician additional recognition and administrative time.
What are you willing to walk away from? One friend “Janet” revealed that she always had a back-up plan every time she re-negotiated her contracts, and used the other programs’ benefits to leverage the negotiations. Her BATNA was to go to the other program if she didn’t get what she wanted. For my first job offer, my BATNA, ultimately after lengthy negotiations, was to not work. Knowing what you want, what you’re good at, and what the hospital needs will help you think more clearly and communicate more effectively, and be comfortable with saying no thanks if the fit is not right.
4. Know their BATNA
In the scenario mentioned above, Janet re-negotiated contracts at the same hospital a few times, so she had insider knowledge of the hospital’s BATNA. She knew that she was the second most senior member on the team and quite valuable due to her research skills and interests. She knew that asking for more time to do research was not a hardship for the department because they had enough physicians to handle the patient load. Without already working at the hospital, how can one know these things? By being kind, caring, and curious.
When networking, you may know a physician, nurse, technician, or secretary who worked or works at the practice. Ask them about the daily work routine, about new projects and goals that the department is taking on or would like to take on. During the interview period , connect with other physicians and staff. What are their hobbies, where are they from? Having something in common with you may be enough to inspire them to share additional information that might help you with a clue about the other side’s BATNA — their needs, the weight of the other candidates, or the upcoming retirement of a physician that leads a project you are interested in.
5. Know that paid help is available
A local physician contract lawyer is probably already familiar with the local hospital’s procedures and knows their BATNA. Consider two scenarios where hiring a lawyer is easily a financially savvy investment. If $1000 is spent on a lawyer now and that results in $1000 more in the contract, that’s $1000 more per year for the next 2–5 years, a net of $1000 to $4000. Also, remember that the starting salary now is a stepping stone to how much one makes with each subsequent job. $1000 spent now might mean meeting a financial goal sooner.
Hiring an expert can help clarify goals, gain additional non-monetary benefits, and save time by negotiating more efficiently. A lawyer can also help translate legal language into English. After all, does that tail coverage clause really protect you in case of a lawsuit years after you have left a practice? Not only can these lessons be helpful now, but they will be paid forward down the road by providing insight and wisdom for the next job and to many future mentees asking for advice. A few years ago, I paid a lawyer $1000 to help me negotiate my first job offer, which I ultimately declined, and here I am sharing part of my story and lessons I have learned along the way.
Dr. Joannie Yeh is a pediatrician and a 2018–2019 Doximity Author.