The text message came through just as I was finishing a case: "Dr. Anderson, do you have a minute to chat?"
It was Sam, one of our top candidates, a graduating resident with multiple job offers. I had a pretty good idea of what this was about. As the lead recruiter for our group, I’d been having these conversations a lot lately.
When I called him back, Sam got straight to the point. He wanted to negotiate.
I’ve negotiated with plenty of new grads. Most follow the same script: ask a few polite questions, maybe request an extra week of vacation, then sign on the dotted line — relieved to have their first six-figure attending job.
But Sam was different. He had done his homework. He knew his worth. And he wasn’t afraid to push.
He started with the big ask — a higher base salary. When I explained that increasing his base would require adjustments across the entire group, he pivoted to his signing bonus. Then relocation assistance. Then CME stipends. He even asked about call differentials.
By the time we were done, I had to admit — I was impressed. He had fought for every dollar. And while he didn’t win on everything, he walked away with a far better deal than most of his peers.
And I couldn’t help but think: Why don’t more of us do this?
Medicine has always had an uncomfortable relationship with money. We spend years training in a system that discourages us from thinking about compensation. There’s an unspoken rule that talking about salary is somehow beneath us — that we’re here for the patients and the purpose, not paychecks. Even when we do want to discuss salary, barriers exist. Some contracts contain unenforceable clauses prohibiting salary discussions. Some physicians worry about retaliation from administrators if they’re on the high end of the pay scale. Others — especially those who negotiated well — are hesitant to share their numbers, fearing resentment from colleagues.
But the biggest problem? Most doctors assume their salary is fair and unmovable. They trust that their employer’s offer aligns with industry standards. They hear that their pay is at the "50th percentile of MGMA" and take it at face value — without realizing how many ways that number can be manipulated. If you’re working harder than average, taking more call, or seeing more patients, why settle for median pay?
We want to believe the health care system is fair. That if we work hard, we’ll be fairly compensated. Yet compensation in medicine is full of inequities. Primary care physicians are grossly underpaid compared to procedural-based specialties. Pediatric subspecialists often earn less than general pediatricians despite years of extra training. The gender pay gap remains a staggering 24%, costing female physicians $2 million over their careers. There are endless examples.
Why hasn’t any of this changed? Because physician salary data is intentionally opaque. This lack of transparency benefits the system, not us.
Nearly 80% of physicians are now employees, further removed from the business side of medicine and the decision making than ever before. Meanwhile, the gold standard for compensation data — MGMA — is locked behind an expensive paywall. Even for those fortunate enough to access a benchmarking report, its limitations are obvious: it’s summary-level, employer-reported, and often outdated — yet it sets contract terms for years into the future.
So how are we supposed to negotiate when we’re flying this blind?
We first need to recognize that we're not powerless. I know it doesn't need to be this way because my twin brother, Tim, happened to be part of the early team at Glassdoor, a company that transformed salary transparency across entire industries. Since then, there have been many other platforms like Glassdoor that crowdsource salary data, giving employees leverage and exposing pay inequities. Medicine, somehow, missed the memo.
There’s power in this collective knowledge. When employees in other fields started sharing their salaries, they gained negotiating confidence and drove positive change in their industry. It’s time for medicine to do the same. Yes, some will likely advocate for unionization or legislative efforts — but the simplest and most immediate solution starts with us: normalizing these conversations, openly and responsibly sharing our numbers, and lifting each other up.
I believe that each of us holds the underlying information needed for a free, “people-powered” alternative to MGMA. Many of us are already sharing these details among trusted friends and colleagues, but much of this information sits in silos. With an anonymous salary sharing solution and a “give-to-get” model inspired by Glassdoor (i.e., share your salary to unlock all those shared by your peers), I’m confident more will become comfortable sharing their information more broadly. We might just unlock this collective knowledge for everyone in medicine.
And with the benefit of free, anonymous, and trusted salary details crowdsourced directly from our peers — I hope we will all have the confidence to do exactly what Sam did.
He didn’t expect to be handed what he deserved — he asked for it.
At the end of the day, hospitals and corporations will always look out for their bottom line. It’s on us to look out for ours.
What is your experience with negotiating pay or benefits throughout your career? Share in the comments!
Dr. Rob Anderson is a practicing anesthesiologist in Richmond, VA and the Co-founder of Marit Health, bringing salary transparency to medicine.
Illustration by April Brust
