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Negotiating a Job Offer (introduction).

I recently gave a talk to psychiatry residents about how to negotiate a job offer.[1. The focus on the talk was on negotiating a job within an organization that is already established—a “typical” job for a physician. There is more flexibility—and uncertainty—for start-ups and other innovative programs that deviate from standard models of medical practice. For those of you who are trying/creating something new and different, good for you: We need you.] Our resident cohort did not receive any formal instruction about this[2. When I was a resident a few attendings in private practice did talk with us about how to hang up our own shingles. Most of the people in my cohort did not go into private practice.] and I don’t know if this is a topic that is common in resident education. It seems that physicians, as a population, aren’t skilled in negotiating job offers.[3. I wonder if physicians don’t think or learn about job negotiation because of our training experiences: To get into medical school we learn to jump through various hoops that others set aflame; we learn how to sit through interviews, though we’re rarely in a position to ask for what we want; we cannot negotiate where we go for residency; we are usually unable to negotiate the finer points of our clinical rotations; and, by the time we complete our residency training, we’re relieved to have more freedom and salary than we did as trainees, so we don’t ask for anything more.]

My suggestions for negotiating a job offer may not be comprehensive, though I hope that they will help new graduates and “early career” physicians have more confidence and skills when talking with potential employers.

I’ll write about two items of information candidates should always ask employers for. Most candidates don’t ask for these two items, though they can clarify the job, set expectations for both employer and employee in the future, and provide ideas for negotiations.

I’ll also share a list of negotiating items that are particularly relevant for physicians. Given that each specialty in medicine has its own practices and culture, consider the list a starting point.

Lastly, I’ll suggest general attitudes and perspectives that candidates (particularly women) can hold during the negotiation process to make it less daunting. Expect some cheerleading.

A caveat to begin: Do not start negotiating until a job has been offered to you. Even though you might burst with excitement about the job and believe that you are well suited for the work, the employer may not share your sentiments. Negotiating details of a job before it is yours is foolish. Imagine if the tables were turned: You’re sitting in an interview and you don’t want the job. Meanwhile, the employer is saying things like, “So… could you work every Thanksgiving, Christmas, and New Year’s?”

The interview process is your opportunity to ask questions, watch how the employer is behaving (because the people talking with you should be on their best behavior), and learn if you, the work, and the employer are a good enough fit. Though the employer initially has more power (as they are offering you a job, not vice versa), that doesn’t mean you are powerless: All the things you learn during the interview will help you decide whether you will accept their offer. And maybe there are some things you’d like to be a little bit different before you agree to work with them. That’s what negotiating is about.

Next post: The first of two things you should ask for during the interview.


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