Author: Maria Yang, MD

Negotiating a job offer can make us all feel uncomfortable because the noise in our head stops us from asking for what we want (and often deserve). Ladies, this post is for you because, even as physicians, we still earn less money than our male colleagues[1. From the White House: In 2014, Women Continue to Earn Less Than Men. From Forbes: Even Women Doctors Can’t Escape The Pay Gap.] and we often do not assert ourselves as much as we could during negotiations. That doesn’t help us as individuals or as a population.

One of the most important things to keep in mind during negotiations is that you’re not asking for “too much”. You are going to work hard for your employer. You want to arrange the details of your job so that you can create your best work with as few obstacles as possible.

As a resident, we had to pay for parking on nights when we were on call. We all hated that. Why do we have to pay for parking when we’re in the hospital working all day, then all night, and then for most of the next day? If we could have negotiated our jobs so that parking was covered when we were on call, then we would have felt less resentment about our roles. This is an example of a psychological obstacle that could get in the way of doing your best work.

First, consider that it is your employer’s job to say “no” to any negotiation request you make. That doesn’t mean that s/he will say no. If you assume that it is your employer’s job to say “no”, though, it’ll make negotiations feel less personal. (This is an example of a mental shift that is meant to help you, even if it is inaccurate. Sometimes cognitive distortions are helpful.) This mindset will also help you assess your priorities during the negotiations: What matters most to you, where you won’t take “no” for an answer? What is less important, but would be nice to have?

Second, consider it your job to ask for everything you want. By asking for everything you want, you demonstrate multiple things to the organization:

1. You have the confidence to ask what you want.
2. You show your strong communication skills in asking for what you want.
3. You have the skills to advocate for yourself.
4. You can use those same skills to advocate for your patients, your colleagues, the organization, and other parties.

On a practical level, naming everything you want also provides room for compromise. Your inner critic may balk at the idea of asking for everything you want (“I’m asking for too much!”). Organizations use your inner critic to their advantage because they know it is difficult for potential employees to ask for what they want. However, organizations need employees and, if they’ve already offered you a job, it shows that they specifically want you.

Know your style when it comes to negotiations. Some people aren’t “phone people”. Some people prefer conducting negotiations over e-mail, where one can take time to mull over options before responding. Some people prefer having conversations in person. This last preference has an advantage over the other two: It is hard to say “no” to someone’s face. Negotiating in person also sends a meta-message that you can manage potentially uncomfortable conversations with skill.

Lastly, remember that potential employers should be on their best behavior during interviews and negotiations. If they aren’t treating you with respect when they ought to be courting you, how will they treat you once you are formally working for them? All of these interactions provide information: Do you want to work for someone who isn’t putting forth a best effort to impress you? You’re likely working hard to make a good impression on them, right?

I hope the posts in this series will help you have more confidence and skills as you seek work. People often talk about “self care”, a concept that can sound hollow and corny. May these concrete suggestions help you in the realm of self care, as crafting a job that brings you satisfaction will help you take better care of your patients. Good luck.

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We’ve discussed the value of a job description and a table of organization when negotiating a job offer. You can negotiate specific items on either one of the documents, now that you know how your employer has structured them.

Common and obvious things you can negotiate include salary (usually on the job description) and title (usually on the table of organization). The reason why these are common negotiating items is that, in some ways, they are the most flexible. The job might be in a clinic and everyone is expected to see patients between 8am and 5pm; that is not negotiable. How much you are paid, though, could vary. Title may not be as flexible, but, depending on your interests, there could be room to craft your specific title if it will accurately reflect what you do.[1. To be clear, titles, at the end of the day, are just words. Some people believe that achieving an important title grants you leadership, influence, and power. I believe that who you are matters more than what your title is. We’ve all known people with fancy titles who do not appear to have the substance to support the description of their position. We also have met people who do not have fancy titles, but have integrity and wisdom and, as a consequence, influence and lead others. Yes, titles can give you access to information and people that you might not otherwise have. When you go home, though, you bring along whoever you are, not your title.]

For example, if you’re interested in education and would like to run a regular journal club and case consultation series, you could negotiate a title of “assistant medical director of education”. I’ve recently heard about some physicians who applied for “medical director” posts, but all the other leadership staff were “chief [blah blah] officers”, so they negotiated for a “chief medical officer” title. Again, from my perspective, the substance of what you do is more important than what words people call you.

Here’s a list—in no particular order—of stuff you can negotiate:

Bonuses. These seem rare in medicine, though some people are offered “signing bonuses”, particularly when they join hospital systems. You could negotiate the value of the bonus… or you can fold this into your salary so that your regular salary is higher.

Time off. If your employer can’t increase your salary, could they give you more vacation days?

Part-time, full-time, flex-time. Perhaps the job is posted as a part-time job, but you would like to work full-time. Or maybe vice-versa. If the fit is good between the employer and you, they might accommodate your preference.

Scheduling. Instead of working five 8-hour days, maybe you could work four 10-hour days or three 12-hour days. This depends on the setting, of course: Some clinics will much prefer that you are present five days a week for urgent appointments and coverage. They also may not have clerical and other staff available to work outside of the standard 8-hour day.

CME. Look at the job description: Does it mention CME? If not, ask for both time and money. Under the best of circumstances, you would get paid your regular salary while you are away and the employer would cover the cost—registration fees, hotel, travel—of attending any educational events.

Licensure. If the job requires that you maintain an active state license—which it should!—then you can ask if the employer will cover the cost of your license. You could also ask them to pay for your DEA license.

Transportation costs. If travel is part of your job—maybe you work in different clinics throughout the week—you can ask the employer to pay for your bus pass or reimburse you for gasoline or miles driven. Is there a company car you could drive?

Administrative support. Can you have a dedicated staff person to fax prescriptions for you? Format letters you write? Help with scheduling meetings or appointments? The employer is paying you to see patients; they don’t want to pay you to fax prescriptions.

Non-clinical time. If the job description includes administrative, teaching, or research duties, you can negotiate for more time or resources to do those things.

Office space. Maybe you can negotiate for a bigger room. Or the corner office. Or a room with a window. Or a quiet space.

Malpractice insurance. Many large physician employers already pay for this, but if your employer doesn’t, ask them if they will.

Call. If taking call is part of the job description, you likely can’t negotiate the amount of call you take because people probably aren’t paid extra money to take call. You could negotiate a decrease in salary amount if you don’t want to take call. Or you could negotiate when you take call—for example, you’d prefer to take call in week-long chunks instead of every fifth night.

No compete clauses. This is that thing in a contract that states that, if you leave the organization, you can’t practice within fifty miles of the clinic for five years and you can’t take any of your patients with you. If you plan to stay in the area, keep an eye out for this and know that fifty miles is a lot.

This is just a short list: Depending on the context in which you work, there may be other (obvious) things that you can negotiate.

It may seem daunting to ask for any of the items in the above list… but it doesn’t hurt to ask. I’ll talk more about that in the last and final post in this series.

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