Author: Maria Yang, MD

Categories
Education Lessons Medicine Systems

Negotiating a Job Offer (I).

The first thing you should ask for—if you haven’t already received it—when negotiating a job offer is a job description. This is a document that often has bullet points that describes the title and duties of the job, required and preferred qualifications of the applicant, and basic (and sometimes vague) information about salary and benefits.

Sometimes employers post the entire job description as a classified ad. Sometimes they post an ad that is a three-sentence summary of the job description. Sometimes they send out an e-mail that announces a job opening. Sometimes you hear about a job from a friend and you’re invited to sit for an interview when you call the employer to express interest.

The point is that you could end up sitting for a job interview without ever seeing a formal job description. If you can get a job description before or during the interview, get it: You can ask clarifying (not negotiating) questions during the interview.

It sounds obvious, but the value of the job description is that it tells you what your employer wants you to do. You learn what is expected of you and what you can expect in return.

Maybe you prefer hospital work to clinic work. The job description should tell you if you have to do any clinic duties, such as providing coverage when people are on vacation. If you will be conducting research, teaching, or doing administrative stuff, the job description should tell you how much time and other resources you will have to do that work.

Without a written job description your employer could shift or change your job duties in what seems like a unilateral fashion:

“But when I interviewed, you told me that I would never have to cover the inpatient consult service.”

“Well, that’s where we need coverage right now. Starting next month, we’d like you to do that two days a week.”

Thus, the job description also provides the basis for job negotiations. Review the job description to see if anything is missing (like specific job duties, particularly things you like to do) or if there are details that you want changed (perhaps you want more leadership responsibilities that merit a higher salary).

The job description can provide the foundation for a job contract (or a “hire letter”, as some agencies don’t use contracts). Not every detail about your job has to be in writing. For those details you care about, though, written descriptions of your role and responsibilities make expectations clear to both you and your employer.

Sometimes employers—such as small agencies or new, innovative programs—don’t have job descriptions. Maybe the job description is vague (“will provide clinical services”). What should you do then?

You’ll have to look for other cues during the interview and recruitment process to discern how much to push for a job description. In some cases it is clear that a job description won’t be useful. Consider a start-up project, where no one can anticipate what the program will eventually look like or how your role will evolve over time. Maybe the organization only has ten people and things are routinely discussed and resolved informally. To be clear: If the employer doesn’t give you a job description, that doesn’t automatically mean that the employer is going to screw you over. It just means that they don’t have a job description to give you. It also suggests that you have the opportunity and flexibility to tailor the job to your specific interests and strengths.

Given the often rigid structure of medicine and that physicians are trained to do specific things, we may not think that a job description can help us (“I’m going to work as a doctor”). Asking for a job description, though, can help you shape your job so that your work life is as fulfilling as possible.

Next post: The second thing you should ask for.

Categories
Education Informal-curriculum Lessons Medicine Systems

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.

Categories
Medicine Random

Belief in the Occult.

“Some weird things have happened in my life that I can’t explain,” I said. My friend, a radiologist, said nothing, though I could feel her rolling her eyes through the telephone.

“I’m not saying that I believe in the occult; I’m just saying that some strange things have happened,” I concluded.

“Well,” she huffed, “the only occult I believe in are occult pancreatic cancer, occult head tumors, and occult fecal blood.”

Categories
Nonfiction Observations Systems

Commute Through the Jail.

To get in, out, and through the jail one must go through a series of locked doors. The doors are both taller and wider than standard doors; they are also thicker and made out of metal. Next to each door on the wall is a small silver panel, perhaps the size of two playing cards, that has a small silver button and a flat speaker. Several cameras are bolted to the ceiling near the doors.

“Central control” monitors all the doors through the cameras and speakers. Pushing the button on the silver panel alerts central control that someone wants to pass through. After central control looks you over on the camera, they unlock the door. When the bolt disengages, a loud and jarring “CLICK” bounces off the cinderblock walls and concrete floor. You may then pull or push the door open.

People can wait several minutes before central control unlocks the door. We’re all accustomed to adding five to ten minutes to our commute through the jail.

When I first started working there, I was advised to be patient:

  • “The officers will yell at you if you push the button too much.”
  • “The officers learn who is patient and who is not, and if they know you’re not patient, they might make you wait longer.”

If you wish to call an elevator, you push the button as you would with any other elevator. However, you’re not actually calling the elevator; you’re asking central control to bring it to your floor. As with any other door, there is a silver panel with a speaker and button nearby.

“What floor?” a voice usually asks through the speaker.

You answer into the speaker and, when the elevator arrives, the button to your floor is often lighted. If central control didn’t ask you what floor you wanted before you boarded the elevator, there is also a speaker, paired with a camera, inside the elevator. The floor buttons are “placebo buttons“; nothing happens when you push them.[1. Everyone shares the elevators: Officers, inmates, ancillary staff, visitors. That is why the elevator buttons are “placebo” buttons.]

If central control recognizes an officer in the elevator, sometimes central control becomes mischievous: The entire button panel will light up simultaneously and the elevator looks like it will stop on every floor. After everyone has chortled, all the lighted buttons will darken except for the button for the floor the officer wants.

During my first few weeks in the jail, I often was unsure where I was going, particularly when I was trying to exit the building. (There are no “exit” signs and all the doors and corridors look the same.) Upon stepping out of the elevator, I would look confused and lost.

“Over here,” a voice would call through a panel ten feet in front of me.

“Thank you,” I would say as I tread through the empty corridor. If I didn’t know where to go next, the same voice would call through a farther speaker, “Down here. Go through this door, then turn right.”

These were creepy reminders: People are watching you.

Now that I know how to get in and out of jail with confidence (which helps boost one’s sense of competence in general), central control rarely talks to me through the speakers.

A few weeks ago, central control was extraordinarily attentive. Every door unlocked as I approached it. I didn’t need to push any buttons. I preemptively spoke into the speaker at the elevator to request the floor I wanted. The elevator doors slid open a few seconds later and the button for the floor I wanted was already lit.

It felt like victory: I did not have to wait. I did not have to stop walking. Doors literally unlocked for me.

For a moment, it almost felt like God was watching, that God was opening doors, that God was showing me The Path.

Except it wasn’t God. It was an officer in central control who, for whatever reason, decided that it was worth his or her time to make my trip go smoothly.

Categories
Observations Policy Reflection Systems

How People Agree to Torture Others.

Atul Gawande posted a series of tweets, based on findings in the Senate CIA Torture Report, about the significant role physicians and psychologists played in torture. He comments, “But the worst for me is to see the details of how doctors, psychologists, and others sworn to aid human beings made the torture possible.”

Agreed. Upon reading how these professionals used their knowledge to torture their fellow human beings I felt disappointed, sad, and sick.

“How could those people sleep at night?” I exclaimed.

But I know how “those people” were able to sleep at night, perhaps even with pride that they were doing good work.

Three studies—all controversial, though still illustrative—provide hints as to how people who engage in “bad behavior” believe that their actions are noble.

One is the Stanford prison experiment.

Briefly, college students were divided into two groups: One assumed the role of “guards” and the other became “prisoners”. Though everyone knew that this was an experiment, the behavior of the “guards” became more cruel and sadistic over time. For example, they forced the “prisoners” to be naked; they also refused to empty the buckets that “prisoners” used as toilets. As Wikipedia comments, this experiment demonstrated the “impressionability and obedience of people when provided with a legitimizing ideology and social and institutional support”.

Another is the Milgram experiment.

In this experiment, an “experimenter” instructed subjects (called “teachers”) to push a button that reportedly delivered electric shocks to a “learner” if the “learner” did not answer a question correctly. The “teachers” could not see the “learner”, but could hear the “learner”. The intensity of the electric shocks increased each time the “learner” answered the questions incorrectly. In fact, no one was receiving any electric shocks, but the “learner” would scream and start hitting a wall as the intensity of the electric shocks increased.

Most of the “teachers” continued to deliver shocks even though they heard the distress of the “learner”. Wikipedia quotes Milgram’s conclusion: “The extreme willingness of adults to go to almost any lengths on the command of an authority constitutes the chief finding of the study and the fact most urgently demanding explanation.”

The third is the Rosenhan experiment.

Here, volunteers were instructed to try to get admitted into psychiatric hospitals by reporting that they were hearing vague auditory hallucinations. Once the volunteers were actually admitted to the hospitals, they were supposed to “act normally” and to state that they were now feeling fine and were not hearing voices.

All of the volunteers got admitted and all received psychiatric diagnoses (often schizophrenia). None of the patients were released until they agreed with the psychiatrists’ assessments and plans: that they had a mental illness and should take antipsychotic medication.

All three experiments suggest the power of context in influencing human behavior. Most of the “guards”, “learners”, and staff at the psychiatric hospitals did what they thought they were “supposed” to do. From an outsider’s perspective their behaviors were “wrong”. To the subjects, though, they were doing the “right” thing because that is what they were “supposed” to do.

I don’t know any of the physicians or psychologists who participated in the government-sanctioned (!) torture, though I suspect that most, if not all, of them believed that they were doing “the right thing”. That they were using their knowledge and power for good, and not for evil.

Many of us—myself included—would like to believe that we would never do something like help torture people, that we would never be one of “those people”. We want to believe that we would have the mental fortitude to exercise independent thought, stick to our values and morals, and speak up against injustice.

But with experiments and events like these, how can any of us be so sure that we wouldn’t bend to authority and get sucked into groupthink?