Know your worth, plan ahead to successfully navigate physician contract negotiations

Key takeaways:

• Reach out to colleagues and mentors for advice before negotiations begin.
• Think about factors other than salary, such as vacation time and clinic hours.
• Your leverage is highest during initial recruitment.

For physicians, negotiation is a daunting — but essential — component of job searching and career advancement. Experts also say negotiating skills are key to helping physicians achieve their goals and career satisfaction.

But many physicians, and especially women, struggle with asking for what they want out of fear of rejection, Leena V. Padhye, MD, FACAAI, allergist at Family Allergy & Asthma in Noblesville, Indiana, and vice president of the Indiana Allergy & Immunology Society, told Healio.

“I think a lot of physicians are people pleasers, and that especially applies to women,” Padhye, who also serves on the American College of Allergy, Asthma & Immunology’s Public Relations Committee, said. “Most people who go into medicine are empathetic, giving people, and it feels like we should be thankful for our opportunities and that we can’t speak up for ourselves more.”

Once physicians finish their training, they usually have not had much practice with negotiating and asking for what they want, Padhye said.

“You get into medical school, then for residency you go through the match where a computer chooses, and when you do fellowship, a computer chooses again,” she said. “The constant message is to put your head down, work hard and one day you will get your first real-world job. I think we as physicians are very scared to miss any opportunity.”

Research shows that women overall tend to ask for less than their male counterparts while job searching, according to survey data from Dreber and colleagues. Results of their analysis showed that the reasons for this may stem from women having different beliefs about the appropriate salary for an ideal candidate.

“We know historically that women are not as good at negotiating,” Vivian Hernandez-Trujillo, MD, allergy/immunology division director and fellowship program director at Nicklaus Children’s Hospital, owner of Allergy and Immunology Care Center of South Florida and a Healio Women in Allergy Peer Perspective Board Member, said in an interview. “We need to get better at representing ourselves and advocating for ourselves.”

Healio spoke with Hernandez-Trujillo and Padhye — both of whom have taken a personal interest in this issue in order to educate themselves and others — about how women physicians can improve their negotiation skills, pitfalls to avoid when it comes to discussing contracts, and factors to consider outside of salary when negotiating.

Preparing to negotiate

Both Padhye and Hernandez-Trujillo suggested physicians take the time to plan and consider what is important to them before beginning to negotiate.

For instance, even prior to interviewing, physicians should research average salaries in the area, Padhye said. She recommends reaching out to classmates to see what their contracts look like and asking mentors if anyone in their network can offer advice.

Leveraging your network is especially important, Padhye said, as part of what originally got her interested in this subject was her discovery about how secretive contract negotiations can be.

“If you aren’t someone who is outgoing or looking for networking opportunities, you may feel awkward asking someone how they negotiated their contract, what their salary is or how much paid time off they got,” she said, adding that this is why she has tried to bring transparency to the issue. “No one teaches you any of this.”

Padhye also recommends looking for information on the internet, such as salary data from the Medical Group Management Association, at university libraries and through social media, too.

“There is a group called ‘Physician Side Gigs’ that was started by a physician couple,” Padhye said. “They have a community of thousands of doctors, and they share anonymous data provided by members on what the median salaries are in different regions of the United States.”

Hernandez-Trujillo said to think about what assets you would bring to the institution and add those to your value as a job candidate. Also, take time to identify your priorities in a contract, she said.

“Remember, negotiation is a compromise,” Hernandez-Trujillo said. “Both sides are going to have to make concessions. Know your non-negotiables so you can work out the things that are most important to you.”

Even though negotiation can seem like something that is not addressed enough in training, researchers Berman and Gottlieb argue physicians do practice negotiation skills — with patients. Coming up with treatment plans that meet patients’ health needs and fit into their lifestyle requires listening, providing evidence and coming to a mutual agreement, just like job negotiations, they wrote in their paper, published in Journal of General Internal Medicine.

“By harnessing negotiating skills honed in clinical training ... residents and fellows can begin their first position with the best chances for professional success,” Berman and Gottlieb wrote.

Hernandez-Trujillo agreed that physicians’ interactions with patients can be thought of as a negotiating skill.

“Negotiation is not taught in medical school, but certainly we're good about advocating for our patients,” she said. “We just need to learn to be great about advocating for ourselves.”

Other pieces of the package

There are many factors to consider in a job offer outside of salary, and having generous vacation time or flexible office hours could be the deciding factor between multiple offers with similar pay, according to Padhye.

While interviewing, it is important to understand the expectations for clinic hours and on-call duties, she said.

“There are offices that have some days open and close earlier or later than traditional business hours, such as opening at noon and closing at 8 p.m.,” Padhye said. “There may be weekend hours, too, which is a great service for patients, but you should clearly understand how often you may have nontraditional hours. Even every other Saturday can get to be a lot when you have kids, because all their activities are on the weekends.”

If the position comes with hospital duties, Padhye recommended asking about whether the position is an outpatient referral setup or includes overnight on-call shifts for allergic reactions and drug desensitization. In academic medicine, you will need to look at whether the focus will be seeing patients, teaching or both.

Vacation is another important part of contracts, and Padhye said many people do not think about whether paid time off includes sick time or time to attend CME conferences or lectures.

“Really try to get at least 3 days to a week of additional time off for CME, because CME is not a vacation, and your employer or group should want you to learn and be at the top of your field because it makes you a good doctor,” Padhye said.

Do not forget to ask how the process to request vacation works as well. Padhye recommended asking questions such as, “How far in advance does it need to be requested?” “Is there a rotating schedule among the staff?” and “Do senior physicians get priority?”

Padhye also recommends physicians of all genders ask about maternity leave and breastfeeding policies, even if they are not planning to use them right away — or at all.

“If you get some type of negative feedback from that answer, it tells you something too,” she said.

Important takeaways

The biggest mistake Padhye sees people make in negotiations is not asking for what they want.

“If you ask for it respectfully and kindly, whether it’s over an email or in a phone conversation, the worst thing that can happen is someone says no,” she said. “Say, in the absolute worst scenario, they end up rescinding the offer, then clearly that was not going to be a good fit. Think of it as a blessing in disguise before you signed a contract.”

Padhye also said some believe it is better to wait until they have been at the practice for a few years to update their contract, but it is actually much easier to make changes at the outset.

“Do the negotiation now, because they are still trying to recruit you,” she said. “You can of course negotiate things when your contract is due for renewal, but your leverage is different because your employer knows you, they like you and you like them.”

Another way to get more leverage during negotiations is to consult a lawyer, Padhye said. Make sure to find a lawyer licensed in the state where the practice is located, and verify they have experience with physician contracts. Padhye said her lawyer helped her clarify points in her contract and used their previous experience to explain to her what they typically see in physician contracts.

“It is also nice because you have an intermediary when making requests, so it feels less like everything is coming from you,” Padhye said.

Finally, Hernandez-Trujillo advised to know your value and to not lower your standards.

“Aim for the stars, because whatever you aim for is what you are going to reach,” she said. “You cannot aim any lower.”

References:

• Berman RA, et al. J Gen Intern Med. 2018;doi:10.1007/s11606-018-4632-2.
• Dreber A, et al. Labour Econ. 2022;doi:10.1016/j.labeco.2022.102204.
• Physician Side Gigs. https://www.physiciansidegigs.com/. Accessed Aug. 1, 2024.

For more information:

Vivian Hernandez-Trujillo, MD, can be reached at office@sflallergy.com.

Leena V. Padhye, MD, FACAAI, can be reached at lpadhye@familyallergy.com.