‘Everything is negotiable’: How to approach employment contracts
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Jonathan D. Leffert, MD, talks with Armand Krikorian, MD, MBA, FACP, FACE, about why health care providers need to consider all the features of an employment contract, from salary and performance expectations to benefits.
Leffert: Why is it important to negotiate when reviewing an employment contract?
Krikorian: Negotiating is important. A lot of us are inclined to just quickly agree to employment terms and sign a contract without reading the fine print, but I feel negotiating is essential to long-term endurance in an organization. If we’re happy with the terms of our contract, that can ensure we’ll be happier and stay with the organization for a long time. But if we are feeling stuck with something we didn’t ask for or want because we didn’t read the fine print, that can lead to bitter feelings, which is never a good scenario.
Leffert: I completely agree, and I think those who understand this process do a lot better and can get the best outcome. Tell me a bit about how to do it. How do you prepare for contract negotiations?
Krikorian: Negotiation is both an art and a science. You can’t master the art without knowing the science, and the science starts with doing your homework.
Know the market and what kind of leverage you have — or don’t have. Know what number you’re looking for and if the number is reasonable within the market where you’re looking to practice. But also look at other variables: the number of days off you’ll get, the amount of CME dollars provided, whether there’s a signing bonus and relocation expenses, whether you’re going to have your own office and your own administrative assistant, how many clinics you’re going to do, whether you’ll be covering weekends. A lot of this homework helps you to go into the negotiation prepared.
I think about it as your wants, your needs, and the items that are not essential but are good to have. There are also “give aways,” which are items you really don’t care about — you’ll do them if asked but will trade them for other things.
Leffert: In relation to that, I understand that part of the science is that there are different contracting styles, and these contracting styles are somewhat inherent to an individual. But we can learn to use different styles. What can you tell us about those styles and how you might use them in a negotiation?
Krikorian: You’re absolutely right. I think you’re referring to the Thomas-Kilmann conflict mode instrument, which is the most famous validated one, and one I would encourage everybody to take. It’s quite an eye-opener as to what your personal style is naturally.
For example, some people are naturally more compromising. Some people are completely avoidant and do not want to deal with any negotiation or perceived conflict. Some people are very competitive and go into a negotiation ready to muscle their way through.
Start by knowing your style, knowing what kind of person you are, and then adapting or changing your style depending on what leverage you have or what the market is so that you get the best out of this process.
Leffert: That’s really important. In relation to that, salary is obviously very important. You have to be able to make enough to live, but there are things in addition to salary that make your life more enjoyable in the workplace. Tell us a bit about how you would negotiate salary, specifically, and then what are those other things and how you would get them to be part of the contract.
Krikorian: Yes, salary is an important number, but it should never be the only number to come up in a negotiation. Salary is typically tied to a certain productivity expectation. So, the salary on its own may look attractive, but when you read the fine print, you might find that you are required to meet a very high productivity target to achieve that salary. Also, that salary could be tied to a certain sign-on bonus or how many weekends you’re working or how many calls you’re taking and how intensive those are. You might be required to cover more than one hospital and have to increase your commuting time to jump from one hospital to another. Those are important to consider.
You may feel that the person you’re negotiating with is not willing to move much on salary based on their budget. You should acknowledge that, but then you can negotiate around the number of calls you have, the number of weekends you’ve covering, maybe a restrictive covenant attached to the contract or how many days’ notice you must give if you ever need to change your position and want to apply somewhere else.
Pretty much everything in a contract is negotiable. The only thing that’s probably not negotiable is benefits because these are typically standard across in an institution — dental and medical insurance and 401k — but everything else is negotiable and should be on the table.
Leffert: I’m in private practice, and I’ve had employees who have negotiated benefits with me too, but in a large institution, they probably wouldn’t be able to do that. As you indicated, everything is negotiable, and that’s really the most important thing people need to understand.
Jonathan D. Leffert, MD, is managing partner at North Texas Endocrine Center and past president of the American Association of Clinical Endocrinology. He is an Endocrine Today Editorial Board Member and the Putting It Into Practice column editor. He can be reached at jleffert@leffertmail.com; X (Twitter): @JonathanLeffert.
Armand Krikorian, MD, MBA, FACP, FACE, is chief medical officer for AdventHealth Bolingbrook and GlenOaks hospitals in Illinois and professor of clinical medicine at the University of Illinois at Chicago. He can be reached at armandkrikorian@gmail.com; X (Twitter): @ENDOUNO.
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