13 lessons to advance, negotiate as a woman and a physician

MIAMI — Everything is up for negotiation, one physician reminded the audience at Scrubs & Heels Summit 2022. And those negotiations require preparation, relationships and knowing your worth.

“This right here is one big giant sponsorship session,” Jami Kinnucan, MD, senior associate consultant at Mayo Clinic Jacksonville, said during her presentation to an audience of mostly women. “We are navigating. We are networking. We are connecting. ... It’s likely to accelerate careers.”

Kinnucan presented 13 lessons she learned in her career, having just moved from the University of Michigan to Mayo Clinic Jacksonville.

Lesson 1: Medicine is a lifelong journey

“Medicine and the practice of medicine and the business of medicine are a lifelong journey. The challenge is sometimes you never feel like you’re going to make it to the end,” she said. “You’re going to land your dream job ... but it may take you a few tries to get there. And that’s OK. You’re going to learn more along the way.”

When you do arrive at your self-described dream job, you will ask: What are the next steps? What goals do I now need to set?

“You have to find your tribe. You are not walking these steps alone. We are walking together,” she said.

Lesson 2: Take the time to appreciate your opportunities

Training and early career are the times to seek and secure new opportunities, whether it be additional skill sets or the chance to shadow an expert in your field, Kinnucan said.

“I did not, and I’ve watched others miss those opportunities as well,” she said. “There are other opportunities to help you build what you want to do. ... Training is a safe space. Early career is a safe space. You’re given some time to figure it out.”

This early time in one’s career is also a time to establish both a reputation and a brand, she added.

“Building your reputation is the second you decide to go into medicine. Make sure your Miami beach spring break trip from 2000 is erased from the internet,” Kinnucan said. “Building your brand ... is what is your voice? What do you want people to know you from?”

Additionally, take the time to find mentors and sponsors and those “who are willing to disrupt for you.”

Lesson 3: Learning doesn’t stop during fellowship

Kinnucan said this is the time to look at your path.

“Are you going to be an educator? Do you want to be a researcher?” she said. “There’s a lot of money in clinical trials ... and ultimately, they will allow patients to have better care.”

She pointed to leaders like Anita Afzali, MD, a gastroenterologist and professor of medicine at The Ohio State University Wexner Medical Center and co-founder of the Scrubs & Heels Summit, who have established their own paths in leadership and academics.

Lesson 4: It’s never too early to be a mentor or a sponsor

“Mentors can be at any level. They can be a peer,” Kinnucan said. “It can be structured or very casual.”

But sponsorship has a different role, one which women seem to receive less than men. Sponsors, she said, must be more highly placed in an organization. They have active and intentional missions and can further others’ careers through their sponsorship.

“We really need both. We know we are over-mentored and under-sponsored, and that’s because many of our mentors have been men. We have the opportunity to change that and sponsor each other,” Kinnucan said. “I challenge you all to do one thing sponsorship-related in the next month. And it doesn’t have to be someone junior to you.”

She gave an example of when she suggested a colleague, a peer, for a talk she herself could not deliver.

“Sponsors don’t just help chart the path forward; they clear it. They’re opening new doors for you, not just showing you where the door is,” Kinnucan said. “If we start opening those doors for each other, we are going to make it much it easier to change the way that we practice medicine and also the way that we change medicine.”

Lesson 5: Learn what it takes to be an effective mentee and mentor

Kinnucan said an effective mentor actively listens, facilitates, promotes independence and balance and rejoices in successes while conveying joy.

What they don’t do is fix the problem or take credit for something a mentee has done. They don’t threaten or use their influence negatively.

“Allow them to fix their own problems but be a really good listener,” she said.

Lesson 6: Define your dream job

Kinnucan said each person’s dream job looks different, and each person must visualize and define what that means to them.

Know where you want to live. Set work-life balance priorities. Understand what your path to advancement looks like. What does job satisfaction look like?

Once you have defined your goal, then prepare yourself for when the opportunity arises, she said.

Clean up your social media presence, do monthly maintenance of your curriculum vitae, draft an intention letter that can be personalized. All these steps will allow for a smoother application process, Kinnucan said.

Lesson 7: The interview can set you apart

“A lot of us look very similar on paper, but this is when you can differentiate yourself from someone else who is interviewing,” Kinnucan said.

She offered the following dos and don’ts of interviewing:

Be authentic and honest

Dress appropriately

Show your passions

Exude the innovation you want to bring to the practice or institution

Don’t be late

Don’t be too rehearsed

Don’t multitask in these days of Zoom

Don’t ask immediately about vacation and call because it will come up later in the negotiation process

Lesson 8: You don’t have to do this alone

Kinnucan reminded her audience that they are not experts at contracts, but they need to find someone who is.

“Any role that you’re going to be taking, you will be making enough to have a lawyer look at your contract,” she said.

First identify the negotiables in the contract and then find an expert, she said.

Lesson 9: If you don’t value yourself, they may not see your value

As a woman applying for a role, Kinnucan said research is critical to knowing what others in the area are making and what you have to offer the practice or institution.

“Women are more likely to underestimate their worth,” she said, adding that women tend to take decisions and criticisms personally, fill silence when they do not need to and not counter an offer.

“Women are more likely to take the first offer,” she said. “You shouldn’t do that.”

Kinnucan suggested looking into resources that give averages of what gastroenterologists in your geographic area make to ensure you are being paid fairly.

Lesson 10: So many things are negotiable

Though physicians are often focused on salary, Kinnucan warned there are many other factors in a contract that should be considered.

RVUs, vacation, signing bonuses, retirement packages, student loans, tuition remission for employees and their children, call schedule, restrictive covenant, CME days and reimbursement for them, and title and time to advance are all factors that may carry more than monetary value, she said. Smaller logistical items such as a cell phone or a guaranteed office can make a difference in the day-to-day satisfaction at a job, Kinnucan said, and can be negotiated.

“I am student loan debt-free because I negotiated for that,” she said. “These are opportunities that are not just salary.

“Contract negotiation is a discussion. ... If they say there is no negotiation, understand that is the start of the relationship for you. There won’t be a lot of wiggle room later,” Kinnucan said. “If you don’t ask, you don’t know the answer. ... There will be a response.”

Lesson 11: Understand benchmarks for advancement

“Talk to your chief early about what your goals are,” Kinnucan said. “Different paths for advancement have different criteria.”

Often, she said, women expect that advancement will come in a set timeframe, but they don’t check what requirements are needed to fulfill that advancement in that timeframe. Know when you are eligible and make sure you are working on your regional and national reputation, she said, including your presence on Twitter.

In addition, set up letters of recommendation early on and know the criteria, such as not having worked or published with your recommender.

In private practice, she said, women must understand the path for partnership.

Lesson 12: It is OK to say no (thank you)

“Saying yes all the time is not the way to advance your career,” Kinnucan said. “You will get burnt out. I’m telling you that from experience. ... I did not learn to say no thank you.”

This need to please and agree seems to be more common in women due to the need to be valued and not disappoint friends, colleagues and managers, she said.

“You have to ask yourself: Does it help you meet your goals? You need to define those goals. Is it going to lead to advancement? ... Is it going to make you more money? ... Is it going to allow you to spend more time with your family?” Kinnucan said. “If it isn’t going to meet those goals, then for me it’s a no thank you.”

Kinnucan added that “maybe” is also an option. Take a few days to decide if it meets your goals and, if it does not, consider passing and sponsoring another woman to fulfill the need.

Lesson 13: Building relationships is the most important lesson

“Building those relationships that we all started this weekend are just the foundation for not only finding those dream opportunities that are out there but also for helping each other advance,” Kinnucan said.

Mentorship, sponsorship, dream jobs, negotiations, role models all come down to relationships, she said. And taking the risk to meet new women, ask for help, listen to advice and then pass it along to others creates a path for change and growth.

“I look forward to sponsoring those I’ve met along this journey,” she said.