Physicians, know your worth

Five years into practice as an attending radiologist, I have negotiated my first contract, multiple pay increases, call compensation, and independent contractor status.  I prepared by researching my market value and reading about negotiation strategy.  The following are some things I learned along the way.  As physicians, we must know our worth, and be able to leverage it in a negotiation.

If you negotiate in medicine, you may feel like the only one.

Over the years, some colleagues have confided that they have not received any pay increases.  Since I started at a lower salary, right out of training, I realized that knowing my worth and negotiating would be critical to increasing my salary over time. Not negotiating was not an option.

My first lesson in knowing my worth

In 2014, the depressed radiology market worried my co-fellows and I.  After sweating the job search for several months, we each received job offers with the same starting salary.  We were each able to increase on the starting offer by asking for more.  It is intimidating to ask for a pay increase, especially when making a first impression on a new employer. But the practice managers on the other side of the table see medicine as a business, and if you want to be properly compensated, you should too.  

Consider your options to counter an initial starting salary offer:

a)  Counter offer = (initial offer) * 1.05

b)  A number just below the one that will get you laughed out of the room.

c)  Something in between

Negotiation isn’t taught in medical training.

During residency and fellowship, salary is based on one’s “PGY,”  or post-graduate year level, with some geographic variation.  In this model, trainees don’t negotiate their salaries for three to six formative years!  They just accept what is given.  Then, when training is over, salary increases to a junior attending level, and multiple variables are added to the salary equation.  Therefore, the new attending must know her worth, quickly learning to advocate for herself.

Know your worth, vis a vis:

• What’s the going rate for a shift?
• What do others receive for call compensation?  
• Is call pay included in a daily, weekly, or yearly rate?
• What is the most you can realistically hope to get?
• What is the least you need to feel adequately compensated?

Knowing these figures is key to avoiding a negotiation hangover.  

Renegotiating: it’s not a one time deal.

After a year at my attending job, I prepared to return to the negotiation “table,” albeit over the phone. I was working for a flat salary, and was often asked to work extra weekends for no additional pay.  At the time, I figured I was paying my dues. But after that year, there was no question that I had to negotiate for better terms. 

My approach was as follows: I considered the difference between average attending pay in my field and where I started.  I figured my salary should reach the higher figure in the first five years of practice, if not sooner.  Then, I divided the difference between the median and starting salary by five to calculate the yearly raises I’d aim for.  It helped to calculate these figures ahead of time. Being familiar with these figures was key to avoiding settling for too little.   

Yearly Raise =  (Dream salary – Starting Salary)/ Years to partner or peak earning potential

Break taboo & talk about compensation

To know your worth, you must talk about pay: with those around you, those you trained with, and colleagues at meetings.  Talking about pay helps foster transparency, and can help even the playing field. Women and minorities are particularly vulnerable when transparency is lacking. An analysis by Glassdoor.com in 2016 quantified the gender pay gaps in the US, Great Britain, and Australia, based on their crowd- sourced data.  Controlling for various factors, the authors revealed an “adjusted,” or unexplained gender pay gap across various industries, including medicine. Transparency helps women, minorities, and those early in their careers to bargain for optimal compensation.  

Research your worth

The following are some online resources to help figure out your market value:

• Radworking.com has job descriptions including starting and potential compensation.
• Payscale.com shares anonymized information from other users regarding pay and benefits, when you create a profile on their site.
• Doximity.com has an interactive salary map populated with anonymous data from more than 18,000 physicians across the U.S.
• Job recruiters and industry representatives can serve as regional sources of information and opportunities.

Gauge your target audience

Are you negotiating with a peer, or someone of a different generation?   Are there cultural factors at play? I was negotiating with three men, and was the youngest physician in the practice. I was and remain the only female interventional radiologist in the group. These factors can contribute to how attempts at negotiation are perceived. Consider Sheryl Sandberg’s analysis of the “tightrope” women must walk in her best selling book, Lean In.

Put on your thick skin, just in case.  I was called “money hungry” for negotiating early in my career.  Going into the discussion, this was my worst fear: being criticized for advocating for myself and my family.  In the moment, I was non-reactive and business-like. Later, I received an apology.  It’s not greedy to negotiate for maximal compensation. It’s smart to know your worth.

Practice (finite) patience.  

After my first year as an attending, my contract negotiation was postponed for months. Decision makers in the group awaited the results of  hospital contract negotiations. It was a period of uncertainty, during which my Chief Operating Officer seemed to prepare me for a pay cut.  Finally, my contract was reviewed.  I was given an increase in call load, and a significant increase in compensation.  At that time, waiting for the group to secure its footing with the hospital was a key prerequisite to negotiating my first contract amendment.

Nurture relationships with decision makers

Demonstrate the ways in which you are an asset to your group or institution. “Toot your own horn,” as Debra Condren describes in her book, amBITCHous: (def.) A Woman Who: 1. Makes more money 2. has more power 3. gets the recognition she deserves 4. has the determination to go after her dreams. Share any accolades you receive with your boss. When a patient of mine sent a complimentary letter to our hospital CEO, lauding me and my team for providing excellent care, I received a thank you letter from hospital administration. I immediately forwarded the letter to my group’s CEO.  His reaction was to praise me as a “star.”  

Highlight any flexibility you offer: can you perform high-end interventional services one week and diagnostic services the next?  This allows for tremendous flexibility in physician scheduling. Are you the most up to date in a certain area, for example, just out of fellowship at a transplant center? Have you improved the practice through your leadership?  

Show your decision- makers evidence of increased referrals, improved departmental efficiency, excellent patient outcomes, or rave reviews from your referring physicians. Presenting yourself as a consistent asset to the group increases leverage at the time of negotiation.

Negotiate anything

Some institutions pay based on academic rank or other hierarchical factors.  If a higher salary is not possible, or even if it is, consider negotiating something else.  Like:

• Paid time off
• A new title
• Academic or administrative time
• An educational stipend
• Office space
• Access to assistant(s)

At the end of maternity leave, I negotiated an independent contractor agreement.  I now have greater control over my schedule, and aim for at least ten weeks off per year.   

Contract review

The contract serves as a framework for the working relationship.  It’s important to review it with an attorney, particularly one with experience negotiating physician contracts.  This is especially important if you are new to concepts like non-compete clauses, partnerships, buy-ins, or malpractice coverage.  

I was initially offered a standard contract used for diagnostic and interventional radiologists.  My attorney was able to help shape my agreement to reflect the combination of work I’d be doing as a hospital-based interventional radiologist, in-house diagnostic radiologist, and occasional remote reader.  For example, I initially received no call compensation, but negotiated a cap on the number of call weeks I would take that year. 

Tail coverage would not be covered by the practice, and was non-negotiable. My attorney helped me to understand the implications of this future cost, should I change jobs. The contract indicated a minimum number of studies to be read in an imaging shift.  We added language to protect me from docked pay in the case of factors beyond my control, like low hospital volume. 

I found my attorney using an online marketplace called UpCounsel.  The contract review included a phone consultation, follow-up emails, and a review of contract revisions.  A personal referral to an attorney, particularly in the geographic area you will be working in is ideal, if that is an option for you.  

See opportunities to negotiate

These strategies are not just for exceptional candidates or those with multiple offers. When you know your worth, you can earn the level of compensation you deserve. Variations of the negotiation game can be played in different settings, whether academic or private, diagnostic or interventional, city or countryside. 

What strategies have you found helpful in researching your worth, or succeeding at the negotiation table?