Negotiating the Contract for Your First Oncology Job

Aug 24, 2016

By Jack Lambert, Staff Writer

When does a job interview at an academic institution become a negotiation?

It’s often difficult to predict, especially for an early-career oncologist trying to impress and persuade the person across the table. Yet there is a moment, either during the actual interview or shortly thereafter, where the question is no longer, “Why should we hire you?” but rather, “What will it take for you to join our team?”

It’s a welcome, albeit difficult, question. There is a fine line between ensuring the best possible situation and running the risk of the institution deciding to move on to other candidates.

Filipa Lynce, MD, of Georgetown Lombardi Comprehensive Cancer Center, spoke on this challenging topic at the 2016 ASCO Annual Meeting in the Trainee and Junior Faculty Member Lounge. Here, she shares her advice on how early-career oncologists should approach contract negotiations with an academic institution.

AC: What factors should a person consider and be prepared for ahead of their salary negotiation?

FL: It’s important to determine both where you are looking, because factors vary by city or state, and what type of job you are looking for.

There is a rate that is determined by the state for a physician’s salary. That said, it does not hurt to have multiple offers in the same city or town. You would be surprised; a lot of times, a rule is a rule that can be broken. Usually your salary is standard for your first job; however, if you have a few years of experience or bring something unique to the institution, that will help in your negotiation.

Most of a physician’s salary comes from the revenue they create by seeing patients. If you go into private practice, you will see more patients; if you are looking for an academic position, often salary will depend on how many days you are in clinic.

AC: How should early-career oncologists approach the length of their contract? Is it necessary to consider incentives?

FL: In my experience, physicians in many academic institutions have yearly contracts that get renewed in a fairly smooth process. There can also be longer contracts depending on personal circumstances.

Depending on where you are starting, it might take longer to build your practice. If you are replacing a physician, you will be busy very quickly. But if you are a new member in a practice that already has seven oncologists in your specialty, it will take a little bit longer to build up your practice.

For many institutions, your salary is protected during your first 2 years and is not dependent on incentives. After a certain amount of time, your salary can go up or down depending on the number of patients you are seeing or what you are contributing in grants, publications, or patients placed on clinical trials. In academia, all of those factors—service, committee work, teaching, giving rounds or conferences to students—can be taken into account for both promotion and salary.

AC: Early-career physicians often feel overworked. Can you negotiate your schedule into your contract?

FL: There are two things you should try to make clear in your contract. The first is the amount of time you spend in the clinic and how that time is measured (e.g., in terms of patient volume or days/half-days spent in clinic). The second is the inpatient load. If you are interested in pursuing an academic career, you need to ensure that you will have enough time to accomplish your research goals, and it is important to define this in your contract. It is also important to define what type of staff support you will have when it comes to patient care.

AC: What is the danger if you are not clear about your schedule?

FL: Sometimes more experienced physicians can think that a junior physician’s availability is wide open. The department might split the number of inpatient weeks throughout the department equally, or senior staff may have fewer inpatient responsibilities. Even if it is not written in the contract, junior physicians should discuss how inpatient distribution is made.

As a junior faculty, you might not have a lot of patients, so inpatient service may be a source of revenue. But if the service is busy, and you are planning to start research projects, it will be hard to accomplish anything meaningful if every other week you are covering everyone else’s patients.

AC: How should an early-career oncologist approach restrictive covenants in contracts?

FL: Restrictive covenants, or clauses that might bar a candidate from working in a specified geographic area for a certain number of years if they decide to leave, are becoming standard in academic medical practice. What you can do is look at the miles specified in the restrictive covenant to see how it applies to other institutions in the area. Figure out if it might bar you from working in a neighboring institution or a place you might want to work in the future. Ask around to make sure that the covenant is standard and not just in your contract.

AC: What are some aspects of a contract that a person accepting their first job may not think about?

FL: Ask about what kind of support you will get to present your research. Some contracts give you a certain amount of money per year toward your education or research, and others may pay for one annual meeting but also might have internal funds to use when presenting your own work. As junior faculty, you might not have a lot of grants and will need funding to attend these meetings. Other small things to consider include software computer, and whether credentialing fees, licensing fees, or board exams are reimbursed.

AC: Physicians often join academic practices in order to work under a specific mentor. Is that something you can write into a contract?

FL: Yes, you can ask for it. Sometimes you will go to an institution because there is a person you really want to work with. But when you get there, you may find that the person is so busy that you don’t have enough mentorship. Putting specific terms for mentorship in a contract is a way to make your mentor more responsible and ensure that the institution takes ownership of your career.

As with many other things in life, contract negotiation is a learning process. You learn as you go and as you talk to other people who have been through a similar process. So don’t feel disappointed if on your first contract you didn’t negotiate anything because you were just glad you got an offer. The next one will be better!

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