Nov 07, 2019
By Jennifer Leigh McQuade, MD, MS, MA, LAc, and Graham T. Watson, MD
As the final stage of your job search, the contract negotiation phase is both exciting and intimidating. One of the most critical aspects of contract negotiation is understanding your own priorities, needs, and wants, and this can be quite challenging when you are finishing training and negotiating for a job you have never actually done. Although the negotiation is a final phase, you should be mindful of gathering the information you will need throughout the interview process to understand what is standard and negotiable at a particular institution, as well as what your options are more broadly. Much of this knowledge can be derived by asking questions of peer interviewers along the way.
Whether you are going into academia or private practice, many of the same tips apply: do your research, understand what you can negotiate, seek a win-win scenario, and advocate for what you need in order to be successful and fulfilled in the role. Here are a few things to consider as you sit across the table (literally and metaphorically) from your future employer.
Dr. McQuade: Contract Negotiation in Academic Medicine
Know What You Can Negotiate
Key components of a contract include:
- Role and title (title, tenure track vs. non, and track)
- Percent effort division (clinic, research, education, administrative, service)
- Start-up package
- Physical resources (i.e. lab space for a physician-scientist)
- Support staff (clinical, administrative, and research)
- Pay structure (salary +/- productivity bonuses/RVU)
- Benefits (retirement, paid time off, moving expenses, discretionary funds for travel)
You can be up front in asking what is negotiable and what is not. At some state institutions, salary and benefits may be largely fixed and even published. In academics, the majority of your negotiation may be around the elements that will define how you succeed in your chosen path rather than your paycheck.
What Do You Need in Order to Be Successful?
You and your future employer both want to see you succeed, and the negotiation should therefore be approached in a “win-win,” rather than adversarial, light. The book Getting to Yes is a great resource for understanding this concept. Your starting point should be a thoughtful assessment of the time and resources you need to accomplish your career goals and how that fits into fulfilling the mission of the institution and department.
This is easiest to conceptualize for physician-scientists where protected research time, physical lab space, capital equipment, and start-up funds are obviously critical elements to establishing a new lab. Prior to an offer letter, you will likely be asked for your list of needs. It is very helpful to ask someone with a similar lab structure who has recently been through this process if they can share their list.
While the list of needs for a clinical investigator to succeed may in some ways be less tangible, the basic elements of time and resources are no less critical to success on this path. For clinical research, you will be largely reliant on the infrastructure that has already been established; you need to carefully assess if these resources are sufficient. If not, is the department/institution truly committed to investing in and building the research, or are you being asked to build a program without the time and tools to do so? If negotiations stall here, it may be that your values and priorities and those of the institution don’t align. Reassess.
Understand the Whole Package
As far as timeline, you should expect a discussion of what will be in the offer at the second interview and a formal offer thereafter. If the prospective employer gives you the offer in person, go through it section by section together, but don’t react to each section—seek to understand the whole package.
Make a Persuasive “Win-Win” Case
Take the offer and review it with a trusted advisor (or a few!) before responding. What is negotiable? What is missing? Identify your priorities as far as what more you may need, be it time or physical resources.
If the offer does not meet what you need to succeed, frame it that way in your negotiation—remember, the goal is a win-win.
Consider All Your Options
In an ideal world, you would receive multiple offers around the same time and compare them, but often your interviews and eventual offers will be staggered. If you are in that space, don’t try to nail down a final offer with one institution, as your values and priorities may become more clear as you see your other options. Be transparent when you are still waiting on and considering other offers, and ask the institution if they have a definitive timeline for an answer. Align expectations if you will need more time.
Ultimately, this is an exciting time and the culmination of many years of hard work. Remember that the end goal is a structure that enables your career to flourish, a win-win if you and the institution are aligned.
Dr. Watson: Contract Negotiation in Private Practice
Understand the Process
The prospective employer will make the first move. It is not your responsibility to ask, “How much will I get paid?!?”
Once the interview process is complete, “We would like to offer you a job” should be followed promptly with a written contract that outlines the terms of the offer. This will include salary and pay structure, the process for making partner if that is available, and vacation time.
There are some items that will likely not be written in the contract, such as the number of patients per day, number of clinic days per week, and office location for multi-office practices. These are things you need to glean from your interviews, and any quality practice will be very candid about what they expect. If you are not getting a clear answer, ask clarifying questions until you are satisfied.
You will be expected to make a counteroffer, which is often done verbally or by email. If the prospective employer agrees to any changes, you should get an amended written contract to review before signing.
Do Your Homework
When negotiating anything, it is important to have some context. Their opening offer may sound like a lot compared to your fellow salary, but how does it compare to other starting salaries? This is a time to use your network: recent fellow grads from your program, friends you made at the ASCO Annual Meeting, mentors, and program directors from your training program are all good sources of information.
As you consider a counteroffer, it may helpful to know what the more senior members of the practice earn. While it may not be appropriate to ask for this information on your formal interview day, these figures will often be revealed in follow-up, one-on-one conversations. You want to know what your next 30 years will look like.
Before you sign anything, I recommend that you hire a lawyer with experience in physician contracts to review yours. It is worth their fee in the long run.
Know What’s up for Negotiation
Salary, vacation time, partnership track, office location in multi-office practices, signing bonus, protected research time—these are all items that may be on the negotiating table for a private practice position. You need to know what is negotiable. If every partner gets exactly 30 days of vacation a year, you are not likely to get 35. Some hospital-owned practices may have very little wiggle room to change your starting salary, but more flexibility to increase a signing bonus. Most practices may not be willing to give you the corner office on your first day, but if there are resources that are important to you, make them known. Remember, the practice wants to make this work just as much as you do—maybe more!
Play the Long Game
We are not NFL running backs with an average of 3 or 4 good years in our profession. The plan for most of us is to practice for 30 years. You should select a job with that career longevity in mind. For example, most practices with no partner track (i.e. hospital-based practices) will offer a higher starting salary with a lower ceiling. A physician-owned practice may require 2 to 3 years of making less money, but the partner salary could be substantially more. That is not to say that one model is better than another, but it is important to understand the difference.
Understand Your Value
If you only take one piece of advice about contract negotiation, let it be this: You are a hot commodity! If you have been offered a contract, it is because the practice wants to retain your services. A common fear is that by asking for too much, you will offend your future employer and their opinion of you will change. On the contrary, knowing your value and asking that your contract reflect it will, if done the right way, garner respect, not ridicule.
It’s okay to ask for more than you think you can get. One strategy is to ask for more than one thing in your counteroffer. For example, if you would like a 10% increase of your salary, you may consider asking for 15% as well as some additional vacation time. If the employer has said no to one ask, they are more likely to grant you another. Leave some room to align in the middle—it’s that win-win scenario again.
In the end, the goal of negotiating a contract is that both parties get what they want. The negotiation process is not “you versus them,” but rather future teammates agreeing on the terms of their professional partnership. You have invested so much into your education that it only makes sense to be prepared to advocate for yourself as you negotiate your first contract. Remember—you’re worth it!
Dr. McQuade is an assistant professor and physician scientist in melanoma medical oncology at The University of Texas MD Anderson Cancer Center. She is a member of the Melanoma Measures Expert Panel and the Systemic Therapy for Melanoma Expert Panel. Follow her on Twitter @mcquadeMDLAc.
Dr. Watson is a hematologist/oncologist at Virginia Oncology Associates.