Emergency medicine residents who recently entered the job market or will soon frequently ask me which parts of the employment package are negotiable. For answers, I went to a variety of hiring sources. Contract groups come in all sizes and differ greatly in management style and compensation formulas, but I learned that negotiating with a contract group can be based on the concept that size matters!
Because emergency medicine is a competitive market, a great deal of negotiating power depends on supply and demand and geographic location, according to David Hexter, MD, the director of the Delmar Emergency Specialists at Union Hospital in Elkton, MD. In Dr. Hexter's one-site, truly democratic group, every physician acquires partnership from day one. “It's a matter of open books,” he said. “What goes for one has to go for all.”
He said he believes that smaller, truly democratic groups are prevented from entering into significant physician contract negotiations because of the open-books policy. “Everyone knows if someone gets a special favor.”
Norman Label, MD, the president of Emergency Physicians' Medical Group in California, also subscribes to the supply-and-demand scenario of negotiating. With his group of sites in the Sacramento area, “the compensation is what the compensation is.” Because of the popularity of the group's geographic region, they do not front interview expenses for candidates. He said the average graduating resident requires six months to a year of re-training. “So why pay more for that?” he asked. Beyond compensation, Dr. Label said his group offers physicians long-term job satisfaction. Oliver Twist-inspired candidates all generate the same reaction from Dr. Label: “When I hear, ‘I want more,’ I respond with, ‘Good luck!’”
Most smaller groups don't negotiate packages for recent emergency medicine graduates
Even newly established small groups like Comprehensive Emergency Solutions at Methodist Medical Center in Peoria, IL, have issues with providing wiggle-room when it comes to graduating resident contracts. CES was recently created from a larger, regional group, and its CEO, Elsburgh Clarke, MD, the chairman of emergency medicine at Methodist, focuses on keeping compensation upfront and fair. “If a group is really democratic and equal, then everyone should get the same base salary,” Dr. Clarke said. “It's the incentives that separate the men from the boys! The hospital even got involved with designing the incentive income formula because the hospital wants our new group to succeed.” Dr. Clarke noted that when he first graduated, the rate was $34 an hour and non-negotiable.
Part 1 in a Series
Richard Sullivan, MD, the assistant medical director of Jefferson Regional Medical Center's Emergency Physicians of Pittsburgh, takes a stand similar to Dr. Label's. “The most important thing about hiring a new physician is that the group come to a consensus as to a candidate's value,” he said.
His group offers a strong compensation package, but noted that they have to dedicate a lot of time getting new graduates up to top form. “I prefer they work slower, and work on rapport with nurses, patients, and families. Their productivity will pick-up in six to nine months.”
Dr. Sullivan said negotiating is extremely limited for the graduating resident who offers just the required training. He admits he wouldn't rule out some latitude for a superstar who brings more than that to the table.
Also in agreement with this theory is Cyril Walsh, MD, the medical director of Appleton Emergency Physicians in Appleton, WI. “We have a really good package, and the group has thought about it in great detail, so for a graduating resident, the answer is nothing is negotiable. We negotiate as a group, having gone from hospital employee to group status less than five years ago. So, new hires have to be successful.”
When Dr. Walsh's group looks at graduating resident candidates, they gauge where they expect them to be in five, 10, and 15 years. “That's where the difference is,” he said.
Of all the small group hiring authorities I interviewed, the Ohio-based Emergency Medical Consultants of Lorraine County was the most open to negotiating an incentive package for a graduating resident. Daniel Walsh, DO, the president and medical director, said his group provides ranges of base compensation to allow for different ranges of candidate quality, along with incentives and partnership. He has been known to go the extra mile to keep from losing an exceptional candidate. “If the group puts something extra in the pot, we expect to get extra from the candidate,” he said.
But generally, most smaller groups don't negotiate packages for recent emergency medicine graduates. For those willing to take the bull by the horns, Dr. Walsh provides some sage advice: “Never be afraid to ask. You may be surprised at the answer. But if you overdo it, you can give the impression of never having enough. Negotiate soft issues, those things that make life easier. Don't keep adding requests throughout the interview/negotiating period. Figure out what's most important and stick with it. You only get one shot, and the best one is while they see the pen in your hand, and you say, ‘I'm ready to sign, but I need this.’ If you get the nod, just handwrite it into your contract and have both parties initial it.”
Next month: Negotiating with the larger regional and national contract groups.