Hospital and academic employers make up the smallest portion of jobs for emergency physicians. As I tried to locate hospitals that directly employ their emergency physicians, I was surprised there seem to be so few of them, and that most are concentrated in the northeastern part of the U.S.
Anthony Guarracino, DO, is ED director for Carlisle (PA) Regional Medical Center (now owned by a large health care company). “There was more flexibility with negotiating compensation packages when we were a private hospital,” he noted. “Because we are now part of a large company, there is nothing negotiable when it comes to benefits or standard full-time hours. Moving expenses can be negotiated, though we have a defined maximum, and there is always the potential for a sign-on bonus, but only if a candidate asks for it.”
Like nearly all those interviewed in this series, Dr. Guarracino is turned off by candidates with the “gimmees.” “It's always a trade-off,” he said. “Candidates have to give me something in order to get something more, like earlier access to incentive bonuses.”
As the ED director of Great Plains Regional Medical Center in North Platte, NE, Deborah Weaver, MD, has negotiated emergency physician compensation with the hospital board of directors “because of a specific candidate deal negotiation. The only area where we have some wiggle room is with student loan repayment, with the amount as well as the commitment, an average of three years.”
Hospital benefit plans are not negotiable, and Dr. Weaver said she was turned off during recent recruiting activities by candidates who made unreasonable requests. “With all the benefits, paid time off, stipends, and moving and financial support, what more could they expect?”
A red flag to Dr. Weaver is the candidate who asks for a schedule structured to meet his needs rather than those of the department. “We may be a lower volume (14,000), fairly rural ED, but we still need a top clinical team player. We know a graduating resident will enhance skills here, so no one should think to use our rural location as a bargaining chip.”
In Bennington, VT, Southwestern Vermont Medical Center's ED director, Jeffrey Yucht, MD, said he is always willing to listen. “I'm always interested in hearing what is important to a specific candidate; it gives me additional insight into the person. I look at negotiating a contract as part of the entire interview process.” Dr. Yucht said little is negotiable in his medical center's package, but if a candidate brings more to the table, he may be able to go a little further and invest some salary dollars to help a candidate increase a special skill level. “Give me a reason to give you more, and be specific. A loose, ‘I want more,’ doesn't impress me. Ask for too much and I know you will be a high-maintenance employee, rarely if ever satisfied.”
From the academic sector, Marc Borenstein, MD, the chairman and emergency medicine residency director for Newark Beth Israel Medical Center in Newark, NJ, was not sure he represented the average academic employer because he considers himself more approachable than others. “If someone is talented and the right fit for my department, I won't lose them over a few dollars,” he said.
Dr. Borenstein has a unique approach to hiring. “When it comes to employing new grads, it's the position we're recruiting for more than the candidate,” he said. “That doesn't mean we aren't looking for the right person who is a good fit for our department and who shares our core values. It just means most grads are equal in what they bring to the table, so the emphasis is on filling the position, and then developing the talents of the person we hire. I have to be careful to offer the same salary to everyone so that equal skills and training earn equal packages. But a graduating resident who brings more than usual to the table and asks for special consideration could be accommodated.”
Dr. Borenstein noted that female candidates don't negotiate as aggressively as the male ones. “I think they need to be more assertive,” he said. “I'd like to think that female grads are getting more savvy about the job market, and will be more proactive when negotiating their own deals both now and in the future.”
Jeffrey Schaider, MD, the chairman of the emergency department at John H. Stroger Hospital of Cook County in Chicago, has a different set of circumstances. As a county hospital, the wiggle room is pretty much nonexistent. “The salary is set, so are the benefits and the clinical time. We try to match administrative responsibilities by putting physicians in areas where their interests are as strong as our needs,” said Dr. Schaider, adding that working in the ED at Cook County is “a harder job because it is a county hospital.” As far as negotiating goes, Dr. Schaider emphasized that “the happiest faculty here didn't have to negotiate; they just wanted to be here. It didn't even come up.”
Dr. Yucht provided some sage negotiating advice for grads: “Candidates need to be a wise consumer when shopping for a job, adding all the pieces together and making a decision based on the whole pie.” And more good advice came from Dr. Borenstein: “There is nothing wrong with asking, ‘Is there some flexibility with that offer?’ It is a professional and nonthreatening way to get the process started. If a candidate doesn't bring it up, it doesn't come up. I don't ask someone, ‘By the way, do you want $5,000 more?’”
A new graduate's ability to negotiate is directly linked with what he brings to the table as a candidate, and marketability is directly linked with experience. Once a candidate passes his emergency medicine board examinations and has a few years experience, marketability and ability to negotiate a contract, either with a current employer or with a new one, increase dramatically.
Thanks to all those who participated in this series. Their contributions are greatly appreciated.