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Simone's OncOpinion: Physicians as Job Negotiators

Simone, Joseph V. MD

doi: 10.1097/01.COT.0000407726.80548.f2


Recently I gave a seminar via the Internet (webinar) entitled, “Fundamentals of Negotiating—Tips for Fellows to Mid-Career Faculty.” Some members of the American Society of Pediatric Hematology-Oncology had felt unprepared for negotiating the terms of a new job or for an improved arrangement or pay in an existing job. The topic of negotiation is an important one for physicians at all levels. How to do it, and what to negotiate, are key discussion and teaching points. I was asked by the ASPHO Professional Development Committee to address this issue. About 80 ASPHO members signed up to participate.

Most of my talk was based on several simple principles of preparation (preparation! preparation!), approach, and technique. I will summarize the talk and add some material that came from the submitted questions. I will later address the significant interest from applicants in how to negotiate improvement in their current jobs.

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Being Invited to Look at a New Job

First, the nuts and bolts of being invited to look at a new job—I do this to provide a framework and timeline for the steps in the process I will later recommend.

A common sequence (it is not this way in all cases) starts by receiving an invitation to visit an institution to consider a job opening there. Sometimes considering the job is implied rather than explicit and is couched in an invitation to give a seminar. In either case, it is common to be asked to make a relevant presentation.

This first visit is an opportunity to meet as many people in your own specialty who would be colleagues if you went there. It is very important to obtain their contact information so you may ask questions or clarify issues after you leave. You may be asked if you would consider a move, and it is OK to say you are not sure or “yes, if the job turns out to be a good opportunity.” However, do not commit to anything. This visit is a “freebie;” you incur no obligation to take the job or even explore it further.

If you are invited for a second visit, this should be taken seriously—only accept the invitation if there is a real possibility of a move. So get a sense from your spouse if there are any serious negative feelings about it before you accept the invitation. On this visit (or the next), your spouse is often invited as well; typically, you look at housing and schools, and you may receive an informal offer orally. Negotiating may begin informally, but be prepared and do not commit to anything at this point. You must have a detailed written offer to consider the job seriously.

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Start Doing Your Homework

Once you agree to the visit, you must start doing your homework in earnest beforehand. You must prepare to give a coherent vision of your short- and long-term goals and describe what value you bring to the institution. It will be important to practice describing this vision, preferably with a colleague in your present institution.

You also must gather as much information as possible about the recruiting program (in this case, hematology-oncology). Is it a high-quality program with a good reputation and a respectable grant and publication record? Are the clinical and support facilities ample (labs also, if relevant to you)? Is the clinical effort well organized and well staffed? Is the volume sufficient for clinical research? Are the clinical loads of future peers reasonable? Is there a good nurse practitioner program?

Sources for information include your current boss or other senior faculty (keep in mind that if they want to keep you they may try to dissuade you in their own interests, not yours). Fellows and faculty in the offering institution are good sources, as well as the websites of the department or division and web searches of individuals there to judge productivity and tone of the program.

Get salary ranges, if possible, in your current institution and potential future institution. This is not always easy, so you may also go to the Association of American Medical Colleges, or, in this case, ASPHO; both periodically publish salary ranges for the various ranks. But keep in mind that these are not binding, and some are often lower than reality because they do not include clinical or other incentives or bonuses.

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Financial Needs

You must also investigate what the financial needs of your family are. What is the cost of living in the new city compared with your current one? Do you have special financial needs—e.g., a chronically ill or handicapped child, loan repayments? What is the cost of housing, insurance, and commuting to work and schools in the new environment? All of these and more will influence your family's financial needs.

Have a good idea of what you will need to earn for your family to be comfortable and why you need that much (loans, chronic illness, etc.). Have in mind both a deal-breaker salary—i.e., one so low you cannot accept the job—and a deal-maker salary—i.e., one that meets or exceeds your calculated needs.

Some of this research will be undertaken on the second (or later) visit. You should have detailed discussions with persons in the program face to face or by phone (not by email, in which they may be less candid). Have promises been kept concerning workload and academic time? Has the environment been productive for those at your level? How is your future boss to work for? Is he or she always on the road? Try to have as much actual data as possible, which puts you in a stronger negotiating position.

If you plan to carry out laboratory research, be prepared. Don't underestimate the time you need for your lab work to be grant-competitive. Starting out with a few months to work 100% in the lab will help you get a good start. Do not break up your day—e.g., half day in the lab and another half in the clinic, but have days set aside for one or the other. In a split day, both will suffer. Be certain there are lab scientists there that work in your general scientific area; if you are a junior faculty member try to identify and hook up with a lab mentor; without either, failure is more likely.

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Written Offer

You now have a written offer in hand. Study the specifics and see if anything is missing. Are your duties and responsibilities and the time required to carry them out well clearly defined? Are salary and benefits clearly described? Is the offer for tenure track, clinical track, or a contract arrangement? What are the requirements for promotion?

There likely will be subsequent negotiation, which may occur face to face or electronically. They want you so soak it in, take notes, and ask for clarifications if needed. Ask questions, but give few opinions at this point (“I will need to think about that”), unless you are rock solid sure of something. If you have done your homework and have data, you should feel confident that you know the landscape and possibilities, and know what the deal breakers are for you.

Be confident but not cocky. Don't be afraid to say, “I don't know” or “I don't understand” or “That might be a problem.” Never say, “It's up to my spouse.” This is a very off-putting excuse. If you and/or your spouse do not want to go there for any reason, your response should be, “It is just not a good fit for me/us at this time” or “We have come to realize that we are very happy where we are.”

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Final Negotiations

Now that they want you and you want the job, the final negotiation begins. Notify them that you want the job but need changes in the offer—salary, workload, duties, lab setup, etc.

Many terms are negotiable, but some are not because they are hard-wired in the institutional regulations—e.g., insurance or promotions policy. They may say I can give you A and B, but not C or D. Only you can decide how important C or D is to you compared with how badly you want the job.

Keep in mind that you are in the strongest position to bargain before you sign the acceptance. Once you sign, it is over, so push for what you must have. For something critically important and vital to your success, don't count on a response of “maybe next year when finances are better.”

Most important, you must have confidence in your new boss and institution to treat you well and fairly and help you along. If that confidence is lacking, do not take the job and move on (gut feelings are important barometers).

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Getting a Better Deal Where You Are

What about those who do not want to move but want to better their situation? This was a common question in the webinar and almost always revolved around an “inadequate salary.” In some programs, the leader has an annual “career assessment” meeting with faculty. If so, what I will say can be done at that meeting. If not in your case, I suggest you request such a meeting AFTER you have done all the preparation and research that I have noted above.

You state that you want to meet to ask for advice on your career development. You are concerned that you are not growing professionally and this is reflected in your inadequate salary. What can you do to improve both?

This is a hard thing for many people to do. You fear angering the boss and being worse off. But if he declines to change anything, you must push for an explanation.

If you absolutely do not want to move, you may have trapped yourself. If that is the case, I suggest that you still look at other jobs (one visit only) to get a sense of your value to others and to see what the landscape is out there. Preferably, this should be done before you have your meeting as part of your preparation, but it could be done after. You cannot sit tight and wish for something good to happen.

If things are bad enough, your only option is to move or change your career path (pharma, health care administration, etc.).

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Traps to Avoid

  1. They really only want you to carry a large clinical load—clues include the amount of on-service and clinic time and grousing faculty about no academic time (some always grouse, so this is a valid clue only if it's widespread).
  2. You and/or your spouse love the geographic location (San Diego, hometown, etc.) so much that you don't question the key professional issues and push hard for what you must have to succeed and live comfortably.
  3. The institution's stature is impressive so, once again, you do not adequately question the key professional issues critical to your personal development.

More tips about jobs and job changes can be found in “Understanding Academic Medical Centers: Simone's Maxims,” available at Simone

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Webinar Online

The full webinar of Joe Simone's “Fundamentals of Negotiating” is now online at (Education/Webinars)

© 2011 Lippincott Williams & Wilkins, Inc.
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