Pharmado

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I'm a CA-3 really just getting into the interview process. I will likely take a job 1000+ miles from where I currently live so I can't afford the time off or money to interview many places. That said, I have several upcoming first contact phone interviews with varying group managers or other first contact representatives. My question really comes down to when is the appropriate time to ask about salary, vacation, work hrs etc? I am willing to work hard, but I'd like to get paid for my work and I don't want to come off the wrong way. I also don't want to waste time learning about a sub par job if the salary isn't acceptable. Any help on when is the most appropriate time to ask these important questions would be appreciated.
 

urge

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I'm a CA-3 really just getting into the interview process. I will likely take a job 1000+ miles from where I currently live so I can't afford the time off or money to interview many places. That said, I have several upcoming first contact phone interviews with varying group managers or other first contact representatives. My question really comes down to when is the appropriate time to ask about salary, vacation, work hrs etc? I am willing to work hard, but I'd like to get paid for my work and I don't want to come off the wrong way. I also don't want to waste time learning about a sub par job if the salary isn't acceptable. Any help on when is the most appropriate time to ask these important questions would be appreciated.
I would say as soon as possible. Definitely during the first conversation. The paycheck is the reason why 99.999999% of the population works. I would ask the guy to describe me the job in terms of patients, services, surgeons, etc., and when he is done ask him to describe the benefits.
 
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Definitely early on. I would even say in the phone conversation before an in-person interview. Are you going to take time off, fly 2 hours, only to find out they are paying 250k with 4 weeks vacation? As a new grad they will try to play games with you, but don't let them. After they describe case variety, call schedule, etc...make sure they tell you about pay, benefits, and vacation.
 
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Pharmado

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Thanks. I figured that I should find this out early, before wasting my time or anyone else's, but I wasn't really confident in asking. I've had a couple of opportunities that didn't work out already, and I've been hesitant to risk burning any bridges since. It just so happened that I randomly had someone call me shortly after this post about a job I hadn't actually applied for. I asked all the usual questions before asking about salary, vacation and benefits. I feel much better in evaluating the job knowing what I'm getting myself into. I appreciate all the advice.
 

Notorious T.E.E.

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ASAP. Years ago I thought it was better to wait until an in person interview, and went on a few only to be surprised. As some have mentioned, taking valuable time from work, or burning vacation days, to interview with a job you would never go to because of the low salary isn't productive for either party.
 
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IlDestriero

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Agree with all of the above. There is great variability in groups even within the same city. You're taking the time off and maybe paying for your trip out there. If they can't at least paint the broad strokes, that's a big red flag. We pay well, fair, appropriately, good benefits, equal vacation and call, etc is BS. You'll make 3-400 and partners make significantly more, people average 8 weeks vaca, you'll get 6 to start, call is 1:8. That's the level of detail you should expect, and demand.


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Wiscoblue

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If it's as an employee, then ask up front. If it's a percentage of revenue or a blended unit, then get specifics about average unit value and number of units generated by each Doctor.


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anes121508

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For salaried employees at AMC, what is the appropriate way to negotiate? Email? Telephone? Who do you make the request to? Recruiter who sends the contract? Regional Manager?

How do you make the request for additional salary? State reasons why? Just ask? Ask for exactly what you would like? Ask above what you would like?

This seems like a touchy thing that none of us new grads are really used to.
 

GravelRider

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For salaried employees at AMC, what is the appropriate way to negotiate? Email? Telephone? Who do you make the request to? Recruiter who sends the contract? Regional Manager?

How do you make the request for additional salary? State reasons why? Just ask? Ask for exactly what you would like? Ask above what you would like?

This seems like a touchy thing that none of us new grads are really used to.
I doubt there will be much negotiating room with an AMC...especially as a new grad without board certification yet and no experience. Although, in my limited experience, AMCs are more willing to negotiate than private practices only offering employed positions. You may have more leverage to negotiate if you have a fellowship in an area that they have a big need.

In terms of who to ask, start with whoever sent you the contract. They can direct it from there. I think email is fine in order to lay out a counter offer, but you might get them to hide more perks in the form of "CME" money/time if you get someone on the phone. I always think backing up a proposal with a reason is a good idea. Do you bring a skill that they need? Are you invested in the region the practice is located and more likely to stay? Were you a top percentile on exams and such and have great references?

I wouldn't go crazy asking for way above what they offered because then they won't take you seriously. Ask for things like an extra week of vacation (or CME time), for them to kick in more to your retirement, or maybe a bonus for signing or passing the boards. As a new grad, this first job is very unlikely to be your last job. You'll have more ability to negotiate once you have that certificate on your wall and a few years experience. AMCs know that new grads hop jobs a bit, so that makes them even less likely to negotiate.
 

anes121508

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I doubt there will be much negotiating room with an AMC...especially as a new grad without board certification yet and no experience. Although, in my limited experience, AMCs are more willing to negotiate than private practices only offering employed positions. You may have more leverage to negotiate if you have a fellowship in an area that they have a big need.

In terms of who to ask, start with whoever sent you the contract. They can direct it from there. I think email is fine in order to lay out a counter offer, but you might get them to hide more perks in the form of "CME" money/time if you get someone on the phone. I always think backing up a proposal with a reason is a good idea. Do you bring a skill that they need? Are you invested in the region the practice is located and more likely to stay? Were you a top percentile on exams and such and have great references?

I wouldn't go crazy asking for way above what they offered because then they won't take you seriously. Ask for things like an extra week of vacation (or CME time), for them to kick in more to your retirement, or maybe a bonus for signing or passing the boards. As a new grad, this first job is very unlikely to be your last job. You'll have more ability to negotiate once you have that certificate on your wall and a few years experience. AMCs know that new grads hop jobs a bit, so that makes them even less likely to negotiate.
This is very helpful, thanks.

I like the idea of CME time and bonuses for board cert/tee cert. The only thing is that bonuses are a one time thing and don't contribute to the long term earnings. Sadly, they don't have retirement contribution.

In reply to some to some of the points you mentioned in your post that might help you all guide me or give suggestions:
1. "especially as a new grad without board certification" - I will have taken my oral and echo boards by the start date (passing results will probably be afterwards)
2. "You may have more leverage to negotiate if you have a fellowship in an area that they have a big need" - I'm not sure about the entire area, but the hospital/CT surgeons are demanding a dedicated cardiac call team with TEE cert
3. "Do you bring a skill that they need?" - CT fellowship with very good TEE training at a well regarded program, very comfortable with regional (heavy ortho place in addition to cardiac)
4. Are you invested in the region the practice is located and more likely to stay? - This the home town for my wife and I and a long term move (hopefully)
5. "AMCs are more willing to negotiate than private practices only offering employed positions." - private groups in the area offer less up front, but catch up very quickly and end up higher in the long run
6. "Were you a top percentile on exams and such and have great references?" - top percentile on every ITE/ABA exam, my reference letters are good.

How much do you ask for over initial offer? Sure, I'd love another 100K, but I want to be reasonable. What is a reasonable request that you guys have seen?

What things have you all negotiated into your contract that you are very glad you asked for?
 
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Pharmado

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One of the biggest failures of most AMC's is that they often skip the pre-tax benefits completely. This seems like something that would really sway people away from them, but they don't seem to be suffering for it. The complete lack of retirement contributions with associated long-term tax free benefits really hurts the overall package if you are looking at things long term.
 
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BLADEMDA

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This is very helpful, thanks.

I like the idea of CME time and bonuses for board cert/tee cert. The only thing is that bonuses are a one time thing and don't contribute to the long term earnings. Sadly, they don't have retirement contribution.

In reply to some to some of the points you mentioned in your post that might help you all guide me or give suggestions:
1. "especially as a new grad without board certification" - I will have taken my oral and echo boards by the start date (passing results will probably be afterwards)
2. "You may have more leverage to negotiate if you have a fellowship in an area that they have a big need" - I'm not sure about the entire area, but the hospital/CT surgeons are demanding a dedicated cardiac call team with TEE cert
3. "Do you bring a skill that they need?" - CT fellowship with very good TEE training at a well regarded program, very comfortable with regional (heavy ortho place in addition to cardiac)
4. Are you invested in the region the practice is located and more likely to stay? - This the home town for my wife and I and a long term move (hopefully)
5. "AMCs are more willing to negotiate than private practices only offering employed positions." - private groups in the area offer less up front, but catch up very quickly and end up higher in the long run
6. "Were you a top percentile on exams and such and have great references?" - top percentile on every ITE/ABA exam, my reference letters are good.

How much do you ask for over initial offer? Sure, I'd love another 100K, but I want to be reasonable. What is a reasonable request that you guys have seen?

What things have you all negotiated into your contract that you are very glad you asked for?
Typically, in terms of money the MAC may go up another $25-$50K (you will need to actually have those certifications in hand with at least one year experience) during negotiations.

Year 1: $325 plus $25K bonus
Year 2: $350 plus $25K bonus
Year 3: $375 plus $25K bonus
Year4: $400 plus $25K bonus

I doubt they go as high as year 4 but it is definitely worth a shot and I believe "fair" compensation after 4 years is at least what I have posted.

Bonuses do contribute to long term earnings but you have to be employed the entire year to get them. AMCs retirement plans are terrible so I think more new grads with fellowships should be demanding a package like I have posted above or simply not signing up with them.
 

anes121508

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One of the biggest failures of most AMC's is that they often skip the pre-tax benefits completely. This seems like something that would really sway people away from them, but they don't seem to be suffering for it. The complete lack of retirement contributions with associated long-term tax free benefits really hurts the overall package if you are looking at things long term.
I know it's terrible. I'd rather have the money in a retirement plan than in salary getting taxed.
 

GravelRider

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This is very helpful, thanks.

I like the idea of CME time and bonuses for board cert/tee cert. The only thing is that bonuses are a one time thing and don't contribute to the long term earnings. Sadly, they don't have retirement contribution.

In reply to some to some of the points you mentioned in your post that might help you all guide me or give suggestions:
1. "especially as a new grad without board certification" - I will have taken my oral and echo boards by the start date (passing results will probably be afterwards)
2. "You may have more leverage to negotiate if you have a fellowship in an area that they have a big need" - I'm not sure about the entire area, but the hospital/CT surgeons are demanding a dedicated cardiac call team with TEE cert
3. "Do you bring a skill that they need?" - CT fellowship with very good TEE training at a well regarded program, very comfortable with regional (heavy ortho place in addition to cardiac)
4. Are you invested in the region the practice is located and more likely to stay? - This the home town for my wife and I and a long term move (hopefully)
5. "AMCs are more willing to negotiate than private practices only offering employed positions." - private groups in the area offer less up front, but catch up very quickly and end up higher in the long run
6. "Were you a top percentile on exams and such and have great references?" - top percentile on every ITE/ABA exam, my reference letters are good.

How much do you ask for over initial offer? Sure, I'd love another 100K, but I want to be reasonable. What is a reasonable request that you guys have seen?

What things have you all negotiated into your contract that you are very glad you asked for?
It sounds like you have some good reasons to be able to negotiate. There was a feature on the Doximity website that showed average salaries for a specialty in a given region. There are other websites with similar information. You can use that as a guide. I wouldn't try to ask for 100k more than what is average for an area, but at least make sure their offer is competitive. Instead of bonuses, you can maybe try asking for raises that are contingent upon you getting certified. So, you are basically laying out a case for them showing them why you are a good candidate to keep around and using data available online to show what you are worth. You should also make sure your workload is very clearly spelled out and how you are compensated for working more.
 

pgg

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Were you a top percentile on exams and such and have great references?
Curious, do you put your ITE %ile on your CV or do you trust those references to bring it up?
 

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Curious, do you put your ITE %ile on your CV or do you trust those references to bring it up?
I haven't, unless asked. I assume my program director does when they speak to him because he put a lot of weight into the tests.
 

anes121508

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Typically, in terms of money the MAC may go up another $25-$50K (you will need to actually have those certifications in hand with at least one year experience) during negotiations.

Year 1: $325 plus $25K bonus
Year 2: $350 plus $25K bonus
Year 3: $375 plus $25K bonus
Year4: $400 plus $25K bonus

I doubt they go as high as year 4 but it is definitely worth a shot and I believe "fair" compensation after 4 years is at least what I have posted.

Bonuses do contribute to long term earnings but you have to be employed the entire year to get them. AMCs retirement plans are terrible so I think more new grads with fellowships should be demanding a package like I have posted above or simply not signing up with them.
Something like this is exactly what I was thinking. The offer of base salary is high for year one, but my understanding is that unless you negotiate something similar to what you proposed, it never moves. I'd honestly rather take 20-25KK less than their offer in the first year in exchange for an increasing salary scale over the course of several years.

How would would you determine the bonus? Maintenance of TEE certification? Quality metrics?
 

BLADEMDA

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Something like this is exactly what I was thinking. The offer of base salary is high for year one, but my understanding is that unless you negotiate something similar to what you proposed, it never moves. I'd honestly rather take 20-25KK less than their offer in the first year in exchange for an increasing salary scale over the course of several years.

How would would you determine the bonus? Maintenance of TEE certification? Quality metrics?
Typically, it's internal quality metrics but in certain cases I could see TEE Certification as something they would view as beneficial.
 

Notorious T.E.E.

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Interesting question, I never did. Figured in the real world people don't really give a shi** what you got.
I don't think we have ever used exam percentile to choose one candidate over another. Honestly, when I see it on a CV it comes across as a little arrogant, but this is medicine so a little arrogance comes with the territory. Maybe it's just because my scores were never something to brag about....
 

BLADEMDA

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I don't think we have ever used exam percentile to choose one candidate over another. Honestly, when I see it on a CV it comes across as a little arrogant, but this is medicine so a little arrogance comes with the territory. Maybe it's just because my scores were never something to brag about....
Leave your exam scores out. Instead, emphasize affability, availability and team work on the interview. If you must "boast" about being smart it shows insecurity. That said, an inoffensive way to put it on your CV is "top 1/4 on all ITE exams" as that is more than adequate. I find work ethic and affability to be way more important in private practice than ITE scores.
 

kidthor

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Yeah... exams scores? We aren't pre-meds anymore.
 

GravelRider

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Leave your exam scores out. Instead, emphasize affability, availability and team work on the interview. If you must "boast" about being smart it shows insecurity. That said, an inoffensive way to put it on your CV is "top 1/4 on all ITE exams" as that is more than adequate. I find work ethic and affability to be way more important in private practice than ITE scores.
I've been asked by academic places. A high level academic place where you are working with residents and possibly helping them prepare for exams might care. Know who you are applying to. NAPA just wants a warm body, but an academic place might want someone who has a good knowledge base.
 

AdmiralChz

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I put my scores in my CV almost reflexively without really thinking about it, but my USMLE scores are on there as well for inquiring minds. Maybe too much, but I don't think it has really helped or hurt me at all. When I revamp it I may take them out.

Very important to include a pass on the ABA BASIC exam on your CV.
 

pjl

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I put my scores in my CV almost reflexively without really thinking about it, but my USMLE scores are on there as well for inquiring minds. Maybe too much, but I don't think it has really helped or hurt me at all. When I revamp it I may take them out.

Very important to include a pass on the ABA BASIC exam on your CV.
For the love of all that is holy, dont put USMLE scores on a private practice CV. May as well put high school GPA and note that you were captain of the mathletes. Nobody cares. If you simply must put scores down, throw in the ITE %, but really, most of us care a lot more about how well you work with people. It is assumed that you are a great clinician based on where you did residency/fellowship. What is less easy to decide on is personality, which is where the LORs and our contacts come in.

A 10% boost over offered salary will be inoffensive, but likely will not be granted unless you are especially qualified. The poster above is special enough to warrant a salary above the standard starting, in my mind.
I would give them an extra 25-50k first year, only if they asked.

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Less is more in a CV. Keep it to one page if possible.

Saw this one CV before I left my previous practice in July from interview candidate and it was 10 pages long. It even listed the percentage of cases he does solo (we do our own cases 50% of the time and all cases solo on call). So that does help to see they aren't a preop scut monkey.

But the added stuff (like usmle scores, percent tile on in training from 7 years ago as a ca-3!). He needed to delete that stuff. It's like he kept adding to original CV when he finished in 2011 from fellowship.
 
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Wiscoblue

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One of the guys that we hired had a personal interests paragraph on his CV. He likes to golf and he brews beer. He got hired. We like to hire folks that have a life outside of work.


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