Can you Negotiate Residency Salary?

[overit]

Can you negotiate residency salary? Are there any NRMP rules stating anything like you have to be given a copy of a sample contract and or estimated salary at your interview? In this regard, are there any rights afforded to applicants with regards to salary, disclosure of salary or contract terms or anything along those lines?

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[cabinbuilder]

Seriously doubt it because your salary is allotted by CMS, not the residency program.

 

[overit]

Seriously doubt it because your salary is allotted by CMS, not the residency program.

CMS probably funds the majority of programs but there are many programs that are not CMS funded. For example many County based programs do not get their funding from CMS. Just because money comes from CMS, I don't see how that would absolutely preclude you from negotiating anything. Any insight out there from anyone who has tried or with more knowledge.

 

[NotAProgDirector]

In general, you cannot negotiate for your salary. Residents are usually hired by the GME office (rather than the department in which you are training), and the GME office uses a standard PGY level payscale -- so all PGY-3's are paid the same. Occasionally some programs will offer stipends above the GME pay scale -- I remember one program doing this but not allowing moonlighting (they argued that they would simply pay you more, and then you don't moonlight).

You absolutely should be shown the contract at your interview (or earlier if that would help you decide to interview or not), and all programs should disclose what the current PGY salaries are. Resident salaries are often adjusted in July, so your actual salary may be slightly different than the salaries that current PGY-1's are getting (but usually are a bit higher).

You should get a raise with each PGY increase.

Almost all programs will post salaries right on their websites.

Comparing actual benefit packages can be more difficult. How much you pay for your health care. Is parking included? Is there a retirement plan? But this is no different from any other job. All of this should be disclosed by programs. It's not anything we have any control over, since it's usually decided by the GME office.

 

[Raryn]

Seriously doubt it because your salary is allotted by CMS, not the residency program.

CMS pays the hospitals between $100k and $150k per resident. How much of that goes to the resident salary as opposed to resident benefits, program administration, and subsidizing any inefficiencies caused by having residents is completely up to the hospital.

That said, every hospital pays all the residents on the same scale, with the only variable being PGY year and whether or not you're a chief resident. Fellows are a bit more complicated, especially if they're in a non-ACGME accredited fellowship.

 

[Law2Doc]

Can you negotiate residency salary? Are there any NRMP rules stating anything like you have to be given a copy of a sample contract and or estimated salary at your interview? In this regard, are there any rights afforded to applicants with regards to salary, disclosure of salary or contract terms or anything along those lines?

You can't negotiate salary -- everyone in the same PGY year at the hospital gets the same. In fact you don't have much leeway to negotiate anything in your contract. You get a copy of your contract when you are given one to sign. There is no ACGME rule that says you can have one before, but some programs do give samples anyhow. Estimated salaries are estimates. They reserve the right to change them. Every resident could give you a ballpark at their program. Many programs will tell you the salary up front, but the differences within different cities is not usually large enough to base a decision on.

 

[Raryn]

You can't negotiate salary -- everyone in the same PGY year at the hospital gets the same. In fact you don't have much leeway to negotiate anything in your contract. You get a copy of your contract when you are given one to sign. There is no ACGME rule that says you can have one before, but some programs do give samples anyhow. Estimated salaries are estimates. They reserve the right to change them. Every resident could give you a ballpark at their program. Many programs will tell you the salary up front, but the differences within different cities is not usually large enough to base a decision on.

There is most certainly either a ACGME or an NRMP rule that everyone who interviews at a program has to be given access to a copy of the programs contract, either via hard copy or on the programs website.

I think it's NRMP, but programs have to abide by it either way.

 

[Anon212]

It also ultimately doesn't matter. When you sign up for Match, you sign a contract with the NRMP that says that no matter what you get on Match day, you're gonna put up and shut up, so to speak. Due to the nature of the Match, you don't even get to choose where you go, much less how much you'll make when you get there. So you may end up at the place that pays its PGY1's 45k a year or the place that pays them 65k a year (that's pretty much the broadest pay differential I had among my choices). You have no negotiating power after Match because you're already locked in at that point.

It's sort of absurd when you explain it to people who are not in medicine. Yup, I have an advanced, professional degree. Yup, I'm over 100k in debt. Actually, I don't know where I'll be working next year- I find out in a letter- in fact I may not have a job at all and be totally SOL. If I do have a job, I may be working near home or be relocating to rural Kansas or be living in urban Detroit. How much am I getting paid, what are my benefits etc? No idea. I guess they'll tell me when I get there. Hopefully above minimum wage. For what it's worth, they are required to show you a copy of the contract or at least the salary/benefits at your interview day nowadays (some places make you sign a piece of paper that says you've seen them) but again, given the nature of Match it doesn't matter all that much.

 

[Anon212]

You can't negotiate salary -- everyone in the same PGY year at the hospital gets the same. In fact you don't have much leeway to negotiate anything in your contract. You get a copy of your contract when you are given one to sign. There is no ACGME rule that says you can have one before, but some programs do give samples anyhow. Estimated salaries are estimates. They reserve the right to change them. Every resident could give you a ballpark at their program. Many programs will tell you the salary up front, but the differences within different cities is not usually large enough to base a decision on.

You'd be surprised. For EM at least, I applied to a mix of academic/ community/ county programs. The salary differential of ~20k/ year I encountered was within one city. Not that I think that should be a huge factor in making a decision or anything- it wasn't for me- but the difference is there.

Edit: just double checked for accuracy. Difference is actually ~16k in the same city. Still. I rest my case.

 

[survivordo]

The best way to "negotiate" your salary is to preferentially rank programs with higher salaries. As others have stated, these can vary considerably between programs. Several programs I applied to offered housing stipends or discounted housing to residents. These are important to consider as well.

Survivor DO

 

[235009]

You absolutely should be shown the contract at your interview (or earlier if that would help you decide to interview or not)

what exactly should i have been looking for in the contract? to be honest i got a copy of the contract from every program i interviewed at and never looked at a single one. in fact i haven't even read the contract for the program i matched at...what's the point really?

 

[Law2Doc]

The best way to "negotiate" your salary is to preferentially rank programs with higher salaries. As others have stated, these can vary considerably between programs. Several programs I applied to offered housing stipends or discounted housing to residents. These are important to consider as well.

Survivor DO

However sometimes the most prestigious places in certain specialties are at hospitals that pay the least. You'd be silly to decrease your marketability or fellowship prospects to get an extra couple of K in salary during residency.

 

[Law2Doc]

what exactly should i have been looking for in the contract? to be honest i got a copy of the contract from every program i interviewed at and never looked at a single one. in fact i haven't even read the contract for the program i matched at...what's the point really?

Agree there's not much point. They can put whatever they want in there, and people will just shrug heir shoulders and sign. You have no real leverage to negotiate so it sort of a joke. You are already bound to go there based on the match.

And this is from a lawyers perspective.

 

[Impromptu]

You have no control over your salary. Our university even decided to rescind the contracts we and they had already signed and force us to sign new contracts for $1000 less a year. They blamed Obama.

On the plus side, we are not a low tier salary, and our benefits package is great, with full health insurance for me and all my dependents. In-network PCP co-pays $0, specialist co-pays $10, ER visits $75, surgeries $50, and so forth. Other places just offered reduced rates on health insurance, or would pay for me but not my dependents, and co-pays were generally higher.

Your health insurance benefit is probably the one that will affect your bottom line more than any other.

 

[Paddington]

Negotiate? Salary? In residency?

Yeah, just try this, bro:

[YOUTUBE]l91ISfcuzDw[/YOUTUBE]

You could get William Shattner in on it:

See how quickly the Program Director replaces you with one of a thousand unemployed MD scutmonkeys whose resumes are sitting on his desk.

 

[mbe36]

No.

 

[cpants]

Your residency salary is basically a take it or leave it thing. You have two chances to not accept the salary a place is offering. First, you can choose not to rank a program if you aren't willing to work for the money offered. Second, you can choose not to sign the contract after you match. However, you will be ineligible to work as a resident elsewhere if you choose option two. It's pretty transparent. I saw a copy of salary schedule at pretty much every interview I went on and most places have it on their website as well. After you have already entered a contract to accept the salary by ranking the program, you can't really expect to negotiate after the fact.

Negotiation is possible collectively. Many places have resident unions or organizations which have negotiated better pay and benefits. Get involved if you aren't happy with your pay.

 

[Law2Doc]

...

Negotiation is possible collectively. Many places have resident unions or organizations which have negotiated better pay and benefits. Get involved if you aren't happy with your pay.

while I have heard of this I wouldn't use the word "many". It's actually very rare and regional.

 

[dynx]

Negotiation is possible collectively. Many places have resident unions or organizations which have negotiated better pay and benefits. Get involved if you aren't happy with your pay.

This.
and a couple other things:
1. Not all folks of a certain PGY level get the same pay at all hospitals. The pay scale is the same BUT i've been in hospitals where a certain dept. of residents gets their **** together and negotiated for overtime pay. Anesthesia in one and radiology in another. So its possible, but if you're an individual going it alone...you're pretty much screwed.
2. Nobody MADE the above poster resign a contract for 1000 less. Your guys just collectively decided to bend over and take it. If you had stood together as a group and said NO that was a fight you would have won hands down.

Where I did my residency we went with the flow, but at one point the administration tried to pull some crap that amazingly got EVERY one in the surgery program pissed at one time. We all sat down and said no more trauma coverage, no more ICU coverage you can page the attending and you can go f*ck yourself if you don't like it. The attendings flipped, we had a meeting with the CEO the next week and ALL stuck with the script, and the problem was solved by friday. They can replace anyone of you with a snap, but they can't replace all of you at the same time. Its amazing what you can do together but nobody does...wish we had asked for more pay.

the problem is medical school admission folks and the process of medical school is moving/has moved to finding/creating the most educated pansies they can. Why do they look for bleeding hearts that think they want to serve in rural uganda and when they've finally given all they can give crawl up on a cross and die? Because those people are suckers and will happily be f-d by the system for the rest of their career.

 

[Law2Doc]

This.
and a couple other things:
1. Not all folks of a certain PGY level get the same pay at all hospitals. The pay scale is the same BUT i've been in hospitals where a certain dept. of residents gets their **** together and negotiated for overtime pay. Anesthesia in one and radiology in another. So its possible, but if you're an individual going it alone...you're pretty much screwed.
2. Nobody MADE the above poster resign a contract for 1000 less. Your guys just collectively decided to bend over and take it. If you had stood together as a group and said NO that was a fight you would have won hands down.

Where I did my residency we went with the flow, but at one point the administration tried to pull some crap that amazingly got EVERY one in the surgery program pissed at one time. We all sat down and said no more trauma coverage, no more ICU coverage you can page the attending and you can go f*ck yourself if you don't like it. The attendings flipped, we had a meeting with the CEO the next week and ALL stuck with the script, and the problem was solved by friday. They can replace anyone of you with a snap, but they can't replace all of you at the same time. Its amazing what you can do together but nobody does...wish we had asked for more pay.

the problem is medical school admission folks and the process of medical school is moving/has moved to finding/creating the most educated pansies they can. Why do they look for bleeding hearts that think they want to serve in rural uganda and when they've finally given all they can give crawl up on a cross and die? Because those people are suckers and will happily be f-d by the system for the rest of their career.

You can do a "go F yourself" move once as a group, on a relatively minor cost issue, and probably have a shot at success. you do it more than once or force them to open their checkbooks in a big way, and they will replace you. Also if they really wanted to play hardball, they could identify one or two people as instigators and fire them, ostensibly for patient care issues, and all your compatriots would fold like a cheap deck of cards.

 

[Gasworks]

This is why residents have unions. Way back when I was on the interview trail there was some 10-15k difference in pay between CIR and non-union hospitals. One program that I didn't even rank due to their unbelievable $39k pgy1 salary shot up to $51k 2 years later after CIR stepped in to negotiate on behalf of the residents. Where I trained (anesthesia) we had a staffing shortage and were able to pick up weekend crna shifts for $30/hr. Quite the slap in the face considering they would pay a nurse double to cover the same shift but a nice way to make some extra change nonetheless. For the record, this was shot down by the PD, chair and vice-chair but after a dozen of us had a meeting with the dean of the med school he was able to push it through almost overnight.

 

[dynx]

You can do a "go F yourself" move once as a group, on a relatively minor cost issue, and probably have a shot at success. you do it more than once or force them to open their checkbooks in a big way, and they will replace you. Also if they really wanted to play hardball, they could identify one or two people as instigators and fire them, ostensibly for patient care issues, and all your compatriots would fold like a cheap deck of cards.

I don't think you'll push through a 100 million dollar issue for sure but our beef easily cost the hospital in the 6 figure range closer to 1 million than 100k. Not big money but not chump change and for residents, a big difference.

And firing a resident takes time. They will threaten to fire you for sure. But if they just up and fire you one day without a file and documented episodes and evaluations they'd be f*cked. Sure they could start the process and 6-12 months later you're out of there but that doesnt quite have the chilling effect of pack up your desk and get out.

The threat alone would clearly make many fold, its what keeps things like this from happening 99% of the time and from the tone of your post....I can clearly see they'd have you quaking so you're right, not a typical moment when residents all find thier balls and stick together.

 

[Law2Doc]

I don't think you'll push through a 100 million dollar issue for sure but our beef easily cost the hospital in the 6 figure range closer to 1 million than 100k. Not big money but not chump change and for residents, a big difference.

And firing a resident takes time. They will threaten to fire you for sure. But if they just up and fire you one day without a file and documented episodes and evaluations they'd be f*cked. Sure they could start the process and 6-12 months later you're out of there but that doesnt quite have the chilling effect of pack up your desk and get out.

The threat alone would clearly make many fold, its what keeps things like this from happening 99% of the time and from the tone of your post....I can clearly see they'd have you quaking so you're right, not a typical moment when residents all find thier balls and stick together.

They already likely have documentation they need to fire most residents. That is why they collect semi annual reviews and the PD meets with you twice a year to discuss things you ought to improve. Everybody has some paper in their file that could be used if needed. And they could just tell someone they aren't going to be renewed. That has adequate chilling effect and doesn't take six months.

 

[Law2Doc]

This is why residents have unions...

not in most of the country they don't.