General principles of negotiating your first job post-residency?

peppy

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Does anyone have any general advice about the types of things it is reasonable to ask for in negotiations for a first job out of residency/fellowship? (I know that the specifics depend on where exactly you are looking, but I would appreciate some guidance so I just don't look ridiculous in what I am asking for)

I assume that the things that are open to negotiation are different if you are looking at an academic job vs. a private hospital organization. Correct?

For example, if you are working for a place that offers you a salary, I would of course expect you would want to focus on asking for more in terms of salary. But what about a place where the compensation is mostly/entirely based on RVUs? Are there certain benefits that I might not think of asking for that I should?
 

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Do they pay you for Board Certification? I felt very fortunate that my organization picked up the tab for those exams (as well as my current recertification).
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nancysinatra

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Does anyone have any general advice about the types of things it is reasonable to ask for in negotiations for a first job out of residency/fellowship? (I know that the specifics depend on where exactly you are looking, but I would appreciate some guidance so I just don't look ridiculous in what I am asking for)

I assume that the things that are open to negotiation are different if you are looking at an academic job vs. a private hospital organization. Correct?

For example, if you are working for a place that offers you a salary, I would of course expect you would want to focus on asking for more in terms of salary. But what about a place where the compensation is mostly/entirely based on RVUs? Are there certain benefits that I might not think of asking for that I should?
Well, everything depends on your local market. But if you are going to start a job where compensation is based on RVUs, and if you are being offered a minimum salary the first year or so, then I recommend asking to have it put in writing that the RVUs will be reconciled against salary after the first 6 months of your employment and then again after the 2nd 6 months, and after that, annually or whatever their normal practice is. During your first few months on the job there is little chance your RVU's will exceed any minimum salary they offer. After a few months, you'll be more productive, and you will exceed their minimum. If you let them reconcile all your RVUs from the first 12 months, the extreme highs and lows will average each other out and converge towards the minimum salary. So ask for 6 month reconciliations. (If you succeed in this, then schedule all your optional vacation days during the first 6 months! You want to take your vacation when you're on salary and not when you're on productivity.)

I would also ask lots of questions. Get things put in writing if they are important to you. I've had 2 jobs out of residency now, and at both, the perks promised during recruitment ended up differing to varying extents from reality. Especially where time flexibility is concerned.

And if you have specific questions, let us know. PM me or others if you don't want to post publicly. When I interviewed 2 years ago in the state I am in now, I was totally confused. The job market was very different from where I did residency. Early on, I was offered a "Medical Director" position in a hospital in a remote small town. I turned down that job, with a huge salary, because I was intimidated by the title. I assumed that "Medical Director" meant a huge amount of responsibility, like it did in my residency, where people trotted their titles around all over campus. I assumed that the salary was high because the responsibility was high; and did not appreciate that salaries and titles rise with desperation, not duties, in non-academic psychiatry. Later on I learned that "Medical Director" means: "Person who comes to work." So ask! And when you're looking at a local market, figure out what their strengths and weaknesses are, and play to that.
 
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peppy

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Many thanks to all of you for giving some direction here. :)

I've had 2 jobs out of residency now, and at both, the perks promised during recruitment ended up differing to varying extents from reality. Especially where time flexibility is concerned.
Would you feel comfortable giving more details about this? I have not yet seen the contract for this one place that is promising me all kinds of things...I am wondering how much of it will actually end up in the contract.
 

whopper

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Take side jobs in the community at other places, make friends with other psychiatrists, have lunch with them, go to their parties, throw a few of your parties Why? It'll open doors to selling yourself and let you see how other places run. After several months of doing this in Cincinnati, I had a feel for how all the major hospitals and case management agencies worked, the atmosphere, pay, pros and cons, made connections, starting building up a roster of people that I could partner with for private practice, etc. I never had a "grass is greener on the other side" thought after about three years of doing this and found ways to maximize my salary in the way I wanted without having to compromise.

The social thing is important. If you saw the HBO miniseries Rome, political alliances that led to or prevented wars were all started from clique social circles. Such things do happen in real-life. Besides, if it's a doctor throwing the party, it'll likely have good food and if you're single you might hook up.
 
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peppy

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Do they pay you for Board Certification? I felt very fortunate that my organization picked up the tab for those exams (as well as my current recertification)
I already took my board exam and expect I will find out if I passed pretty soon. Do you have other suggestions on things I should ask for in place of that? Do you feel that just coming to them (hopefully) already board certified means I am entitled to ask for more money? Thanks for the ideas and suggestions. :)
 
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peppy

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Take side jobs in the community at other places, make friends with other psychiatrists, have lunch with them, go to their parties, throw a few of your parties Why? It'll open doors to selling yourself and let you see how other places run. After several months of doing this in Cincinnati, I had a feel for how all the major hospitals and case management agencies worked, the atmosphere, pay, pros and cons, made connections, starting building up a roster of people that I could partner with for private practice, etc. I never had a "grass is greener on the other side" thought after about three years of doing this and found ways to maximize my salary in the way I wanted without having to compromise.

The social thing is important. If you saw the HBO miniseries Rome, political alliances that led to or prevented wars were all started from clique social circles. Such things do happen in real-life. Besides, if it's a doctor throwing the party, it'll likely have good food and if you're single you might hook up.
Did you feel like there were certain pit-falls that you avoided because of what you learned from that time you spent? For example, certain things you made sure to look for in the contract, or certain perks that you made sure to ask for?
 

whopper

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Yes.

This is something that's much easier to talk about in person because I can speak volumes on this. I figured out a way to make $240K doing 40 hours a week with EASY work. I'm talking way easy work where half the day I wouldn't have had to do anything. I chose not to do so because I love this field and love working in it, but the thought that I might retire to that 240K job when my brain gets slower is on the back of my mind.

I also learned how valuable I was. It gave me the confidence to demand higher pay knowing my boss would have to fork it over, and how to make such demands while not looking bad.

Here's just 1 example...
"Dr. X (my boss), I had dinner with Dr. Y (the CCO of another hospital that is looking for new doctors and Dr. X knows it. in fact they need a forensic doctor and I was one of the only ones in the entire damn city). Wow, what an interesting conversation."

That basically sends the message to Dr. X. that Dr. Whopper has an open door to go to Dr. Y's hospital at any time, without me having to go up to him and basically say in an very confrontational manner, "you better pay me what I'm worth or I'm leaving."
 

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Gross salary, PTO, conference days, educational expenses, moving expense, health insurance and deductible, compete clause, call, overtime pay. Once you have all that info you can compare it to your other offers then start negotiating.

Think of it like purchasing a new car. The dealer is going to try to distract you by asking how much you want your monthly payment to be. Never give in to this. You need to negotiate the final price of the vehicle and always walk out the first time. "Thank you for your time. I will take a look at my options with my other offers."

Send a thank you card. Look at all of your options. Think about it. Pull the trigger.
 

whopper

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Don't walk into the first job thinking it'll be your last. Many first jobs are merely temps until you find what really suits you. Give it a chance but don't think you're bound to them either.
 
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alina_s

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Ask about the proportion of direct patient contact time. At my first job, 20 minute med management appointments sounded reasonable, until I got there and discovered that I'd been scheduled for 36 hours of patient time in my first week and 38.5 hours in the second week, with no extra time to get to know patients who were new to me and only 4.5 hours a month to meet with the case managers for the hundreds of patients. That also left no time except for lunch to call PCP's or other providers, and I was usually writing through lunch.

I also completely agree with whopper about side jobs, networking, and your first job being a chance to see what you really like.
 
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