Pay parity and salary negotiations

Started by transitioning19230
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transitioning19230

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Recent grad in clinical. Interviewed at a few AMC's and all followed a pay parity model, where every new hire makes the same amount of money. My attempts at negotiation went nowhere including with legal counsel advising. I found this frustrating as I went to a well regarded school, have great training, strong recommendations that speak favorably to my skillset, and research productivity. One of the recruiters made a comment about how I should remember that I will be surrounded by "esteemed" colleagues (ivy) to justify the salary which really did not sit well with me.

I ended up interviewing at a few private practices where I was able to negotiate. One place even stated they normally start at x but given my credentials were willing to offer a higher base rate. I ended up accepting that offer. Pay is substantially better but it's not what I envisioned for my career and I am having mixed thoughts about this decision as I miss research and teaching. Curious to hear from others - is this the model everywhere these days? I spoke to a few classmates and about half had a similar experience with negotiations.
 
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transitioning19230 said:
firm is on retainer due to circumstances not germane to this topic. edit - didn't mean this to be dismissive, just not comfortable disclosing additional details.
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No worries and no need to say more.

As to your OP, it's fairly common (though not universal) for AMCs to have these kinds of policies. It's (at least) intended as an equity measure to address multiple issues, including gender disparities and discontent from existing faculty.

The "esteemed colleagues" part aside, it seems like this is bothering you because you feel like you deserve more and/or deserve to have your pay reflect your individual experience and achievement rather than a blanket compensation policy for new faculty, as well as it forcing you to choose between compensation vs. work setting and the scope of your role (e.g., getting to do research and teach vs. solely clinical work in PP, more specialty work and nice populations vs. a more generalist PP population).
 
Well, we are in a revolt against expertise in this country, among other things, so this is where it's at in a lot of places. I'm surprised you had latitude for clinical PP to negotiate a great deal, though that may depend on if they are cash pay vs. insurance. If I am hiring in my practice, someone can have the best credentials that I've ever seen, insurers are still paying out the same as the worst credentials.
 
transitioning19230 said:
Recent grad in clinical. Interviewed at a few AMC's and all followed a pay parity model, where every new hire makes the same amount of money.

Pay is substantially better but it's not what I envisioned for my career and I am having mixed thoughts about this decision as I miss research and teaching.
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Let's get rid of the noise, here is the the meat of your post.

A few thoughts on this:

1. I am not sure of your salary expectations or what you expected of the field. You may be realistic or unrealistic. Hard to tell without a ballpark figure. Overall, $150k is doing well in this field. Over $200k is generally, killing it. There are people that make much more than that. However, they are often doing something other than the basics we are all trained for (Running a business, doing legal work, really good at grant writing, etc.)

2. I am going to let you in on a secret, the most prestigious places rarely pay the most money. Why? Because they have a stack of impressive candidates to choose from. You may have passed on the job, but someone else in the stack was happy with the salary offer. You have more leverage in private practices, rural settings with no providers, and areas of specialty where there is a shortage of competition.

3. Clinical generally pays the bills. Research only makes money if you are good at securing grant funding, and teaching pretty much never pays you well. Welcome to the real world. All that smoke they blew at you in academia doesn't really stand up.
 
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I used my first jobs to develop experience and connections so that I could build my own business where I get to teach by having a training program for local MA level practicum students and interns. I love teaching and I find that the MA people need lots of foundational knowledge in addition to clinical supervision. The research part is an aspiration and one day want to be able to integrate that into my company but as Sanman said, it doesn’t pay the bills so I have to be able to be profitable enough to absorb the cost.
 
Half is about right. I did something similar (applying to multiple AMCs and talking with other applicants and mentors). Typically, the biggest names leave little room to negotiate, often because salaries are determined by HR rather than the department. Some recruiters would tell me to negotiate directly with HR or to bring in another offer for them to present to HR.

I was only able to negotiate a slightly higher salary because I could provide services in another language, which in some places is treated as a policy-based exception. In addition to addressing pay disparity issues, a couple of the places I interviewed at had conducted their own salary surveys to determine a "competitive" rate, grounding their offers in research. At least one had adopted a step system where everyone with X years of experience earned the same salary across all ranks. While equitable, this created significant hiring challenges, as those with extensive experience could earn much more elsewhere.

Smaller AMCs or those in less desirable locations tend to be more willing to negotiate, but from what I’ve heard, they often start with a lower offer, and even with negotiations, their salaries rarely exceed those of brand-name institutions by much. That’s just the reality of AMCs; you’re extremely unlikely to earn more there than in private practice, since AMCs carry higher overhead. Many people accept lower pay in exchange for the infrastructure, prestige, and benefits that come with an AMC, but ultimately, only you can decide if those trade-offs are worth it.
 
psych.meout said:
You retained a lawyer to advise you on negotiating pay for your first job out of fellowship?
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Not to derail this thread too much, but I also right out of fellowship spent a few hundred to have an employment lawyer who specialized in physician/provider/psychologist contracts review my contract with me before signing. They also offered a similar package where they would help with negotiations for more $, but I didn’t take them up on that part. I did think the contract review though was worth it. It gave me a much better understanding of what I was signing and nuances of the different clauses/policies.
 
I also found that every hospital system I interviewed at used a parity model, and this was the experience of my friends as well. The only way I know someone was successful in upping the base salary was by talking to HR about how they counted years of experience and were able to negotiate starting at a higher rate when factoring in the 2 year postdoc and when they actually got licensed.

Other ways of getting something more was by negotiating starting bonuses, relocation fees if applicable, and other perks, like covering board application fees, license renewal fees every year, etc. I also looked at other things in terms of quality of life in the AMC, such as psychologists being credentialed as medstaff and therefore on par with physicians and getting the same CEU compensations and other perks vs being credentialed as an advanced practice provider (APP), which often resulted in less money for CEUs, etc.
 
R1/AMC are running a confidence game and have for decades. The worst offers I received coming out of fellowship were from two Ivys, both in high COL areas too. As others have mentioned, you can negotiate around the edges (e.g. moving expenses), but they do the parity model ON PURPOSE to suppress wages. Subsequent years are based on the first year, so they don’t budge and it’s “cost containment”, so it’s easier to budget and profit off of faculty.

I knew this going in, and I decided to go with the best mentor option, at a respected public university AMC instead. I put in my time and then bailed once I vested in their pension program. Some probably still prefer to have the Ivy names, but I don’t regret my time.

Private practice + IME/Expert work is still the best ROI. I can work a couple of cases per month and sprinkle in some clinical work and have far more flexibility than when I was grinding as an assistant professor.
 
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I work for an AMC in the south, lower cost of living. Our salary is based on national numbers, which is fantastic in my case.

We did advocate for a uniform pay bump in our AMC for neuropsychologists, which is an extra $15,000 on top of the salary schedule.
 
megamaramon said:
I work for an AMC in the south, lower cost of living. Our salary is based on national numbers, which is fantastic in my case.

We did advocate for a uniform pay bump in our AMC for neuropsychologists, which is an extra $15,000 on top of the salary schedule.
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This is a great data point to share with other psychologists (maybe on a list serv?), as *sometimes* a dept chair will be willing to consider a bump if there is something they can point too, ESPECIALLY if it is a "peer institution" (size/prestige/whatever and not necessarily just geographically close).
 
Therapist4Chnge said:
Private practice + IME/Expert work is still the best ROI. I can work a couple of cases per month and sprinkle in some clinical work and have far more flexibility than when I was grinding as an assistant professor.
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I need to find a way into the IME world. A mentor or part time 1099 gig to get established.

I found the same to be true as others have shared in this thread re: salary and AMCs. It’s part of why I haven’t budged from VA just yet despite preferring AMC environment.
 
No one cares how "strong" your training is at an AMC with regards to salary - it can help you get your foot in the door (i.e., hired) but "I went to a good school" doesn't help them generate revenue so it doesn't get you any more pay. Parity is not universal, but incredibly common - all assistant profs are paid identically at my center to start. Trying to differentiate based on training would be a nightmare for our HR department.

The key to AMCs is to get your foot in the door, prove you can "make it rain" and then renegotiate. Bring in a couple million dollars in grants, launch a niche high-demand clinic that provides unique training opportunities or brings in big donation dollars, then you do a soft job search and threaten to leave if they don't match your offer (+ be actually willing to leave because - depending on circumstances - they may not).

There are MUCH better options for starting pay than AMCs, but if you win the game you'll almost invariably be in Sanman's "killing it" range by mid-late career.
 
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Ollie123 said:
No one cares how "strong" your training is at an AMC with regards to salary - it can help you get your foot in the door (i.e., hired) but "I went to a good school" doesn't help them generate revenue so it doesn't get you any more pay. Parity is not universal, but incredibly common - all assistant profs are paid identically at my center to start. Trying to differentiate based on training would be a nightmare for our HR department.

The key to AMCs is to get your foot in the door, prove you can "make it rain" and then renegotiate. Bring in a couple million dollars in grants, launch a niche high-demand clinic that provides unique training opportunities or brings in big donation dollars, then you do a soft job search and threaten to leave if they don't match your offer (+ be actually willing to leave because - depending on circumstances - they may not).

There are MUCH better options for starting pay than AMCs, but if you win the game you'll almost invariably be in Sanman's "killing it" range by mid-late career.
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Agreed with this. I will say that research funding or a very select specialty niche, something like sleep medicine comes to mind, are the best cases for selecting an AMC career.

If you can't do that, private practice (or until recently) the VA were better career options for general clinical money without the AMC headaches.
 
@transitioning19230


Ask yourself,

1) "What revenue generating activities do I bring to the table?"
and "
2) What unique revenue generating activities can I perform?".

That is the employer's perspective. If you can answer those questions in a succinct fashion, you can define why someone should hire you. Insurance pays the same for everyone, so that's out. Can your prestige be marketed to cash paying patients? If so, what is the established model in your local area for that? Can you bring in huge grants for research, or some other revenue generating activity, relative to an adjunct affiliate professor teaching 5 classes for $3k/semester? There's probably some idea here, but you have to be able to succinctly say why you are a better financial choice than another psychologist.
 
PsyDr said:
@transitioning19230


Ask yourself,

1) "What revenue generating activities do I bring to the table?"
and "
2) What unique revenue generating activities can I perform?".

That is the employer's perspective. If you can answer those questions in a succinct fashion, you can define why someone should hire you. Insurance pays the same for everyone, so that's out. Can your prestige be marketed to cash paying patients? If so, what is the established model in your local area for that? Can you bring in huge grants for research, or some other revenue generating activity, relative to an adjunct affiliate professor teaching 5 classes for $3k/semester? There's probably some idea here, but you have to be able to succinctly say why you are a better financial choice than another psychologist.
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This is incredibly important advice and, unfortunately, is something many grad programs seem to neglect (at best) or purposely eschew, especially at clinical science oriented programs (entirely anecdotal from my own experience and talking to peers and other colleagues).

This business side and perspective are really important even if psychologists aren't going into private practice. It's important in AMC settings because it gives another perspective on what the institution is looking for in terms of T&P and also how to find other opportunities to make more money within the institution (e.g., contract buyouts from your primary department that don't have wRVU requirements, moving to a role with some or better productivity bonuses beyond target wRVUs). Even if it isn't giving you immediate remuneration, the same things that would help you make money in PP are the kinds of things that will eventually help you get promoted and give you a huge jump in your base salary without any extra effort beyond your target wRVUs.

E.g., for those that are solely clinical in focus, having the prestige and name recognition for your specialty would obviously help you attract patients and give you a full cash pay schedule at a high rate if you were in private practice. In an AMC setting, sure, you're not able to be cash pay and make more money directly from your specialty, but your recognition is a significant advantage when it comes time for review and T&P.

Those business skills and mindset are important if you do choose to go into private practice while remaining faculty at an AMC. I know many psychologists who do this. They stay on as faculty for the benefits, socialization with their colleagues, resources, ability to practice one of their specialties that wouldn't be practical to focus on in private practice (e.g., certain health psych roles and populations), stable salary, and other advantages. Some care about T&P and some don't. Those who don't care will do enough to hit their wRVUs and stay in the good graces of their department, but devote most of their real effort to their private practice where they make their real money.
 
Ollie123 said:
No one cares how "strong" your training is at an AMC with regards to salary - it can help you get your foot in the door (i.e., hired) but "I went to a good school" doesn't help them generate revenue so it doesn't get you any more pay. Parity is not universal, but incredibly common - all assistant profs are paid identically at my center to start. Trying to differentiate based on training would be a nightmare for our HR department.

The key to AMCs is to get your foot in the door, prove you can "make it rain" and then renegotiate. Bring in a couple million dollars in grants, launch a niche high-demand clinic that provides unique training opportunities or brings in big donation dollars, then you do a soft job search and threaten to leave if they don't match your offer (+ be actually willing to leave because - depending on circumstances - they may not).

There are MUCH better options for starting pay than AMCs, but if you win the game you'll almost invariably be in Sanman's "killing it" range by mid-late career.
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This, 100%. Also keep in mind that AMC departments typically operate within a defined 'salary pool' for all faculty each fiscal year. So if they hire someone outside the typical entry level for new Assistant Professors, it throws off the numbers and creates an equity issue for others. That disparity often needs to be adjusted/corrected at the next annual review, which is hard to do when the salary pool is fixed (e.g., if they bump certain faculty up at a higher percentage rate, then the remaining faculty have to take a lower percentage annual increase).

It's a nightmare for the decision makers (usually but not always the Chair) to manage at annual review, at least in highly productive settings, because typically most everyone is equally as deserving. The real way around this is to get a competing offer, which (depending on the university) might be matched with retention funds from another pool of money, which would not take a disproportionate amount of funds out of the larger pool for all faculty. I'm not a dept Chair, but am in a leadership position that has me closely involved in these decisions... it's not an easy balance and they're not just being difficult for the sake of being difficult, or to intentionally squeeze people. It really is an issue of parity; not only at the entry point but over time.
 
Sanman said:
I am not sure of your salary expectations or what you expected of the field. You may be realistic or unrealistic. Hard to tell without a ballpark figure. Overall, $150k is doing well in this field. Over $200k is generally, killing it. There are people that make much more than that. However, they are often doing something other than the basics we are all trained for (Running a business, doing legal work, really good at grant writing, etc.)
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This is true and, once again for you students out there, why it is generally a bad idea to take out $100k+ in loans for a doctorate degree.
 
Sanman said:
Having done the first part, imo, it is highly overrated unless you have money for fun stuff. My dating life was never better though.
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As someone who had money for fun stuff (thanks hedge fund life) but love backpacking more than clubbing, I had a lot of early 20s fun going to restaurants and shows and was perpetually single. TBH, grad school hasn’t really helped with the single part so I’m still waiting for the time and place where I have better luck there
 
Therapist4Chnge said:
NYC is a *great* place to live if you can live in Manhattan, make at least $1m/yr, and can afford to buy a home.
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Meh, I don't want to live anywhere I can't be in a heavily forested area or on a large body of water away from most people in about 20-30 minutes.
 
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Sanman said:
Hudson River and Fort Tryon Park are not that far away.
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Wouldn't call either of those 'heavily forested' or 'away from most people'. Although Ft Tryon Park is lovely and the Hudson is in much better shape than it used to be.

NYC is fantastic if you are into cultural offerings, nightlife, niche hobbies, restaurants, etc. Green space, not so much.
The day to day QoL (physical environment, ease of managing tasks of daily living etc) is abysmal though, which can be partially mitigated if you have boatloads of cash.
 
WisNeuro said:
I can get to any of about 30+ different good fishing spots in less than half an hour.
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Define "good" fishing spots. Most of my fishing trips involve being at the dock at the crack of 10am, meeting several friends, loading a cooler n full of beer onto a boat, and maybe catching 1-2 fish, storing them in now empty beer cooler.
 
Sanman said:
Define "good" fishing spots. Most of my fishing trips involve being at the dock at the crack of 10am, meeting several friends, loading a cooler n full of beer onto a boat, and maybe catching 1-2 fish, storing them in now empty beer cooler.
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That's all good and dandy, but I'd also like to occasionally get a good size pike/walleye/whitefish.
 
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