Say the hospital in a rural area offers $250,000 base salary with some possible “quality practice” bonus of 40-60 thousand. What can be done to increase that offer?
There are a few things to consider in salary negotiations.
First, you need to know what your BATNA is. Google it if you don't know what that is. At what salary level are you prepared to walk? Figure that out.
Second, get a sense of what the market is like. If this rural hospital is all there is in where you want the job, you don't have a lot of alternatives.
Third, get a sense of what they can realistically offer. If this hospital job covers primarily Medicaid patients, a 250k offer will still imply a loss of 50k-100k a year. It's highly unlikely that you'll be able to bring the number up. It's possible that you can bring the workload down. If you want a raise, you should focus on that--that is, get more free time to work somewhere else on a part time basis that pays more. As a side note, hospitals of this type close down Medicaid driven psychiatric components ALL THE TIME. These individuals invariably get referred to either a state run facility with supplementary staff budget but very long waiting lists, or they continue on their progressively downward trajectory. But it's not your job or the hospital's job to fix this system at the moment. If this IS a state job, they often have a difficult time recruiting, but they can't raise their staff salary line because it's determined by the state budget. So jobs are often empty for months to years at a time. Nothing necessarily changes except that the patients to be seen will wait longer, and perhaps kill themselves (or, perhaps overdose on opioids) waiting. The government budget is insufficient and this problem is not in actuality an urgent priority by the electorate despite what may be covered in popular media.
Think of salary negotiation as collaborative not adversarial. The hospital is looking for a candidate to help them achieve a certain goal. You are looking for a fulfilling and financially rewarding job experience. Figure out what their list is, and what your list is, and where the overlap/misalignments are. Figure out which misalignments you absolutely cannot give up. It's not just a matter of salary.
