Tips on how to negotiate salary?

[Angry Birds]

When you are interviewing for jobs, any tips on how to negotiate salary?

What about for moonlighting gigs? How do I get them to bump the hourly up like $30/hr?

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[Docinthetrenches]

I have found most moonlighting places (like for locums or for large hospitals) have a set rate and that's pretty much what you get. To raise the rate requires the director to go to admin, etc so they can't give you a higher rate on the fly. Now, for small democratic groups where they have the power to do so, you can negotiate. I would haggle like you would for a car - go about 10-20$ over what you will take and hopefully they meet you in the middle. To bed able to this though, you need to be willing to work within their scheduling needs (ie if they need nights and weekends) and you should come well recommended. Generally if you are flexible and available they will be more willing to raise your salary then if you are bound to a fixed availability. Also if you have more experience but are not loaded down with lawsuits, that gives you some leverage as well. Finally, if you are moonlighting in a rural or otherwise "undesirable" location where ER docs are hard to find, you be be more aggressive with your negotiations.

 

[NinerNiner999]

If you are a board prepared, board certified physician, recent graduate with computer skills and EMR adaptability, and have good recommendations, set your price and go from there. Don't take a locums assignment for anything less than 25% above the regional market rate. Anything you don't take, the locums agency will. If you can incorporate yourself, find your own malpractice insurance, and contact sites directly, you will be able to ask for a higher rate. Locums companies typically pay doctors 1/3 to 1/2 of the rate that sites are actually paying them to staff doctors.

When interviewing for permanent local jobs, get a few things answered before you consider your price point:

1) Does the hospital require residency-trained/board certified physicians, or do they have IM/FP trained docs who were grandfathered in.
2) What is the going market rate. I have actually called local physicians in other groups in the same area and asked them - doctor to doctor - what the going rate in the market are. Sometimes, they will even tell you their group has an opening that is not advertised.
3) What type of group are you interviewing with (CMG, Local CMG, Democratic partnership, local multi specialty practice).
4) Is there a bonus structure and how is it paid?
5) How are benefits paid?
6) 1099 vs 1040?
7) How much do you need

Successful negotiation is an art, and must leave all parties feeling like they "won" something. Never reveal what you need, and always put yourself in a position to "sacrifice" something to make the deal go through - even if its not a true "sacrifice."

If you tell the group that your spouse needs you in that specific location, you already bought a house, or reveal anything else that suggests you "need" to work there, you have lost all bargaining power. Be smooth.

 

[Uranium678]

As for negotiations with groups, are groups like EMCare TeamHealth EMA salary-negotiable? Talking to recruiters it seems as if the hourly rate is set in stone.

 

[Arcan57]

As for negotiations with groups, are groups like EMCare TeamHealth EMA salary-negotiable? Talking to recruiters it seems as if the hourly rate is set in stone.

Unless you're providing emergency coverage, the hourly rate or multiplier is what it is. Signing bonuses or initial hourly guarantee (for rvu based shops) may have some wiggle room. There's more latitude for stipends, mostly for uncommon positions such as chest pain director or US director. The FMD and AFMD stipends tend to be fixed since the companies have pretty good data that tossing more money at those slots doesn't improve performance or retention.

 

[EM Junkie]

Coming from an ED Medical Director for a SDG community group in Houston, our pay is not negotiable. All docs are paid the same, and it's all open book. Someone coming in looking to negotiate and coming across as being "all about the money" will quickly find themselves being shown the door in our group.

 

[da8s0859q]

Coming from an ED Medical Director for a SDG community group in Houston, our pay is not negotiable. All docs are paid the same, and it's all open book. Someone coming in looking to negotiate and coming across as being "all about the money" will quickly find themselves being shown the door in our group.

And here I am asking for my sign-on to be upped a bit. Also an open-book SDG. I suddenly feel bad.

 

[Angry Birds]

Coming from an ED Medical Director for a SDG community group in Houston, our pay is not negotiable. All docs are paid the same, and it's all open book. Someone coming in looking to negotiate and coming across as being "all about the money" will quickly find themselves being shown the door in our group.

I wonder why you would have this antiquated view. The idea that physicians don't care about money is silly, especially with the level of debt that we tend to have.

Shouldn't we be adequately compensated for the work we do, and advocate for ourselves?

I realize money shouldn't be the ONLY thing, but it is certainly one of the most important things, among several others.

I remember a recruiter who spoke during my internship about finding a job post-residency. She said that if someone asked her about money, she would say, "well, the hospital across the street from us is paying more... Why don't you go there?" I responded, "OK, can you give me the address?"

 

[docdragon]

Part of the point of an open-book SDG is that everybody knows how the finances are working. In a country where men consistently get paid more than women for doing the same job, this should be a rare opportunity for openness and equality.

If that's really true, then you wouldn't be able to negotiate your salary without negotiating everyone else's. The bonus certainly might be negotiable. The contract itself should at least be open for discussion and consideration of negotiation. Some of the CMGs negotiate a ton and change the contracts easily, some don't change anything.

 

[NinerNiner999]

And here I am asking for my sign-on to be upped a bit. Also an open-book SDG. I suddenly feel bad.

See what happened there? Now you feel bad about trying to ensure your financial security. Well played.

Keep in mind that strong SDG's were set up 10-15 years ago (some even longer) when reimbursement was higher, core measures weren't present, metrics weren't enforced, and original members planned for a large retirement and partnership bonus structure. Fewer physicians could be staffed without threatening throughput, ED holds were encouraged by administration, and a reduced workforce allowed group members to be paid higher rates.

These things are no longer a long-term reality for Emergency Physicians in today's current environment. As SDG's continue to cling to the model they set up, and hang on as long as they can for their retirement payout, rates in these groups with fixed economy of scale will always favor those who have been there the longest (even with open books, and shared bonuses). The more doctors that need to be hired, the more dilute the bonus pool becomes, while patient reimbursement likely drops over the next 5-10 years. The economic reality of some SDGs is that they will never be able to increase their rates without seriously impacting their bottom line, and will eventually be outcompeted by other groups able to pay higher rates - likely SDG hybrids, or full-blown CMG's who pay higher rates with productivity bonuses.

I don't think asking these questions would label someone as being "all about the money." For a new graduate looking to establish long-term roots in a community, the economic health of such a group can be critical to making a long-term decision, and a group's rigid adherence to a set pay rate and formula can be a sign of economic trouble ahead and potentially long-term instability. For the average physician who wants a steady paycheck, this isn't an issue - until 5-10 years pass and a stagnant rate fails to keep up with inflation. Of course, by then, the major shareholders in the current group will have cashed out, leaving the remaining members to pick up the pieces and eventually change the business model.

A better question might be to ask what the group's margin is. most SDG's today (unless they have diversified their capital and put up barriers of protection) operate on a VERY slim margin. Benefit prices will also continue to rise, and if a group pays for these, their margin will become even smaller. This margin will continue to erode until they are no longer economically viable.

Ask for that increased sign on. Ask for moving expenses, board fees, license fee reimbursement, and everything else you need to establish yourself as a member of the group and the community. If a group is economically sound, investing a couple thousand dollars in a future partner should be money well spent - and easily accomplished.

 

[emergentmd]

SDG - Rate/benefits are fixed. Nothing to negotiate here. They would never pay a new guy more than what everyone is making. Most are closed books. If its open, you have no chance of getting more that everyone else.

CMG - Rates are different for most docs esp when its a hard place to staff. Much easier to negotiate but it all depends on how short they are. I have seen contracts where some make 50-100/hr more than the regulars.

I too would be wary of joining any SDG with partnership track. I have been in a SDG and the last 3-5 yrs, income has gone down. Pay stayed steady for the most part but everyone was working more. With all of the metrics, charting programs, hoops you have to jump through, you will not be as efficient. With payments lower and payer mix worse, everyone either takes a big pay cut or work harder. Think about get a subsidy from the hospital? ask and they will get a CMG in quicker than your head turns.

I believe SDGs in nice cities are the thing of the past. They will only exist in smaller cities where CMGs have no interest in.

 

[Arcan57]

If there are significantly different rates for regular docs at a CMG shop, that's a sign of of an unhealthy contract. You may see shift bonuses paid out to fill the schedule right after an acquisition or unexpected doc departure or to internal locums/dedicated nocturnist positions. Otherwise differential pay rates goes against the model of us being equally valuable/equally replaceable staffing units. There's not normally a doctor that's clinical work is worth enough more to be worth pissing off the docs being paid the standard rate and everyone demanding the new rate. If there is someone that's worth it consistently, they'll get offered some management stipend that doesn't show up on the hourly rate and can be defended to the other docs.

 

[emergentmd]

If there are significantly different rates for regular docs at a CMG shop, that's a sign of of an unhealthy contract. You may see shift bonuses paid out to fill the schedule right after an acquisition or unexpected doc departure or to internal locums/dedicated nocturnist positions. Otherwise differential pay rates goes against the model of us being equally valuable/equally replaceable staffing units. There's not normally a doctor that's clinical work is worth enough more to be worth pissing off the docs being paid the standard rate and everyone demanding the new rate. If there is someone that's worth it consistently, they'll get offered some management stipend that doesn't show up on the hourly rate and can be defended to the other docs.

This is the typical cycle that happens at hard to staff hospitals. You could not pay docs enough for them to stay and usually the CMGs put a cap. Once a few docs leave and they can't hire another, then their only choice is to money whip the docs to work harder or hire at a higher rate. Once you hire at a hire rate, people will quickly jump ship. No regular would stand for making less than a new doc. Once that cycle starts, there will be very few regulars and then everyone is being paid at different rates, different bonuses.

There is a place that is like this and the regulars dont leave. I do not understand why esp when they know locums are making so much more. I guess they have been there so long that they are happy with their top 95% pay and don't care for an extra few K a shift. But I am waiting and once they jump ship, I will be glad to jump in to fill their void at my higher rate.

 

[EM Junkie]

Let me clarify. We're completely open book, and no partnership shenanigans. On day one you can make the same as the guy that's been here 10 years. We're also open and honest about our compensation, and encourage an honest discussion in our interviews.

It's the emails I get or PMs on SDN asking "what kind of money are we taking about here" in their first communication with our group that are off-putting.

When you have the luxury of choosing which doctors you hire, we'd rather get the guy/gal who is an all around good fit. Someone that comes across as only caring about the $$ and not the group as a whole will go against the grain on every decision we make.

 

[Vandalia]

If you are in a position where you can negotiate (and you need to find that out before anything else):

1) Have some idea of your current numbers. Figure out how many wRVU you generate during a typical shift, and if you can wheedle it out of your billing people figure out what they are collecting per wRVU. If you can come in and say "I am generating $100 per shift even with dealing with the academic/teaching stuff", it makes me feel better offering you the $150/shift you want. (I am using completely bogus numbers to avoid providing evidence to the CMS reimbursement-cutters. See Radiation Oncology for an example why.) At the very least, it makes me feel comfortable you are aware of the business side. When you are discussing hard numbers in a contract, people love hard numbers as evidence behind it. That holds true even if the numbers don't say much.

2) Know your training programs (perceived) weakness, identify it, and show how you can address it. Example: You are a resident at Mayo and you are applying for a job in North Platte, NE (extreme example.) "Wonderful. You have consultants for everything imaginable at your beck and call. How are you going to handle X when there is no specialist available for 12 hours and you are the only physician in the hospital?" Unless you are interviewing at your training program, the question exists in some form or another. If you address this early on, it tells me you are thinking about things in the right way.

3) More than anything else, know your leverage. This is where your faculty network comes into play. If they tell you place X lost 3 people to retirement/illness, and have each been working 80 hours/week, then you can ask for anything you want. On the other hand, if you personally know 5 other residents in your class are applying to a place, it is pretty much take their offer or leave it.

Bottom line: If you are asking for $X per Y or Z, figure out the employers concerns about giving you that amount or thing. Then identify and address it before they have a chance to ask. It doesn't have to be a brilliant answer. For example on #2, "Well, we rotate at a community program without that consultant support for 6 months total during our training. In addition, I made a special effort on our off-service rotations to gain proficiency in the procedures that I might have to handle one day in a lower level ED."

 

[Arcan57]

You'd probably also want to avoid referring to a shop you're interested in as a lower level ED.

 

[deleted480308]

In a country where men consistently get paid more than women for doing the same job,.

not true

 

[Vandalia]

You'd probably also want to avoid referring to a shop you're interested in as a lower level ED.

Depends on the context. We are a Level II trauma center, and I worked previously at a Level III. I was never offended by us being referred to as a 'lower level' ED with respect to a Level I because there was no doubt we are/were in that objective classification. However, you are correct in that you don't want to say something that can appear to be dismissive.

 

[Janders]

Let me clarify. We're completely open book, and no partnership shenanigans. On day one you can make the same as the guy that's been here 10 years. We're also open and honest about our compensation, and encourage an honest discussion in our interviews.

Precisely. Some SDG have pyramid schemes and partnership oddities and all sorts of shenanigans. OTOH we're open book from day #1, and you see what you are bringing in and get the same share that everyone does. As such, there isn't any utility negotiating your salary-- you're getting all the money already! I'm certainly not offended when people ask money, as we all need to make a living. But do to our structure there isn't much negotiating vis-a-vis pay. We could potentially negotiate other components of the job (scheduling comes up a lot...).

 

[The White Coat Investor]

Precisely. Some SDG have pyramid schemes and partnership oddities and all sorts of shenanigans. OTOH we're open book from day #1, and you see what you are bringing in and get the same share that everyone does. As such, there isn't any utility negotiating your salary-- you're getting all the money already! I'm certainly not offended when people ask money, as we all need to make a living. But do to our structure there isn't much negotiating vis-a-vis pay. We could potentially negotiate other components of the job (scheduling comes up a lot...).

Exactly. Sure, you can negotiate stuff during the partnership track, and if we think you're worth more than someone else (4 years experience vs new grad for instance) we might do a little more for you. But once you're a partner, you're getting ALL the money after overhead. There's nothing else left to negotiate for/with. I'm sure as heck not going to pay your share of the overhead to keep you in the group. You want more than your share/what you're generating? Go do locums in desperate places.

 

[Jelgava]

In my view, having been on the hiring end for more than a few years, I can tell you that it never hurts to ask -- as long as you ask in a respectful and thoughtful way, without being pretentious or acting entitled. Some new hires start developing a bad reputation with a practice from the very beginning by being rude to recruiters.

 

[lisa002]

I think its everyone's right and job to advocate for themselves. As Jelgava says - as long as it's in a respectful way, its better to ask about salary and finances instead of grumbling with coworkers which can create an ugly work environment. If you think your worth more and your work is good - then ask for a raise! Of course it's good to know how much others in the area are paid. I was able to find average wages for nurses in my area here. It also gives you a good idea of nurses wages across the country. Because hey, if moving is a possibility for a huge pay increase sometimes it's worth considering.