Career Resources articles posted on NEJM CareerCenter are produced by freelance health care writers as an advertising service of the publishing division of the Massachusetts Medical Society and should not be construed as coming from the New England Journal of Medicine, nor do they represent the views of the New England Journal of Medicine or the Massachusetts Medical Society.
By Nisha Mehta, MD, a physician leader whose work focuses on physician empowerment, community building, and career longevity in medicine
One thing physicians seldom do in the training setting is talk about money. Between daily clinical responsibilities and call, a never-ending amount of information to learn, and doing your best to keep up with the other aspects of your life, most of us would agree we’re in survival mode for most of our residency and fellowship. Learning the business and financial aspects of a life in medicine doesn’t usually make it to the priority list.
Consequently, as the end of training approaches, most physicians find themselves overwhelmed with the prospect of finding a job, and underprepared for negotiations. Many just feel grateful to have come to the conclusion of a long journey. After years of being paid a very low hourly rate and (on average) holding substantial six-figure debt, it’s tempting to just be happy with the positive cash flow.
Not doing the requisite research before talking about numbers will almost always work against you. I routinely find myself encouraging physicians to know their worth — not just because I think physicians have the expertise to warrant earnings that reflect it, but because career longevity and job satisfaction are closely intertwined with feeling valued. When I counsel early-career physicians who are dissatisfied, this is often the reason they end up seeking other opportunities within the first five years out of practice.
As salary transparency is not commonplace in medicine, trainees (and their older counterparts as well, for that matter) often don’t know how to evaluate offers or know what reasonable expectations are. This is a significant disadvantage at the negotiating table, and why physicians must put the research into figuring out their market value.
Many mistakenly assume that knowing your worth means simply looking at widely cited compensation databases such as Medical Group Management Association (MGMA) and Association of American Medical Colleges (AAMC). These are available for purchase or may be available from your hospital libraries or your contract attorney. Although a great place to start, it’s important to take this data into context. Compare not only the salary numbers, but the actual compensation per RVU. Know that this can range widely even within the same region of the United States depending on exact location, type of practice, stage of practice, how competitive the job market is, and a host of other factors. You should dig deeper. If the job is at an institution where compensation data is published, such as state and government organizations, look up the salaries of other physicians there. Ask your medical school classmates, mentors, training program alumni, and other physicians in your network who may have knowledge of or connections within the pertinent market.
Importantly, realize there is a lot of work that you do that may not be reflected in RVUs. This may take the form of call responsibilities, teaching or research expectations, or administrative duties. These are all things that contribute to your worth to an employer, and should be factored in when calculating your market value.
Next, it’s important to do your research on the employer. Do you have a particular skill they are in need of? Some skills that may strengthen your bargaining position include fluency in a foreign language, procedural skills, the potential to attract certain patient populations, or the ability to develop a niche that the practice does not currently offer.
Finally, utilize a contract attorney, ideally one that is experienced with physician contracts. Many trainees are hesitant to spend the money, but having the objective feedback on how your deal compares to others is well worth it. Oftentimes, they will be able to point out areas where you should ask for more, give feedback on things like partnership and bonus structures, and protect you from expensive mistakes. After all that you’ve spent to get to this point, it’s a worthwhile investment to make sure your contract is fair and in your best interest.
In every negotiation, both sides will understandably try their hardest to get the best deal for themselves. This is a business transaction, and should be approached as such. There will be give and take on both sides, but having a solid understanding of your worth will empower you to advocate for it. And remember…if you don’t ask, you won’t get.