By Nisha Mehta, MD, a physician leader whose work focuses on physician empowerment, community building, and career longevity in medicine  

In speaking to so many about their job offers, I’ve realized that we’re often myopic in terms of what we think can be negotiated when discussing a contract. There are the traditional things everyone asks about — salary, bonus structure, call responsibilities, vacation schedule, and signing bonuses, to name a few. However, when talking to people about what their ideal job looks like, there’s often more random things on a wish list. What we fail to realize is that those are all things that can be asked for, but that nobody else would even think to offer them to sweeten the deal.

Some examples of these?

• An early start and end to the day
• Dedicated academic or administrative time
• Unique FTEs such as 0.7 or unique structuring of their FTEs, such as alternating four- and two-day weeks
• Bonuses for creation of alternative revenue streams for the practice
• Changes in the amount of allotted CME money or money for office furnishings or technology
• The ability to work from home a certain number of days a week (for example, doing telehealth)
• A specified patient population according to their area of academic interest/desired practice panel
• An increased number of support staff such as scribes or medical assistants
• The speaker system which you will have in your operating room

Some of these may sound silly to you to ask for, but I know of physicians who have asked for and received these things as part of their contract negotiations. Remember, what brings happiness in your day-to-day life as a physician is very individualized, and therefore, asking for those things that will enhance your satisfaction (e.g., career longevity) at that job is not unreasonable.

Of course, asking for these things can be an art form. Understand that every institution has different flexibility or bandwidth for accommodating individual requests. You may want to look at what other accommodations have been made for other physicians on staff as precedent for what may be realistic prior to compiling your list of asks. Also, be careful about how many of these additional things you ask for. If you have 10 unusual requests, even if they are relatively minor, the message to the employer could be that this is a pattern of behavior where you will always be asking for exceptions to normal operating procedures.

Figure out which ones mean the most to you. Also figure out which ones are going to be harder to negotiate later, as your negotiating power is always greatest before you sign a contract. Be prepared to justify the asks so they understand why they would make accommodations. For example, if you are able to clearly articulate why something will lead to increased efficiency, lead to better patient outcomes, or contribute to your career longevity and prevent burnout, this would help your case. It would also help them to explain to others who question why these special accommodations were granted.

As demographics in medicine change, unusual asks will become more frequent. The sustainability of our health care workforce requires out-of-the-box solutions, and for some of you, these may be part of them! If you don’t ask, you won’t get it.