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Key Takeaways

  • Medical professionals face challenges negotiating their contracts due to a mindset that links helping others with self-deprivation. Dr. Linda emphasizes the importance of separating patient care from compensation and advocating for fair pay and a safe work environment.
  • Female physicians face unique challenges, including socialization and systemic barriers. Dr. Linda believes that the medical field needs to be redesigned to better accommodate the needs of female professionals, and negotiation plays a critical role in achieving this.
  • Dr. Linda’s three principles for self-assured negotiation are: leading the conversation confidently, negotiating with clarity, and communicating value. These principles empower physicians to effectively communicate their needs, advocate for themselves, and create supportive work environments.
  • Dr. Linda advises hospital physicians facing lowball contract offers to recognize their value, understand fair market value, and separate personal and service worth. By establishing their worth and being informed about market conditions, physicians can advocate for themselves more effectively.
  • The distinction between equal and equitable pay in the medical field is important. Equal pay ensures everyone is paid the same, while equitable pay considers the nature and complexity of tasks to ensure fairness.
  • Beyond salary, physicians should consider negotiating their work terms to include schedule, energy allocation, job distribution, and support systems. Understanding individual priorities and negotiating for fulfilling careers can increase job satisfaction and prevent burnout.

Executive Summary:

Hey folks! Thanks for joining us on a brand new episode of the NEGOTIATEx podcast. Our guest today is Dr. Linda Street, a maternal-fetal medicine specialist, life coach, and negotiation expert. Street, who is also the founder and CEO of Simply Street MD, specializes in assisting female physicians negotiate for better compensation packages, with the ultimate aim of closing the gender pay gap in the healthcare industry. 

Linda hosts the ‘Simply Worth It’ podcast, where she shares valuable negotiation advice with the goal of aiding physicians negotiate better contracts, deliver great care, and prolong their medical practice.

With that brief intro done and dusted, let’s delve into the insights Linda shares in this episode.

Tracing Linda’s Diverse Career Path in Medicine and Advocacy

Linda shares that initially, she was driven by her interest in science and genetics to pursue a Bachelor’s degree in genetics. However, her social nature drew her away from lab work and towards medicine, where she could interact with people and use her knowledge to help them. Linda’s fascination with genetics and human interaction led her to specialize in Obstetrics and Gynecology, particularly Maternal-Fetal Medicine.

The turning point in her interest in negotiation came when she discovered the stark pay disparity between her and her senior male partner, who was earning $150,000 more annually. At first, she felt powerless in addressing this due to her junior position and the intimidating persona of her boss. However, after changing her mindset to approach negotiation as a mutual benefit rather than a conflict, she was able to negotiate a $65,000 raise. 

This accomplishment, along with the realization that many of her colleagues faced similar challenges, fueled her interest in negotiation, eventually leading her to become a negotiation coach. 

Dr. Linda’s Insights on Navigating Contract Negotiations and Self-Advocacy in Healthcare

Moving on, Dr. Linda highlights the challenges medical professionals face when negotiating their first contracts. She believes these difficulties stem primarily from the mindset instilled in medical professionals, which links helping others with self-deprivation, thus creating a mental barrier against asking for more or better compensation. Street views this as a factor contributing to burnout and early career exits in the medical field.

Additionally, she underlines the importance of separating the aspect of helping patients from the compensation part. In her view, medical professionals should see that they can provide help to patients while also receiving appropriate pay and working in a safe environment. She notes the difficulty of shifting from the hierarchical culture of medicine, where practitioners are often discouraged from voicing their needs to the realization that they are now the talent that hospital systems need.

According to her, once medical professionals recognize their value in the system, they should feel confident and justified in asking for appropriate compensation. She asserts that healthcare professionals, as the core elements of the healthcare system, should not feel guilty about being compensated well, as others in the system, like CEOs and administrators, certainly do not.

Empowering Transitions: Dr. Linda’s Work with Military Medical Professionals Moving into Civilian Practice

Other than that, Linda talks about her experience working with transitioning military medical professionals. She shares that they’re usually more motivated to negotiate for a better career position, as they have been under rigid pay bands for years in the military. They are generally further into their careers and excited about the opportunity to carve out a job that suits their needs and aspirations.

However, she notes that transitioning from the military to civilian medical practice also involves breaking away from a certain mindset. Military professionals often come from a very hierarchical system where options and opportunities might feel limited. Street suggests that it’s crucial for them to realize that they can shape their career and their job in the way they want.

Her work with transitioning military medical professionals has largely been a result of her location in Augusta, Georgia, home to a large army base where medical professionals are trained. She appreciates the work with this group and recognizes its importance.

Key Strategies for Self-Assured Negotiation

Next, Nolan expresses his interest in understanding how one could coach physicians to navigate discussions in a self-assured manner. He also seeks advice from Linda on how physicians could be trained to negotiate with clear and precise terms to avoid misunderstandings and ensure a successful outcome.

In reply, Dr. Street explains the three principles that she highlights in her “Control Your Contract” program: leading the conversation with confidence, negotiating with clarity, and communicating your value. She asserts that these principles can be applied by physicians to better their professional situations.

#1 Lead The Conversation With Confidence 

Street highlights that negotiation should be seen as a conversation practice physicians are well-versed in rather than a daunting task. She believes that by reframing negotiation as a conversation, physicians can leverage their existing skills and experience to effectively communicate their needs and expectations.

#2 Negotiate With Clarity 

Next, Linda advocates for clear, direct communication about what physicians want and value in their professional lives. This involves introspection and self-awareness, identifying individual goals, and aligning them with their negotiation strategy.

#3 Communicate Your Value 

Lastly, Dr. Street underlines the importance of physicians being able to articulate their worth to their employers. By doing so, they can advocate for themselves and negotiate a working environment that is tailored to their needs rather than conforming to a pre-existing structure.

Street strongly believes that these practices will help physicians to create supportive work environments, reduce burnout, and ultimately provide better care to their patients. She also underlines the long-term benefit of retaining competent, satisfied healthcare professionals in the industry for the future well-being of society.

Dr. Linda’s Empowering Steps for Hospital Physicians to Assert Their Value

In response to the scenario of a group of hospital physicians faced with a lowball contract offer, Dr. Linda Street offers the following advice:

#1 Recognize Your Value 

It’s important for physicians to understand their own worth and the unique value they bring to the hospital. Despite any perceived power imbalance, physicians have considerable leverage in negotiation due to the shortage of healthcare professionals. Hospital administrators need doctors to function effectively, and it would be very challenging to replace 30 hospitalists in a short time.

#2 Understand Fair Market Value 

Physicians often have little knowledge of their potential earnings. It is vital to be informed about what constitutes a fair wage for their work to ensure they are paid appropriately. They can seek this information from peers, multiple job offers, or third-party services. Some companies provide hospital systems with this data, giving administrators a clear picture of fair market value; hence, doctors should arm themselves with the same information.

#3 Separate Personal Worth from Service Worth 

It is necessary to draw a line between personal value and the value of the service provided. Medicine has a wide pay range, even within specialties, and understanding where a doctor’s specific role fits into this spectrum is crucial in negotiations.

The above steps help physicians prepare for negotiations by clearly understanding their worth and the prevailing market conditions. This empowers them to push back against inadequate offers and advocate for themselves more effectively.

The Importance of Equal and Equitable Pay in the Medical Field

Moving on, Dr. Linda Street discusses the distinction between equal and equitable pay in the medical field.

#1 Equal Pay 

Equal Pay refers to a situation where everyone is paid the same, usually seen in shift work roles such as hospitalists and emergency medicine. It appears to be fair as everyone gets the same rate of pay per hour or unit of work (known as RVs or Relative Value Units in the healthcare industry).

#2 Equitable Pay 

This concept acknowledges that equal pay does not necessarily ensure fairness. Inequity can sneak into the system based on the nature and complexity of tasks. For instance, in an emergency room setting, a female physician who often gets asked to conduct time-consuming and sensitive procedures like pelvic exams may earn the same per unit of work as a male physician stitching up a cut on a patient’s arm. 

Though they are paid equally for each task, it’s not equitable because the female physician’s tasks take more time and effort yet are valued less in the unit system.

Dr. Street highlights this subtle distinction to shed light on potential biases in pay systems even when they seem to be providing equal compensation. The underlying message is to understand the difference and strive for systems that ensure equality and equity.

Negotiating Fulfillment and Energy Management in the Medical Field

Lastly, Dr. Linda explores factors beyond salary that physicians can consider when negotiating their work terms. She highlights the importance of understanding individual priorities to create fulfilling careers, as these can differ greatly from person to person and evolve over time.

#1 Schedule 

First, Linda highlights the significance of negotiating a work schedule accommodating personal needs and priorities. She uses her example of reserving Fridays for her non-clinical business and the weekends for personal recharge.

#2 Energy Allocation 

According to Dr. Street, different tasks deplete energy levels differently. Engaging in activities one enjoys, such as teaching or learning a new skill, falls into the “energy bucket” – they are fulfilling and do not drain energy as much. Hence, negotiating to allocate time for such tasks can lead to more job satisfaction.

#3 Job Distribution 

For those who love teaching or developing curriculum, she recommends negotiating for a certain proportion of their time (for example, 0.2 Full Time Equivalent or one day a week) to be devoted to these tasks. This can prevent overworking and burnout since these tasks align with their core values.

#4 Support Systems 

She brings up the example of advocating for a scribe, someone who handles paperwork, which is typically a disliked part of the job. Having a scribe allows doctors to focus more on patient care and interaction, increasing efficiency and job satisfaction.

Dr. Street stresses that physicians can negotiate conditions that maximize their productivity and happiness by being deliberate about understanding what energizes and drains them. She suggests starting from the energy management standpoint and moving on to time and money for effective job design.

Thank you for listening!

Transcript

Nolan Martin: : Hello and welcome to the NEGOTIATEx podcast. I'm your co-host and co-founder Nolan Martin with me today, as always, my good friend, colleague, and mentor, Aram. Aram, how are you doing today, sir?

Aram Donigian : Well, I'm great Nolan and I'm excited for today's episode. As folks may or may not know, you and I are both married to medical professionals. We both are married to nurses. And so it's amazing to me how often the topic of negotiation and medicine and its application in the medical field comes into my classroom. And as I was poking around listening to some of the other great podcasts that our colleagues in the field have, came across, today's guest who is both physician and negotiation expert, I said, who better to have on to talk about kind of this nexus of where medicine and negotiation fall than Dr. Linda Street.

So, let me give Linda's bio and then, welcome Linda to the show. So Dr. Linda Street is a board certified maternal fetal medicine specialist and life coach who focuses specifically on physician negotiations.

Linda is the founder and CEO of Simply Street MD, Negotiation Coaching where she helps female physicians take charge of their lives and negotiate for the salary they deserve, helping women physicians ask for and earn millions more in compensation. She lives and breathes to close the gender gap. A highly sought-after speaker. Linda has spoken at multiple conferences and hosts the highly ranked ‘Simply Worth It’ podcast, helping physicians get the compensation packages they want, deliver great care and stay in practice longer.

Having listened to a number of Linda's episodes, I highly recommend them to our listeners regardless of whether you're a practicing physician or not. Take the time to add Linda to your listening routine, please. I'll add that Linda is an army brat, lives in a community with a large military base and has worked with military doctors. Transitioning now to the service for that Linda, we are very grateful as two veterans ourselves. And Linda, thanks for joining us today.

Linda Street : Yeah. Thank y'all for having me. I have to live up to that lovely bio.

AD : No doubt that you will.

NM : Well, Linda, thank you so much for joining us today. Perhaps we could start by talking a little bit about your journey, how'd you become a doctor and more specifically, how does a maternal fetal medicine specialist get into the world of negotiation?

Early Life & Professional Journey (02:41)

LS : Yeah. So the, how you became a doctor was really this interesting combination of interests in being 18 years old and asked to decide what you want to do when you grow up, which I think is a really fascinating thing we do culturally. I'm like, what did 18 year old me know about anything?

AD : Yeah, we thought we knew everything.

LS : I thought I knew everything

AD : That's right.

LS : [laughs] So I had an interest in science and genetics and ended up using that to get a Bachelor's in genetics and then went on to medicine because I was like, okay, now what I do with this, I am a little bit of a social human, so sitting in a lab all day was not my ideal first spending the rest of my life. And so medicine felt like a great fit where I could actually use that knowledge to help people and interact with humans all day.

So, that kind of spilled into that. I went into Obstetrics and Gynecology and Maternal Fetal medicine in particular because there's a lot of genetics in embryology and I got to be a nerd and interact with humans and help. So it was a nice combination of both. And then the negotiation actually came from doing a lot of dumb things myself. So I think a lot of us end up becoming the person we wish we would've had. And so my first job after 15 years of training was a little bit of a hot mess and I found that my ability to not negotiate really put me in that position and or my inability to negotiate I guess rather. And so I developed the skillset through just a series of events and found that it was really helpful for me.

So part of it was really from a mindset piece. I approached my negotiation with my boss from a very like tug of war place initially and obviously was terrified to do that because I was this junior faculty member with very little gravitas as far as my position in the hierarchy of academic medicine. And here was somebody who was known to be very intimidating in and out of the OR and had decades of experience. So how am I supposed to go against them and ask for money? Because I found out my male partner who was senior to me was making $150,000 more a year because our salaries were published on the internet. So I was like, oh magic, I'm young, I can do the internet.

And really shifting from that mindset to more of a how does this benefit both of us for me to get what I want, was instrumental. And I had a coach at the time for a weight loss group, so something completely separate who really helped me to get to that place. And when I was coming at it from that mindset, I actually was able to navigate a $65,000 raise in one conversation. So I was like, oh, hmm, maybe this works. And I ended up leaving that job ultimately anyway because the pay was not the only concern. But really having that skillset and being curious about it helped me to be able to translate that into helping others because I certainly was not the only person I knew who had these problems.

NM : Yeah, absolutely. And I think it's a great transition to take something that's so important to you and then be able to help others. It's awesome that that that's the route you took to get into negotiation

AD : Experience can be a tough teacher sometimes, right? When we stumble on ourselves. Now you spend a lot of time, as you said, helping physicians negotiate compensation packages. You shared a little bit about some of kinda your own mistakes, but what is it that makes it so difficult for doctors, nurses, others to negotiate that first contract and why is getting that first one correct so important for someone fresh out of residency or school?

Valuing Medical Talent: Embracing A New Mindset In The Healthcare Industry (06:14)

LS : I think that to answer the first question, it's all mindset. So mindset as you know, drives a lot of things. But we're trained in medical culture that you're a helping profession, which we are and that's great. But I think the mix up is associating helping with I have to be deprived of associating, helping with, I can't have, I can't ask. And that leads to, I could go on for days, a lot of problems in medicine, some of which contribute to burnout in people leaving the field, which is a bigger huge problem which I'm hoping to help by this. But I think also there's this, I should be helping people so I can't ask for more money. That inability to separate what I'm doing for the patients, which is obviously why all of us are in these fields. You wouldn't do medicine any other reason. Like there's no reason to do this to yourself if that's not your goal.

But I think being able to separate that from the compensation piece. So I can do that and I can be well paid and treated like a person and in a culturally safe environment. And so I think separating the either or there and shifting to and because the hierarchy of medicine and y'all both have military backgrounds, so those are very hierarchical environments. The hierarchy of medicine is very much know your place, know your role, do what you're told, don't ask. And when you take that environment and shift it to kind of the compensation piece, you feel like, oh I should be so thankful I have this job. Because all through training you had to fight for that spot in medical school, you had to fight for that spot in that residency program, that fellowship, whatever. And to shift from that to all of a sudden you are in attending and you're now the talent.

You're the person who they need as a hospital system who they need as an organization to be able to take care of the patients. Or in the case of nursing, you are the talent, you're the skillset. They can't run a hospital without you to take care of your patients. So shifting your mindset to, oh they need me to be able to perform this skill that I can perform, and I should be compensated for that. Because I promise you your CEO is not sad that they're making what they're making. They're not sad that there is administrators of the hospital system being compensated. So why should you as the core element of that system be sad that you are compensated?

AD : Yeah. And the impact on how long someone stays in the field and how long they practice, especially given the shortage we have right now in the medical field, is such an incredible tie. I appreciate how you use and right it's possible to separate the care that you provide from a fair compensation and the key word there being and both are important. I'm curious, are the challenges you focus a lot with new female physicians and are the challenges that female physicians even more exasperated than their male counterparts?

Thriving In A Shifting Landscape: The Role Of Negotiation For Female Physicians (09:09)

LS : So I'm a little biased in this position. Just because that's who I work with and as a female physician, I think there are certain barriers that are either from a socialization standpoint present or real actual systemic barriers that are a little bit different than our male counterparts. For example, I've never known a male physician to be like, oh here's the nurse, they just walked in after you performed surgery on someone. I'm like, but I've consented you. I've followed you for an entire pregnancy and I just operated on you and you don't know my position in the team, like really.

So I think there are some kind of barriers from a morale standpoint because it's a little disheartening to be confused with other members in the team. Not that I don't think other members in the team perform valuable tasks, but this is the role that I'm fulfilling.

And so there's some of that from a cultural standpoint. And I think also from a socialization since we were little girls as female physicians and as women or people who identify as women, you're taught like don't rock the boat, you should be nice sugar and spice and everything nice, right? Like you're taught all of those things as a little girl that isn't the same as how men are taught. So I have three older brothers, which is probably how I got good at negotiating because I wasn't stronger. I was not bigger so I had to be smarter because otherwise like death was certain.

And so my brothers were all like, oh be aggressive. Go out there and play football. Go do these things. And they got all those messages where I got like, that's not very ladylike. You shouldn't do that, every time I was aggressive cuz I think of the five of us, I'm the most naturally aggressive

And so when I would display those characteristics, I was told, oh well that's not ladylike. My brothers weren't taught like oh that's not ladylike. So I think there are all those just kind of deeply ingrained cultural barriers that you get from the tiniest stages of being a human. I have two boy children and I try really hard not to do that. But there's that combined with just your position on the team not being recognized always the same. And I think medicine is also shifting. So we're at a little bit of a cusp in medicine where things are shifting a lot and the demographics of who's providing the care and it's starting to become a lot more reflective of the people we're caring for, which is a great thing. But the box that we're being put in is not shifting quite as quickly as the demographics are.

And so we're having more female physicians, you are going to have different needs, different roles. I mean culture has not shifted so quickly in the last 50 years that your life looks completely different than it did at some point in the past when you may not have had the work responsibilities as well. And so the way medicine looks is not shifting as fast as the people shifting within it. And I think that's leading to a lot of attrition. I mean I'm not even quite 40 yet and I know several of my peers who are no longer practicing already. And if we can keep those people in medicine by designing a container that they can succeed in, that they can thrive in, to me that seems like an essential investment and I see negotiation as a pathway to do that.

AD : Yeah. Let me ask about a different, another group that you work with as well, which is the transitioning military medical professionals. Are there challenges that they face any different as they make that career shift or are they similar to other physicians you work with?

Navigating Pay Bands and Cultivating New Opportunities (12:31)

LS : Yeah, I think they're actually some of my favorite people to work with because most of the time, by the time they've found me, they're like, Hey, I've been paid this and I've been told this is your pay band for the last god knows how many years I'm ready to get out there and get this done. So they tend to be a little bit more motivated to like apply the tools and get there because they're usually further in their career and they see that advantage.

So, they're not usually fresh finishing training, they're usually five, ten years out and really looking to carve a job that they get to design how it looks because they've been in a position where they've not gotten to choose those things for for a while. So I think from that standpoint there's a little bit more of a recognition of hey, this is my opportunity, I need to do these things.

But similar to that hierarchical kind of mindset, ‘culturation’, I don't know if ‘culturation’ is a word, but it is today.

AD : I like it. [laugh]

LS : Medicine, they're in a very subset niche culture too. And so I think breaking from the mold of these are my limitations, these are my options, to I can choose how I want this to look, is especially essential for them as well. And I fell into that a little bit just because of where I live. So I live in Augusta, Georgia and there's a big army base here and they train medical professionals and so I just happen to run into them in real life.

AD : Well thanks, thanks for the work with that group too. So necessary.

NM : Yeah, absolutely. Having recently gone through transition last summer from the Army, I know that they're very appreciative of that as well. So thank you.

In your control, your contract program, you focus clients on three ideas, lead the conversation with confidence, negotiate with clarity, and communicate value. Could you say a bit more about each of these and maybe how you could coach physicians to practice each one more successfully?

Thriving In Healthcare: Prioritizing Physician Well-being For Optimal Patient Care (14:29)

LS : Yeah, I think that I pick those things because they seem less intimidating. For a lot of physicians, I think if you say negotiate, it gives you that. Like I'm about to take a feeling where it's like icky in your belly and you just don't want to do it. And I think if you can shift the thought from I'm about to negotiate to, I'm about to have a conversation. Like that seems so much less of a barrier to overcome, then I'm about to negotiate. And so for me it's just, physicians are great at having difficult conversations. I mean we spend all day doing that. We talk to patients about really critical moments in their lives. That's something we're good at. I tell people terrible things all day long and I can do that without blinking an eye. Not that I'm not affected, but I've got that skillset.

So I think if you can take people who already recognize that skillset and tell them, Hey, it's just a conversation, then you can kind of show them they're not as ill-equipped as they think they are, that they do have some skills that they already know, that they already have, that they can apply to this. Because most physicians are busy. They don't have time to like go take a semester long course in something to accomplish one task, which is getting a job that works for them. They want to be out there positioning. And in order for them to do that and to do what they do best, they need to see what skills they already have so they can just shift that mindset piece. And I think focusing on the conversation helps with that too. The second piece in really like focusing on, and I'm off my website too, so I'm looking a tangent, a little bit [laugh], but focusing on communicating clearly and having their values.

I think a lot of that's just really focusing on what do I want? What are my values? And that shifts to the selfish portion of this for me, that I want them to continue practicing. I want there to be really highly qualified people who are good at what they do to take care of me as I'm getting older and needing more healthcare services because I'm not always going to be my age. I'm certainly not 25 anymore. And so my health needs are evolving.

The people I love are needing healthcare professionals. I want people who are good at what they do to continue to do it. And I think that kind of circling back to what we talked about earlier, if the job is built in such a way that it is a container that is molded to you instead of a container you're squishing yourself to be in, you are going to be able to do it longer. You're going to be able to do it from a healthier place because I will tell you, having been burnt out, I didn't show up for my patients the same way I can when I'm not burned out, when I was. Now, I made good medical choices and I made good care plans for them. But as a human, because you're connecting with people at very critical moments in their lives, I was not able to connect to those patients the same way I can when I'm in a good space for me. And so I want people who are able to do what they do best from a good space so that they can do it at the highest level they can do it, and deliver that care at that highest level. And to do that, they have to have supportive environments and that's going to look different for everybody. And so you have to advocate for it for yourself because nobody else knows what's best for you.

AD : It's interesting. I mean, we understand what you're getting at and I think it's an interesting concept, which is, this isn't simply a transactional event, this is longer implications for the service and even the motivation that a physician's going to feel as they provide that service. You discuss mindset. You've mentioned it a couple times now. I know you're a big one into pre-negotiations preparation. I've seen that in your work also the importance of doing post negotiation reviews. Obviously Nolan and I as former military folks love both those things, in terms of getting well prepared and then the good old fashioned after action review or figuring things out. You know, I was going to ask you why these things are so critical. I was wondering if I gave you, maybe a scenario though, maybe you could talk through, how you might coach someone in this scenario.

So a little bit of a loop here throwing you, but I had a colleague recently just talk to me in passing; doctor, general hospitalist, part of a group of about 30 hospital physicians that were renegotiating their contract with the hospital administration and the administration opened with a well below fair market value offer. Enough that it felt insulting, hurtful, and even prompted people to start polishing up the CVs and getting ready to look elsewhere. Getting ready for the next piece of that. How would you coach them when it comes to those hospital doctors? How would you respond when it comes to whether it's preparation for the next piece, their mindset, what would you tell 'em?

The Art Of Negotiation: Knowing Your Worth In The Healthcare Industry (19:19)

LS : I think in that case, to start off you have to recognize why you're valuable. Like what value you provide that the hospital needs. Because hospital admin and I practice in corporate America as well, hospital administration are going to come with this is what we're going to give you, this is what you should take because they're running a business, they have a bottom line. The more they can shrink your portion, the more they have to put in other places where squeaky wheels may be louder. So I can't fault them for that necessarily. I mean I do, but [laugh], that's where they're probably going to come from. And so if they start off there, your responsibility as the physician or the group of physicians who are negotiating is to recognize first, this is why I'm valuable to the system because let me tell you, you can't find 30 hospitalists in five minutes.

You certainly can't do it in any reasonable, from a care perspective time. So if all 30 of you all walk, they are up a creek without a paddle. And that is a value to that system beyond just the value you provide to your patients. And so I think recognizing that you are not powerless in this conversation, because I think it's very easy when someone who is your employer comes and says, this is what we're going to pay you to feel like I don't have a choice but to take that. And you do, you always have a choice. There are plenty of places that would love to have you as a hospitalist. We are in a healthcare professional shortage, not a hospital shortage. I mean there's some of that too, but they need you more than you need them. You just have to be willing to kind of see that [laughs].

So, I think the first step is recognizing, especially in a group dynamic like that, how powerful you actually are. The second piece is knowing what fair market value is. So I see a lot of physicians that have absolutely no idea what they should be making. And the companies that solicit this data do a really good job of trying to keep that secret because the dirty little secret in all of this is that the companies provide that data for free typically to hospital systems if they contribute to the data. And so your administrator has that data.

If I go to negotiate with my administrator, they already have the MGMA and there are several organizations and they all have various pros and cons, but there are similar enough, they have that data in front of them to know what is fair market value for me, because they're highly invested in that for two reasons. One is they want to pay me as little as they can to help their profit margins. I work in for-profit medicine. The second though is they have some actual consequences if they overpay me. So there are stark laws and all sorts of anti-kickback statutes, which we won't get into the weeds, but there are legal ramifications for them if they pay me in excessive fair market value. So for them it's really, really, really comfortable to underpay me because then they're not at risk at all. And so they're going to have that data. So I should too. And there's some free data out there that's really helpful. Talking to peers is really helpful. Having multiple job offers to kind of know what you can actually get in your community, what people are offering is helpful. But that's just a jumping off point. So you need to have some of that or you need to find somebody like me who can facilitate getting you that data directly because I purchased it with the kind of crowdsourcing mentality of, I can charge little snippets and be able to get it to multiple people. And that way everybody has what they need to start off.

So beyond recognizing your value, you have to know what fair market value is because your value as a human and your value as somebody performing a service are different. And I think you have to be able to separate those two things. So to do that you have to know what should I being paid for what I'm offering because medicine is really wide, even within specialties. So you can find a pediatrician making 150,000 a year, you can find a pediatrician making 300,000 a year. You can find an orthopedic surgeon who may be making a million dollars a year.

So, there's a wide range depending on what you do and where you do it and how you've advocated for yourself of what different roles in physicians are being paid. And so you have to know kind of what your pay band expectations should be before you even know to say this is insulting. I mean, some things are so blatantly insulting, you could just tell, but most of the time it's just feasible enough that you feel icky about it. But it doesn't feel like I can't have this job like I have to walk because this is so insane that why would I even work?

AD : Yeah, no, I saw you and you just mentioned it, this is an important piece is sharing the data and looking at the band and going in very well informed. You've talked about this idea of fairness quite a bit, on your podcast and you kind of, if I understand it right, you distinguish a little bit between what's equitable versus what's…

LS : Equal.

AD : Equal. Yeah, thanks. Yeah,

The Hidden Bias: Exploring Inequity In Equal Pay Systems For Physicians (24:06)

LS : Yeah, So I mean I think the big thing between equal and equity, is equal is everybody's paid the same. And you'll see that more often in roles like a hospitalist. So some of the more shift work roles in medicine, which can I just say is a big advancement we've made in the last 10, 20 years to help fit jobs that more fit the evolving workforce because these shift work type jobs allow you to have a life outside of medicine, which ta-da, is going to help you to stay in medicine because we are people too who have hopes, dreams, lives, families. So I think that some of those roles are more prone to vary, this is what we pay, this is what we pay per hour. Emergency medicine has a lot of that. Hospitalists jobs have a lot of that. A lot of the shift work type positions are more, this is what we're going to pay for this and we pay everybody the same.

So that looks very equal. And it may be so it may be this is what we pay that this, this is the same where it can be not equitable is, for example, in an emergency room setting, you can be paid the same dollars per unit of work. So we have something called RVs, which are units of work and you can be paid the same per unit of work as somebody else.

And so you would think, oh, that's really fair. Like they're paid the same per each unit of work. So if they work more then they get paid more. Well, how those units are ascribed to different services may not be equal. There already may be bias built into the system. For example, a pelvic exam is time intensive, very sensitive, takes a little bit of time to do because you can't just walk in and just say hi and do it. So something like that is valued less in a unit system than say stitching up a cut on your arm, which you don't have to like walk in and be very sensitive about.

It's like, okay, here's your arm, let me stitch it up, thanks. And so if the female physician, for example, is always being asked to do the pelvic exams because oh, you're a woman, you're going to understand better and the male physician is getting to sew up all the lacerations, now you have inequity even though they're paid equally for each of those tasks. So it's subtle, it can sneak in there, but there can be a lot of inequity even in an equal system.

NM : That's an awesome point and thank you for clarifying between those two. Beyond salary though, what are some other things that physicians might negotiate around what they sometimes don't think about such as time to conduct research, or teach, remote work, additional training, fellowship opportunities, those kinds of things.

Empowering Yourself: Navigating Negotiations For Work-Life Balance In Medicine (26:28)

LS : All of those things. And that's what's so wonderful and that's why this very individual. So you have to really take times to decide what is your priority, what do you want out of this? What would be a fulfilling career for you? Because how that looks for me may be very different than how it looks for you. How it looks for me today is very different than how it looked for me four years ago. And so that evolves per person and it evolves over time and that's okay, but you just need to be able to identify like what are the pieces of the job that are important to me because that's going to help you negotiate for the things you want that are going to lead you to success so that you stay in that job, which is my ultimate goal. If we haven't gotten a message here, [laugh].

So if you want a different schedule, for example, so for me, I don't work Friday clinically. Friday is for my business. This is when I focus on negotiations and clients and things that aren't clinical medicine. So I was not willing to work five days a week. I'm by myself and my practice, so my office is closed on Fridays. My employer would love to open my office on Fridays because they're in the business of providing a fee for service kind of care model. And that's okay, they can love that, but they also want me to stay. They want me there the other four days. And my ability to show up those other four days, I know as a person is contingent on me having Friday to be able to do my business and Saturday and Sunday to be able to recharge as a human. And so for me that was very non-negotiable. And obviously they would love for me to work the five days a week. Obviously I don't want to work the five days a week. And so that's a negotiation.

That was something I had to advocate for fairly strongly because our goals were aligned on a global level, but not on that specific detail. Schedule is a huge thing that I spend a lot of time talking to female physicians about how to negotiate for their time because I always think of it as a hierarchy. There's like energy, which is to me the most valuable thing because we all know you can spend two hours doing one thing and two hours doing another thing and they don't deplete you the same way.

And so doing the things you love, and this is where like things like teaching or learning another skillset, those type of things fall in that energy bucket because if you really thrive off teaching, you're not going to be happy in an academic job where because you're the junior faculty member, you're seeing all the patients and someone else is doing the more teaching type effort.

So you have to be able to advocate for that. I need 0.2 FTE, which is how we call our salary distributions full-time equivalents. I need one day a week or 0.2 to be able to teach and to be able to develop curriculum and to be able to do these things so that I can be effective and happy in my job. Because if you don't advocate for that, what happens is because that's a core value for you. You're going to do it anyway in your free time and then all of a sudden you're working too much and you're burned out and you want to quit and da, da, da, da, da, da. And then you're no good to anyone, certainly not yourself. And so, salary is big but schedule I think is the kind of catch meow or the mecca of what people are advocating for in their physician negotiations.

And then little things, if a scribe, a scribe is a big popular thing right now to advocate for, for a lot of my physicians. Doctors hate paperwork, I think most people do. But like we want to be interacting with patients, taking care of patients, providing clinical skills to people. We do not want to be doing paperwork. And so much of my job is paperwork. And same for most physicians and really nurses. Everybody on the healthcare team, there's so much charting. If you can advocate for a scribe, which is somebody who writes down in the chart the things that are happening that you're saying so that you don't have to do that piece, that is really valuable to a doctor who wants to just interact with their patients and connect with people. And so that may be a small financial ask, I don't know what they go for, but it's somewhere in the $20,000 to $30,000 range.

And you may be able to be more profitable for the system because you can see a few more patients a day if somebody else is doing the paperwork piece for you to a certain degree. And that may be really valuable to you so that your energy is preserved because you're spending more time taking care of people and less time punching numbers on a keyboard. And so little things like that, you just have to be really deliberate about, in my daily life, what are the things I need? In a day as a physician in my job, what are the things that really irk me and drive me crazy? How can I get rid of those or eliminate them as much as possible? And what are the things that really energize me? How do I maximize that? And really starting from that kind of space of what energizes me, what doesn't, and then going from there to time to money, I think is a really effective way for you to design a job that makes you happy.

NM : Hey everyone, Nolan here. I have to jump in and in today's podcast for part A of this show, be sure to rate, review and subscribe to the NEGOTAITEx Podcast if you haven't already done so. And also join us next week for part B of this awesome interview.

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