A newly hired or early-career IR not only has to learn how to fit into their new group or institution but must also navigate the changing health care environment. A critical part of that effort is learning how to demonstrate your value to your practice and ensure that your contract reflects that value. As an IR completing my second postfellowship year as an employed private-practice physician, I have successfully negotiated both my initial contract and my first raise, learning some valuable lessons along the way.
1. Decide to negotiate
When I graduated fellowship in 2014, during a depressed job market, my co-fellows and I were panicked about our prospects. We were each offered similar starting salaries, though several successfully negotiated 5 percent more by simply asking. It can be intimidating or uncomfortable to ask for an increase on an initial offer, especially in a difficult job market, but it is worth the effort.
During medical training, a salary is provided according to postgraduate level, generally without negotiation. After years of this convention, the new attending must quickly learn to advocate for herself. Is there a going rate for a shift of service you provide? Do you need to factor in call compensation, or is it included in a daily, weekly or yearly rate? What is the most you can realistically hope to get? What is the least you need to feel adequately compensated? Answers to these questions can help you to evaluate an initial or subsequent offer.
After a year at my first job, I found putting dollar figures down on paper helpful in preparing for renegotiation. I made a spreadsheet of 7 percent yearly raises and became familiar with those numbers. Do you have a goal salary that you would like to reach in 5 years? Break that number into stepwise increments to calculate what yearly raises should look like.
Examining these numbers in detail prepared me so that I would not be caught off guard or uncertain in the case of a counter offer. This helped to bolster my confidence going into discussions regarding pay.
2. Seek and foster transparency
At the 2016 Women in IR luncheon in Vancouver, a participant, who suspected she was being paid less than her male colleagues, commented that she had been told it was illegal to discuss her salary with her co-workers. Although it may be discouraged via written workplace policies or management culture, the National Labor Relations Act protects the right of most private sector employees to engage in "concerted activities for the purpose of collective bargaining or other mutual aid."
This means that you may lawfully discuss things that matter to you at work, like compensation.1 Lack of transparency benefits only employers and fosters an uneven playing field. President Barack Obama has said, "Pay secrecy fosters discrimination, and we should not tolerate it.”1 A recent analysis by glassdoor.com substantiates and quantifies the current gender pay gaps in the United States, Great Britain and Australia, based on their crowd-sourced salary data. Controlling for various factors, the authors reveal an “adjusted” or unexplained pay gap across various industries, including medicine.2
Increased pay transparency could help traditionally underpaid groups (including women, minorities and those early in their careers) to improve their compensation.
3. Mine information at every opportunity
Intermittent contact and information sharing with fellow trainees early in my career has helped me to learn about how other practices compensate their members or employees and to gauge prospects locally and in other markets. Attending professional meetings has also kept me apprised of market changes and can lead to opportunities for a better job or compensation package. Finally, job recruiters and industry colleagues, including device representatives, can serve as sources of information and opportunities.
4. Find salary data online
You can find a lot of information online regarding IR salaries. Some websites, such as radworking.com, have job listings that include figures for beginning and potential compensation.3 Other sites use a crowdsourcing model, such as payscale.com.4 When you create a profile on their site, you can view others’ self-reported information from around the country, including the practice setting in which they work, salary, “overtime” pay, number of vacation weeks and other benefits. Doximity.com has launched a salary map populated with anonymous salary data from more than 18,000 physicians across the United States,5 as reported in The Atlantic article, “What Doctors Make.”6 This kind of data is a powerful tool in the negotiation process.
5. Gauge your audience
Are you negotiating with a peer or someone of a different generation? Are cultural factors at play? I was negotiating with two to three men, all of whom were older than I. I was brought in as the youngest physician in the practice, a common occurrence after training, and am the only female IR in the group. These factors superimpose a dynamic I was keenly aware of while negotiating. When I received a colorfully negative reaction to a request to renegotiate terms early in my employment, I compensated by remaining extremely objective and businesslike.
6. Practice (finite) patience
After a year in my position, my new contract was postponed for several months, during the group’s renegotiation with the hospital system we serve. This period required prolonged patience, stretching me beyond my comfort zone. It was a period of uncertainty, during which my chief operating officer seemed to prepare me for a potential pay cut. He shared anecdotes from other radiology groups he’d managed in the past as an indication of “things to come.” Finally, I was granted not only an increase in workload, but a significant increase in compensation. Although I now take far more call than I would like, I feel that biding my time was a successful strategy in renegotiating my contract amendment.
7. Build and nurture the relationship with your superiors
Consistently serving as an asset to the group makes retaining you and paying you well mutually beneficial for you and your employer. Promote your value by communicating to your boss any accolades you’ve received.7
For example, when a patient sent an appreciative, complimentary letter to our hospital CEO, lauding me and my team for providing excellent care surrounding his image-guided biopsy, I received a thank you letter and gift card from hospital administration. I immediately forwarded the information to my radiology group’s CEO. His reaction was to praise me as a “star.”
Highlight any flexibility you offer: can you perform high-end interventional services one week and diagnostic services the next? This allows tremendous leverage in scheduling for your group or team. Are you the most current in a certain area, for example, just out of fellowship at a transplant center? This adds to the overall capacity of your team to deliver high-quality care, no matter your location. Have you improved the practice with your leadership? Demonstrate these points to your decision-makers, whether in the form of evidence of increased referrals, improved departmental efficiency, excellent patient outcomes or rave reviews from your referring physicians.
With these points gathered, I was armed for negotiation and could say, “Here is what others in similar positions are paid, and here is why I should be paid at the top of that range.” If your employer or group does not agree to higher monetary compensation, consider negotiating something else. For example, in my group, everyone receives the same number of vacation weeks. Therefore, they consider this nonnegotiable. Consider other benefits you could ask for, such as a new title, academic or administrative time, an educational stipend, office space, access to assistant(s), et cetera.
8. Obtain legal review
Because your contract serves as a framework for the working relationship, you should make sure you fully understand all its nuances and legalese.
A personal referral to an attorney, particularly in the geographic area you will be working in, is ideal, if possible. Someone familiar with physician contracts will be versed in the specific language needed to establish the ground rules regarding noncompete clauses, call responsibility, malpractice coverage and other physician-specific matters.
I found my attorney using an online marketplace. The comprehensive service included a detailed phone consultation, follow-up emails and a review of contract revisions.8
I was offered a standardized contract used for both diagnostic and interventional radiologists. My attorney showed me several important points to clarify regarding my role in doing a combination of hospital-based IR, in-house DR and teleradiology.
For example, I initially received no call compensation but had a cap on the number of call weeks my first year. It was important to note that tail coverage would not be covered by the practice, should I move on. Unfortunately, this was considered nonnegotiable. Therefore, I will have to budget for this significant expense, should the need arise.
Also, the contract required a minimum number of studies to be read per imaging shift to avoid a penalty in compensation. My attorney added language protecting me from docked pay in the case of factors beyond my control, such as low hospital volume or lack of assigned exams at the level of the telecenter.
Conclusion
As the economy has improved, and the radiology market continues to prosper, there is more of an opportunity to negotiate than in years past. Some authors have advocated negotiating only in the setting of multiple job offers or in the case of a truly exceptional candidate. I would argue that in order to optimize pay, especially for those who have been traditionally compensated less for an equivalent position, negotiation is a crucial skill to hone and harness. It is a game that can be successfully played in various arenas, whether academic or private, diagnostic or interventional, city or countryside.
Best of luck in all of your future negotiations!
References
- Dreisbach T. “Pay secrecy” policies at work: Often illegal, and misunderstood. National Public Radio website. nepr.net/news/2014/04/13/pay-secrecypolicies-at-work-often-illegal-and-misunderstood/. Published April 14, 2013. Accessed Aug. 30, 2016.
- Chamberlain A. Demystifying the gender pay gap: Evidence from Glassdoor salary data. glassdoor.com/research/studies/genderpay-gap/. Published March 23, 2016. Accessed Aug. 29, 2016.
- Harolds JA. Tips for a physician in getting the right job, Part XXI: introduction to contract negotiations. Clin Nucl Med. 2015 Apr;40(4):314–6.
- radworking.com/jobs/search-jobs.html
- payscale.com
- Doximity site Career Navigator. doximity.com/careers. Published in 2016. Accessed Aug. 29, 2016.
- Hamblin J. What doctors make. theatlantic.com/health/archive/2015/01/physiciansalaries/384846/. Published Jan. 27, 2015. Accessed Aug. 28, 2016.
- Condren D. Ambitchous. First ed. New York, NY. Morgan Road Books, a division of Random House, Inc. December 26, 2006:65–66.
- UpCounsel website. upcounsel.com. Accessed of April 2014.
