Negotiating Your Worth

By Melany Hughes

Hiring Entity
“No. That won’t work for us.”
Job-Seeking Physician
“Ok, that’s fine then.”
I’m not going to cry.
I’m not going to cry.
Ugh, are those tears?
Am I crying?
Did they notice?
Hiring Entity
“Do you need a minute?”
Job-Seeking Physician
Noooooooooooooooooo

In our worst nightmares, this is the scenario we think could unfold if we dare make demands during contract and business negotiations. Of course, in reality, it will never happen but the fear of lacking control and losing dignity can be so strong that it compels contract seekers to make no demands and to agree to everything that is proposed; just because it is easier. Women have a tendency to internalize all the cultural, societal, religious and historical characterizations that define us as the “fairer” sex. But let me make it clear that although there is a time and a place for taking a backseat, meetings with potential employers at the negotiation table should not be one of them.

It may seem hard to make demands when you feel that you are approaching the contract process from a place of inferiority. You may even feel that you lack sufficient knowledge to leverage any control in the process. But you have to muster the confidence to serve as your own advocate.

I attend annual meetings and conferences for medical professionals and the horror stories people tell regarding their contracts and work situations would make your hair stand on end. The situations can be downright criminal when there are special circumstances like visa requirements, malpractice settlements or negative hospital inquiries, etc. I know a very competent practicing female surgeon who makes under $100,000 and was required to cover the hospital surgery call schedule 24 hours a day for 4 months at two 200+bed hospitals all for the promise of a sponsorship for a US green card and permanent residency. It is mind-boggling that this beautiful, brilliant, hard-working woman did not think that she was worth more and even more disturbing that despite all our medical training, we are not provided with more business savvy and insight. Happily, through some back-door nudging that I am proud to say I encouraged, she was able to get her contract renegotiated and is living with a slightly better quality of life. But you cannot trust that contract renegotiation will be an option. Sometimes, it is two years later and you are so burnt out that leaving active practice seems a viable option.

Medical school and residency don’t include business classes. In certain cultures, women in the forefront making demands is frowned upon. It is clear that medical training should include more education that relates to contracts and contract negotiation, reimbursement, incentives, malpractice coverage, billing, etc. It’s preposterous that the first time you hear about a non-compete clause or tail coverage is when you are signing the next few years of your life away.

So how do we do this? How do we even approach this?

1. You are a trained professional. You are a “hot” commodity! You are doing them and their patient population a favor by working for them. You do want to let them know what you can do for them and their practice. You should approach this process and the contract negotiations from a presumed position of power.
2. Be sure you understand your own desires and needs (lifestyle, family plans, desired salary range, geographic preferences, career interests, work schedule, paid research hours, tenure options, etc).
3. As a new graduate/physician, you will need to make some compromises to get more experience. But do not give up everything. Keep your soul! If you need two weekends every month to go river rafting or skiing or want two weeks in summer to travel through southeast Asia, then make sure you negotiate for that.
4. MAKE A LIST. For first-time negotiations, renegotiation or any changes, do not approach the meeting without a written list of both needs you have and compromises you are willing to make to come to a satisfactory agreement. For my last contract re-up, my current employer just took one look at the list and agreed to every single thing.
5. Read and Empower Yourself. Here are some suggestions:
   • Women Don’t Ask: Negotiation and the Gender Divide by Linda Babcock and Sara Laschever
   • Getting More: How You Can Negotiate to Succeed in Work and Life by Stuart Diamond
   • AWS Job Negotiations Resource by Dr. Margaret Dunn
   • Read the AWS Navigating Your Surgical Career Guide
6. Have walkaway terms
7. Lastly, make sure you have a contract lawyer familiar with physician contracts.

---

Melany Hughes, MD, MPH is a 2005 graduate of the Howard University College of Medicine. She completed her General Surgery internship and residency in 2010 at Howard University. She received a Master of Public Health Degree in Disaster Management and Emergency Preparedness (MPH) from Tulane University (TU) in 2012. While at TU she received a research appointment with the World Health Organization’s Center for Research on the Epidemiology of Disasters (WHO-CRED) in Brussels, Belgium. Her work focused on the analysis of both man-made and natural disaster-related trauma and injury patterns resulting in contributions to several multi-national collaborative research projects and publications. Following completion of her MPH degree, and with a continuing commitment to public service and humanitarian work, she served as a General Surgeon and Medical Officer with the U.S. Indian Health Service; providing healthcare to the Hopi and Navajo Nations in northwest Arizona. Dr. Hughes strives to practice “socially-conscious” general surgery and is currently employed as a private practice surgeon with Hafa Adai Specialist Group in Guam, USA.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.