Negotiating to get paid what you deserve

Interview transcript (edited for clarity):

Susan J. Kressly, MD, FAAP:

I'm Sue Kressly, a general pediatrician and clinical informaticist, and the current chair of the section on administration and practice management at [the American Academy of Pediatrics].

Contemporary Pediatrics:

Can you break down your session presented at the 2023 American Academy of Pediatrics National Conference & Exhibition?

Kressly:

We really talked about how to leverage and know your worth in in negotiating contracts and workforce challenges, and really looking at the pediatric workforce with some data about both primary care and specialty care and lifetime earning potential. Sort of figuring out how you can leverage where you fit in all of this to make sure that you're finding a good fit for you, for a career batch.

Contemporary Pediatrics:

What are some tools that physicians can use to effectively negotiate their pay?

Kressly:

The data really shows that women of lifetime earnings, and a lot of it is for residents coming out at starting salaries, women are devalued to begin with, so knowing that in the beginning. Really we talked about owning your own, knowing what your own levers are, and owning your own value, which means leading with what's special about you. If you're trying to serve a community that's growing, and you have a special skill set, whether you have a special interest in breastfeeding, or adolescent medicine, or mental health, or you're a tech person and you notice the practice or where your organization is going, or work on a website that looks a little dated, leading with how you can bring value and added value, just that you're not feeling the clinical role of seeing patients, but how I can actually help you strengthen and grow your organization, and why it's valuable for you as an organization to really understand the value I bring.

Contemporary Pediatrics:

Does advice change for more-experienced physicians compared to younger or new physicians?

Kressly:

I think it should be equal, although I think the younger physicians just don't know their value, because they haven't sort of played in the space, but what we talked about today is you have to know what your wants are vs your needs, you have to understand how the business of medicine works and pediatrics works, so that you're at least understanding the business that underpins our care delivery system, and the inequities in payment for pediatrics overall. Older physicians or seasoned physicians really should take some of the expertise of learning from what was good and bad about their prior experience, and go through what really fills their cup up. Compensation isn't just money. It's working in an environment where the culture fits with you. Or you're working in a well-oiled machine where you have the same mission, vision, and values as the organization that you're joining. I always think leading with what you can add to what's already existing, and why you are the best candidate and why they should consider investing more money in some kind of compensation package, because you're not just seeing patients you're adding value to the communities you serve.

Contemporary Pediatrics:

Are there differences for physicians that negotiate pay for private practice vs hospital positions?

Kressly:

Yes. Again, knowing where the levers are as a hospital position, you probably have your best leverage in that initial contract. But both settings people sort of forget that compensation and contracts aren't set it and forget it, there should be an ongoing conversation. But the other thing about being in outpatient, but it's probably true for both owned hospital systems and in private practice, you also want to know why they're hiring. Is it because there's been a lot of turnover and they can't keep someone and how badly do they need you? Do they just lose a physician for unforeseen circumstances? Are they a vibrant, growing organization that's looking to meet additional needs of their communities? Understanding why they're in the position of hiring is just as important as knowing what the position itself entails.

Contemporary Pediatrics:

What advice would you give for a physician that may be uncomfortable negotiating pay?

Kressly:

Practice. It's uncomfortable to ask for money, but they should really think about it as you need the right resources to be able to live your life and they want to invest in you for the long term. And you need the right payment so that you can make sure you can serve your patients and the community and so, payments shouldn't be a dirty word. It completely underpins everything we make in healthcare delivery and you have to make smart decisions for your personal life, as you're CEO of your own life. So, you need to make sure that you have the right resources to fulfill you your vision and lengthen your career. I think we're seeing some people leave and exit careers early because they really didn't at some point to mid-career or iteratively go back and say "does this position meet my needs both from compensation financially, but my work life balance, my ability to engage in my community, myability to pursue a passion that I care about, and add value in a way that fills my cup up and my wallet up at the same time."

Contemporary Pediatrics:

Is there anything else you would like to include?

Kressly:

I'll say one thing. Negotiations are iterative and compensation packages aren't set it and forget it. So even if this is uncomfortable, you'll get used to it or you should get used to it because it should be an ongoing conversation throughout your career, and always think of the exit strategy. When you signed a contract, they all think "I'll stay here my whole career." Very few people stay in the exact same situation for their entire career. So think about the exit strategy and non-competes and other challenges at the other end of the contract, should you decide it's no longer a good fit, even though it felt like it in the beginning.