Negotiation Tips and Insights for Early Career Pathologists

Becca Battisfore:

Welcome to the latest edition of the College of American Pathologists CAPcast. I'm Becca Battisfore, content specialist with the CAP. Today's episode is a collaboration between the New-in-Practice and Practice Management Committees and is one of two episodes on the topic of job searching. In this episode, Doctors Woo and Yoon are chatting with Doctors Larsen and Bailey about how to successfully negotiate job offers. Take it away, Dr. Woo.

Dr. Woo:

Hello and welcome to the College of American Pathologists podcast. So you have a job offer now what? Tips and insights. This podcast is targeted at senior trainees and new-in-practice pathologists who are navigating contract negotiation for the first time. The podcast will highlight different perspectives of negotiation process, including that of a new and practice pathologist who recently underwent negotiation and an experienced pathologist involved in the hiring process.

My name is Dr. Jennifer Woo and I'm a pathologist at City of Hope National Medical Center in Irvine, California. I'll be serving as a moderator for this podcast, along with Dr. Esther Yoon. Who will be introducing our panel.

Dr. Yoon:

Thank you, Dr. Woo. My name is Dr. Esther Yoon and I am Regional section head for Surgical Pathology in Cleveland Clinic, Florida.

We have two knowledgeable and experienced panelists with us today. Dr. Moira Larsen. She is an AP/CP-boarded pathologist and proud member of College of American Pathologists and Practice Management Committee. Dr. Larsen holds MD and MBA with emphasis on medical services management. She has been practicing for over 30 years and since 2009 has had primary responsibility for hiring pathologists into various employment models.

First a private practice, then a hospital employment model, and now MedStar Medical Group, the physician led entity of MedStar Health that employs all physicians and APIs. MedStar Health is a system that includes nine acute care hospitals located in Washington, D.C., Maryland and Virginia. In her current role, she interviews pathologists seeking jobs at an academic center, a large urban referral and trauma center and five community hospitals.

We have Dr. Cedric Bailey. He's anatomic clinical inside of pathology trained pathologist. He recently finished his training at Washington University in Saint Louis and now a junior faculty at Cedars-Sinai in Los Angeles. He has been serving as a junior member on the Practice Management Committee with College of American Pathologists for the past two years. His enthusiasm for understanding varied practice models has helped expand his interest in business and negotiations early in his career.

So we've been offered a job by should we look for in a contract? Dr. Larsen.

Dr. Larsen:

Thank you. I'm so glad to be here today to talk about this. Contracts can be quite variable when you're being offered contracts for different practice models. There are some different things you need to look for, but overall, your contract should include information about your salary, your benefits. It should include information about your time off, whether that's uniquely divided into vacation, health related and continuing medical education, or whether those are unique buckets.

It also includes things related to paying fees for your medical staff, dues for your licensing, whether you get any additional information for continuing medical education activities. It'll include information about expectations for your board certification. It will include a job description that delineates exactly what's expected of you. It also will include all the standard legalese that control backs have, which may include non-compete clauses indicating that if you leave the job, how far a radius around that location must you go before you can go for another job?

It also includes termination clauses, which can be for cause, malfeasance, illegality. But there also is usually a without cause termination statement in all contracts, and that can be activated either by the employer or the employee. When I negotiated one of my first contracts with the hospital, I did have an attorney assisting me. And when we went through the contract, he looked at me and he said, you know, this contract says that this is for a year's employment with automatic renewal.

But this termination without cause clause says that 90 days’ notice is all that's needed from either side for you to leave. So this is actually a 90 day contract, and that's an important thing to understand. And as well, the contract will include information about malpractice insurance, what it is, how it's covered and what type it is. Those are those are the big pictures that should be in your contract.

Dr. Yoon:

Thank you. Dr. Bailey, since you've gone through the interview process and securing your job, can you tell us what you looked for in your contract?

Dr. Bailey:

Absolutely. Thank you for having me. Pleasure to be here with you, Dr. Woo and Dr. Yoon. And that was a great answer. Dr. Larsen, very thorough. Some of the things that I like to approach when I'm thinking about negotiation and contracts is kind of a laundry list of items that Dr. Larson went through. But things in particular, pay attention to you that I thought were helpful.

Beyond specifically what Dr. Larsen said was looking not just at salary but also benefits. So who's paying for benefits? How much is their health savings account? Who's paying for life insurance? Disability insurance? What are the retirement options? Is there matching? Is there a pension? And then, as Dr. Larsen mentioned, time away from work is also important. And I think that one of the things that people sometimes kind of skip over but is a great point to maybe find flexibility is in vacation and time away from work, both for me and for other reasons.

Finally, there were a few extras that I thought of when I was going through this process and speaking to friends more recently. That can kind of serve as an extra little bonus on top of some of those things. So housing assistance is the place you're negotiating with going to help you have a mortgage, give you a stipend for housing.

Is there going to be student loan assistance or is that a self-eligible organization? But sign on, bonuses are available and can you delineate out incentive bonuses so that way, even if the kind of top line on that salary number says a certain value. Is there a way if you were adding significant value to the practice, you can get additional compensation throughout the year of moving reimbursement If you really like this job and they really think you're a great fit, maybe you can find a way to work together to get you there in a more amicable and easier fashion that's less stressful.

And then kind of one. One of my favorites for noon practice pathologists or senior trainees. Can you get this job to pay for your board exams? I think that's a small thing that almost every place would agree they would like. They're up and coming pathologists to have board certification and it's kind of a drop in the bucket for most organizations, but it's really impactful when you're a senior trainee or a fellow in that few thousand dollars really makes a difference, especially when you have to pay for AP or an additional fellowship certification as well.

So those are kind of those little extras that and speaking to my friends I kind of picked up on more recently, too.

Dr. Yoon:

Definitely, all these items that you don't think about, it's really good to hear from someone who's gone through it. Were you able to get all of what you wanted and asked?

Dr. Bailey:

I think that I'm very happy with my contract that I was able to negotiate. And then more importantly, even if I wasn't able to get some of those things, I wanted in speaking to you and kind of collaborating with some colleagues on our all of our contracts as we left training, it was kind of fun to see how we helped inform each other about different ways to help each other.

So not every contract is going to have every line item available or negotiable. But I think that kind of building, that network with recent graduates and new and practice pathologists, you can all kind of learn from each other to find these little extras and additional ways to kind of help put yourself in a good position and then in turn help that organization.

You're going to get pathologists who's happy, well taken care of and be able to work efficiently from the start.

Dr. Yoon:

Dr. Larsen, if I could ask from a hiring point of view, if a interviewee was asking all these options, how do you proceed?

Dr. Larsen:

That's a great question, and I think that Dr. Bailey raised some great points and some great questions to ask. Not everything is negotiable, especially if you're going into a situation where you have a corporate or an academic center contract. They may not be able to change the language in the contract, but those contracts have attached to them schedules, which may have the details of your employment arrangement.

And the schedules tend to be a little bit more flexible. Or you may be able to get a side letter from the employer saying things like, We noticed when you were here, there was a really old microscope we were expecting you to use, and it wasn't going to be particularly good for you and we're happy to buy you a new microscope.

And that might not be in a contract, that might be an aside letter. What's really important when you go into a negotiation is to have done your homework. You need to know what the standard contract, what the standard salary and benefits are for the organization you're looking to join and for the geographic region you're looking to join. Because chances are, if you're hoping to make $300,000 straight out of training, but you're going to a location where geographically the average is $250,000, you may be asking for something too much and you may not be able to get there.

So when you go into the negotiation, you need to have done your homework to have an idea of what to expect. And you need to have prioritized all of those things in the contract to know what is your walk away position, what is the number or the benefit they're going to offer or not offer that would make you not want the job or what is it that is going to make you want the job?

And what are you willing to compromise on? As noted by Dr. Bailey, no one gets 100% of what they want, but what you want to work to do is to get most of what makes the difference to you.

Dr. Woo:

Thank you, Dr. Larsen, and really great point on doing your homework before the negotiation process. This is a good segue way into our next question. What resources do you recommend to prepare for negotiation? And I'm curious, Dr. Bailey, what resources did you use during this negotiation process? And do you have in general tips on on on the preparation process?

Dr. Bailey:

Yeah, that's a really wonderful question. I think, you know, just taking a step back and thinking about negotiation, us as physicians have been negotiating our entire careers, right? In some ways, even like all of the patient interactions we ever had in med school or negotiation, all the interactions we had, we were volunteering before med school. These are all negotiations.

So I tried to take a step back and think about not just getting siloed into what a pathologist looking for a job wants negotiations. So actually my brother, who's a software engineer and runs his own business, he recommended the book Getting to Yes, which is a book that was published in the eighties. And it's really great. And I think it kind of fundamentally changed the way I approach negotiations instead of trying to establish a position as the thing that I want and then kind of getting really tied into that and like I said, getting siloed into the specifics that I think are important.

It helped me through reading the book and talking to him and taking a step back from medicine really to think about negotiation in general. It helped me to understand that building a shared ground and a common goal and then working amicably to achieve that shared goal by Dr. Larson. I have said thinking about the whole process is like a tally of very different boxes that you can use and prioritizing those to find a way to get to that shared ground really helped me.

And I think in addition to that, I hate I hate to just plug it, but being part of PMC was has been really great. As a junior member. I'm surrounded by people who've been doing this for their careers, so learning from them has been wonderful. Shortcutting that there actually is a CAP presentation produced by Dr. Richard and a few others, including Elizabeth Sullivan and Mary Patel on this topic.

I believe it's called negotiation. Getting what you're worth. And so that's like a publicly available for keeping members available hour-long roundtable that the PMC produced. And that's chock full of great resources. And then there was another article written by Nicole Riddle that addressed salary negotiations specifically and from the perspective of an out of training pathologist and the importance of even if you don't necessarily get exactly what you want, putting the effort out to ask and building the habit of asking early in your career.

So that way when you're negotiating not just for contracts, but negotiating as a pathologist with a hospital, as a pathologist, with a different physician group, as a pathologist with insurance, getting into the habit of asking, of negotiating, of beginning that process. Yeah, and those are about the resources I used. I also will say that for salary resources, some of the things that I've heard from a bunch of colleagues because we've kind of spread as a diaspora from WashU, is using Medscape using the MGMA salary numbers and that can help you get a sense of what pathologists in an area are being signed on their contracts.

Again, I don't really think that one big number really captures all the nuance and cost in contract negotiations, but it can help us. Those would be the resources I recommend.

Dr. Woo:

Fantastic recommendations and agree definitely with the resources which are fantastic for our senior trainees and our new practice pathologists, as well as our broader pathology community. Dr. Larsen when you are involved in the hiring process, how do you know who is prepared and who is not? What? What can go wrong if you're not prepared for your negotiation?

Dr. Larsen:

Oh, what can go wrong is lots. You can upend the whole the whole process. It's really important when you're going to negotiate. At this point, you've probably gone through the interviews. So you know something about the practice. You need to avoid certain buzzwords or terms that will that will turn people off. If you go into a negotiation saying, I know you were looking for 1.0 FTE, but I actually want to only work point eight.

That's going to be a problem if you go in. I have to say that the term work life balance is a trigger for a lot of people because it is such a nebulous term that means different things to different people. All of us want work life balance. All of us have different expectations. All of us have different family obligations, hobbies, or whatever it is.

We like to do other responsibilities so that rather than using that phrase and potentially triggering some difficulty, it's better if you go in in a way that you can understand and explain your desire. For example, my preference is not to take lots of short vacations, but to see if I can work together and put together a two-week block to take a vacation that's a little more exotic.

So my question would not be, I want work life balance. My question would be, is it possible to take a two-week vacation with your work system and your workload? Because that gets at specifically what it means to me. I think, too, that if you go in and you have not done your homework so that you're asking for a salary that is wildly out of line with the location you're working with, people might look at you differently as well.

That's where the home workers really and important to do, I think is described by Dr. Bailey that getting to Yes book is one of the best negotiation books out there on the market, which is why it's still in print and why people are still reading it. And I do think it is valuable, despite the fact that we've likely been negotiating throughout our lives.

It's very, very different when you have to go to bat for yourself for the first time for a job that is going to make a significant difference in your life. Most of us are not used to promote ourselves that way and trying to prove to people how good we are and why we deserve more. And it really does take preparation, find someone, whether it's your brother, whether it's a friend, whether it's a parent, whether it's a mentor to practice the negotiation with you so that you can express what you would like, you can express what you want and come across in a way that's non demanding non-combat native, but really reflects that you're asking for

what you would bring to the practice. You're asking for compensation for what value you can bring.

Dr. Yoon:

That's really amazing advice and I think we often forget that we've been negotiating our whole life with different things that that the medicine. So let's, let's hope everyone gets multiple offers and they're looking for their second jobs and third jobs. How do you handle when you have these multiple offers. Dr. Larsen do you have any advice?

Dr. Larsen:

Well, from my point of view, I like people to be honest with me. If I'm interviewing a candidate that I feel very strongly I would like to pull into my practice, I will say to them, I know you're looking at other jobs. I know how this works. Please let me know if another place makes an offer to you before I have or if another place makes an offer after I've provided you what I can do.

And you would like to come back to me to negotiate and see if we can come to a deal that more closely matches the other offer. Please do so. I try and open that door and ask people to communicate with me and don't just take another job without coming back to me if it's someone I truly want to hire.

But I have had candidates say to me, “Yes, I'm here on this interview, but I had this other offer,” and they want me to give them an answer in a week or in ten days. Sometimes you can buy more time. You can go back to the other place and say, I need another week. Something's come up at work.

I've got some other interviews. So that's another negotiation, is trying to give yourself the time you need to make the decision you're most comfortable with. But honesty is going to be your best policy.

Dr. Yoon:

Through open communication is always important in the workplace. Dr. Bailey, when you're looking for a job, I know everybody graduating will, you know, offer and look for different things and many places. How did you handle multiple offers?

Dr. Bailey:

Yeah, for me, I actually had different locations. So I'm from California and I trained in Saint Louis and I was looking in different states other than California. So actually one point that Dr. Larsen made I'd like to emphasize, which is trying to compare benefits by total benefits package, particularly salary across different regions, they're just completely different ballparks. As I'm sure you know, we know Medicare has reimbursed different reimbursement rates for different regions and different population densities.

So the salary ranges changed dramatically, like one of the one of the jobs that I had thought about applying to was in kind of rural South. And its salary range demonstrated that it needed to have that it was trying to recruit pretty strongly. But compared to a coastal job, you know, in the Northeast or in California or Seattle or somewhere along the coast, the salary ranges are going to be lower just because the reimbursements lower and they don't have to have the incentives.

So just bear that in mind. Don't try to take one don't try to take one offer from one area of the country and transmit it to a different part, because you can start, for lack of a better term, like kind of looking like you're not doing your homework. You start trying to extrapolate different offers into different parts of the country.

I think a better choice is to take a step back and figure out what your priorities are in life and then reassess based on the area that you want to be in.

Dr. Woo:

Very true. I have had offers at different states as well, and it's totally different comparing one state that's high cost of living versus somewhere else. So very, very great advice and insight. One question that many new pathologists will wonder is do I even bother negotiating? So I would like to know Dr. Larsen and Dr. Bailey, what are your thoughts on negotiation?

Is it expected? Does the hiring individual expect that there will be some negotiation and should all potential candidates attempt at negotiation if there is something that you know is worth negotiating? Dr. Larsen?

Dr. Larsen:

Oh, that's a great question. And sort of the easiest answer is you're never going to get what you don't ask for. And I think here again, is an area where you have to have done your homework. You have to have thought about what's important to you. It's very easy when someone comes to me, when I've made an offer and says, is this contract negotiable, my answer is always going to be no.

But if someone were to come to me and say, I need more money for moving expenses because I'm moving across the country, what is the maximum allowable? Your letter only said that I could have $5,000 for. Is it possible for me to get a larger amount as a sign on bonus or can I have an extra three days’ vacation because my brother's getting married?

So I'm coming with this existing commitment for time off. If you ask for specific things, you're more likely to get it. If you just say, Can I negotiate the contract? I think the answer is almost invariably going to be no. So it does become a homework related thing again.

Dr. Woo:

Dr. Bailey, when you were negotiating, did you negotiate for all your job offers and how did you approach that?

Dr. Bailey:

That's a great question, and I wanted to piggyback a little bit off Dr. Larsen In that last question, I think that as new and practice pathologists, as young professionals, we should start the habit of negotiating early in our careers. Like I mentioned before, the negotiation is going to be a part of your career as a pathologist, whether it whether you're representing your group in discussions with the hospital system or the insurance company.

It's just a good habit to get started. And I did negotiate for the job offer that I wanted. Again, I was prioritizing location and I just needed to make it work. I took the approach of finding common ground and reaching a shared goal. So I asked for extras here, extras there, things that would enable me to do the job that they wanted me to do.

And Dr. Larson hit it right on the head. I think if you just maybe loosely want to increase X, Y, and Z without specifics, most places aren't going to most people aren't going to understand what that achieves. But for me, I think asking for help, paying for boards, help moving, help, adjusting to the cost of living these kinds of specific requests in specific categories were met with enthusiasm from my employer, like they want me here.

So they wanted to help me get here. So they were very amicable. And I think that kind of approach works because you're trying to get them that shared goal as well. So I think every pathologist should negotiate every contract, and I think it should be in an effort to achieve the specific things that you need it to do the job they want you to do.

I think that's one of the things that I learned a lot from people not in medicine, because I think like in medicine, we get so siloed into this mentality of like, we're here to take care of patients. Also, you should be fairly compensated. And people not in medicine were reminding me of this constantly. I think getting in that process of negotiating is that's what we need to do.

We need to advocate for ourselves and then we can translate that into advocating for our groups, advocating for organizations. And I think that's how pathologists as a group will kind of like keep growing instead of get eaten away at over time. So.

Dr. Yoon:

So, Dr. Bailey, when you were signing your contract, who did you negotiate with and did you have a lawyer to look at your contract? What are your thoughts?

Dr. Bailey:

It's a great question. So generally, the person who will offer you the job offer is going to be the person you negotiate with in settings like large organizations or academic centers. The person may have an H.R. surrogate. It's easy to also just define this because sometimes it can be a confusing. So when I was going through the process, I emailed three people, the chair, vice chair and HR.

Department and said, who should i discuss details of my contract with? They answered and I went forward from there for having a lawyer present or having assistance from to review a contract. I think it can be a little bit variable. So, for example, my contract was very standard. It's through a large institution, an academic center. So the verbiage there is pretty robust and not important necessarily.

Have a lawyer. However, I think if you're going to be entering into a smaller group where the contract is not with a giant corporation or an academic center, I think it's really important, particularly if you start getting into more complicated contracts that involve partnership buy-ins, equity, stock options. Once you start reaching that level of complexity of contract, I think having a lawyer is a great option.

I also say that contracts are written by lawyers for lawyers. So if you want to learn about the words that you're signing your name on to, it's probably good to have a lawyer. So that way you can continue to learn how to interpret these contracts over time.

Dr. Woo:

Thank you. Dr. Bailey. Thank you, Dr. Larsen. This concludes our podcasts. We'd like to thank our panelists for their tips and insights. We've learned that preparing for your negotiation with the resources recommended is vital for a successful negotiation and having our specific asks, as well as knowing yourself what you are looking for. The new in Practice committee is comprised of early career pathologists who are passionate about supporting newer practice colleagues and helping those new in practice set a successful foundation in their pathology career. Please check out cap.org for new in practice content, including blogs, podcasts, roundtables and webinars.

Becca Battisfore:

Yes, thank you for mentioning that Dr. Woo. The Practice Management Committee also has a number of resources, including articles, roundtables and webinars. We'll have links to resources from both committees along with this episode. And I want to thank you all for joining the podcast and sharing really helpful advice on negotiating job offers. And I want to thank you all for listening to this CAPcast.

Don't forget to check out the first episode in this series, which is about interviewing tips and subscribe to the podcast so you won't miss future episodes. For more information about the CAP, visit cap.org

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