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Earn What You're Worth: How to Negotiate Your Attending Job Offers

Want to make sure you earn what you're worth as an attending? Doing so comes down to negotiating your job offers effectively. Here's how.

Dan Cremons

If you’re a physician who is still in training, but about to turn the corner into the ever-exciting attending years, you’ve worked your tail off to get to where you are. The late nights you've grinned and beared. The seemingly endless studying you've done. The hundreds of thousands of dollars you've spent. The umpteen pots of coffee you've consumed. And you of course want to make sure that it all pays off when you become an attending.

Ensuring all your hard work pays off comes down to doing 2 basic things:

First, nailing the attending interviews—which we cover in a separate article here.

And second, negotiating well, so you can ensure that the offer you’re accepting reflects your value—which I'll cover in this article.

As you get out and start doing interviews for attending roles, this is the 1-2 punch that will help ensure you earn what you're worth.

But here's the issue: as important as these two skills (yes, they're skills that have to be learned and developed just like any other) are to your professional and financial future, for most physicians, med school and residency do a poor job of preparing you. When my wife was at this stage of her career—finishing her training and interviewing for attending roles—she’d often lament about how little med school and residency did to prepare her for interviewing and negotiating her job offers.

But worry not, my friend. That's why we wrote this article.

Myth-busting: "But first-year attending salaries aren't negotiable."

Before we get into how to negotiate effectively, we need to dispel a common myth: 

Too often, we hear residents who are interviewing for attending roles say that these salaries or contracts aren't negotiable. I remember my wife telling me this when she got her first job offer. I asked her where she heard this, and she said the HR person at the group she was hiring at told her this.

But one of the universal truths in life is: everything is negotiable. (OK, maybe not everything, but most things.) And formedical residents and attendings, despite what the HR person may try to tell you, salaries and contracts are oftentimes negotiable. See, as much as you want to get hired, these hospitals and practices need to make hires. The war for top physician talent is fierce out there. So if they want you badly enough, it is in a potential employer's best interest to negotiate.

But too many doctors leave money on the table by failing to negotiate their offers.


It is usually because they accept this myth as being true, have a fear of negotiating, or lack the understanding of how to negotiate.

Sure, negotiating can feel awkward if you haven't done it before, and they don’t teach this stuff in med school! But failing to negotiate your employment offers is a mistake that can sometimes cost early-career physicians thousands of dollars—even tens of thousands or hundreds of thousands—over the course of your career. Indeed, the stakes are that high. You’ve worked hard to get to where you are, so its time to earn what you're worth.

So how do you do this? Here are 10 quick-hitting pointers for how to negotiate better and earn what you're worth.

How to Negotiate Your Job Offers Effectively: 10 Pointers

Tip #1: Change your mindset

First, in order for your negotiation to be successful, it is important to get grounded in the right mindset.

To the newbie negotiator, negotiations can feel intimidating, competitive, even contentious. This is how they're often portrayed in the movies, so we accept that as the way it is. But this way of looking at a negotiation will cause you to approach it poorly—or not at all out of fear. So, if this sort of reluctance or skiddishness feels familiar, start by changing your mindset on what a negotiation is.

A negotiating isn't a standoff, a competition, nor a transaction. Rather, think of it as two people who both want the same thing—to work together!—and who are working towards that shared outcome in a way that both parties feel good about. At its core, that's really what a negotiation is. So pull your chair to the same side of the table and work through this together.

This embracing this way of thinking about and viewing a negotiation makes it less intimindating, more empowering, and will cause you to be more effective at it.

Tip #2: Build rapport with your counterparty

The most successful negotiations are grounded in trust and shared respect.

Hopefully you've been intentional about building trust and mutual respect throughout the interview process, but as you get into the offer/negotiating phase, make sure youve taken the time to build rapport with the other party.

When you have rapport and trust, you'll be more likeable. And likeability is key to a successful negotiation Indeed, studies have shown that if you're more likeable, you'll be more successful in negotiation. And it makes sense: the more they like you, the more they’ll want to work with you. And the more they want to work with you, the more likely they are to meet your needs in a negotiation.

Tip #3: Seek first to understand

Seek first to understand—the offer, that is. Make sure you fully understand the offer and its terms before entering into a negotiation. You never want to make assumptions. So review the offer closely, and come up with a list of clarifying questions about the job offer, including compensation, benefits, productivity requirements, expectations, etc. If something is unclear, just ask.

One key term I'd always ask for clarification on is compensation. You want to understand how they got to the number they're offering you. So just simply and politely ask. "The offer letter says $300,000 of annual salary. Would you mind walking me through the logic behind that number, and how you got there?"

Tip #4: Do your research

When it comes to negotiating compensation, you never want to be shooting blindly. Always do your research. To negotiate effectively, you have to know what the market deems you're worth. And what you're worth is, in part, a function of what the market says your skillset, your experience is worth. So research the benchmarks to understand the average salary is for your position in your region, and be sure to factor in your experience, education, and skillset.

Online tools like MGMA's DataDive and Resolve are great resources for compensation benchmarking.

Tip #5: Know your worth

Once you've looked at the benchmarking data and know your worth in the market, you must have confidence in your worth! Own it. Oftentimes, a reluctance to negotiate salary stems from an underlying insecurity—a belief that you’re not worth it. Surely, we all have insecurities. But for some physicians, this insecurity can be one of the biggest internal barriers to negotiating effectively and earning what you're worth.

But remember: you've worked your tail off to get to where you are. And the market is ready to pay you fair value for the years of hard work, blood, sweat, and tears you've paid to get to where you are.

If you change your attitude about yourself, you'll change your net worth.

Tip #6: Be clear what you want

If you've followed the tips above, at this point, you understand the offer and the thinking that went into it. You've done your research and know your worth. Now, it is time to zoom out and ask yourself, "What do I want?"

Consider the key terms of the offer—including not only the economic terms like compensation, but other important factors like benefits, location, paid time off, etc.

Then clearly define your goals, your careabouts, your desired outcomes from the negotiation. What matters most to you? What are you trying to achieve here? What are your must-haves vs. your nice-to-haves?

Get clear on your desired outcomes, and carry that into the negotiation itself.

Tip #7: Think about what they want

In addition to getting clear on what you want, think about what they want as well.

Most everyone approaches negotiations with the mindset of "What do I want, and how can I get it?" But the most successful negotiators also think about, "What does my counterparty want, and how can I give it to them?"

So, based on your discussions about the job offer, what do you expect is most important to them? What do they want? Their desired outcomes?

If you are clear on the other side's careabouts, and you can make someone on the other side believe that they're getting what they want, its going to be much easier to reach an agreement.

Based on your understand of what they want, look for win-wins. Maybe you want a half-day per week of admin time to catch up on notes... this is one of the things on your list of careabouts. If you know that they want physicians to comply with some sort of quality standard on the timeliness and accuracy of their notes, then this ask--for a half-day each week--is good for you and good for them. This is an example of a win-win.

Tip #8: Ask for what you want

Time to make the ask. You're simply not going to get what you don't ask for.

So understand what you're worth (Tip #5), get clear on your ask (Tip #6), and be armed with some win-wins (Tip #7)... and make the ask.

Tip #9: Be firm, but fair

Be firm, but fair. Be clear and well-supported on your asks, but don't overreach.

The goal of any negotiation is to get to an outcome both parties feel good about. This requires give and take. Overreaching and asking for the world, or failing to consider and address what the other party wants, will make you look like a loon.

There's a fine line between firmness and fairness... so be mindful of toeing that line.

Tip #10: Know when it is time to walk away

Know when it is time to walk away. If you don’t get what you believe (and the data affirms) is fair, be prepared to walk away from the job offer.

It’s important to remember that there are other opportunities out there. If one employer isn’t willing to meet your ask, and your ask is well-founded and reasonable, then another one may be.

Don’t be afraid to hold out for what you deserve. You're not obligated to accept any offer that's made to you.

One key is to know what your walkaway points are going into a negotiation. These are the non-negotiables, including the compensation at which you'd be willing to walk away.

Let's say the benchmarks support that based on your experience, your specialty, and the location, you should be able to earn $250,000. The hospital you're interviewing with has offered you $200,000. But you really like the culture there, and really want to work there. So maybe your "walkaway" is $225,000—the threshold below which you're willing to walk away from the offer.

* * * * *

As a physician turning the corner into the attending years, your effectiveness at negotiating your job offers can have a big impact on your professional and financial future. Don't fall for the myth that first-year attending salaries are non-negotiable. As they say, "everything is negotiable." By changing your mindset, building rapport, seeking to understand, doing research, knowing your worth, being clear on your goals, considering the other party's desires, making your ask, being firm but fair, and knowing when to walk away, you'll be in a much better position to nail the negotiation. Remember, you've worked hard to get here, so it's time to earn what you're worth!

Important Note: This blog post is intended to provide general information and should not be considered as professional advice nor investment advice. Please consult with a qualified financial or insurance professional for personalized guidance based on your specific circumstances.

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Earn What You're Worth: How to Negotiate Your Attending Job Offers

Want to make sure you earn what you're worth as an attending? Doing so comes down to negotiating your job offers effectively. Here's how.

Dan Cremons