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Dear Female Doc,

I am a DO family medicine resident in Georgia, and I am currently in the interview process for my first attending job. I wanted to ask you what qualities you felt like are important to seek out in an employer or if you have any tips on big dos and don’ts.

This actually brings up one of my favorite topics, which is contract negotiations. Normally most people aren’t super excited about contract negotiations. In fact, there was a study that showed women describe contract negotiations as a trip to the dentist (no disrespect to the dentists reading), but that men describe negotiating as a ball game. They’re in it to win it.

One of the most important things is just knowing that you have power. Part of that comes from having the knowledge of what goes on in contract negotiations in different industries to better prepare yourself to approach employers, advocate for yourself, and really figure out what is important to you in your future job. 

One of the first studies that I came across was from Carnegie Mellon University, and they looked at the percentage of students who negotiated their first job offer after they graduated with their MBA. What they found was that 57% of men negotiated their first offer, which doesn’t sound like a lot. But wait until I tell you about the percentage of women – it was only 7%! That is a striking difference. 

Another statistic that I found really interesting came out of the book Women Don’t Ask: The High Cost of Avoiding Negotiation. The authors projected salary disparities long-term. Imagine two different 22-year-olds are fresh out of college, and they’re offered a starting job salary of $25,000. One of them is able to negotiate a higher salary, putting on an extra $5,000 and making their starting salary $30,000. 

The authors compounded this $5,000 difference with 3% annual raises and 3% interest on savings all the way to the age of 60. The person who negotiated that extra $5,000 in their starting salary had an extra $568,000. That’s half a million dollars extra! 

So why is it that women don’t statistically negotiate? The big argument is that it is much more challenging for women to negotiate because of all the societal expectations placed on females. 

Men are expected to look out for themselves and provide for their families. Women on the other hand are supposed to be more communal, more nurturing, and more concerned about others. When women don’t meet these expectations, we can be viewed as demanding or difficult to work with or just flat out an annoying bitch. 

From a young age, women are taught that their wellbeing and their success is contingent on acting in very feminine, stereotypical ways – being polite, soft-spoken, smiling, nice, quiet, compliant, and relationship-oriented. This is constantly reinforced by the media and social cues. We are rewarded by society for behaviors that perpetuate these stereotypes, so women act in ways consistent with their learning experiences.

So women are constantly playing this balancing act. You want to appear really eager and appreciative of the opportunity, but you don’t want to get less pay than you deserve. You’re constantly in your head thinking about negotiating and taking control back with a fair market value. 

I’m going to share some strategies that I’ve come up with and that have been very useful for me throughout my entire medical career. I’m not saying that the burden of fixing this problem is on you. I’m just providing you with solutions so that you have tools to use to be able to advocate for yourself while the system is being fixed. Long-term, this is a patriarchal systemic problem. In order to fix that problem, male allies need to show up for us. 

Tip 1: Get Educated

This one you’re already doing. You are now aware of the expectations placed on women and the statistical difference in contract negotiation. Knowledge is power.

It’s my mission to increase the diversity of healthcare leaders. If you know that you’re going to be treated in a certain way because of your gender, your sexual orientation, the color of your skin, etc., you can be prepared to fight your initial reaction, which is that learned behavior to be compliant and let the system take advantage of you. Now, you can fight against this ingrained socialized behavior.

Tip 2: Perfect Your Wording 

People lose their minds when I tell them that I negotiated an extra $25,000 with just one email. I gave myself permission to move from being a nice girl to a professional woman because statistically, I knew that men were negotiating more often. I started to really believe that HR departments and hospital administrators expect some sort of negotiation. 

My ex at the time was actually the one who kept pushing me, encouraging me to just ask in an email. You don’t have to ask directly. You don’t even have to mention the word money.

The way that I worded my email was this:

Thank you so much. This sounds like a really good opportunity for me and my family. But is there any way that you can make this a great opportunity for me? 

And that email earned me another $25,000. They added $10,000 onto my base salary and $15,000 onto my sign-on bonus. Just with one email. You can do that too!

Tip 3: Expect Pushback

Hiring staff is used to being intimidating, and they will try to intimidate you with certain things. One time, I was trying to negotiate a locum job. They were acting like they were doing me a favor by covering my malpractice insurance. I simply responded with: that’s baseline; that’s what the local market does. 

I didn’t say it in a super rude or condescending way. I just let them know that they needed to step up their game if they wanted a high-quality IC physician like me to work at their hospital. You need me more than I need you because I have options. 

Tip 4: Money vs Value

The mantra I live by is I don’t work for free. I think that when you work, it’s an energy exchange and free doesn’t always mean money.

I am on the CHEST Journal Editorial Board. I do not get paid monetary compensation for that, but I derive extreme value in that because I know that I’m contributing to scientific research and ensuring that the best papers are put out there in a peer-reviewed process.

I get great fulfillment from that, and that to me is a fair energy exchange. Most peer to peer reviewed journals rely heavily on physician volunteers, so I know that the fair market value for being on a journal editorial board is exactly what I’m getting, which is zero. So, I’m getting my market value and I’m getting what I want out of this energy exchange for myself.

Tip 5: Set Your Bare Minimum Price

One of my best friends, Rupa negotiated so well when a group of us went to Thailand in 2016. It was so fascinating to watch her negotiate. I’m a strong negotiator when it comes to my work, but get me in a situation where I’m haggling for sweatpants with elephants on it, and I’m kind of a mess! 

We went on a tour where they took pictures of us and put them in frames. The price of the pictures was not expensive, but Rupa simply said “No, I don’t want it.” The seller lowered the cost and she sat there and thought about it. She again rejected the price, and we started walking out of the store. 

Then, the seller chased her down and said a lower price. Rupa said, “No, well, maybe for both of the photos.” The seller said no, and she again said that she didn’t want it and started walking away. 

But he still came back! This time, she actually got it for the price she wanted. Before she even started negotiating, she gave those pictures a monetary value in her mind. After I saw Rupa do this, I started to incorporate it into my own job negotiations. 

I set my bare minimum price, and it has worked wonders. I do not work at a lower hourly wage than what I have set. In fact, my recruiter even knows to not even call me about jobs that are below that value because I won’t accept them. 

Tip 6: Replace “I” with “We”

Here’s some advice that I read about in the book Lean In by Sheryl Sandberg. There’s a Harvard professor who looked at this type of phrasing, and she found that you can replace “I” with “we” to get what you want.

Some phrases you could use with this tactic are:

• “We had a great year.”
• “My manager said I should talk to you about a raise.”
• “My understanding is that jobs that involve this level of responsibility are compensated in this range.”

This places the emphasis less on bragging about yourself and more about what else is going on in the community and what other people might be saying in higher positions. These are some nice phrases and strategies you can use early on until you get to be a more hard-headed negotiator. 

Tip 7: Figure Out What You Want Out of a Job

Figuring out what you want out of a job beforehand is extremely important. My first job out of fellowship, I negotiated no night shifts because that was extremely important to me. I was willing to take a pay cut for that. 

Map out what’s important to you: vacation days, night shifts, call schedule, having a research assistant, etc. All of these little things can add up, and they’re great pieces to negotiate when it comes to being stuck in a base salary.

 

Besides the features that you want in your job role, you can also look at an employer based on their reputation in the community. What is their gender and diversity ratios within each department? Do you feel like the employees are happy? What do they offer employees outside of just benefits? 

Have any of these strategies worked for you? Do you have any tips of your own? Let me know in the comments below!