When It Comes to Negotiating the Job Market, Doctors Need to ‘Heal Thyself’
In a separate post, I offered views on the challenges facing the U.S. physician job market. In this post, I continue to explore the physician job market, but from the physician perspective.
When doctors are looking for a job, researching prospects, and negotiating job terms, they require at least three things – time, market intelligence, and training. Unfortunately, most doctors possess none of these.
According to the Association of American Medical Colleges (AAMC), annual tuition, fees, and health insurance during the 2020-2021 academic year cost medical students, on average, anywhere between $40,000-$60,000. Add in the cost of living and potential increases in tuition over the four-year period and the average medical school debt exceeds $250,000. In many cases, students have the chance to defer paying on loans until after their residency and fellowship training, but in some cases the loans continue to accrue interest. When physicians finally do complete their training, they receive a diploma, a pat on the back, and then a notice that their first payments on their student loans are due. How is that for an introduction into the realities of being a doctor in the U.S.?
What Are You Worth?
There is no ‘gap’ year after medical training; newly minted doctors need to secure their first job while they are still in training and working up to 80 hours a week. It does not get much better when you are looking for that second or third job as an attending physician. You are still likely working between 40-60 hours a week, pulling call, and, if you are a hybrid-physician, you are also trying to manage people and run a business, teach, and/or have a research career. Did I mention family yet? When, in any of this, can a doctor do a thorough job search with due diligence, while also figuring out the serious financial and contractual agreements they are about to enter into?
Even if doctors had the time to properly manage their career and job searches, they don’t have the market intelligence they need to conduct a proper search and negotiate a contract. “What am I worth?” A simple question, but a question doctors struggle with because there is no comprehensive, accurate, specialty-specific, and readily accessible source of physician compensation and productivity information to benchmark themselves against. It’s tough to put a sale price on your home when you have no idea what the comps are in your area. It’s even tougher to buy your next house when you don’t know if the asking price is fair.
Contract Negotiation 101
Another important piece of missing information does not pertain to the doctor, but to the job itself. Every job solicitation I have ever received — and I receive about three a week — offers a position in a great place to live, with college and professional sports, at least one professional symphony, and great schools. A few solicitations will comment on the work day, patient mix, and call schedule, but most do not inform me about the job characteristics I really care about. The absence of clear information in most recruiting solicitations makes them of little value to the job-seeking doctor. “Do I really have to sift through all of these advertisements…?” Delete. This impersonal, and vague, recruitment paradigm discourages otherwise curious physicians from exploring, and finding, the thousands of open positions U.S. hospitals are so desperate to fill. Unlike the Longfellow poem, most doctors and most jobs never “…pass in the night.”
When a physician does happen to stumble upon a good job opportunity, there remains the chore of negotiating their terms of employment. The terms will differ based on a number of factors. Is it a private practice or am I an employee? What is the scope of work? Am I being compensated for non-revenue generating, but essential, job functions? Who pays for the office, malpractice insurance, and paper in the copier? How much vacation will I receive and who covers my patients? How much call do I take, is it compensated, and, if so, at what rate? And, of course, what is the compensation plan – salary, ‘eat what you kill,’ a hybrid? I cannot recall any class in medical school or any rotations during my training where ‘contract negotiation’ was the focus.
Crossing The Chasm
The U.S. physician job market is characterized by employers, on one side, with thousands of open positions they want, and need, to fill. On the other side, we have thousands of physicians looking for jobs without the time, market intelligence, or training they need to do a proper job search and ensure the job is right for them and the employment terms are fair. The chasm between the two is huge, and no bridges are being built. The end result is thousands of unfilled positions and many unhappy physicians who had to make uninformed and hasty employment decisions. Both situations are bad for patients, impact the quality of care, place our hospitals and health systems at financial risk, and decrease the prospects our best and brightest will pursue a career in medicine.