Medicolegal Issues

You Can Always Get What You Want


How prepared are you to negotiate the best possible contract for your next position? Do you know what you can realistically ask for? If the salary offered seems too low, do other factors make the job a perfect fit?

In order to get the most beneficial contract with your next hospitalist position, you must have confidence in your negotiation skills. Here are some steps that may help.

1. Recognize Your Priorities

Before you set foot in your first interview with an organization, you must know your own mind—what exactly do you want to “win” in a contract negotiation?

“Your first step should be quiet reflection, where you figure out what you want and what [part] of that is non-negotiable,” advises Fred A. McCurdy, MD, PhD, MBA, FAAP, CPE, professor and regional chairman of the department of pediatrics, Texas Tech University Health Sciences Center at Amarillo. Most people focus on money when they anticipate negotiating employment, but there are other factors to consider, such as schedule (on-duty and on-call hours); opportunities for advancement, including research, project management, and teaching; and, of course, benefits, including insurance and retirement packages. Consider carefully which factors matter most to you, then rank them to organize your personal priorities.

Dr. McCurdy recommends the process he uses for all the negotiations he participates in as part of his job. “I think through the principles of each negotiation situation and write them out,” he says. “I pick out the non-negotiable items as well as the items I hope to achieve.”

Hospitalist Salaries on the rise

Did you get a pay hike this year? The 2006 Physician Salary Survey Report, published by the Hospital and Healthcare Compensation Service, shows that the typical hospitalist enjoyed a 4.3% increase in salary this year. This increase brings the median hospitalist salary to $152,950.

2. Do Your Homework

It’s tough to negotiate your salary or your benefits when you don’t know the market. “Don’t walk in without knowing your facts,” warns Dr. McCurdy. “Do your homework to see what the market is and how payment systems work.”

Research the potential employer to find out what they’re paying other physicians and how they pay. “You can ask [the interviewers], ‘What are you currently paying your other hospitalists?’ ” says Dr. McCurdy. “You might get [them to tell you] a pay range.”

Ask questions in your interviews, and conduct independent research on the organization and on the market.

“You can obtain a lot of information on your own,” he explains. “The MGMA [Medical Group Management Association] and the Association of American Medical Colleges (AAMC) have salary scales available. Salaries are public information for people who work in public institutions like university hospitals.”

SHM also provides up-to-date salary information in its “Bi-Annual Survey on the State of the Hospital Medicine Movement,” available at

handle a hardball negotiator

By Fred McCurdy, MD, PhD, MBA, FAAP, CPE

Many physicians have been taught—or have experienced—negotiating as a zero-sum game with a winner and a loser. This results in thinking that negotiation skills require them to become skilled concession bargainers. There are still many out there who are quite skilled at this, and I wouldn’t diminish how devastating it can be when a physician attempts to negotiate in good faith and gets bowled over by a skilled concession bargainer. I believe, however, that even these domineering types can be disarmed with skilled negotiation techniques.

There are five different possible outcomes in any negotiation:

  1. I win, you lose.
  2. You win, I lose.
  3. We both win.
  4. We both lose.
  5. No deal, we’ll try again later.

This last outcome is when you walk away from a strong concession bargainer and basically refuse to be bowled over. The risk is that you’ll get nothing. The advantage is that you maintain a strong position, because it’s likely that concession bargainers want something that you have; they just want it on their terms. I’ve used this technique, and the results have been pretty amazing. Faculty members change their behaviors when they know that I refuse to be intimidated.

3. Know Your Strengths

Another homework assignment before the interview process: Know your strongest selling points. Whether you have an excellent record as a faculty member or a strong background in heading up task forces, your unique strengths will be your strongest argument in negotiating your contract.

“The most effective way to negotiate is to talk about the value-added,” says Dr. McCurdy. “Find out what they want, and speak to that. You’ll have to figure that out as you go.”

It might be what you can do to improve the organization’s bottom line; it might be specific skills or expertise you bring to the table, such as teaching proficiency or research skills.

What about recent graduates who are seeking their first job as a hospitalist? “People right out of training seem to have distinct advantages that they don’t emphasize,” says Dr. McCurdy. “They’re young and have a high energy level, for one thing. Their knowledge base is very current, so they’re cutting edge, and they have quality of training—they were recently instructed by cutting-edge teachers.”

4. Look Beyond Salary

Of course you’ll want to negotiate for as much money as you can, but other factors may make a lower salary worthwhile to you. “Lots of organizations have a lot of non-tangibles to offer, but many physicians go into this ill informed” about what they can get, says Dr. McCurdy. You might ask for “some equity holding in the organization you’re looking to become part of” if it’s a privately held hospital medicine group.

“Think about various trade-offs,” urges Dr. McCurdy. “For example, you might accept a lower salary for less on-call time. Or if you’re considering a position in academic medicine, you know that your residents will take most of your night hours—is that worth a lower salary to you?”

You might also consider “access to a foundation that could help you leverage a project you want to do or a situation where you have a chance to spin off intellectual property where you keep the proceeds,” he suggests. “It all depends on the organization. What do they have that would be valuable to you?”

5. Practice Your Negotiation Skills

One last piece of homework before you walk into the final interview: Do a practice run of how the meeting might go.

Physicians don’t always practice negotiation conversations, says Dr. McCurdy. “Find someone who will practice with you, who will throw a lot of questions at you. I used a personal coach. She had me practicing ‘how to deal with Fred when he’s in conflict.’ I hated it, and I’m so glad I did it!”

So do your homework and be prepared to argue your strengths, stick up for your non-negotiables, and resign yourself to giving in on some of your other points. With insight, information, and practice, you’ll be in an excellent position to walk away from the table with most—if not all—of what you want in your next contract. TH

Jane Jerrard writes “Career Management” monthly for The Hospitalist.

On the Rise: Residents Choosing Hospitalist Careers

The percentage of residents interested in entering hospital medicine continues to increase steadily. In data from the 2005 Residents’ Survey, part of the Internal Medicine In-Training Examination (IM-ITE), 6.5% of resident respondents indicated they were interested in pursuing hospital medicine. This is up from 5% in 2003 and 2004—and just 3% in 2002.

While these percentages seem low, hospital medicine was the fourth most popular career plan for residents, following general internal medicine (15.8%), cardiology (12.9%), and hematology/oncology (7.5%).

Residents Forego Rest

A University of Chicago Hospital study shows that first-year residents working a long night shift are much more likely to choose to leave their pagers on than to nap uninterrupted. Hospital residents who finish with all their patients by midnight are encouraged to forward their pager calls to another resident so that they can get a few hours of sleep; the study showed that only 22% did so.

“You know your patients better than anyone else,” says one survey respondent. “You want to keep track of them a little more closely.”

VA Boosts Ranks of Hospitalists

The new restrictions on residency work hours are resulting in a “hospitalist boom” within the U.S. Department of Veterans Affairs (VA). Research by the Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) reveals that 67% of VA medical centers employ hospitalists. An additional 17% are expected to hire one or more hospitalists within two years, at which time it’s estimated that 74% of VA patients will be under the care of hospitalists.

Proof: Being On Call Is Stressful

Physicians who are on-call are definitely stressed—and their hearts prove it, according to a study published in the October 2005 issue of CHEST: The Cardiopulmonary and Critical Care Journal. Twenty-six healthy physicians with a mean age of 34 were subjected to a 24-hour Holter-ECG recording while on call, which was then compared with a normal workday. While on call, the physicians presented decreased values of standard deviation of all filtered inter-beat (RR) intervals. Rhythm disturbances during the on-call period included sinus tachycardia and bradycardia, sinus pauses, and supraventricular tachycardia, as well as premature atrial and ventricular systoles.

Hospitalists as Temps

There are many ongoing opportunities for hospitalists interested in working locum tenens, or in a temporary position. (Some are listed in the new online SHM Career Center— Hospitals looking for these specialists may need to cover for a hospitalist on vacation or to cover while they seek to fill a permanent position. Why do physicians choose locum tenens work? A recent survey of more than 500 physicians showed that 48% said the chance to have a flexible schedule was a key reason for working short-term physician staffing assignments.


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