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What Can You Really Negotiate For On Offers?

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  • What Can You Really Negotiate For On Offers?

    Hi everyone,

    I'm graduating from residency this summer and just received an offer for a practice I like (and suspect I'm going to get another offer for another practice next week). I'm excited and a little stuck on what to do next. I know negotiating is important, but it's a very competitive offer coming from a large physician network so I'm not sure what would be realistic to ask for.

    Some details: It's for outpatient pediatrics. I'd be on salary/contract for 2 years (and the salary is on the higher end for the area), then switch to a completely wRVU model (where reimbursement is the same for all the pediatricians). I'd get a signing bonus, 3 weeks of PTO, a couple of thousand dollars and 5 days per year for CME. The company matches 6% into a 401(a) after the first year of employment. They cover malpractice insurance and it's an occurrence based policy. They do have a restrictive covenant, which is a pain and I'll try to get them to ease up on, but it's standard for the area.

    Looking at all of it, I figured I'd ask to see if they'd cover my boards/licensing/DEA fees and let me have my bonus when I sign rather than when I start. Is there anything else that is smart to ask for? Is there anything you negotiated for or wished you had?

    Thank you!

  • #2
    I'm in a similar situation and I'm planning to negotiate on pretty much anything I have heard or feel is reasonable covered in my specialty, location, etc. if you like a few different jobs and feel that any of them would be acceptable to you from a practice standpoint, you should negotiate between the different practices. The worst they can say is no. I don't feel that anybody that really needs a spot filled is going to rescind a contract because you 'asked for too much'.


    • #3
      Does anyone have experience negotiating payment for student loans? I'm wondering what other offers of people have gotten, as this is commonly found as 'negtioable' on recruitment advertisements. But I have no one I know that has negotiated this type of inclusion in their contract.


      • #4
        It all depends on how badly they need you and vice versa.

        I'm in an outpatient specialty that can be difficult to recruit for in undesirable areas to live. I was coming in at a time they needed a replacement so they wouldn't hemorrhage patients to competitors.

        I was able to successfully negotiate:

        - an increase in base salary
        - a signing bonus
        - more PTO
        - more CME money
        - reduction in restrictive covenant mileage
        - coverage of licensing and DEA fees
        - timing of bonus as you mentioned (signing, not starting)

        I did not ask for payment of student loans as this is not common in my specialty.


        • #5
          Wow, asmallchild, that's great! That's some awesome negotiating. I'm probably not in a particularly strong position- I want to stay in the city I'm doing my residency in, so it's a decently big city with a fairly saturated job market (not overly so, I think everyone who wants to stay here from my class will be able to do so, but no one is being inundated with job offers). I'm hoping I get the second offer- partially because I'm interested in that job too and partially to help with negotiations.


          • #6
            Everything is negotiable if they need you enough.  Also depends on where you are looking.   I signed with a moderate size hospital system, everyone gets the same contract, the only difference is the base pay and wRVU compensation rate based on your specialty.   I asked for signing bonus and originally they said no, then came back and said sure.   But I cant really complain because the benefits package is amazing ( 401k w/ matching, 5week vacation, 1 week CME, CME money, boards, licenses covered. Tuition reimbursement for further schooling if I want an MBA) ...the list goes on.  I would imagine that negotiating with a private practice will have a lot more leeway to change things based on their need.

            With regard to student loan pay back, I believe whatever they pay for counts as income for you and will increase your taxable income.  Just something to keep in mind so you don't get hit will a huge tax bill.


            • #7
              Everything is negotiable, but you need to always look at it from the employer's view. It's all money to the employer and so if something doesn't cost them any more money, it's all the same to them. So if you have health insurance elsewhere, perhaps you can get a higher salary if you don't take health insurance. Or if there is something you'd rather have than cash like moving expenses, perhaps you can take a lower salary and get those covered etc.


              Above and beyond that, it's about how badly they need you. You can make sure you're in the driver's seat by having another job out there waiting for you. Then you have the ultimate power you need to win any negotiation- you can walk. Choose your battles carefully and try not to come across as a greedy jerk.
              Helping those who wear the white coat get a fair shake on Wall Street since 2011


              • #8
                My friend, a sought-after specialist, came to a hospital job and successfully negotiated $300k in student loan debt paid off in full on 3 yr contract.

                I have had less success, not going to lie... I have just learned to search more--far and wide-- for the openings that are a good fit.


                • #9
                  You also need to keep in mind, especially in a small group practice setting, that those you are negotiating with will soon be your colleagues. If they make too many exceptions compared to what everyone else had in their contract, it can lead to some long-term, bitter feelings toward you. You may be viewed as selfish and only concerned about yourself.


                  • #10
                    My residency director told me it's really important to have 2-3 offers, so that way you can go to the job you want and ask them to do the best they can to match the salary/benefits offer of your second choice job. You don't seem like as much of a greedy jerk if you tell them, "I really want to work for you guys but I have $300K in student loans and these guys across town are paying X. I'd rather work for you, but can you try to close the gap a little?" Of course, this has to be a viable, legitimate offer -- not some kind of bluff.


                    • #11
                      Does anyone have experience negotiating with the VA?

                      What types of things are negotiable besides salary, bonus and student loan repayment? Teaching time? Research?

                      With regard to salary, if you are at the top of your pay table ( in a specialty that has had multiple vacancies for years, in an undesirebale and underserved area, can you negotiate above the highest salary listed in the pay table? Should additional salary be given for a medical director position? How much?

                      Thank you for your time.




                      • #12
                        I do think it is harder at times in a large health-system academic type job.  A smaller underserved place may be a totally different ballgame.  "Everything" is negotiable but I would think long and hard about a non-compete agreement!