How to Negotiate Your Attending Job Offer: A Physician’s Guide to Maximizing Compensation

The medical industry is recognized nationwide as offering some of the highest compensation packages, with healthcare systems typically recruiting experienced professionals at premium salaries to address any workforce shortages. The average physician compensation reached approximately $475,000 and is expected to continue growing, as the industry faces a projected shortage of up to 124,000 physicians by 2033. This means that you are in a healthy position to negotiate your compensation and make sure that you aren’t leaving any money on the table

The goal of this guide is to equip you with the general information you need for your upcoming attending negotiation. If your situation is unique or you require one-on-one support to ensure you maximize your compensation, please sign up for a complimentary consultation with one of our expert negotiators.

Table of Contents

1. Medical Attending Compensation Components

2. What to do before you start negotiating

3. Negotiation tactics we recommend using

4. Most negotiable aspects of a physician's salary

5. Mistakes to avoid

Medical Attending Salary - Understand your full package

Employers and hospitals often prioritize highlighting only the base salary in their offers, knowing that physicians typically focus on this figure. They tend to downplay or remain silent about other components that contribute to your actual "true" salary. It is crucial for you to fully comprehend your entire compensation package.

Look for:

1. Base Salary: The fixed annual pay

2. Signing or relocation bonus: A one-time payment to sweeten the deal. In areas where there is a shortage of physicians, signing bonuses can reach up to $100,000

3. Productivity Pay: Often tied to RVUs, depending on your contact you could get an extra 40-60 per RVU after a certain threshold, negotiating lower thresholds means easier bonuses

4. Call pay (not common): Some hospitals pay extra for the overnight call, while others just bundle it into your base salary

5. Academic or leadership stipends: If you’re a director or member of faculty you could possibly earn $5,000-$30,000 extra

6. Benefits: CME allowance, malpractice insurance, licensing fees, health insurance, and 401(k) match

For example, a hospital offers a $280,000 base salary, a $20,000 signing bonus, $10,000 in CME, and $15,000 in other benefits (relocation, malpractice insurance, etc.). The actual first-year value of your offer is $325,000, not $280,000.

It’s essential to know your full offer breakdown before considering a counteroffer.

You’re close to getting an offer! Now what?

In negotiation theory, BATNA, or "Best Alternative To a Negotiated Agreement," signifies the most favorable outcome a negotiator can achieve if the current negotiation falls apart. Knowing your BATNA is essential for effective negotiation, as it serves as a benchmark for evaluating potential deals and gives you the power to decline unfavorable agreements. Basically, it’s Plan B and you want to make sure that hospitals know that you are okay with going with Plan B, if push comes to shove.

If you haven’t yet received an offer, here are a couple of things to consider during the interview process:

1. Identify Key Decision-Makers: Focus on building early relationships with department chairs and division chiefs, as they hold the most authority in the hiring process.

2. Delay Compensation Discussions: Although unlikely, avoid sharing your salary expectations until you have a formal offer. Most hospitals are open to negotiation after an initial offer and are prepared to pay competitively. Providing a high number upfront without a complete understanding of the compensation package can complicate future negotiations. If asked about your pay expectations, a good response is, "I'm focused on the interview process and still researching market data. I am confident we will get to a number that works for both of us."

3. Convey optionality: Even if you have a target hospital in mind, make sure that you are interviewing at multiple places to improve your BATNA

Negotiating salary, signing bonuses, and other benefits can seem intimidating. However, with adequate knowledge and preparation, you can significantly improve your chances of securing a fair and competitive offer. We recommend you:

1. Research the market: Before you start negotiating, research the current market for your specific practice. SalaryDr can help you with this by providing salary and benefits data submitted by practicing physicians. This will give you a better understanding of what to expect and what other hospitals are offering for similar positions.

2. Understand your value: As a medical practitioner, you bring unique skills and expertise. It's essential to understand the value of your skills and experience and to articulate this value to hospitals during negotiations. Frame your ask in terms of value:

   1. Increased productivity

   2. Improved educational commitments

   3. Leadership contributions.

3. Remember you can walk away: Securing a job offer can be a lengthy process, making it tempting to accept the first one you receive. However, if negotiations falter and the offer isn't exciting, walking away might be worthwhile. Your skills are valuable and in demand, and it's likely that a better, higher offer that truly reflects your worth is only a few weeks away.

4. Testing to see if the hospital will go above band: Because physicians are in high demand, many hospitals are willing to exceed their standard pay scales to attract the right candidate. You can create leverage for your counteroffer by having another offer or by speaking with another hospital. Additionally, we've observed that a patient and deliberate approach to negotiation can lead the company to consider if you are exploring other opportunities.

5. Ask for support from the department chiefs: Fostering a robust relationship with your department chair or chief attending is paramount not only for successful negotiations but also for your overall success within the hospital. When negotiating, it's beneficial to engage department leadership in addition to HR, as they better grasp the value you bring to the team. Furthermore, adopting a long-term perspective can underscore your commitment to joining the hospital.

Negotiation tactics we have used:

HR departments often employ various tactics to gain an advantage in negotiations, and it's crucial to be aware of these to avoid being exploited. Common strategies include imposing tight deadlines with "exploding" offers, claiming an initial offer is non-negotiable (when it often is), emphasizing future growth and substantial increases in offer value through bonuses, and promising to revisit pay in the near future.

Some of the most common negotiation strategies that we use in rebuttal are:

Here are a few ways to strengthen your negotiating position when seeking a higher salary or better benefits:

• Leverage time pressure: Hospitals often need to fill positions quickly. You can use this urgency to your advantage by clearly stating your salary requirements, e.g., "I know you're aiming to finalize negotiations—here's what I'd need to sign."

• Show your value with other offers: Having a competing job offer puts you in a powerful negotiating stance. This allows you to assert your preferences regarding salary, benefits, and sign-on bonuses.

• Gather market insights: Outside information can bolster your position. For example, discussing compensation with a competitor or consulting recruiters can provide valuable insights into market rates.

Most negotiable aspects of physician offer

When negotiating a job offer, the signing bonus is often the most flexible element, more so than base salary or benefits. Hospitals tend to prefer one-time payments like a signing bonus over consistent, higher guaranteed cash outlays.

While a change in annual bonuses are unlikely unless your role changes, it's worth inquiring about almost every aspect of an offer. If further compensation increases aren't possible, consider asking for more flexibility (e.g., more research time, better call hours) or other valuable perks, such as education reimbursement, conference budgets, etc.

Mistakes to avoid

Negotiating your job offer is a crucial step that can significantly impact your career. To ensure you secure the best possible terms, it's important to be aware of common pitfalls. Here are some key mistakes to avoid:

1. Failing to Negotiate: The most common mistake is not negotiating at all. Hospitals anticipate negotiation, and the offer stage is your prime opportunity to secure a better deal. Even if the initial offer exceeds your expectations, consider asking for more flexibility or at least a small sign-on bonus.

2. Negotiating Without a Clear Strategy: Effective negotiation requires more than just "asking for more." You need a well-defined point of view and specific, data-backed requests. Prepare by understanding the offer's components, how offers are determined, and the rationale behind your requests. A well-planned and adhered-to strategy leads to a stronger agreement.

3. Attempting to Negotiate After Signing: Once you've signed the offer, you've agreed to the terms. Trying to renegotiate afterward will be perceived as signing in bad faith and is likely to be ineffective. The time to negotiate is always before you accept the offer, to avoid buyer's remorse.

4. Focusing Solely on Your Desires: While your financial needs are important, successful negotiation involves reaching a mutual agreement. You're unlikely to succeed if your focus is exclusively on what benefits you, as there are two parties involved in the discussion.

Negotiation requires practice, but the effort is worthwhile. Reaching mutually agreeable terms with your future employer will establish a positive foundation for your new role and contribute to your long-term career success. For personalized support, consider signing up for a call with a negotiation coach.

Can my offer be rescinded?

This is by far the #1 fear any new physician is thinking. It is a very common and valid fear, but based on our data, what’s the actual probability that a hospital would decide to pull the offer if you try to negotiate?

Spoiler alert: it’s less than 1% of the time

Negotiating a job offer can be daunting due to the fear of the offer being rescinded. However, this is highly unlikely. To boost your confidence and reduce this risk, consider the following strategies:

Do's for Successful Negotiation:

• Maintain Professionalism: Avoid sensitive topics like politics or inappropriate humor that could raise concerns about your professionalism.

• Justify Compensation Requests: Provide clear reasons for your desired compensation increase. This could be based on market value, alternative opportunities, your unique expertise, or your established rapport with the department heads.

• Initiate Compensation Discussions by Phone: We've observed that initial compensation requests are more often successful and better understood when made over a phone call rather than via email.

• Understand the Role's Importance: Research the criticality of your role to the team and how long it has been open. This insight can help you assess your negotiation leverage.