Why you should care about salary negotiations

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Owuemene. Welcome to the Clinician Researcher podcast. I'm your host, Toyosi Owuemene, and it is an absolute pleasure to be talking with you today. Thank you so much for tuning in. I am excited to bring you this episode titled, Salary, Why It Matters. Okay, that episode title again is Salary and Why It Matters. And the reason I bring you this episode today is because of my...

1:24 I literally just got off a coaching call with my clients, and I asked them to rank in order of priority, what was the most important in selecting their next or first academic job or first faculty job. And I listed geography, activities of the job, and salary. And 100%, 100%, these were 10 people in this meeting, 100% said salary was the least important consideration, 100%. Okay. Now, I have to say that even though that didn't surprise me, I was 100%. I was surprised because I thought it couldn't be 100%.

2:05 I was sure at least one person, at least it would be 10%. But 100% said it was the least important consideration. And so I thought that was important for me to create an episode that helps academic faculty think about why salary actually matters more than we want it to. What was number one? Number one was the kind of activity they would be doing in their job. And number two is the geography was geography. Okay. So here's the spoiler alert for the seven things I'm going to tell you, seven reasons why early career faculty should be thinking about their salary, should care significantly about their salary.

2:51 It's because salary affects your ability to do the things you want to do. And it also sometimes affects where you live. But all right, that's the spoiler alert. But why do I think it's important for you to care about salary? Now, I will say that this is me 11 years from my first faculty position job hunting, right? I didn't care about salary either. It was the least important of all considerations to me. And in retrospect, now I would say, wow, it absolutely should have been important to me. And I want to share now why. The first and most important thing about salary is that even if it doesn't matter to you, it matters to so many other people, including people who are hiring you.

3:36 Have you ever heard the phrase, whoever dies with the most toys wins? Yeah. I don't believe it. I don't even endorse it. But people are keeping score with money. And for whatever reason, money is an indicator of value. Now you can be like, well, no, my value is not wrapped up in my salary. And that's great. You are so awesome and so altruistic, but everybody else is not thinking about. People are equating value with salary. The lower salary you get, the lower value is associated with the activities that you do. Now, every institution is different in terms of what they prioritize.

4:17 But I will tell you that when you look across the board of new recruits coming in, value depends on how much salary is offered. And that when we think about the salary equity gap, right, which exists, let's just call it out, there is a pay equity gap in salary and it affects gender. So women are more likely to be affected and underrepresented minorities are likely to be affected as well. And in that inherently is a suggestion of value. Because if everything, everyone was valued equally, then why would there be a pay disparity? Right?

4:58 So it matters because people are valuing what you do based on the salary they give you. Now if everybody got the same salary, we wouldn't even need to have this conversation. It would just be like, oh, okay, everybody gets the same thing. Why does it matter? But there is a significant differential, even looking at the same position, the same academic position, the same job description. So now we're not talking about orthopedic surgeon compared to pediatric infectious disease. We're talking about, okay, all pediatric infectious disease doctors of all comers, right? All genders and all races and ethnicities, there is pay disparity.

5:39 And so salary, for better or for worse, is often a reflection of the value you bring. Now here's the challenge. People are happy to offer you a lower salary. And sometimes the rhetoric is that people who are underrepresented or women tend not to negotiate, and that may be true to some extent, but also what is first offered tends to be disparity in that. Now I have that based on anecdotal evidence, based on people sharing what they were initially offered, and there's disparity in that as well. So if you're starting out with a very low ball offer, you're not likely to negotiate to a much higher amount. So I remember that whole idea about women don't negotiate, women don't negotiate, and that filled my mind.

6:22 And so when I went to negotiate my salary, I did negotiate, but I started from such a low position there was nowhere I was negotiating with too, because I didn't understand anchoring, right? I didn't understand how to negotiate well. And that's not a deficit. It's not what we're taught to do in medicine. And for many of us, before we get to our first faculty positions, we've never negotiated a job. For many of us who've just gone straight through, right? We've never done that. And so it's not a skill we've built, and it's a skill that can be built over time. So anyway, when you don't get appropriate value for the work that you put in, you actually don't get it.

7:03 Your work is recognized as less valuable. The more somebody has to cough up out of pocket to pay for something, the more they value what they paid for, even if they don't think it's worth that much. Now, I'm not even sure you're worth that, but I paid this much, so I expect to get this much out, right? So even when people are not trying to equate salary with value, the person who gets paid more is perceived to bring more value than the person who gets paid less. That's the way it is. So I'm not telling you what you should negotiate, but I'm letting you know that you should be careful about it, because if you don't think carefully enough about it, you may be signaling to your institution that your work is of lower value before you even had a chance to declare the value of your work.

7:52 So salary, whether we like it or not, is often a reflection of how an institution values that position, values the work that is done, you should pay attention so that your compensation speaks to the value of your work. That's number one. Number two is sustainability. Now here's what I didn't recognize when I did not really think too critically about salary when I first started. I was a young mother of two children. I needed full-time childcare to be able to do my faculty job well. But because my salary did not support my ability to find full-time help, guess who was doing all the additional running around?

8:34 I'm very fortunate. I have a very supportive spouse who was so helpful. I had help. And so if I didn't have that help, I would be stuck. So many times when faculty are thinking about how, oh, salary is not so important to me, they forget that if they're going to work as hard as they need to, so I hope you're not thinking that you're going to finish your training and then life is going to get easier. You're going to work less hard. If anything, you're going to work very, very hard, especially in your early career faculty years. And probably I don't know that working hard ever really ends in academic medicine, but you're going to be investing a lot of time in your job. Who's going to help you take care of all the other needs that you have?

9:17 You might have student loan debt that you need to retire. What if your salary doesn't even allow you to pay that student loan debt off? How do you manage all the other activities? So now then you have to go get a moonlighting job that keeps you from excelling in the research and scholarship that you went to this academic institution to do. That is a problem. If you don't earn enough to meet your other needs, including childcare needs, elder care needs, supporting or retiring your student loan debt, paying for your mortgage, if you don't have enough salary to cover even the basic and beyond the basics, then it becomes a distraction from the academic value that you say you want to bring.

10:02 Salary matters so that you do not have a burden and now that now distracts you from the work that you actually came to do. Number two is career sustainability. Number three has to do with opportunities for professional growth. Okay, I know you made a lot of investment into getting your medical degree and congratulations. It was absolutely worth it. You were worth the investment even if you have not finished paying off your student loans. That is not the end of your professional development. You may be like, oh no, I'm only interested in the professional development offered by my institution. Think again, you are someone who must continue to grow and expand and build skill.

10:49 Professional development is part of your life forever. I'm not just talking about CME. Please go get those CME hours. In fact, you're not going to be able to renew your license without the CME hours. So that kind of is required. Professional development on the other hand is optional, but it costs money to do professional development activities. All of these activities, especially those that are outside of your institution, take time and investment and energy and effort. If you are struggling even just to meet all your other basic needs and you don't even have enough money tucked away for some of these professional development activities, that is a challenge. I've done professional development activities that cost a couple of tens of thousands of dollars and my institution doesn't want to pay it, or at least they want to pay only a partial amount.

11:38 I need to be able to support myself to be able to do that. Attending conferences is important, whether or not they're going to cover you. Imagine if you're like, oh, my institution only covers $3,000 worth of a conference, therefore I can't go to this other conference. Why would you limit the number of conferences and opportunities you have for networking, expanding your career to just whatever is in the budget? Why wouldn't you be able to have more than that? So I am saying that if you are interested in salary only as like, oh, I just need the bare minimum to get by, I want you to think again about the opportunities a higher salary brings you. Now, not just opportunities for professional growth, but opportunities for investment, opportunities for you to ultimately one day be able to be financially independent, which you may not be as focused on when you are in your early career days because you're like, I just got to get those grants out.

12:31 I just got to get those scholarship. I've just got to do all the scholarship things. And I'm saying, please do all of that. And while you're doing that, make sure you have enough of a cushion to meet your financial needs so that you can advance both professionally and financially. Okay. Number four is increased flexibility. Okay. Okay. Flexibility. Now, let's go back to the example of childcare. If you don't have enough money to support the childcare needs that you have, guess who does not have very much flexibility? You don't. And maybe you're like, well, children are not my challenge. I'm like, okay, great. But if you don't have enough money to support your going away on your dream vacation, you're working so hard, what is the point?

13:15 Or if you don't have enough financial flexibility that you have to go into debt every time you have a major demand on your income, what are you going to do? And so you may be thinking, oh, I don't have to worry about finances because I have a significant other who is equally well paid. And I'm going to say, that's great. And consider if for whatever reason, this second income doesn't come in, are you going to be able to sustain the entire ship? And those are the things you want to think about. You want to be independent. And sometimes that's the challenge, especially for women, I think, who are in other significant relationships or finances are coming in from a partner. Sometimes it's like, well, I don't have to make very much because the other person is making up more than enough for both of us.

13:57 And I would say that if you were not able to access that income for whatever reason, would you be able to independently support the entire family? And I think that's an important question to consider when you're considering your salary. Okay. Number five is compensation for your time and effort. Now, I don't want you to do this math. Actually, maybe you should do it, but I want you to go in and for a week, keep track of how much time you're actually spending investing in your job activities as an academic physician. Now, I know we all talk about, oh, yes, the 40 hour work week or it's a 50 hour work week. Maybe it's a 70 hour work week. How many hours are you actually putting in relative to what you're compensated?

14:41 And that's an important question. Salary is a beautiful thing. I love to see the paycheck come in every month. And at the end of the day, when you tally those hours, are you actually being fairly compensated for the work you do? Now, in every academic environment, there tends to be a range of salaries that faculty are paid based on their position, based on their role, based on their specialty. So there is a range. And I'm not suggesting that you're going to go and be way outside of that range, be an outlier. If you can be an outlier, go be an outlier. But what you want to do is make sure that you are as close to the ceiling as you can be, as reasonably can be.

15:22 But you don't want to be, at the minimum you should be average, right? But what you don't want to be is at the bottom. You want to make sure that you are well compensated for your time and effort. Because if you're not, and you actually have to go do a second job moonlighting just to be able to make up for your lack of compensation, then that's also a drain on your time and your energy. Okay? Number six is equity and negotiation practice. Okay. Negotiation is all we do primarily, though we're very good advocates for our patients and we negotiate well for them. But we should be able to negotiate at least minimally for ourselves.

16:03 You can't negotiate what you don't understand. You can't negotiate what you don't do. Now I will tell you that the faculty in my group were so, they were so apathetic about salary that no one even looked up what's the expected salary for their position. You've got to know these numbers because if somebody comes in with a low ball offer that's too little to support your needs, you don't even know it's a low ball offer. How can you negotiate it? Negotiation is about having information, having access to information. If you know that the median salary is 250,000 and someone says, we're willing to pay you 150,000, you want to be able to say, hmm, I would like to understand why this is not at the median for academic medical centers in the Southeast.

16:54 It's a question. You don't even really have to be a hardcore negotiator to ask questions. And at the end of the day, negotiation is a lot about asking and answering questions or asking questions in curiosity. But if I didn't know that the median salary is 250,000 for this area and for my specialty, then how can I know where I should be negotiating to? I might just start with 150 and say, oh, well, let me negotiate up to 170,000 and feel like I've done well negotiating and not realize that I'm totally out of range because I lacked information. So this is the point at which I pause and say, for those of you who are early career thinking about your first or next faculty job, please go find out what the salary is.

17:39 Go find out. Don't guess. Don't imagine. Don't say, wow, it's greater than my residency salary. It must be amazing. Go find out the numbers. In one way you can do that is look at the AAMC faculty compensation report. And for any academic institution, if you're a member of an academic institution that contributes data to that report, you can get it for $60 in today's dollars. As of today, you can get it for $60, at least the last time I checked. Hopefully it hasn't changed. And if you are part of an academic institution that does not contribute data, then it's $1,500. So it's not cheap. So if you don't have access to it or you can't cough up the dollars or you don't have the dollars to be able to pay for at either end of that spectrum, I would say that you can go to your library and ask them.

18:26 And it's a document that usually sits in the reference side of the library, at least in my library, and someone can look at the pages and give you access to the information you need. Or you can show up at the reservation desk and get that information yourself. But the number exists. It's out there. And at a minimum, even if you're like, I don't want to negotiate, I don't care, you should know the number so you understand how close to it you are, how far you are from it. You want to know. Okay. All right. Finally, long-term financial help. This is so important. And I wasn't thinking about this at all. In fact, I wasn't thinking about any of the things I'm just sharing with you. But your long-term financial help matters. Because as a physician, when you compare yourself to your classmates who graduated college and went off and found their entry-level jobs, they've had 10 years longer than you have for the most part to build up their savings or to build up their investments in their 401k or their 403b or whatever investment vehicle that they chose.

19:28 Whenever it comes to investment and thinking about long-term finances, especially with regard to retirement, time in the market matters most. I remember whenever people would come talk to us about finances at the end of medical school and they would show us the same two graphs of the people who started saving when they were 25. And I would always look at those graphs and say, well, why didn't you come talk to me? Oh, no, they would start at 18, I think. It was like, Jerry started when he was 18 and he contributed until he was 18. He was 30 and he stopped contributing forever. And then the other person starts at age 40 and then contributes for 30 years. And when they compare the two, the person who started will always have more than the person who started late.

20:12 Right? The person who started early will always have more than the person who started late. So already, if you are a physician who spent most of your life in training, not really contributing to retirement, not really making significant investments, you started out late. And so you need to catch up. You need to catch up because I hope you're not planning to work forever. You're not. But you want to have a plan for your retirement. You want to have a plan to become financially independent. And that does involve investing. And the more time you have to invest, the more you're able to meet your goals more easily, at least in a reasonable amount of time.

20:53 And so salary matters in those decisions because your salary is the seed that allows you to make those investments. All right. I've given you seven reasons now why you should be thinking about your salary, even if it's not the most important thing for you in your next or first academic job. Number one, whether you like it or not, salary is a reflection of value. Number two, career sustainability. Number three, opportunities for professional and financial growth. And before increased flexibility. Number five, compensation for your time and effort. Number six, equity and negotiation practice. And number seven, your long term financial health. And I'm inviting you this week to go figure out what is the median salary for your specialty based on the academic, the part of the country that you're in, based on whether it's a private or a public academic institution.

21:42 Do you know those numbers? I challenge you to find out what they are this week. And I'll be curious to know your thoughts. Someone who did this exercise in my group was like, I am totally surprised. How can a specialist make less than a generalist? And it was one of those, I mean, it wasn't funny, but I was in that place. I was like, yeah, that is exactly me. I was like, why did I spend this extra time and I make less than a generalist? And I tell you that is not an unusual finding, but she wouldn't have known that if she hadn't looked it up. And so I invite you to do the same this week. Go look it up. Share your surprises or maybe you're not surprised. You're like, yeah, I knew that all along. I would be interested to hear.

22:23 Reach out to me on LinkedIn. I look forward to hearing from you. All right. It's been a pleasure talking with you today. Thank you so much for tuning in and I look forward to talking with you again the next time on the Clinician Researcher podcast. Thank you for listening. Thanks for listening to this episode of the Clinician Researcher podcast where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. If you found the information in this episode to be helpful, don't keep it all to yourself. Someone else needs to hear it. So take a minute right now and share it.

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