Jennifer
Specialty: Pediatrics
1. What are your current and past work experiences in the field of medicine?
I have practiced pediatrics since 1996. I initially worked part-time (about 80%) then full-time. I was a stay-at-home mom for 2 years and then worked per diem (on an as-needed basis, anywhere from 0 days for a full month to a maximum of 4 days per week from 10 a.m. to 3 p.m.) for 2 years. I am currently working 70% as co-director of a newborn nursery and academic pediatrician at a teaching institution and will soon be moving and have not yet looked for a new job.
2. What role has your ability to negotiate played in the career choices you have made?
I have been able to tailor my career choices to match my work/life balance needs at different times in my life. Being able to negotiate in general is not unique to finding a job. It is similar in many ways to buying a car or bargain hunting. You first need to determine what you absolutely must have and what bells and whistles you can live without.
Often it is not a completely equal/proportionate decrease; for example, I now take full call despite working less than full-time. This is a point that people may wish to negotiate, but in my group, the group decided that it was for the best of all physicians involved to have this type of system since so many people are part-time in a clinical capacity. Liability insurance rates may be unchanged unless you work less than a certain amount (at my previous job, that amount was 24 hours per week or less).
3. Can you offer some insights as to how you learned to negotiate?
In my first job, the employer didn’t offer health insurance as a benefit but instead allowed ½ day of paid time per week. For people who don’t need health insurance through their employer even though it is offered, they could negotiate and ask for the cost of the health insurance to be added back to their salary, or to have a shortened workweek in exchange.
In my second job, the employer had already had experience with part-time physicians and nothing was negotiable because it had to be fair for all the 400 doctors working in the system. In such a case, if something needed to be negotiated, all the part-time physicians would need to come up with a proposal for change to be presented to the employer.
In my third job, I signed a contract that allowed me to be a per diem physician. It was agreed that I would only work when I was available to work but did not have benefits such as vacation time, CME days or health insurance. This way I was able to build my work time around my personal schedule and was easily able to attend meetings out of town or to take vacation when I wanted to without having to find coverage.
In my fourth job, there were multiple variables: how much time I would spend in the clinic, how much time I would spend teaching/supervising pediatric residents, how much time I would spend attending in the newborn nursery and what my administrative responsibilities were as director of the newborn nursery. I spoke to the previous nursery director as well as to the pediatric inpatient hospitalists about their contracts to see what was considered fair and reasonable and what needed negotiating before I signed my own contract. All of them happened to be part-time physicians as well.
4. What advice would you give someone who is negotiating their first part-time or other work arrangement?
Figure out your ideal work arrangement and then talk to other people who have successfully (or unsuccessfully) negotiated similar positions. For example when I was negotiating a work arrangement, I basically asked other people locally (in the same practice or in other practices) and at national meetings who worked part-time or even full-time. Most of the basic negotiation principles are the same although the details specific to part-timers can vary. I also attended lectures at CME conferences, and read as much as I could about the subject of negotiating. When it comes down to the actual job position you're going for though, that's pretty unique and it would be unusual for someone else to have had the same experience unless they're in the same practice. I have ended up being a resource to some other folks following in my footsteps too.
5. There can be variety of different part-time work options available for physicians, making the opportunities and experiences of physicians unique in some ways and similar in others. Can you comment on that and how it might impact your strategies for negotiating?
I think in certain areas, being part-time really isn’t uncommon anymore. But the many variations of part-time work are countless and so everyone’s situation may be just a little different. For example, even though most people in my current group are part-time from a clinical perspective, they have multiple research, educational and administrative responsibilities that add up to a full-time job. They also have to be able to negotiate.
One problem is people don’t always like to reveal their own negotiations for fear that someone will get a better contract than they were able to get or discover what a good deal they have that is not common knowledge. More often though, other people’s situations are different from yours (they are the primary household earner for example and need health insurance from the employer) and their negotiation experiences may not be as applicable. But you can get some good ideas about how they pieced together their positions.
6. How did you prioritize what was important to negotiate?
My priorities changed based on what was going on in my life at the time: the need for more time spent with family after having a baby, the need for a higher family income when my husband returned to a fellowship position, and the need for health insurance benefits. For example, my husband and I worked out a budget for necessities vs. luxuries to decide how much I needed to work since his position/income was fixed. I also talked to colleagues and friends to figure out what was a reasonable benefits package to expect (insurance, vacation, CME money/time, etc.) and that helped me decide what to ask for if it was something that was negotiable. Many larger employers have standard benefits (my vacation and CME went down proportionately with my FTE) that are not negotiable. But knowing what was customary in the field/specialty helped me decide if the job was worth it or not. I was fortunate to have an employer with reasonable benefits, so having to take 100% call was a tradeoff I was willing to make.
My husband is still in training and we don’t feel we are able to live on his income alone. So I definitely needed an income and we calculated what the minimum amount was and that’s how much I chose to work because I personally prefer not to work more than I have to. We are fortunate to be in this situation; many people are not able to make this type of choice and so their maximum achievable income may limit the way they live.Because CME can now be done easily online or by reading journal articles, I placed vacation time as a higher priority than CME. In my current situation, health insurance for family members through my husband’s employer was costly whereas I could get insurance for the family if I worked at least 0.5 FTE (50% time). So that was a priority for me to work at least 0.5 FTE.
7. Clearly, there are big differences between someone who is working full-time and wants to negotiate a part-time position versus someone who is approaching a new employer for a part-time position. Can you comment on this?
It can be hard to get any position, full- or part-time, especially if you don’t have an established track record within a given practice. New employers may have a need for only part-time physicians based on their work load and budget. Also, employers have had more experience with full-time contracts, so the call expectations, benefits, medical liability insurance rates and other factors may not have been decided for part-time employees. The employer may have to create a new system of compensation for people working part-time (if you work 50%, do you take 50% call, get 50% benefits, pay 50% for liability insurance, etc.).
8. What if the position you want is already defined as "part-time"? How does this alter your strategy?
This situation may give you a head start because the employer is already willing to consider a part-time employee, but it could present a problem if your idea of part-time is not the same as the employer’s definition. For example, you may want to work 70 percent but they only have enough funding for a 50 percent position. If this is the case, it would be helpful to suggest possible strategies to make it a win-win situation. One solution might be to see if another department or division within your department may be willing to fund part of your salary.
9. Whom did you consult for information on establishing a part-time contract?
I have consulted an attorney in the past, but unfortunately that individual was not as familiar with medical employment contracts as I would have liked. I have found great resources within medical organizations such as American Academy of Pediatrics state chapter where I lived, the American Medical Association (AMA), the American Academy of Pediatrics, and my state and county medical societies. The AMA Young Physicians also has great written resources available on-line to its members.
10. Is there anything you would have done differently given what you know now about negotiating?
In my first job, I would have been less eager to accept that contract. I should have kept negotiating or kept looking for a different position, but at that time, I did not have a good idea of my priorities so I wasn’t really sure what I wanted and needed. But hindsight is 20-20, so that was actually a good learning experience.
Other comments.
In my experience, it has always been easier to start working less and then increasing if necessary than to work more and then try to cut back. Practices and patients become somewhat accustomed to the amount of service you provide, and if you were to cut back just 10 percent or so, it may be harder for them to fill a very part-time position like that. If you have the luxury of working less, do so at first and then work more if your needs or desires change.
Content provided by: Women Physicians Congress