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All surgical trainees eventually have to take on the challenge of finding the right fit for themselves within the workforce. Our training typically lacks a step-by-step guidance for entering the workforce. The first article of this three-part series on the Art of Negotiation (ACS Surgery News, 2015, p. 13) gave us a 30,000-foot view. Now let’s take a more granular look at the necessary components needed to get a competitive compensation package.
The process can be overwhelming, and so it is vital that you have a graduated approach to accomplishing the necessary tasks. You should begin by gathering the relevant information so that you can be prepared to negotiate and eventually make the most informed decision.
Understanding the base salary
The majority of us will focus on how much direct compensation or base salary we should ask for. While I don’t want to minimize the importance of this one number, it is far from the only thing that needs to be considered, as many variables play a role when deciding whether or not to accept a position.
There are two resources that should be used to give you a frame of reference. The first is the Association of American Medical Colleges (AAMC) report of medical school faculty salaries, which provides us with academic salary information. The second is data regarding private practice salaries that is from the MGMA physician compensation survey. These resources can be expensive to purchase on your own; however, nearly every institute will have a copy that you should be able to use.
When determining the competitiveness of base salary, one must take the following into consideration: Specialty, Practice Setting, Professional Level, and Geography.
Specialty – A wide range of salary support exists between surgeons based on specialty with neurosurgery at the top of the spectrum and other surgical specialties somewhere below. You will need to look closely at the AAMC and MGMA data to get a good idea of what salary range to expect in your specialty.
Practice Setting/Professional Level – This category is divided into two sections, academic and private practice. These can be further broken down into professional levels: assistant professor and associate/full professor in the academic setting, and starting salaries, 1-2 years in a specialty, and all physicians in the private practice setting.
The differences between salaries for these groups can vary depending upon level of experience and geography. For those that are fresh out of training it is important to notice that salaries early on in one’s career can be similar between the academic and private practice setting yet become widely disparate as surgeons become more seasoned. An example of this can be seen in neurosurgery where if you look at the physician compensation in 2011, the median starting salary for private practice is $400,000. The equivalent academic median salary is $408,000. You might look at this and think it is more beneficial from a purely monetary standpoint to be in an academic job; however, when you look at what happens after 1-2 years in private practice, that median salary jumps significantly to $634,884. Even as an associate professor, which is five or more years out, the median salary is $487,000.
Geography – Location can be important, considering the significant differences in compensation across the country. Imagine the following two opportunities: One is employment in the DMV (D.C., Maryland, Virginia), at an academically affiliated medical center just outside our nation’s capital. The other is in the rural Midwest at a comparable medical center. Taking into consideration the same professional level, which base salary is going to be higher? In the majority of circumstances it will be the rural Midwest, as they attempt to recruit candidates that might not otherwise have an attachment to the area. This can be important during the negotiation process, as it provides you with a bit of insight when it comes to how far you might be able to push the envelope. It also is important to note that in areas that are highly saturated with surgeons, or “attractive” cities that people want to live in, this will ultimately diminish your negotiating ability.
Retirement packages
One other aspect that is not typically included in these resources has to do with retirement packages. These can vary widely and should be looked at carefully. For example, there are some institutes that will put $20,000 toward your retirement while others will contribute $55,000 annually. Everything else being equal, even if the base salary is higher by $25,000 at the institute contributing $20,000 toward retirement, the other offer is still advantageous. While almost everything in a contract is negotiable, the one exception is typically the retirement package. The majority of centers have a standard that is across the board for all faculty. Therefore, focus your time and energy in other areas that can be negotiated.
Division of Time
How your contract structures your time matters a lot. Assume that you are taking a position at an academic medical center. You are interested in maintaining a “triple threat” model of clinician, teacher, and researcher. How do you ensure that you will be successful? The terminology that you should be familiar with is the clinical full-time equivalent (FTE). If your contract has you at a 100% clinical FTE, you are likely not to get any protected time for research. For those highly motivated individuals, you would end up burning the midnight oil, an using your free nights and weekends to pursue your research interests. However, most physicians would not consider this a sustainable model, not to mention the negative impact it would have on your personal life. If your focus is research heavy, the perhaps you’re looking for a position that is 50% clinical FTE. A good rule of thumb is that every 20% of an FTE equates to one day of protected time during the week. Therefore an FTE that is 80% clinical, and 20% research should average to one day a week of protected time. It is reasonable to ask the department to support you for the first 3-5 years as you build your research portfolio. Some institutions might then require you to bring in funding through grants at the end of that time period.
Get it in writing
During the negotiation process, it is highly likely that you will be negotiating with someone that has trained you – perhaps a mentor, or a prominent surgeon. You must learn to remove the emotion from the business aspect of this process. Promises are not sufficient, and your contract needs to clearly articulate the reached agreement. An example of a situation I saw where the agreement was not formalized happened to a colleague of mine, who after he was hired ended up having his division chief move to another institute. The new division chief that took over had different plans for how he would function within the team. The bottom line is that everything you believe is important to your success must be in writing.
The next article will finish highlighting other important aspects that will set you up for success when negotiating your compensation package, and provide some final tricks of the trade that will help make this somewhat intimidating yet exciting process easier!
Dr. Sakran is an assistant professor of surgery and Director of Global Health & Disaster Preparedness for the department of surgery at the Medical University of South Carolina. He is currently chair of the ACS Resident and Associate Society and recently finished a year at the Harvard Kennedy School of Government studying public policy, economics, and leadership development. He has no relevant disclosures.
All surgical trainees eventually have to take on the challenge of finding the right fit for themselves within the workforce. Our training typically lacks a step-by-step guidance for entering the workforce. The first article of this three-part series on the Art of Negotiation (ACS Surgery News, 2015, p. 13) gave us a 30,000-foot view. Now let’s take a more granular look at the necessary components needed to get a competitive compensation package.
The process can be overwhelming, and so it is vital that you have a graduated approach to accomplishing the necessary tasks. You should begin by gathering the relevant information so that you can be prepared to negotiate and eventually make the most informed decision.
Understanding the base salary
The majority of us will focus on how much direct compensation or base salary we should ask for. While I don’t want to minimize the importance of this one number, it is far from the only thing that needs to be considered, as many variables play a role when deciding whether or not to accept a position.
There are two resources that should be used to give you a frame of reference. The first is the Association of American Medical Colleges (AAMC) report of medical school faculty salaries, which provides us with academic salary information. The second is data regarding private practice salaries that is from the MGMA physician compensation survey. These resources can be expensive to purchase on your own; however, nearly every institute will have a copy that you should be able to use.
When determining the competitiveness of base salary, one must take the following into consideration: Specialty, Practice Setting, Professional Level, and Geography.
Specialty – A wide range of salary support exists between surgeons based on specialty with neurosurgery at the top of the spectrum and other surgical specialties somewhere below. You will need to look closely at the AAMC and MGMA data to get a good idea of what salary range to expect in your specialty.
Practice Setting/Professional Level – This category is divided into two sections, academic and private practice. These can be further broken down into professional levels: assistant professor and associate/full professor in the academic setting, and starting salaries, 1-2 years in a specialty, and all physicians in the private practice setting.
The differences between salaries for these groups can vary depending upon level of experience and geography. For those that are fresh out of training it is important to notice that salaries early on in one’s career can be similar between the academic and private practice setting yet become widely disparate as surgeons become more seasoned. An example of this can be seen in neurosurgery where if you look at the physician compensation in 2011, the median starting salary for private practice is $400,000. The equivalent academic median salary is $408,000. You might look at this and think it is more beneficial from a purely monetary standpoint to be in an academic job; however, when you look at what happens after 1-2 years in private practice, that median salary jumps significantly to $634,884. Even as an associate professor, which is five or more years out, the median salary is $487,000.
Geography – Location can be important, considering the significant differences in compensation across the country. Imagine the following two opportunities: One is employment in the DMV (D.C., Maryland, Virginia), at an academically affiliated medical center just outside our nation’s capital. The other is in the rural Midwest at a comparable medical center. Taking into consideration the same professional level, which base salary is going to be higher? In the majority of circumstances it will be the rural Midwest, as they attempt to recruit candidates that might not otherwise have an attachment to the area. This can be important during the negotiation process, as it provides you with a bit of insight when it comes to how far you might be able to push the envelope. It also is important to note that in areas that are highly saturated with surgeons, or “attractive” cities that people want to live in, this will ultimately diminish your negotiating ability.
Retirement packages
One other aspect that is not typically included in these resources has to do with retirement packages. These can vary widely and should be looked at carefully. For example, there are some institutes that will put $20,000 toward your retirement while others will contribute $55,000 annually. Everything else being equal, even if the base salary is higher by $25,000 at the institute contributing $20,000 toward retirement, the other offer is still advantageous. While almost everything in a contract is negotiable, the one exception is typically the retirement package. The majority of centers have a standard that is across the board for all faculty. Therefore, focus your time and energy in other areas that can be negotiated.
Division of Time
How your contract structures your time matters a lot. Assume that you are taking a position at an academic medical center. You are interested in maintaining a “triple threat” model of clinician, teacher, and researcher. How do you ensure that you will be successful? The terminology that you should be familiar with is the clinical full-time equivalent (FTE). If your contract has you at a 100% clinical FTE, you are likely not to get any protected time for research. For those highly motivated individuals, you would end up burning the midnight oil, an using your free nights and weekends to pursue your research interests. However, most physicians would not consider this a sustainable model, not to mention the negative impact it would have on your personal life. If your focus is research heavy, the perhaps you’re looking for a position that is 50% clinical FTE. A good rule of thumb is that every 20% of an FTE equates to one day of protected time during the week. Therefore an FTE that is 80% clinical, and 20% research should average to one day a week of protected time. It is reasonable to ask the department to support you for the first 3-5 years as you build your research portfolio. Some institutions might then require you to bring in funding through grants at the end of that time period.
Get it in writing
During the negotiation process, it is highly likely that you will be negotiating with someone that has trained you – perhaps a mentor, or a prominent surgeon. You must learn to remove the emotion from the business aspect of this process. Promises are not sufficient, and your contract needs to clearly articulate the reached agreement. An example of a situation I saw where the agreement was not formalized happened to a colleague of mine, who after he was hired ended up having his division chief move to another institute. The new division chief that took over had different plans for how he would function within the team. The bottom line is that everything you believe is important to your success must be in writing.
The next article will finish highlighting other important aspects that will set you up for success when negotiating your compensation package, and provide some final tricks of the trade that will help make this somewhat intimidating yet exciting process easier!
Dr. Sakran is an assistant professor of surgery and Director of Global Health & Disaster Preparedness for the department of surgery at the Medical University of South Carolina. He is currently chair of the ACS Resident and Associate Society and recently finished a year at the Harvard Kennedy School of Government studying public policy, economics, and leadership development. He has no relevant disclosures.
All surgical trainees eventually have to take on the challenge of finding the right fit for themselves within the workforce. Our training typically lacks a step-by-step guidance for entering the workforce. The first article of this three-part series on the Art of Negotiation (ACS Surgery News, 2015, p. 13) gave us a 30,000-foot view. Now let’s take a more granular look at the necessary components needed to get a competitive compensation package.
The process can be overwhelming, and so it is vital that you have a graduated approach to accomplishing the necessary tasks. You should begin by gathering the relevant information so that you can be prepared to negotiate and eventually make the most informed decision.
Understanding the base salary
The majority of us will focus on how much direct compensation or base salary we should ask for. While I don’t want to minimize the importance of this one number, it is far from the only thing that needs to be considered, as many variables play a role when deciding whether or not to accept a position.
There are two resources that should be used to give you a frame of reference. The first is the Association of American Medical Colleges (AAMC) report of medical school faculty salaries, which provides us with academic salary information. The second is data regarding private practice salaries that is from the MGMA physician compensation survey. These resources can be expensive to purchase on your own; however, nearly every institute will have a copy that you should be able to use.
When determining the competitiveness of base salary, one must take the following into consideration: Specialty, Practice Setting, Professional Level, and Geography.
Specialty – A wide range of salary support exists between surgeons based on specialty with neurosurgery at the top of the spectrum and other surgical specialties somewhere below. You will need to look closely at the AAMC and MGMA data to get a good idea of what salary range to expect in your specialty.
Practice Setting/Professional Level – This category is divided into two sections, academic and private practice. These can be further broken down into professional levels: assistant professor and associate/full professor in the academic setting, and starting salaries, 1-2 years in a specialty, and all physicians in the private practice setting.
The differences between salaries for these groups can vary depending upon level of experience and geography. For those that are fresh out of training it is important to notice that salaries early on in one’s career can be similar between the academic and private practice setting yet become widely disparate as surgeons become more seasoned. An example of this can be seen in neurosurgery where if you look at the physician compensation in 2011, the median starting salary for private practice is $400,000. The equivalent academic median salary is $408,000. You might look at this and think it is more beneficial from a purely monetary standpoint to be in an academic job; however, when you look at what happens after 1-2 years in private practice, that median salary jumps significantly to $634,884. Even as an associate professor, which is five or more years out, the median salary is $487,000.
Geography – Location can be important, considering the significant differences in compensation across the country. Imagine the following two opportunities: One is employment in the DMV (D.C., Maryland, Virginia), at an academically affiliated medical center just outside our nation’s capital. The other is in the rural Midwest at a comparable medical center. Taking into consideration the same professional level, which base salary is going to be higher? In the majority of circumstances it will be the rural Midwest, as they attempt to recruit candidates that might not otherwise have an attachment to the area. This can be important during the negotiation process, as it provides you with a bit of insight when it comes to how far you might be able to push the envelope. It also is important to note that in areas that are highly saturated with surgeons, or “attractive” cities that people want to live in, this will ultimately diminish your negotiating ability.
Retirement packages
One other aspect that is not typically included in these resources has to do with retirement packages. These can vary widely and should be looked at carefully. For example, there are some institutes that will put $20,000 toward your retirement while others will contribute $55,000 annually. Everything else being equal, even if the base salary is higher by $25,000 at the institute contributing $20,000 toward retirement, the other offer is still advantageous. While almost everything in a contract is negotiable, the one exception is typically the retirement package. The majority of centers have a standard that is across the board for all faculty. Therefore, focus your time and energy in other areas that can be negotiated.
Division of Time
How your contract structures your time matters a lot. Assume that you are taking a position at an academic medical center. You are interested in maintaining a “triple threat” model of clinician, teacher, and researcher. How do you ensure that you will be successful? The terminology that you should be familiar with is the clinical full-time equivalent (FTE). If your contract has you at a 100% clinical FTE, you are likely not to get any protected time for research. For those highly motivated individuals, you would end up burning the midnight oil, an using your free nights and weekends to pursue your research interests. However, most physicians would not consider this a sustainable model, not to mention the negative impact it would have on your personal life. If your focus is research heavy, the perhaps you’re looking for a position that is 50% clinical FTE. A good rule of thumb is that every 20% of an FTE equates to one day of protected time during the week. Therefore an FTE that is 80% clinical, and 20% research should average to one day a week of protected time. It is reasonable to ask the department to support you for the first 3-5 years as you build your research portfolio. Some institutions might then require you to bring in funding through grants at the end of that time period.
Get it in writing
During the negotiation process, it is highly likely that you will be negotiating with someone that has trained you – perhaps a mentor, or a prominent surgeon. You must learn to remove the emotion from the business aspect of this process. Promises are not sufficient, and your contract needs to clearly articulate the reached agreement. An example of a situation I saw where the agreement was not formalized happened to a colleague of mine, who after he was hired ended up having his division chief move to another institute. The new division chief that took over had different plans for how he would function within the team. The bottom line is that everything you believe is important to your success must be in writing.
The next article will finish highlighting other important aspects that will set you up for success when negotiating your compensation package, and provide some final tricks of the trade that will help make this somewhat intimidating yet exciting process easier!
Dr. Sakran is an assistant professor of surgery and Director of Global Health & Disaster Preparedness for the department of surgery at the Medical University of South Carolina. He is currently chair of the ACS Resident and Associate Society and recently finished a year at the Harvard Kennedy School of Government studying public policy, economics, and leadership development. He has no relevant disclosures.
