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Can I rectify this mistake: Not negotiating shrewdly?

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  • Avatar ChristopherMD20 
    Participant
    Status: Physician
    Posts: 176
    Joined: 10/31/2017

    Hello,

    I am a new attending. I started my job in August. I was just named a medical director of a specific division. There was no conversation about compensation for this additional new role. Should I ask for compensation? I already accepted the promotion, but there was not conversation with regard to compensation. I do not even have an office right now, should I just ask for that? Should I just suck it up then when it comes time in 1-1.5 years to renegotiate my contract use all the things that I am doing to improve the hospital as “leverage?”

     

    I feel a bit silly now. I am not a good advocate for myself. I am a really hard worker, but I let people take advantage of me.

     

    Thanks!

    #161353 Reply
    Avatar Peds 
    Participant
    Status: Physician
    Posts: 4206
    Joined: 01/08/2016
    I was just named a medical director of a specific division. There was no conversation about compensation for this additional new role.

    Click to expand…

    was there talk about roles, responsibilities, hours, etc?

    I already accepted the promotion

    Click to expand…

    doesnt mean you cant “quit”

    #161354 Reply
    Avatar ChristopherMD20 
    Participant
    Status: Physician
    Posts: 176
    Joined: 10/31/2017

    There was no discussion about how this changes my responsibilities etc.

    #161357 Reply
    Vagabond MD Vagabond MD 
    Participant
    Status: Physician
    Posts: 3420
    Joined: 01/21/2016

    There was no discussion about how this changes my responsibilities etc.

    Click to expand…

    This is very common in medical careers. We are trained and groomed to be agreeable. We are asked to do something and are accustomed to saying “yes” before thinking about it.

    I would go back and ask whoever asked you to be the medical director: “Hey, when you asked me to be medical director, I never asked what was involved. Provisionally, I will still take that role, but I would like to know what are the additional responsibilities, additional time commitment, where that time is coming from, and potential additional compensation.”

    I virtually guarantee you that whether the time commitment and responsibility is minimal or huge, the answer will be along the lines of “oh, it’s no big deal…”

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #161360 Reply
    Avatar ChristopherMD20 
    Participant
    Status: Physician
    Posts: 176
    Joined: 10/31/2017

    How then should I respond to the oh no it’s not a big deal response?

    #161363 Reply
    Avatar pulmdoc 
    Participant
    Status: Physician
    Posts: 432
    Joined: 09/19/2016

    “If its no big deal, I don’t need to do it.”

    #161401 Reply
    Avatar Kamban 
    Participant
    Status: Physician
    Posts: 2412
    Joined: 08/01/2016
    alpha investing

    How then should I respond to the oh no it’s not a big deal response?

    Click to expand…

    “If it is no big deal, I would rather have someone else do it than me.”

    Unless it will negatively affect your current job and compensation for it, you are not obligated to take on added responsibilities that were not agreed upon in the initial contract.

    #161404 Reply
    Liked by Hank, ENT Doc, Lithium
    Avatar ChristopherMD20 
    Participant
    Status: Physician
    Posts: 176
    Joined: 10/31/2017

    I am the only person with subspecialty training in this particular discipline at my hospital. I was hired to revamp the program but was not given the title upfront. The transition to being an attending has been a lot easier so I am taking over the role earlier than expected. There was no discussion specifically about the additional administrative responsibility but my role will increase so I logically think there should be compensation. I am not sure what to ask for or if I will have the fortitude to say something.

    #161414 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2680
    Joined: 01/03/2017

    You really need to have your responsibilities in writing (along with appropriate compensation). Right now, everything is incredibly vague and they will take complete advantage of that.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #161416 Reply
    wonka31 wonka31 
    Participant
    Status: Physician
    Posts: 680
    Joined: 03/24/2018

    Yes you can rectify it. As noted above, you need to spell out what your role is. Also, what exactly are you directing if you’re the only one in that sub specialty?

    #161426 Reply
    Avatar ChristopherMD20 
    Participant
    Status: Physician
    Posts: 176
    Joined: 10/31/2017

    Stroke program. Any neuro can do it but I am a vascular neurologist.

    #161427 Reply
    Vagabond MD Vagabond MD 
    Participant
    Status: Physician
    Posts: 3420
    Joined: 01/21/2016

    Stroke program. Any neuro can do it but I am a vascular neurologist.

    Click to expand…

    Ugh, sounds like a lot of call, responsibility, and meetings. It was never discussed in advance?

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #161428 Reply
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 2828
    Joined: 09/18/2018

    “You really need to have your responsibilities in writing (along with appropriate compensation). Right now, everything is incredibly vague and they will take complete advantage of that.”

    That’s your ticket.
    Medical Director means what?
    “ I was hired to revamp the program but was not given the title upfront. The transition to being an attending has been a lot easier so I am taking over the role earlier than expected.”
    The question is revamp and your roles and responsibilities. Has you authority and responsibility expanded? Do you have to do anything else? Is the title at the same HR job grade?
    If the “revamp” is done (which probably wasn’t in your contract) and nothing else changed, you are still smart to get that on paper. What do you do if they put one or more attendings under you? Now you have oversight and training? Six months in will they bump you?
    If you were hired to build a specialty, does the title change impact your job? No big deal, sign it!
    It’s all internal, patients still call you “Doctor “.

    #161429 Reply
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2587
    Joined: 05/07/2017

    I have a lot of thoughts on this, but it’s truly a challenge to imagine the culture and background of any system.

    For us, there would have to be a significant reason for an offer to be made to a new graduate to be a medical director.   I can’t even imagine a situation where this would occur.  Most medical directors supervise different specialties anyways.  The medical director is responsible for much more higher level functions-strategic medical decisions, high level disciplinary activities, negotiation of contracts, internal negotiations of responsibilities across various specialties, development of institutes and centers of excellence, etc etc.  even associate and assistant medical directors would never be offered to new graduates.   Maybe after two years experience if someone were the only one in a specialty, they might be offered a service line lead.

    They then are enrolled in a leadership program for one year.  They have a project they develop.  They train you how to handle difficult situations and have so called crucial conversations.   Write up business proposals.  Take accounting class so you can participate in meetings with administrative dyads.  Etc etc

    if your position has you doing those things, i would say quit.  Your first two years should imo be spent gaining clinical excellence.  No matter how good your training you still get better in your first few years.  You need to build a solid reputation of excellence and availability.  you need to learn who your lifelines are—clinical and administrative.  You need to learn how to bill.  You need to learn what programs you want to develop, and which ones to say no to.   Go sit on some committees.  Chair some committees.  Learn how people lie to your face.  Learn to smile while someone is being ridiculous and wait them out.   See how effective people get things done.  Learn the players.

    i’m not thinking of the mistake that you are—not negotiating salary.  I’m worried they are using your name and reputation without you even being aware of it.  This policy was approved by Dr. x.   Dr. X, the medical director, has decided we can no longer afford to pay you overtime.   I have some minor concerns that trying this too early will hurt your long term career aspirations.  Capacity for human beings to be self absorbed is limitless.  Things that are inefficient for you probably are helpful to someone powerful.  You think you are helping clean up a problem, but you are pissing off the chair of another department.

    The first few years after you graduate are easy in some way—you don’t have ‘that’ many patients yet, you have a lot of energy, you are amazed at how much money you are making.   The next few years you have kids, you don’t get any sleep even when you are not on call, and you start taking vacations and buying a doctor house.   You have to read more to stay current.  You sit on more and more committees.  You have to learn how to restrain your innate desire to be helpful and learn to just listen to people complain.  You have to learn to have a few knives in the back.

    Of course i have no idea of the culture of your place.  But i would never put you in the situation that early on, certainly not without having a frank conversation about what responsibilities there are and an estimate of time requirements.   And if pay were appropriate, i would ensure you got the going rate.  But most of these jobs are not worth the pay.  Especially if you are the only one there, quit, and tell them you are flattered but you need another year to get settled.  Spend that year thinking and learning what the other medical directors do, how much time it takes, what the expectations are, and what the pay is.  Come back to them next year or whenever you think you are ready with a plan you design.  You control the narrative and the time.  Even when they screw you, it will have been a useful exercise.  :).  For me, pay is absolutely the last thing i think about with administrative duties.  There are many ways to get screwed worse than pay imo.

    good luck!

    congrats on being a successful attending!

     

    hatton1 hatton1 
    Participant
    Status: Physician
    Posts: 3056
    Joined: 01/11/2016

    Wow Q hit it out of the park.

    #161507 Reply
    Liked by Vagabond MD, Tim

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