By Dr. Jim Dahle, WCI Founder
Many doctors think that the negotiation of a job contract is primarily about going back and forth until both employer and employee agree on a salary. Wiser doctors know there is far more to negotiate than just salary. Give in on items you don't care much about in order to win on the items that you do care about. Here are 28 things you can negotiate on besides salary.
Salary is not the only way you are paid. Benefits also matter, and one of the most valuable is health insurance. Employers may also be willing to offer dental insurance, vision insurance, disability insurance, life insurance, and malpractice insurance. A smart employer recognizes that all of this money comes out of the same big pot, but, in practice, larger, more bureaucratic employers may have their hands tied with some buckets of money but not with others.
#2 Loan Forgiveness/Payback
If nonprofit employers were smart, they'd spend a lot of their negotiating time with new attendings pointing out how valuable Public Service Loan Forgiveness (PSLF) can be for them. Many employers will offer loan payback in some form or other. If you can actually use that benefit (i.e. you have loans and don't expect to get PSLF for them), that money is just as good as more salary. The tricky part comes in once the loans are paid back and you try to get the employer to pay you more in salary since they don't have to pay on your loans anymore.
#3 401(k) Match
Try asking for a larger 401(k)/403(b) match or 401(a) contribution. For large employers, the answer is often no as those plans tend to be pretty standardized. A smaller employer has a lot more flexibility. Some WCI employees have more put into their retirement plan than they take home in salary every year. It's all the same money to me; I'm more than willing to put it into whatever form my employees value most.
#4 Access to Retirement Plans
Along those same lines, there are times when you can negotiate access to retirement plans, such as an earlier start date to use the 401(k) or the ability to use a defined benefit/cash balance plan.
More information here:
#5 Moving Allowance
If you're going to spend the money anyway, a moving allowance is just as good as salary. Both are equally taxable under current law.
#6 Signing Bonus
This is even better than a moving allowance since you can spend it on anything and it often comes long before you start working.
#7 HSA Contributions
Just like a bigger 401(k) match, a bigger Health Savings Account (HSA) contribution may be negotiable.
#8 FSA Contributions
If you have an HSA, you probably don't have a healthcare Flexible Spending Account (FSA), but you may still have a childcare FSA. Get the employer to contribute to that instead of paying you more.
#9 Improve the Retirement Plan
Ever looked at a potential job—especially in a small practice or partnership—and discovered the retirement plan sucks? High fees, bad investments, and low contribution limits? The list goes on and on. Why not negotiate a commitment to improve the 401(k) and maybe even put you on the 401(k) committee?
More information here:
#10 Partnership Track Changes
Many employee jobs are really pre-partner/partnership track jobs. You can negotiate the details of making partner. Perhaps insert some sort of guarantee, shorten the time or hours required to make partner, ensure more fair scheduling, or otherwise make the track less onerous.
#11 Access to Other Income Sources
Some practices and partnerships own other businesses or assets, such as the practice real estate or an associated surgical center or dialysis center. You can negotiate ownership of those entities as well.
#12 Staffing Levels
You can negotiate the staffing levels for doctors, APCs, nurses, techs, clerks, and scribes. You may very well be willing to work for a little less money if your work life is much better. If you are paid on production, staffing levels have a significant effect on your productivity. You could possibly see 30% more patients if you can get one more staff member.
#13 Expected Patient Load
Perhaps there is an expectation to see four patients per hour. Maybe you can negotiate that down to three patients per hour for the same salary. In some ways, that's the equivalent of a 33% raise.
#14 Start Date
Want to start earlier or later? That's a negotiating point. “OK, if you don't want to pay me more, that's fine. But that means I can't start until October 1. I could be there August 1 for the right price.”
#15 Productivity Increases
Many doctors are paid a mix of a flat salary plus productivity bonuses. They may be much more willing to negotiate up the productivity bonus since additional productivity brings them extra money too.
#16 Proportion of Guaranteed Salary
On the other hand, if you think it is going to be tough to be highly productive in that environment (or you know you're not the most efficient doc), you could negotiate to have more of your salary guaranteed and less based on productivity.
#17 Vacation, Personal Leave, and Sick Time
Even in a large organization, leave tends to be far more negotiable than salary might be. Why people take jobs with just 2-3 weeks off a year is beyond me. Of course, I'm basically unemployable due to my leave “requirements.”
#18 Work Schedule
Your willingness or unwillingness to work a traditional schedule is an important negotiating point. If you're willing to run an evening or Saturday clinic, that's very valuable. If you want to be off Wednesday afternoons and every other Friday or you want to knock off at 3 every day, that might cost you something. But if you can hold the salary constant and work less, that's a win in a negotiation.
More information here:
Similar issues surround call. If two jobs pay the same, why wouldn't you take the one where you have to take less call? Or where the call is less busy? Or where a nurse line takes the first call and only forwards the more serious ones to you? Or where the call is paid well?
#20 Automatic Raises
Hate negotiating? Why not build in automatic raises each year?
#21 Professional Fees
Can you get the employer to pay for your state license, DEA license, or board certification fees? That's just as good as salary since you're going to spend the money anyway.
#22 CME Dollars
CME money may not be just as good as more salary, but it's better than a kick in the teeth. I think every WCIer should negotiate for more CME dollars so they can spend them taking WCI online courses and coming to the Physician Wellness and Financial Literacy Conference each year.
#23 CME Time
You're also going to need time off to spend those CME dollars. Ask for a separate pot of time from your vacation and sick leave.
#24 Malpractice Tail Coverage
Most employers cover malpractice, but if the policy is claims-made instead of occurrence, someone is going to need to pick up the cost of the tail insurance. Negotiate for the employer to pick up as much of it as possible.
While they may soon be illegal, noncompete agreements (restrictive covenants) can and should be negotiated, especially if they're so ridiculous they're not even enforceable.
#26 Intellectual Property
This one is particularly important for academic docs. Your contract may restrict what you do on your time off and who owns the products and ideas you develop while working there. That's negotiable too.
#27 Committee Participation
Don't want to serve on six different committees for free? Negotiate a limitation on (or additional pay for) participation on committees.
#28 Academic Requirements
If you're an academic, you can negotiate protected time to work on education and research initiatives. Or perhaps negotiate down the amount of nonclinical work you are expected to do.
What do you think? What did I miss? What else can you negotiate on besides salary? Which of these have you had success negotiating with? Comment below!