In Practice: Reflections from NPs and PAs

Bianca Belcher, MPH, PA-C, practices neurosurgery in Boston, MA.

 

This is the first installment of a four-part series dedicated to what I like to call “The Fringe” of working in medicine. I call it The Fringe because it really has nothing to do with the practice of medicine; yet, we all deal with it. As clinicians, we spend a significant amount of time learning and practicing the clinical component of our jobs, the part that makes sure that others (our patients and their families) are taken care of. Unfortunately, many of us neglect the financial/reimbursement aspect of our jobs that ensures that we (our families and ourselves) are taken care of. This is The Fringe.

In this series, with input from some financial industry experts, I will be addressing the four most common topics that I am asked about by PA students and experienced PAs who are transitioning roles or jobs. This series is meant to give you a basic idea of each topic and empower you to seek help and ask questions regarding your own personal finances. The topics are:

1. Negotiation Basics
2. Debt Management
3. Deciphering Your Benefits Package
4. Retirement Contributions

Let me start by saying that I’m not an expert in negotiation, but I have done a lot of research on the art of negotiating, interviewed experts in the field, and helped dozens of PAs negotiate their contracts. I first became interested in negotiation when I realized that I had no idea what I was doing. The whole process seemed so complicated that I basically accepted defeat before it even started. Negotiations are awkward. No one likes discussing money with a total stranger, but if you don’t ask for what you want– rest assured – they won’t offer. You won’t always get everything you ask for; in fact, sometimes you may not get anything, but the point is — if you don’t ask, you’ll never know. Over time, I have developed a few tips designed to increase your comfort level with the negotiation process and enable you to have reasonable expectations.

Tip #1. Do your research. You would not walk into an exam or new surgical procedure without preparing; you shouldn’t walk into negotiations without preparing either. Here are a few things to investigate before you discuss salary.

1. Know what the regional starting salary is for your position and level of experience. The AAPA works hard to survey practicing PAs regarding their salary and benefits packages to create the AAPA Salary Report that is available free to AAPA members. (Remember this when the survey lands in your inbox next time – the more people that complete the survey, the more accurate the report is!) In addition to the Salary Report, I received helpful information by just asking classmates and colleagues with whom I have a good comfort level about their current salary range. It isn’t necessary to know the exact dollar amount, but a range of $10-12K was helpful to know if I was in the ballpark. Along with salary, you should also be asking about years of experience, hours worked per week, and other job demands. If you are applying for an outpatient family medicine position without night/weekend/call requirements – your friend in CT surgery who works 80hrs a week plus nights/weekend/call probably isn’t the best point of reference to start salary discussions.
2. Know the range of benefits packages in your area. What are practices in your area offering for annual CME money? Do they cover your initial licensing costs or is there a delay? Some practices will only cover licensing and certification costs 6-12 months after start of employment, which means you may be responsible for those expenses. Remember, DEA fees alone are $750. Do they offer community perks like reduced-cost childcare, gym memberships, or subsidized parking/public transport passes? What do the short term/long term disability plans look like? Do you have employer matching for retirement plans? Do they offer a health reimbursement account? These aspects of a benefits package are easily overlooked but can save or cost you hundreds of dollars per year.
3. Know the pay structure for the position. Are you salaried or hourly? This makes a huge difference when you continually work longer than scheduled. Hourly payment is becoming increasingly less common for PAs, but it still exists.
4. Know the demands of the position. Will your job include nights, weekends, call? Are they compensated or part of the offered salary? Consider these demands in the context of your work-life balance as well.

Tip #2. Know your worth. What can you offer the employer in this position that others cannot? If you are a new graduate applying for a sports medicine orthopedic position and worked as an athletic trainer for 5 years before PA school – use that in your negotiations! Do you have an additional degree (MPH or MBA) that may help advance the practice? Don’t just expect them to add more money to the offer because you have more letters after your name. Discuss specifically how your prior experiences/degree could benefit your prospective employer.

Tip #3. Once you receive an offer, ask for time to consider your options. Accepting a job is a big decision. Most of us wouldn’t impulsively buy a house or make a large investment without taking some time to think about it. Consider accepting a job offer in the same way. Once you receive an offer, it is common to ask them for 48 hours to discuss this great opportunity with your family. Take the time to sleep on it, think about negotiations, and consider whether or not the job is a good fit for you.

Tip #4. Never, and I mean NEVER, take the first offer. This is a hard concept to teach people, especially new graduates and women. I have found that new grads are grateful for a paycheck and often jump at the first offer. Women, as seen in study after study, are much less comfortable with negotiating for themselves than their male counterparts. Interestingly enough, women are excellent negotiators on the behalf of others. I have discussed this concept with women I have helped with negotiating, and often times, changing their thinking from negotiating on their own behalf to negotiating on the behalf of their family (in other words, a better salary means more money for little Johnny’s college fund or Suzie’s braces) helps mitigate their discomfort.

Tip #5. Try thinking about salary talks in the long term, not the short term. You salary today could dictate your earning potential from here on out. Let’s say you take a job for $100,000 and annually you get a 3-5% cost of living raise (I’ll use 4% for the math). In year 2, you would be earning $104,000. Year 3 would be $108,160, etc. Now let’s say you negotiate a starting salary of $105,000. In year 2 you would be earning $109,200. Year 3 would be $113,563, etc. By year 5, you would be making nearly $6,000 more per year than if you didn’t negotiate at all.

Tip #6. Be prepared for the negotiation. You should craft a list of “wants/needs” and rank them in order of importance. This list is for your eyes only and will help keep you on track during negotiations. This list will likely change over time – I tend to see “Salary” on the top of most young negotiators’ lists and things like “Work-Life Balance” or “Retirement” on the top for more seasoned clinicians. A good starting point for talks may be the following statement: “Thank you for your generous offer…” then discuss some of the job/offer aspects that you liked, then you can state that “the base salary was a little lower than I was expecting, is there any room for negotiations?” And with that, the discussions begin. If they say yes, I recommend giving a range of expected salary and go from there. If they say no, you may ask if other aspect of the benefits package are negotiable such as vacation days, CME money, etc.

Tip #7. Mentally prepare for all outcomes. No matter how good of a negotiator you are, sometimes the employer cannot meet your non-negotiable needs. It is at this point that you will have to reassess your needs or walk away from the position. Thinking about your limits prior to negotiations is paramount. After looking at your finances (rent, loan payments, insurance, car payment), what is the absolute lowest base salary for which you are able to work? Are you passionate about teaching students and this new job has a firm policy against taking students? Ultimately, the job may not be a good fit, which is OK. A polite conversation declining the offer with your reasoning will prevent you from burning bridges for future employment offers.

Tip #8. Be reasonable. Sometimes this is a tough conversation to have with new graduates. They heard about this PA in plastic surgery who makes $300,000 a year (totally possible, but obviously not the norm) and wants to negotiate something similar for him/herself. At the end of the day, salary is important, but it isn’t the only thing when considering a new job. Be sure to take all aspects into account and back up your salary and benefits requests with data – not just a one-off that you heard about through a friend of a friend.

I hope these basic tips will be helpful in your next negotiation. Comments with additional words of advice are always welcome!