As someone who talks to many physicians about burnout and life in medicine, I find myself having a lot of discussions about the circumstances of people’s jobs. Almost inevitably, there comes a point in the conversation where someone expresses dissatisfaction about an aspect of their contract or an additional responsibility that was placed on them.
As physicians, we’re groomed to take care of patients. During training, we don’t talk about compensation, work-life balance, or the business of medicine. In many ways, it’s actually frowned upon to do so, and our hierarchical systems discourage open conversation on these subjects. We also very rarely say ‘no’ during the course of our training, and this tendency stays with us for the remainder of our careers.
Ultimately, these things hurt us. Physician burnout is multifactorial, and so much of its rise can be attributed to institutional and administrative factors and the changing healthcare landscape. We can’t predict the future, but there are certain steps that we can take to protect ourselves:
1. Don’t be afraid to ask uncomfortable questions. Yes, patient care always comes first, and I certainly don’t advocate a ‘me first’ mentality in the job interview process. However, although being a physician is a calling, it is also a job, and money and lifestyle do matter, not only for your own job satisfaction, but for that of your family.
If there are things that are matter to you, such as how many weeks of vacation the partners get, how often you get to eat lunch, or how often you get called in on call, ask these questions. Hopefully, groups are upfront with you with answers, because it’s also in their best interest to recruit someone who will be happy within the framework of their group. If there are certain topics they are avoiding talking about, keep your antenna up and dig deeper.
2. Negotiate. Newsflash: groups expect you to negotiate, and almost always have some wiggle room built into their initial offer. I don’t care how competitive the job market is, if it’s academic or private, or how lucky you feel that they are even talking to you. As long as you do so tactfully, nobody is going to deny you a job for negotiating.
This applies to salary, benefits, days off, protected academic time, restrictive covenants, malpractice tails, you name it. The worst they can say is no. If they’ve made you an offer, they’ve already made a decision that they like you, and you should feel comfortable asking. Before you do so, do your research and try and find out what others in the group have been able to negotiate. That will give you more power at the bargaining table, as well as alert you to things that you may have thought were nonnegotiable. Once you’ve agreed to something, you’ll have a hard time dropping it later, so have the conversations before you sign on the dotted line.
3. Network. The more people you know, the more you’ll hear through the grapevine. Although job boards and MGMA numbers are out there, the best jobs are often the ones that aren’t advertised, and survey numbers don’t do a great job of breaking down salaries by what job requirements are. Posting a job on a board or through a recruiter typically costs money, and groups are understandably more comfortable getting somebody who is a known entity.
Finding a job through a contact gives added security on both sides. Even after you’ve taken a job, it’s a great idea to keep up with your connections. It will allow you to keep a pulse on the rest of the market, hear about what steps groups are taking, and what solutions they’ve come up with to problems you may be having.
4. Have a lawyer experienced in physician contracts review your contract. It’s amazing how many people do not have their contracts reviewed since they trust the people offering them the job. Many of those people regret it later. These lawyers have seen the problems caused by exclusions/inclusions in people’s contracts and will alert you to any red flags. Don’t fall under the, ‘well, this is the standard contract’ trap – group contracts are obviously set up to protect the employer and you should do the same for yourself.
5. Know your deal breakers and don’t be afraid to say “no” or ask for additional compensation. This is the one I want to emphasize the most. Before and after contract negotiations, it is always in your employers best interest to get the most out of you, both financially and in workload. I think about it like this: when you call someone to your house for some work you need to be done, they aren’t shy about billing by the hour or even just to provide a quote. A lawyer isn’t timid about charging an hourly rate just to take a phone call.
Why don’t physicians value their time more? We’ve put in a ton of time in training, and yet so much of what we do is uncompensated. Yes, there are things we do out of personal interest, such as teach residents or sit on professional committees, but there are typically a lot of responsibilities added to our plate that weren’t part of our original contract agreements. I’m not saying to say no to them all – but if there’s something that you know will make you unhappy or be a huge time sink, don’t take it on. At the very least, don’t take it on without asking what you get in return.
If you flip the situation around and you were asking for more from your employer, I’m fairly certain there would be pushback on that end. If there is something that will actively make you unhappy on a regular basis, such as increasing the number of patients you have to see in a day or having to supervise a midlevel provider without any additional compensation, be willing to walk away from an existing job or wait for a better job in the job search.
Of course, it’s important to keep in mind that you’ll ideally be working with your employer/colleagues for a long time, and this is not a confrontation. Good working relationships require some give and take, and there are some battles that are not worth fighting. But please, put some thought into figuring out which ones are, and in those cases, don’t be afraid to do it. Believe in your value and your skillset. If you don’t ask, you can be sure that you won’t get it.