Physician Advocates: Created from a call to action!

You may see me as a physician, but I see myself as an educator.  I have been doing it for over 20 years, lecturing all the country, and I’ve received several teaching awards. In fact, it’s a personal source of pride.  Of course, I am dedicated to patient care and I really love my work.  But teaching is my passion.  If you were to ask me how I approach my interactions with patients, it would be with education as my primary goal.  I consider the pathophysiology and how I can educate my patients to understand the treatment and empower them to take control.  One of the greatest joys of being a teacher is developing long-term relationships.  Over the years I have trained hundreds of residents and medical students, and have enjoyed watching them mature into their careers.

In the last few years, I have noticed a very worrisome trend.  The physicians that I had trained are coming back to me with some troubling complaints.  Many of them were now looking at their 2nd or 3rd job only a few years out of finishing training.  Many of them are completely turned off by medical practice.  Several of them are considering a change in career, or leaving medicine altogether. Many have the syndrome called “burnout”.  I could not understand! I love my career and love taking care of patients.  How could the same doctors who showed the same passion now have such change of heart?

As I dealt into the problems deeper with the physicians I came across a consistent trend.  They all felt betrayed by the contract process.  They realized there are under-compensated, often had poor benefit packages compared to their peers, and were expected to generate more productivity for a lesser bonus.  Before starting their first job they had no education regarding contracts, market value reports, and negotiation techniques. It was all a complete mystery!

Further investigation revealed that they also did poorly in developing their careers.  They did not understand the role of networking or how to work effectively with an organizational structure to achieve their goals. They felt underappreciated and their progress was stymied. The hadad poor conflict management skills-tending to “back down” or “blow up” and rarely saw any problem come to a meaningful resolution.  They complained of always being on the losing end of conflict and group decisions.  The inability to get their ideas heard had led to depression and disappointment in medical practice.

The cause was obvious; we had done a poor job teaching them the professional skills they needed to survive.  We had spent years teaching them about the Krebs cycle, how to manage sepsis, and that insulin makes the sugar go down.  The one thing we never taught them is how to manage their medical careers.  They never learned how to interviewnegotiate, interpret contracts, and to deal with conflict or office politics.  They were unable to make the financial decisions required as well.

I had gained a lot of this knowledge over the years, some of it the hard way by making costly mistakes.  I had taken several courses and seminars and had personal experience in negotiating contracts, teaching conflict management, and the successful use of organization structures to effectively achieve goals.  Starting gradually, I began to teach residents and students medical professional skills.   Over time, the word got out and I became very busy responding to requests.  Not only was I being approached by students and residents but also by attending physicians!  Many of them had over 15 or 20 years of experience but still felt uncomfortable ins some very basic matters.

As my former students fanned out throughout the country, I began to be approached by physicians outside of my immediate institution.  The lack of preparation for the “real world of medicine” was an eye-opener.   Realizing the tremendous need for negotiation and medical professional business skills training, a movement was born to prepare the upcoming generation of physicians.  This was as important as evidence based medicine or any other educational initiative.  The other initiatives were designed to protect patients.  My initiative protected physicians-assisting the next generation of healthcare providers to practice without burnout and truly succeed in their medical careers.

I would continue advocating for patients, like I had done for my entire career. Only now,  I would also start advocating for physicians.




Medical Job Interviewing: How to avoid the biggest mistake made by most physicians.

Interviewing for a new medical job can be a distressing experience.  You may be very excited about the new position, but at the same time job interview anxiety is very common. You may be afraid of saying the wrong thing or making a big mistake and losing the job opportunity. You may also have the fear of not being properly qualified and being seen as an “imposter” or “fraud”. Although, the experience can be nerve wracking, the purpose and process of the actual interview is often very different than you may have been led to believe.

Job Interviews are not oral exams.   As physicians or other healthcare providers, you may believe that a job interview is simply another oral exam or the same as being questioned during bed-side rounding. The events may seem quite alike- you are in a high stress environment, you are being questioned by a physician of greater rank, statue, or experience, and the stakes are high. After 4 years of medical school and several intensive years of post-graduate training, we have all become accustomed to the oral exam style. This is the biggest mistake physicians will make when preparing to interview. Approaching a medical job interview like an oral exam is a certain way to come across poorly.

How does a job interview differ from an oral exam? Based on your previous experience with oral exams you probably have a few false beliefs about medical interviewing.

  1. There is not a standard set of questions. If you were to do a search on interviewing, you’d likely find a series of articles that list the questions you will be asked. This may give you the belief that there is a script and if you have the right answer for each question you will get the equivalent of a passing grade as a job offer. This simply isn’t true. You may see some of the same questions pop up, but most interviewers are going with the “flow” of the interview and don’t have prepared questions.
  2. There are no correct answers. The purpose of the interview is not a test with the goal of providing an acceptable response in the form of correct answers.  The interview is instead a directed conversation and learning experience. The interviewer is trying to understand your skills, expertise, desires, and goals. They are trying to determine whether your skills set and personality will fit within the organizational culture. Standard answers are obvious to the interviewer and will ultimately cause you to come across as not being genuine.
  3. There is a one-way flow of information. In an oral exam, there is one person who asks questions and another who provides answers. The person asking the question purposefully will not provide any information, as to avoid contaminating the test results. A job interview is much different. Most job interviews consist mainly of the employer providing information after asking questions from the applicant. For instance, they make ask the applicant about their experience in teaching. This may then be followed by 5-8 minutes of discussion about the interaction with residents and medical students. There is no “right” answer here. The questions are being asked to determine whether your style and goals are a proper match.
  4. There is one question you will probably be asked that may catch you by surprise. More and more applicants are being asked, “How do you handle conflict?”. This one often seems to come from way out in “left field” and can be difficult to answer. Organizations recognize that corporate culture is vital to success and that disruptive physicians are a financial and legal nightmare. If you’ve never had conflict management training, you should consider looking into a seminar developed for physicians.

What really matters in a Medical Interview? As you can see, the medical interview is very different from your previous experiences. It’s certainly not an oral exam and there are no set questions or answers. So what does matter?

Interviewers are looking for a few straightforward qualities:

  1. Expertise: Can you perform the responsibilities of the role with reliability and with an anticipated consistently high-quality manner?
  2. Brand or “fit”: Does your personality, practice style, and goals match well within the practice? Will you be effective within the corporate culture? Do you have the proper professional and business skills to succeed? Will your personality and conflict style allow you to thrive within the practice framework?
  3. Legitimacy: Legitimacy differs from expertise. Expertise and skills come from within. Legitimacy is bestowed upon you from others or by recognized organizations. You may be able to perform a certain procedure, but having a certificate or being board certified by a regulatory commission gives you legitimacy.

Interviewing for your next medical position may be an uncertain time. Don’t make the mistake of approaching the job interview like an oral exam. There is a vast difference between a job interview and a test of your knowledge.  Emphasize your skill sets, your earned accomplishments, and be approachable and likeable. Interviewing is a skill and with practice and training, you can present your “best” self with ease and confidence.

BONUS: Don’t be caught flat footed! It’s not unusual to start the salary negotiation process during the interview. Innocent sounding questions like, “what’s your current salary?” or “what compensation range are you considering?” could end up costing you $25,000 or more. Have your market value report and negotiation skill set ready before you interview.



Do I really need to negotiate?  

I get asked this all the time.  Won’t I get fired if I ask for more money?  Is it really worth all of the effort?  Will it actually make a real difference in compensation, especially over the long-term?  As a doctor, isn’t it in poor taste for me to talk about money?

Physicians negotiate every day, they just don’t realize it.  You negotiate when you are discussing timing of a test, the starting dose of a medication with a patient, or getting a prior authorization for a procedure or medication..  Here’s the thing, if you do not learn the vital skill of negotiation your career will suffer.  Being underpaid for a single contract is bad enough.  Being under compensated for 30 years really hurts. And it is not just your salary.  Bonus structures, vacation time, CME funds, signing bonuses, and student loan repayment are all open to negotiation.  Most human resource representatives have the authority to offer better package deals.  However, they are specifically do not mention the ability to improve these non-salary related benefits unless it is directly brought up in the contract negotiation.

How much of an improvement in salary can you expect from negotiation? Anecdotally and based upon the economic science that studies negotiation, most initial offers are given at about 20% less than the expected final agreement. In a most physician contract negotiations, this is typically $25,000-$35,000, possibly more based upon your specialty. In my experience, our usual client negotiates an average $25,000 above the initial offer, although many of our clients have negotiated even better deals.

Remember, this is extra compensation that you receive just by asking! You don’t need to see a single extra patient or work an extra hour. This newly negotiated salary serves as the base for all future negotiations. All your raises will be based on this extra amount, with a compounding effect annually. When it’s all taken into it account over a 30-year career and assuming some annual salary increases, the ultimate difference in compensation can be over $5 million, possibly more.

You are expected to negotiate. If you don’t negotiate, you’ll harm your reputation. It will seem as though you are desperate or lack business skills. What would you think of a person who bought a used car from you at your initial well-researched but very high offering price? You’d think they were uninformed at the least. Not only does negotiating help your financial situation, it also will improve your standing and reputation. After all, you’d much rather have the reputation of the shrewd and clever business-savvy physician than the uninformed push-over.

Negotiation skills extend beyond salary negotiation. You’ll want a great deal on a house and a car. You’ll need to renegotiate contracts with your hospital and third-party payers. Eventually, you’ll move up in the organization and negotiate employment contracts for new hires. In your daily practice you’ll need to negotiate with other departments, your colleagues, and staff. Doctors negotiate every day, so it is in your interest to master these skills. Negotiating your physician contract requires more skill than your typical haggling over a vintage lamp at a flea market. We recommend looking at the resources available for physicians or consider our CME approved negotiation and professional business skills for physician seminars. If you can’t attend the larger conference, consider a small group workshop.