Simply Worth It: Physician Negotiations with Dr. Linda Street

Most high achievers were raised to believe that hard work will always get rewarded. This belief is untrue and harmful, and the root of the burnout and overworking culture in medicine.

We carry the belief that being tired all the time is the price we pay for success and excellence. We put ourselves under pressure to do it all, and work jobs that weren't even designed with our wellbeing in mind.

Attaching our value to our productivity and overworking has tripled our risk of disease and mortality. For female physicians, making a change is literally a matter of life and death.

How do we challenge the thoughts we have around our value when it comes to productivity? What are some of the problems within our industry caused by the disparity between genders?

In this episode, I talk about the beliefs that drive overworking, why it doesn't serve us, and how to build a healthier relationship with our productivity.

Three Things You'll Learn In This Episode

- The health risks of overworking Long hours for female physicians increase the risk of anxiety and depression, but the risk isn't just to our mental health. Our risk of developing life-threatening diseases like heart disease or cancer triples when we work more than 60 hours a week.

- Why female physicians are prone to overworking For female physicians, it's been deeply ingrained in us that being "helpers" and sacrificing our wellbeing for our productivity and jobs makes us more valuable. This is in part, driven by how we were all raised - to believe that hard work will always get rewarded and that we should always put others before ourselves. This is exacerbated by many jobs designed for the male physician of yesterday that don't allow flexibility that could better serve female physicians of today.

- How the medical industry can solve the physician overworking problemWe need to rethink the job structures in medicine, and make a push for a model that is customizable to the health and needs of different physicians. As we negotiate for positions that serve us, we need to prioritize our wellness, plan time for rest, and ask for work schedules that are more humane. Our goal as physicians is serving our patients, and we can do that better when we honor ourselves first.

A growing number of women have moved into the breadwinner role in their households, but very few are prepared for what it entails. As a result, we struggle to make financial choices that position us for the lives that we want.

The subconscious belief that we would never be main earners impacts some of the most professionally successful women. If we don't understand how critical it is to build wealth, it's hard for our professional success to translate to long-term financial stability.

How do we adopt a breadwinner's mentality in our salary negotiations? What do we need to start investing strategically?

In this episode, I'm joined by financial expert, Chief Education Officer at Acorns and author of Think Like a Breadwinner, Jennifer Barrett. She shares how we can take charge of our financial decisions, and change the trajectory of our lives with one mindset shift.

Three Things You'll Learn In This Episode

- The mindset of a breadwinnerEarning more money doesn't necessarily mean feeling like a breadwinner. For so many women, even high earners, our focus is often on the day-to-day budgeting and handling of money for the household. As a result, we miss out on opportunities to invest and grow wealth.

- Why a high income doesn't always translate to wealthYour paycheck and your ability to build wealth don't necessarily go together. To become wealthy, we have to consciously invest and grow our money. Even if we're earning a lot, if we're not investing it, we're dependent on the next paycheck, and that puts us in a very vulnerable position.

- Jennifer Barrett's tips for maximizing our negotiations When you get a job offer, there is usually room for discussion and negotiation, and a salary range that has wiggle room. When you negotiate, think beyond the salary and consider peripheral benefits like vacations. Don't be afraid to say you're the breadwinner in your household. When men are the breadwinners, it's something they state.

Guest Bio

Jennifer Barrett is a Startup Executive, Financial Expert, Chief Education Officer at Acorns, and author of Think Like a Breadwinner: A Wealth-Building Manifesto for Women Who Want to Earn More (and Worry Less). The book is packed with tools, stories and insights to help expand the way women think about their financial capabilities and the possibilities for their lives, and to recognize and overcome the internal and external barriers that can get in the way of that. It's specifically designed to help women move beyond just covering the bills and saving a little for retirement to truly taking care of themselves and their future.

Jennifer is also the Chief Education Officer at Acorns, a saving and investing app with more than 8.5 million users.

For more information, visit https://www.jenniferbarrett.com.

To pre-order Jennifer's new book, visit: https://800ceoread.com/coupons/redeem/breadwinnnerpresale.

Understanding the other side of a negotiation is important in our ability to present our value, and come to an agreement that serves both parties. But there's one part of a physician contract that does no favors for a physician, and that's non-compete clauses.

A non-compete is nothing more than a greed-based legal clause that at best guilts you to stay in a job, and at the very worst keeps you handcuffed to a toxic work environment even after you've left the position.

Non-competes don't just hurt physicians, they also compromise the communities doctors serve and the patients themselves. The truth is, any conversation on physician wellness and mental health is meaningless if we aren't addressing these restrictive barriers that stop physicians from doing what they do best.

What are the components that make up non-competes, and how do we navigate them to make them less restrictive? How do these clauses create suffering?

In this episode, I talk about non-competes, how to negotiate around them, and why we have to get rid of them at a systemic level.

Three Things You'll Learn In This Episode

The components of non-competes we need to pay attention toWhen it comes to details like what the non-compete pertains to in terms of your specialty or area of focus, and the areas they cover, anything on the vague/broad end will be less favorable. You want these parts of the contract to be as specific as possible because that gives you more options.

How non-competes differ by stateEvery state has specific laws when it comes to non-competes, some enforce them more harshly while others prohibit or try to limit them. It's important to talk to a physician-focused contract lawyer who can give you clarity on the non-compete laws in the state you'll be practicing in.

The goal we need to have when it comes to negotiating around a non-compete There's a wide degree of variation in non-compete clauses and you want to be aware of this before you sign them. The goal is to negotiate the non-compete to be as least restrictive as possible or to even negotiate it away in its entirety.

The law states that male and female physicians should be earning the same, but time and time again, the data has proven that this is not the case. Unfair pay structures and circumstances impact female doctors, and they all add up to an uphill battle for equal pay.

It's not just that female physicians are earning less generally.

The specialties we dominate are paid less. We are funneled away from the higher-paying specialties. There also aren't enough women in leadership advocating for equal pay, and we're conditioned not to rock the boat.

When it comes to getting paid what we're worth, there are biases and barriers that are layered in at every step of the process.

How do leadership structures get in the way of advocacy? What are some of the societal structures we are battling? What can we do to empower ourselves?

In this episode, I'm joined by certified life coach, physician, and founder of Wealthy Mom MD, Bonnie Koo. We discuss some of the key issues that play into the gender pay gap.

Three Things You'll Learn In This Episode

The specialty pay gap There are some fields that are more associated with women than others. Those specialties not only earn less, but the female physicians within those fields earn less than their male counterparts. Not only are women being pushed into certain specialties, but once they enter those fields and become the majority, the pay in those fields also drops considerably.

Why female leaders in medicine are so important Data shows that if there's one woman in a group of men, she often doesn't speak up. If you have a token woman at the leadership table, and she's uncomfortable speaking up, she's not going to feel open to share her thoughts and impact the conversation. If women in leadership have no voice, their presence is more about optics than actual progress.

How the pay gap robs female physicians on two frontsClosing the gender pay gap isn't just about making things equal going forward. An equally devastating issue is making up for the lost potential and lost earnings from not earning what we're worth in the past. The past is even harder to fix and mitigate, and very often women don't have the resources to fight back and correct it.

Guest Bio

Bonnie Koo, MD is a certified life coach, physician, and founder of Wealthy Mom MD. She is a proud graduate of Barnard College and Columbia University's College of Physicians & Surgeons. Her mission is to help women create wealth and rewrite history. Bonnie is the host of the Wealthy Mom MD Podcast and author of Defining Wealth for Women: (n.) Peace, Purpose, and Plenty of Cash! debuting Fall 2021. For more information visit https://wealthymommd.com/ and follow @wealthymommd on Instagram.

In the negotiation process, we have to advocate for ourselves and work towards signing a contract that aligns with our goals and our worth. Every contract is going to be different, but there are key common areas that we, as physicians, often overlook to our own detriment.

There are big areas where there's room for negotiation at best, and at worst, variability that might not benefit us.

It's also key to understand what we're signing, and even though our lawyers may have the knowledge, having a personal understanding of the most important components of our contracts will only improve our negotiation.

Besides compensation, what are the other areas we need to be aware of in the negotiation? In this episode, I share some of the intricacies that go into your contract and how to navigate them.

Three Things You'll Learn In This Episode

One negotiable area we ignore on our contracts There's a fair amount of flexibility in the start date of your contract. Even as a new physician, the start and end dates of your contracts have more wiggle room and you should leverage it wherever possible.

How to make sure your non-compete doesn't work against youNon-competes don't benefit the physician, they benefit the employer. But in many cases, there's simply no avoiding them. If you're signing a non-compete, make sure you understand it and what it entails for you. What's the geographic range, how is the range calculated, does it cover the role you have in the organization or your entire specialty, and is there a pre-defined buyout if another opportunity presents?

Why outside interests are a key area of our contracts we can't overlookOne of the next areas of the contract that physicians overlook is outside interests. Physicians are starting to have more outside activity to supplement their income and contracts aren't usually designed with that in mind. It's important to protect your inventions, intellectual property and profits.

Physician burnout is a huge topic in our industry. It's compromising the health of doctors, driving attrition, and costing billions in lost productivity. A good career in medicine cannot be built with the fear of falling apart, and we need to protect ourselves. Most conversations about burnout are centered on what physicians should be doing to take care of their health, but there's another approach. We can insulate ourselves from burnout in the negotiation process. Getting paid what we worth isn't just about the salary piece, it's also about our health.

Whether we're negotiating a contract for a new job, or renegotiating our contract, there are measures we can put in place to avoid burnout altogether. If we focus on the areas that lead to burnout, we can thrive in our jobs.

How can we deal with the areas that are contributing to the high rates of physician burnout? In this clip, I share how we can align our package negotiations with measures that prevent the health issues physicians are personally facing.

Three Things You'll Learn In This Episode

The biggest causes of burnout The biggest reasons for physician burnout are their environments, schedules, and a lack of autonomy, engagement and lines of communication. If we can include those factors in our negotiations, we can insulate ourselves from burnout.

Why engagement at work combats burnout Engagement at work is associated with feeling valued, secure, supported and respected. That cannot thrive in a high stress cutthroat environment which is what we have created in medicine.

How to use micro-negotiations to improve our current situation Micro-negotiations are the small changes and shifts we can make in between contract renewals. This is where we can discuss measures that can help us mitigate burnout, increase our job engagement, and thrive at work.

Understanding the factors that determine how much we get paid is one of the most important steps in negotiating effectively and getting paid what we're worth.

In 2021, the new Medicare guidelines are set to impact how much some physicians are going to earn, and for many of us, fair market valuations are going to be used to adjust our packages.

Yet, fair market value is a term that's so ambiguous and vague, it's hard to know what it effectively means, and what the outcome will be for our contract negotiations.

What drives hospital systems to put in place fair market valuations? How can we navigate a fair market value if it comes up?

In this episode, I give some detail on the meaning of fair market value and how it can impact you in getting paid what you're worth.

Three Things You'll Learn In This Episode

How we can navigate a fair market valuation

Hospital systems have fair market valuations to protect themselves from hefty fines and possible legal ramifications. They want to make sure they are safe, and as physicians, we end up as cogs in that system. Being involved in the valuation process helps us balance the equation.

The factors that go into calculating fair market value

There are many things involved in determining your fair market valuation. This includes where you are, your skills, the value you offer to the hospital, the demand for what you do, and other roles you serve or abilities you have outside of your clinical skills.

What fair market valuations are meant to prevent

Fair market valuations were created to avoid kickbacks, overutilization of services, and to reduce the risk of the physicians ordering extra things that are not necessary for the patient's care.

Your Best Alternative to a Negotiated Agreement (BATNA) is one of the most powerful ways to strengthen your starting position in a negotiation. It's a lens through which we can clearly and confidently assess every package to make sure we're making the best decision according to what matters to us.

When you have a great alternative to the offer that's in front of you, you negotiate and present your value differently - you make your leverage stronger.

A BATNA allows us to make the most of what we bring to the table, which brings us closer to getting what we're worth and what serves us.

How can you create your BATNA so that you go into negotiation with strength and confidence? What is the risk of going into a negotiation without a BATNA?

In this episode, I share strategies for developing a strong BATNA and why it's a critical piece of a successful negotiation.

Three Things You'll Learn In This Episode

The main purposes of your BATNA Your BATNA protects you from entering into agreements you should reject and saying yes to a job that won't serve you long-term. It also helps you optimize the assets you have so that every agreement you make will satisfy your interests as much as possible.

How to use the BATNA to make a decision on an offer Having your BATNA is going to protect you from accepting terms that don't serve you, but it will also prevent you from rejecting terms that might be in your best interest to accept just because they aren't 100% perfect.

Why your BATNA should be the starting pointSome of us adopt the approach of negotiating first, seeing what happens and then figuring out your BATNA. The problem with this is that we'll go into a negotiation blind, and that uncertainty will make it hard for us to advocate for ourselves. If you've already sought out an alternative and you have another offer on the table, you're going to be more willing to go to bat for yourself.

On January 1st, new Medicare guidelines for physician earnings were introduced, and this is set to impact our contracts in a multitude of ways. Many physicians are going to see either a significant increase in their earnings or a substantial drop.

Because of potential impact on revenue many hospital systems are either unilaterally staying or requiring addendums to stay on the 2020 rvu values for compensation.

Whatever your situation is, don't panic until you have the data. It's important to get into the fine print of your contract to know what your next move should be.

What are the contractual ramifications of these new guidelines and what legal actions can we take as physicians?

In this episode, I'm joined by Health Law Attorney and Healthcare Advisor, Ann Bittinger. She shares how to deal with the new RVU physician schedules and codes, and make sure you're still getting paid what you're worth.

Three Things You'll Learn In This Episode

What the new changes to RVU codes and schedules mean for physicians Without your contract changing in any way, your salary may go up or down based on what RVU codes you bill. This could be really good for some physicians if the 2021 fee schedule is applied to them. If that's the case, you have to be really skeptical about signing an amendment because you could make a whole lot more if you don't change your contract.

How to deal with your employer threatening to withhold payWithholding your salary is definitely in breach of contract and state labor laws. In some cases, breaching a contract also voids your non-compete clause. You have to look at the entire contract and see what kind of leverage you have.

How to gather data to empower you in negotiations Look at the whole of your contract to see what you have that's advantageous. Some of the areas where you can have leverage are whether your physician contract has fair market mandates, what the amendment section says, and possible termination provisions.

Guest Bio

Ann M. Bittinger is Health Law Attorney and an Advisor to Healthcare Executives, Entrepreneurs, and Physicians. Ann specializes in advising healthcare entities in their business transactions. Her particular expertise is in legal relationships between hospital systems and physicians or physician groups, such as co-management agreements, joint ventures, clinical integration arrangements, practice acquisitions, and employment agreements.Ann's clients include all types of entities and individuals in the healthcare industry: health systems, physician groups, physicians, a physician-hospital organization, laboratories, pharmacies, distributors, and other practitioners. Board-certified by The Florida Bar in health law in 2005, she is in particular demand from companies located outside Florida that are expanding their businesses into Florida. She has serviced client companies headquartered in Dallas, Nashville, Boston, New York City, San Francisco, Los Angeles, and London, U.K.

For more information, visit http://www.bittingerlaw.com.

Imposter syndrome is a common problem for female physicians, and a huge barrier to successfully negotiating what we're worth. When we can't see past our own self-doubt, we amp up the difficulty of what we're trying to accomplish.

We have to examine how imposter syndrome is showing up for us, or else we'll sabotage the negotiation and even the entire trajectory of our careers.

What are the most surprising ways imposter syndrome manifests? How can we make sure imposter syndrome doesn't get in our way?

In this episode, I talk about how to examine and deal with imposter syndrome so that it doesn't hold us back at the negotiating table.

Three Things You'll Learn In This Episode

How imposter syndrome makes negotiating so much harder In negotiations, we have to convince the other person of not only your skillset, but also the unique qualities and abilities you bring to the table as an individual. If you feel like you're not enough or that you just got lucky, you'll make this job harder because you have to convince yourself and them at the same time.

Why overachievement can be a sign of imposter syndromeOverachievement can be an unexpected and sneaky sign of imposter syndrome. On the surface, it might seem like a good thing, but if it's driven by not feeling good enough, we'll burn out. If we feel like we have to try harder just to measure up, we're doing ourselves a disservice.

How to interrupt our imposter syndrome One of the most common signs of imposter syndrome is feeling like we've only come this far because of luck. It's important to spend time looking at all our accomplishments, and realize that it's impossible to build a successful medical career on luck. There are so many barriers to becoming an attending physician. The fact that you crossed them is a sign of the value you bring to the table.