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News & Press: eConnections

How to Negotiate - Practicing Surgeon

Wednesday, March 15, 2017  
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Sharon L. Stein, MD, FACS, FASCRS

When I was finishing fellowship, I accepted a job at my home institution. Although the basics of the job were worked out, we didn’t talk salary until late in the year. At that point, I was already committed to staying where I was. The conversation went something like this:

Boss: Sharon, we are very excited that you will be joining us. We would like to offer you a starting salary of $180,000.

Me: Gosh, Dr. Boss-man, that is quite a bit lower than I was expecting.

Boss: What were you expecting?

Me: Something in the nature of $225,000.

Boss: That is quite high.

Me: I have spoken to several colleagues, who have accepted positions with similar training at other institutions, and that seems to be a
reasonable salary.

Boss: What institutions?

Me: Prestigious University #1 (in my own city) Prestigious University #2 (in another city)

Boss: Well, those are world class institutions.

Me: Dr. Boss, I thought that I was negotiating with a world class institution.

Boss: Ok, $225,000.

Most of us don’t like negotiating. We feel like we should be offered the salary we deserve without having to negotiate. After all, we are good people, we work hard and we should be rewarded. The reality is that only 37% of people always negotiate their salary, and 18% never do.

Those numbers are even worse among women – 46% of men, but only 30% of women alwaysnegotiate. It is important to remember that the hospital, department, partnership (whomever you are negotiating with) has to make money to stay afloat. They are in business. And they make more money by paying you less. But that doesn’t mean that you have to accept it.

What difference does a few dollars make? By negotiating, the average earner’s starting salary is 7% more than someone who doesn’t negotiate. It isn’t just that 7% once – the salary of your next job has a lot to do with your prior salary. Over the course of a professional career, that may add up to over $500,000 (which is enough to pay for most medical school expenses).

There are keys to negotiating. Here are a few of my favorites:

  1. Ask: If you don’t ask the answer is always no. Just start by asking.
  2. Keep your cool. Getting excited, emotional, angry just won’t help. And don’t take it personally.
  3. Do your homework. It helps to be prepared when you are trying to keep your cool. The more you know about what other people are making, the more you will feel comfortable asking for what you deserve.
  4. Use numbers. I purposely left the numbers in the scenario above. If we don’t talk about how much we make, how will we know what we should be making? If you are comfortable asking your colleagues about their salary, we can be better informed and ensure that we are appropriately compensated.
  5. Make your priority list. Know what your bottom line is – how much are you willing to accept? What is too little? What is worth walking away from?
  6. There is more to negotiate than money. At the time that I negotiated my first job, I was also negotiating support for a master’s degree – time off to work for Medecins sans Frontiers. Perhaps you need a nurse practitioner, or new equipment. The money may matter less than some of the other negotiables that you can request.
  7. A little flattery doesn’t hurt. One of the keys to successful negotiation is making the other party feel good. If you can get what you want, and they leave happy as well – that’s a win–win.
  8. Practice – have friends or family walk you through mock negotiations to help prepare for the meeting. The more questions they ask, the better prepared you will be.

My mother used to tell me, “If you don’t ask, the answer is always no.” Learning negotiation skills can go a long way toward making you more. More comfortable, more prepared, and more money. Here are some recommendations of interesting reading on negotiations.

How to Negotiate Salary: 37 Tips You Need to Know | The Daily Muse Editor

Most People Don’t Negotiate Due to Fear & Lack of Skills |

Negotiating in Academic Medicine: A Necessary Career Skill | Journal of Women’s Health

Nine Words And Phrases To Avoid When You’re Negotiating A Salary | Amy Elisa Jackson, Glassdoor


Sharon L. Stein is an Associate Professor of Surgery at the University Hospitals/Cleveland Medical Center and Secretary of the Association of Women Surgeons. By no means is she an expert at negotiation, but is trying to learn to do better. Tips and tricks warmly received. @slsteinmd1