Good morning, everybody, or wherever you are in the world, whatever time zone you're in. My name is Annie Wildermuth, and I'm excited to share Winning the Job Search, Strategies for Securing and Negotiating the Ideal Position. I don't have any conflicts of interest to disclose. I do work for the military and the Department of Defense, and my views do not necessarily represent their views. When you leave this presentation today, I am hoping that you feel empowered to use some strategies to secure an ideal job offer, and then negotiate things about that job, whether it be salary or benefits that would be helpful to you in your life. I want you to be able to understand different parts of a job contract. I know there's a lot of language and words that comes with those, and so I want you to pick out the important pieces of those and feel confident that you know what you're getting yourself into, and also, importantly, that you know how to get yourself out of it when it's time to move on. A little bit about me. I'm an emergency medicine PA, and I have been teaching for about eight years now. Throughout both my clinical roles and my education roles, I've been on both sides of hiring and negotiating. Along the way, I realized we really just don't teach career literacy and career education. It's really important. We are all trained in the amazing skills of actually rendering care for people, but there's so much more to our work that's really important for us to be able to know and comprehend. I started teaching career things many years ago and have helped lots of people throughout contract negotiation and really navigating other complexities of this process. The most I ever helped somebody negotiate up was about $75,000 on their APP contract. While that's an extreme end of the norm, nearly everybody has some degree of success in asking for what they want by using the things that we're going to talk about. I'm excited to dive in with you and hope that you leave empowered in your job search and to have your jobs work for you, and so you can protect yourself and enjoy your life and your career. First things first, I want you to say wherever you are these following three things after me. I am skilled, I am valuable, and I am worthy. It's really important to remember all of these things. So often in the job search process, we can get lost in thinking that we have to be the ones to constantly prove to the employer that we are valuable and worthy, when really this is a two-way street. We need to be sold on the job itself because we have a lot of options. There's tons of clinical jobs available for us and lots of jobs available in general, and so recognizing it's a two-way street and that you are skilled, valuable, and worthy is really important. So what matters about finding a job? There's lots of different things and it's going to vary in terms of what you individually find important to you about a position, but optionally you want to find a job that's compatible with your skill set, a supportive and collegial environment. You want compensation that reflects your responsibility and skill level, that renders you with financial freedom and work-life balance. You want your contract to protect you. When's the last time you thought about your job contract actually protecting you or serving you? And then you want the ability to move on when the time is right. Something that I have learned over the years is that the people that you work with and the workplace culture seem to have the biggest impact on job satisfaction. I'd encourage you to reflect back on a time in your professional journey when you were really happy and think about what made you happy in that role. And I'd be willing to bet that the people you were with or the environment you were in were a big factor in that. So as you start the job search process, I encourage you to do a self-inventory first. You want to know what you need and what you want, which regrettably are two different things at times, but equally important, we need to know what we don't want and then things that are absolutely hard no's. At this point in my life, I do not do night shift. My brain does not work at night. It screws me up for the entire week. I'm not a good person to be around if I have to work night shift. So for me, that's a hard no now where it didn't necessarily used to be. It used to just be kind of an undesirable thing. Please know that there is more than one great job out there. It may not be posted yet. It may not be on your radar yet, but there is more than one great job out there and it may be coming if it's not readily available yet. Also something to keep in mind is that there's more things than the specialty that you work in and money that matter in a job. So I have a list here in the middle of things that you might want to consider. What is the specialty that you're interested in? We're at a neurosurgery conference, so I imagine that neurology is high on the list for many of you, but other things like geographic location, compensation, what's the practice setting like? Are you in the hospital? Are you in the clinic? Are you in the OR? What's the workplace culture? How many hours do you have to work? Do you take call? What kind of formal onboarding or mentoring do you have available to you? And the list goes on and on. This is not an exhaustive list and there's definitely other things that you can consider that are important to you. The more experience that you have in your area, in duration of time, the more things that you can get when you're looking for a new position. So I'd really encourage you to think about this list and add whatever else you want to it and prioritize the top five or so things in order of importance to you. And when you're very early in your career, you can probably get one or two of those things on your list, but the further you go, the more that you're able to get and to negotiate for. I want to talk briefly about why this all seems so daunting. I'm a PA, but I know from teaching basic scientists, nurse practitioners, physicians, that none of these professions teach these skills. So while these are the PA standards I have up on the screen here, the problem is that we just don't teach this when we're going through our training to become whatever our health profession is that we are. It's not required for the PA accreditation guidelines to actually teach this. And what we know from program survey reports is that it's literally not being taught at most places. In order to actually publish results about how we're teaching professional development to PA students, at least five programs would have needed to respond out of the 300 or so that exist to say, yes, we teach it. And that didn't actually happen. Also, the gender gap can make it really hard to kind of comprehend all of this. There's a lot of intersectionalities and layers that make it more difficult to feel empowered with negotiating salary. Again, looking at the PA data, there are more female PAs practicing than male PAs. However, they're paid significantly less. Female PAs were paid 93 cents for every dollar that male PAs were paid starting in the first year of practice. And that gap widened by $201 for every year of work experience. Also, a Glassdoor survey. So Glassdoor is a major company, publicly traded. That is kind of a job search site, career navigation site, and 59% of job seekers did not negotiate salary, but a higher percentage of women chose not to negotiate versus the percentage of men who did not negotiate. And so there's definitely this gender gap both in pay and in negotiation confidence or attempts. Also, looking at a different set of literature. This was a survey of 427 general surgery residents across multiple different residency programs. 74% disagreed or strongly disagreed with the statement that, I believe I have the tools to successfully negotiate an appropriate salary. But it broke down further by gender that women had less favorable views on salary negotiation. Currently about half of women compared to the male respondents felt that they had the tools to negotiate and they were also less likely to pursue other offers to aid in salary negotiation. We're going to talk about how to do that in a little bit. So with all of this in mind, it's completely understandable why this can feel so daunting. But I want to start to debunk some of the common misperceptions around this and then give you a skill set and give you some tools to be able to apply this and do this yourself. So some common misperceptions. Employers don't expect you to negotiate. Well, actually, over half of employers are willing to negotiate salary. And this study, also done by CareerBuilder, also included positions that were entry-level positions. So there was no discrimination whatsoever in terms of the types of positions included in this. So everything from entry-level hourly workers all the way up to phenomenally skilled presidential, vice-presidential jobs. And so we know that you're less likely to be able to negotiate when you're working in those entry-level hourly positions, but for PAs or nurse practitioners, we are in those highly skilled positions and still more than half of employers in this survey were willing to negotiate. That number is actually higher the more skilled that you get. The next myth to debunk. It's common to lose a job offer if you negotiate. It's actually extremely rare. 87% of employers in one study said that they've never rescinded a job offer following negotiations and 0% demoted or fired an employee for asking for a raise. The only cited examples I could find in the literature of people who rescinded a job offer following negotiations were things that were somewhat out of control of the applicant. Like there was a loss of funding for the position. Additionally, it was cited that if you kind of waver back and forth or you never stop negotiating, so you agree to terms and then you try to renegotiate after that, that can make employers a little bit nervous. But as long as you negotiate fairly, which we're going to talk about, employers are not going to take your job offer away from you. Another myth, only salary is negotiable. Actually, everything is. You can potentially negotiate salary, benefits, start date, even your job title, bonuses, stipends. The list is really endless. That doesn't mean you're necessarily going to get everything that you ask for. But I have helped people negotiate all of these things in various capacities and it's definitely doable. You will have a better opportunity to negotiate after accepting the job. This one is definitely not true. You want to hold off on saying yes when you receive your initial offer because it gives you more power to negotiate. It's kind of like playing poker. If you hold up all of your cards for everybody to see, it makes it a lot harder to play the game going forward. You can still do it, but you may not be as successful. And I'm going to show you some ways that you can express enthusiasm for the offer without actually saying yes. And then lastly, verbal offers are sufficient when deciding on a job. I would really encourage you to get things in writing. It is the best way for you to know what you can expect and to make sure you're protected. And it is very difficult to prove verbal employer promises legally. There are ways to do it depending on what state you're in, but it's really challenging. So you want to get everything you can in writing and that actually also takes some pressure off you to be able to have these conversations in writing when you can kind of carefully craft what it is that you want to say. You have more power than you think. The Bureau of Labor Statistics showed that the PA job outlook for the next decade showed a 31% growth for PAs and 38% for NPs. So there's a ton of jobs available for us, which is a great thing that shifts the balance of power into our favor. Once an employer offers you, there's a lot that goes on behind the scenes before an employer is in the position to actually offer the job. They are truly on edge about whether or not you're going to take it. There was one study that reported on common thoughts of hiring managers when they were in the process of trying to hire an employee and three common themes were, I hope we can pay this person enough. I'm nervous this candidate has multiple offers on the table and I really hope this works out. So keep that in the back of your mind. We may be anxiously thinking about, oh my gosh, are they going to offer me the job? What if I try to negotiate? Will they still want me? The employers are thinking the same dance. They really want to get you and make sure that they can give you whatever they can to get you on board. From the employer perspective, arranging the job search is a ton of work and it often takes six or more months to actually get somebody in the door. You have to get a position improved, meaning there's money to fund it, write the job description and get it posted. There needs to be some kind of search committee or formal HR process. Usually it involves one or two rounds of interviews before you can actually make the offer and enter contract negotiation. By the time all of that is wrapped up, it generally takes six months or longer and that's before even somebody can actually start to leave their current job and come in. So really when an employer is posting a job, they're looking at bringing somebody in six to nine months later. This is part of the reason they are so invested in you coming to this job because they are desperate at that nine month point to get somebody in the door. I look at negotiation as a game. It makes it easier to take some of the pressure off and it's a game that's winnable. If you use certain strategies that we're going to talk through, if you use your resources and if you communicate effectively, you can absolutely shift the odds of this game in your favor. Before we launch into the actual negotiation component, we need to talk about what actually makes up a contract because these are all things that you will be able to negotiate. The major bones of your contract fall into these five buckets, compensation, benefits, responsibilities, malpractice, and terms, and the total value of your contract includes all of these components. So let's talk about compensation first. This is the money stuff. There's four main focuses of compensation, which include the method, so how are you getting paid? Are you getting paid salary versus hourly? How much is that going to be? When do they distribute it, meaning are you getting it biweekly, are you getting it monthly, and is there any stipulations around it, meaning are you only getting bonuses if you're in the top 50% of performers, or if you get assigned on bonus, how many years do you have to stay to be able to retain that? So there's all four of those things to actually think about. There's more than one method to be able to get paid. Annual salaries and hourly is probably the most common, but we also definitely see productivity payer, RVU, relative value unit-based pay. There are some jobs that have patient satisfaction-based pay. One of the departments that I was in for a while only paid the top 50% of patient satisfaction performers, a bonus associated to that patient satisfaction, which created a really interesting dynamic in the department. There was competition around patient satisfaction, and I'm actually not sure that was productive, but in any event, lots of different methods for us to get paid. Benefits. This is not an exhaustive list. There are so many different kinds of benefits out there. In general, I kind of lump them into the health, finance, continuing education, time off, and other buckets. But you want to think through your benefits and read through them carefully to understand what it is that you're going to get, especially in a full-time position, and then think about asking for anything that you need that you don't have. For example, really important to be able to do things like this, come to a conference, get continuing medical education hours. You need both time off and money to pay for the conference to be able to do that. Another thing, being a licensed healthcare provider costs a lot of money. You need to pay for your national license, your state license, your DEA license. If all of those things come out of your continuing education budget, for example, you're not going to have any money to actually continue your education. You're just going to be paying for your licenses. So all of these benefits are things to think about and are potentially negotiable, and the importance of them is going to vary depending on where you are in your life and what actually matters to you during that time. I would be remiss if I didn't mention this when we're talking about compensation and benefits. Something to think about is taking the opportunity to contribute to your retirement fund. There are a lot of employers that offer matching for full and even part-time employees. What this means is if you contribute a certain amount of money to your retirement account, they will match a certain percentage of it. So if I contribute 5%, for example, they will just donate 5% of their own money. It's basically free money. Now something to think about with this is the term vesting or what it means to be vested. Employers when they're donating money or matching money to your retirement account, they often will only let you keep a certain percentage of that money that they've donated depending on how long you've worked for the company. For example, my current company, it takes five years to be fully vested. Every year I work up until five years, I get to keep 20% more of the money that my employer has matched. I get to keep all of the money that I've put in, but I only get to keep, I'm currently in year three at my current place. So I'm currently only 60% vested. So if I were to leave, they would take 40% of the money they've contributed away. The reason this is important is if you're thinking about leaving a job, you want to make sure if you're at like the four year and nine month mark, can you hang on for those three more months to get 100% vested because it might make a huge difference in terms of finances when you're leaving that position. Strongly consider a financial planner if you haven't already. Certified financial planners are my go-to. They take a bunch of board exams, like seven of them, in order to render financial advice. So it's not just an internal training to get people designated as a financial professional. And they can offer information not only about retirement and about money, but also about various aspects of planning for life. So I really would encourage you to think about talking to a financial planner about this stuff if you have additional questions. And the last thing I'll leave you with about finances is about the importance of disability insurance. It is the norm for most employers to offer short-term and long-term disability insurance. And this is something that's worth purchasing if they don't offer it. But it's also something you can negotiate to try and get them to pay for. None of us ever know when we're going to get hit by the real bus and whether or not it's going to impact our ability to work. Many of us in this profession need our hands and need our bodies to be able to do our jobs effectively. So thinking about disability insurance is really critical from a financial stability standpoint. And it's definitely something that we can negotiate. Now, responsibilities. This will also be in your contract. So this includes your job duties. What is it you're actually doing at your job and where are you doing it? What hours are you working, including what days of the week, hours of the day, and total hours? Are you on call and how often? Your work locations and then your working relationships and any supervision that you need, depending on what state that it is you're practicing in. You really want this to be well-defined in your contract. Really important for it to be well-defined. I was working at a facility once where it was written into the contracts for APPs. It was a surgical subspecialty, not neurosurgery, a different one. And it was written into their contract that they were to split call 24-hour in-hospital call evenly among all of the APPs on the team. Well, this team started at seven APPs. So they were taking one day of call, 24-hour in-hospital call per week. There was a mass exodus of APPs at that job due to workplace satisfaction challenges and other things. And very abruptly, five people left, all within about a week or two. And so what happened was suddenly those two APPs who were left because of what was written in their contract were now taking 24-hour in-hospital call every other day because their contract read that they were going to split it evenly among the APPs. You can imagine the impact on quality of life if that happens. So thinking through these things carefully and making sure that they're well-written out so that everyone understands the expectations is really important. Malpractice insurance. This should be covered by the employer. The type of insurance and who is covering it should be clearly identified in your contract. There's two primary types, occurrence and claims made, which I'll talk through here in a second. And you want the policy limits to be a minimum of $1 million per event and $3 million aggregate each year. There's a couple of common coverage schemes, although there are more than this. There can be a hospital that protects every practitioner who is working at that hospital. For PAs, you can be a rider on a supervising physician's policy, although we're seeing that less and less frequently. And you can also have a personal policy as an APP. Really important to know the two different kinds of malpractice insurance. So occurrence-based insurance covers events that occur during the active policy period and protects against future lawsuits as long as the incident occurred while the policy was active. Basically, occurrence-based malpractice insurance is the gold standard because it covers you while you have the policy and for any events that are reported later. We know that most lawsuits are reported often years after the event actually occurred. Claims made insurance covers incidents that happen and are reported while the policy is active only. So if there's an incident reported, but you're no longer at that job and that policy is no longer active, then you would not be covered. So if you have claims made insurance, you really need either tail coverage or nose coverage. These are largely the same thing. One is paid for by the current employer before you leave the job and one is paid for by your future employer, protecting you from a job that you just left. Optimally, you want to have this all in place ahead of time for your current job, which is why tail coverage is preferable. So if you see when you're looking at a contract that comes to you via a job offer that it has claims made insurance, you want to make sure that there's also language in there about tail coverage. It's critically, critically important because we know most lawsuits are reported well after the fact. And the employer should be paying for your tail coverage. That is the standard for APPs. And this is also something that I've seen people have a lot of success in negotiating. Terms and termination. This is the length of time, quote unquote, required to work at a job. This is actually outdated in a lot of ways. Every state except for Montana, it has at will employment. And Montana is mostly at will employment. So really, even if your job contract is for a certain length of time, and they're all pretty much written this way for a term, that doesn't mean that you have to stay until that term is over. There may be certain things tied to the term things like bonuses, and that's okay. But a term obligation is really just the time that the contract will need to be renewed or relooked at knowing that you can leave a job at any time. Use that end of term as a great time to renegotiate. Often you can ask for a performance review or an opportunity to review how things are going. When you're entering the renegotiation process, I'm always shocked at how many, especially clinical employers, don't have regular performance review meetings. And that's a great time to be able to ask for more money and more of what you need in terms of schedule and other things as well. Other things to keep an eye out for in this section of your contract are termination with and without cause. For without cause, if you are being let go for no particular reason, let's say that the practice has too much overhead and they're trying to save money, then there needs to be a specified number of days that they have to pay you after they terminate you without cause. And so for some, let's say it's 90 days, if they let you go on a Tuesday and they don't want to employ you anymore, they're still obligated to pay you for whatever that term is for without cause. And then with resigning, this is you deciding to leave. And again, in an at-will state, you do not need to stay until the end of your contract expiration date. But there will be a length of notice, most likely, that you need to give. The shorter the time, the better. There is nothing worse than being ready to move on from a job and saying that, for example, you have to give six months notice before you can leave. That's actually a thing in some contracts, and it is really painful to not be able to make new plans for your life, to be able to move necessarily if you want to move to a different geographic location, because that length of notice is so long. So the shorter the time, the better. I like to tell people to shoot for 90 days or less. And again, this is something you can negotiate. A couple other common terms. Restrictive covenants, aka non-compete clauses. This was something that I was hoping I wasn't going to have to talk to you about anymore, because they were banned temporarily. There was an order that was supposed to go into effect of April this year that was banning these in one of the circuit courts. So now we're back talking about non-compete clauses. But it's really important for you to know whether or not your contract has one. These prohibit with other employers in a given geographic area and or specialty for a defined length of time. So let's say I worked in neurosurgery in rural Iowa, for example. If I had a non-compete clause, it might say that I can't work in another neurosurgery job within 100 miles of my current job. Or I might not be able to work in any specialty within 100 miles of my current job for the next two years. You can see where if you work in a city, or if you work in a really rural area, that this can totally dominate your job availability of being able to find another position without actually moving. And so that's where these non-complete causes can be really challenging and stressful. So you want to keep an eye out for them when you get your initial contract to look at it. And you want to try and negotiate that if it seems overly restricted, or if it's going to make you have to geographically move if you were to leave that position. And then moonlighting clauses that may or may not be allowed in your contract to moonlight or work a second job. Some places require prior approval before you can moonlight. So just having awareness of this is really important if you do think about working another job in addition to your primary job. And then intellectual property. Many of you may have patents or things that you're doing on social media that you want to promote professionally, you might be writing books, anything that is kind of outside of the normal scope of your job, you want to make sure that there's language in your contract that protects you in terms of your intellectual property. All right, let's talk about negotiation. Now that we've talked about the bones of a contract, something I want you to keep in mind is that everything is potentially negotiable. And it's really important to think about that in terms of the total value of your contract, because what's important to you may not be the most money, or it may not be the most time off, it could be some other aspect of that. And so keeping that in the back of your mind can really help you negotiate a contract that works for you. This is a learned skill. Absolutely everybody can excel at negotiation. So keep that in mind. It doesn't matter if you're an introvert or an extrovert, or if you get really nervous having certain conversations, we can all practice this and we can all get better at it. I want to talk through first a common order of events, likely you will be offered a job verbally first, someone will call you let you know the job, this is the salary. And this is a preliminary response timeline. And usually it is followed up by an offer letter of sorts. These offer letters are typically non binding, they usually say that, and they tend to have very minimal information saying what the job is, what the salary is, and that you're entitled to benefits. This is your first opportunity for negotiation, you can request a copy of the benefits at that point. So you can review it. And you also have information about the initial salary and the job title. So this is a great opportunity to negotiate. Usually from that point, you'll sign the offer letter after you negotiate there, and it will be followed up by a formal contract. This is where you get more details about malpractice insurance, the terms of the job, the actual duties, more details about benefits. And it's another opportunity to negotiate anything new that you discover. Once you go through that process, then you sign it if you want to, and you're good to go. Now, this is a common order of events, I would say it applies to probably about 60 to 75% of jobs. There's some jobs that don't use offer letters at all, they go straight to the contract. There's some jobs that don't use contracts, they only have a non-binding offer letter in place. So know that whenever you get information, it represents an opportunity to negotiate. There are lots of great resources out there to help you negotiate. The AAPA has a salary report, nursing journals and the nurse practitioner organizations also publish salary guidance and compensation guidance. Business and career forms can be really helpful. Harvard Business Review and Forbes publish a whole bunch of stuff talking about salary negotiation, expected salaries, job markets. Please talk to your colleagues and your PA and your NP faculty from when you went to school, they're always happy to help you support you in these situations. And then legal help is available and we'll talk through when to actually seek that out. Getting a second opinion when you get a job contract is critically important. It is so easy to kind of get lost in all the boilerplate language around our contracts and also to only see the things we want to see. So we can be really excited to get a job offer, we can see a really great salary number and forget to look at all the rest of us which can actually cause a whole lot of suffering later on. So get someone else who can be objective to read through your contract. I'm going to talk through these five key negotiation principles with you. Don't say yes immediately, gather supporting information, communicate in writing, keep your ass clear and be prepared to walk away. So don't say yes immediately. I told you this earlier, but it's the equivalent of showing your cards in poker. And so once you accept the job, your ability to negotiate successfully goes down. You can still negotiate if you do say yes, but less effectively. One of the ways I see this manifest is when you're applying for a job online, and it asks you to put in what your salary expectations are, set them higher than what it is that you actually need and would hope to get. It's not going to prevent them from reaching out to you as long as it's not egregious and like double the amount that you would expect the position to be paid for. But they're never going to go above that amount that you originally type into that annoying little field box that asks for you to say what your salary needs are. You can absolutely be positive and upbeat without accepting. So thank you for your phone call. I'm pleased to receive the offer. And I'm excited about the possibility of working with you. I look forward to reviewing the original written offer. Say this out loud like 10 times before, like as soon as you finish an interview, you're like, yeah, I feel good. I'm expecting an offer to come practice this. So when you do get the phone call, you don't impulsively say yes. You want to use data to back up your ass. So gather supporting information. Ask yourself, why am I worth more? And you are. But you want to have clear ass around this. Is it your experience? Is it the field of expertise that you're in? And what are competitive wages within that field? Are you multilingual? Have you done fellowships? All of these things are worthy of extra compensation. I would also encourage you to consult the salary reports or compensation guides, looking at your salary or hourly pay, what bonuses are normal based on your state specialty and years of experience. And often within those compensation guideline reports, it also looks at call schedules and benefits and tells you kind of what's the norm in your area for how much PTO people get, how much you get for CME allowance. And also consult your colleagues who work in a similar environment. Salary transparency helps all of us. We have been socialized to not talk about how much money we make. But that actually puts the power in the hands of the employer. This is how you hear about those horrible situations where there's a bunch of people working in the same job at the same place, and they're all getting paid vastly different amounts of money. Salary transparency helps all of us, takes the power away from the employers and helps promote fair pay among everybody. So consider being open with talking about this. Feels weird at first, but it actually ends up being really helpful, especially when you're on the end of needing this information. Negotiating and writing. When you communicate in writing, there's a written record of everything. That paper trail is really important. It also allows you to clearly articulate what you want to say in advance. It can be really stressful when you get these phone calls to get out exactly what it is that you want to say. And so it takes some of the pressure off and gives you an opportunity to really clearly write what your asks are and why you're asking for them. You want to make sure there's no typos. So proofread it, spell check it, read it out loud, put it through Grammarly or whatever software you use. Repeat this process. It's an hour. Make sure you're comfortable with it and then hit the send button. You want to keep your asks clear and concise. One of the biggest shortcomings I see in negotiation emails is that they stretch out forever. They get longer and longer and longer. You want to keep your email short. Say thank you. State that you're going to negotiate. This is really important to let people know that you're kind of entering the negotiation process, especially for women and minoritized individuals. There's lots of literature to show that women in these situations are more likely to be viewed as being abrasive or hostile, or challenging when they're doing the exact same thing as their male counterparts are. Same for minoritized individuals. So by stating that you're entering negotiation, which is a normal accepted thing to do, it takes some of that pressure off. Supporting reason, and then we want a conciliatory confident closure. I'm going to give you examples of all this here in a minute. I would encourage you when you're asking for more money not to use a salary range. If I say, hey, I would thank you for your offer, but I would actually like a salary of $120,000 to $130,000. How often do you think they're going to pick the $130,000? Yeah, never. Employers always want to pay you the least amount of money as possible. So whatever the number is, just pick it and move forward with it and don't give a range. You want to avoid filler words. Keep your tone confident and positive and keep these asks as short as you can. So here's an example for you. Good afternoon, Dr. So-and-so. Pleased to receive the job offer on Friday with a base salary of $150K for 36 hours a week, $1,000 annually for CME and company benefits. I'm excited about joining the institution for the contributions I can make. As I'm in the unique position of being an experienced clinician and bilingual, both truly beneficial to this position, I would like to negotiate several aspects of the contract with you. I would like an annual salary of $165K. The salaries can measure it with the AAPA salary report. I'd like an annual CME budget of $3,500, which will allow me to pay for my DEA license, and it's also part of the salary report. And I want this start date because I already have something planned. We're going to end it with, I'm confident I'm bringing significant value to the organization and look forward to reaching an agreement. I look forward to hearing from you. And this was a successful actual example of contract negotiation. While this individual asked for $15,000 more, they wound up getting $11,000 more. They matched their CME budget request, and they got the start date that they wanted. So short, sweet, to the point. And then lastly, we want to be prepared to walk away. I recognize that there's some privilege within this statement, for sure. Not all of us are in a financial position to actually be able to walk away from every job offer that we get. However, we can still embody the mental attitude and or explicitly state it. And I'll show you an example of this. But what I'd really encourage you to do in thinking about maintaining your value is determine the bare minimum that you need to make your life work, both from a salary, hours and flexibility and benefits standpoint. Because you are not going to feel good if you switch jobs to either make less money or have to work more, or for your life to get more difficult as you move to a new job. So think about the absolute bare minimum that you need. This is the difference between need to have and want to have. And think about negotiation as moving towards that want to have standpoint, and definitely not dropping below what you need to have. So I'm going to give you an example of this real life example. CJ was a PA for two years in cardiac critical care, currently making 122k a year working three 12s a week, including six straight days over the weekend, one time a month. And she wants to leave for an outpatient medicine job that offers better work life balance and more collegial working environment. In order to make her life work, she needs a minimum of $120,000 a year. And she has applied for multiple jobs, including and she has applied for multiple jobs, which gives you negotiating power. So great thing to do. And of these two jobs, the job she really wants is an outpatient job where she'd be working 36 hours a week, where the initial offer is $103,000 a year. That is below what she needs to make her life work. So her initial letter to the employer, thanks for the offer and opportunity. I'm excited to be considered for a position in primary care. I'm passionate about this. In order to accept the position, I need you to reconsider your starting salary. I'm asking for 120k a year. As outlined in my application, I have two years of experience. I'm also a certified athletic trainer. So I can offer preventative care and orthopedic medicine as well. Candidly, I do have another offer competitive with my current salary. However, I really want to work here and hope we can reach an agreement. So what CJ gets back from the hiring manager is, I appreciate your transparency. Unfortunately, I've confirmed that we're unable to meet your salary expectations. We always offer the best salary we can manage without affecting our internal equity. Please let me know if you have any questions regarding the position or if there's anything we can do with the benefits that might help you out. Now, key point here, just because you get one no doesn't mean that's the final answer no. So CJ called me after this and was like, what do I do? So we crafted a response after talking about what she could get from this job that would still make her life work if it wasn't the salary. So she wrote back and said, okay, there's actually is something that you can do that would work for me, which included regular biannual salary increases for the first three years, student loan repayment assistance, short-term disability assistance. And all of that brought the value of her contract up to a level that she was comfortable with. So the manager writes back and said, wow, I really appreciate your careful consideration of the offer and benefits and for you advocating for yourself. But unfortunately, we're not able to negotiate it at all or the offer must stand as is. Please let me know if you still want to meet about this. So CJ decided to decline the job because it didn't meet her needs. And she had another offer on the table that did meet her needs. So she wrote back and said, I'm declining the job. I can't accept that salary. The very next day they called her back giving her exactly what she asked for. It's pretty powerful, right? It works when you have either the mental attitude or the explicit ability to actually say, nope, I'm walking away. Because remember, the employer has spent six to nine months trying to get you and your very talented self in the door, right? So they're really invested in you. So some keys to communication throughout all of this. You want to stay positive and confident. Keep your ass clear and streamlined. Be timely in your communication and demonstrate your interest in serving the employer in the position well. You want to avoid being negative or rude. Don't go back on something that you already agreed to. This is really important. You don't want to respond late. One of the red flags for employers is if they reach out to you with a job offer, if you don't respond for four or five days, sure doesn't seem like you're interested. And that can make it a lot harder to negotiate. And then anything that would make your character or suitability or work ethic be questioned. So as long as you're prompt, positive, confident, clear, you don't need to worry about that. Employers care about these things when they're negotiating with you. They want you to know that there is no such unalterable things such as the standard contract. Any contract can potentially be altered. The contract should say what both parties mean. The contract should mean exactly what it says. You don't get a do over once you sign it and you both agree to it. So definitely make sure that you're asking clearly for what you need and not waffling back and forth on that. And it should also define a satisfactory exit process. So these are the very same things that we are often thinking about when we're going into contract negotiation. And it's worth remembering that the employer is thinking about the exact same thing. So I want to address some commonly asked questions as we wrap up. The first is, how much more money should I ask for? So my recommendation would be at a minimum, you start at the 50th percentile in the appropriate category for specialty, state, and years of experience in the AAPA salary report or the AANP compensation report. If the salary you're offered is unreasonably low, like offensively low, for example, they want to pay you 75k a year for full-time work, it is very reasonable to ask for a lot more money. So consider asking for 20k to 40k more, for example. You can even get close to doubling what it is that they offered you. But if the salary is low, but not offensive, consider asking for 10 to $15,000 more. Within that range, I've never seen a job taken away from somebody when they've tried to negotiate kind of within that amount. If you need or want a specific amount in order to accept the job, ask for it. But be prepared to walk away if they're unable to meet exactly what it is that you need. And again, I highlighted this before, but if you have another better offer on the table, use it to negotiate. I always encourage people to apply for more than one job. Even if it's a job that you're not sure you necessarily want, it's okay. Apply for it, you can think through it. You may actually find that the job is more desirable than you think you are, but it will also help you negotiate your current job. I want to tell a quick story about how educating the employer is actually effective. And this is something that you may need to do if you encounter offers that are incredibly low, or if you get pushback on negotiating. So I was a faculty member at a PA program at a large academic medical center. And I taught contract negotiation to my students. And many of them went to enter the same health network where our program was. And they found that their negotiation was met with a lot of pushback. And all of a sudden, the dean at my school one day gets a phone call saying, Hey, your PA faculty member is causing us a whole bunch of problems over at the hospital. She's telling all of these students crazy things to ask for after they interview. So the dean calls me and is like, what are you doing? What are you teaching? And so what I told them was, well, I'm teaching them how to negotiate using the APA salary report and showing them how to ask for what it is that they need. And the dean was like, that's great. And everything you call this. So I called the hiring manager over at the hospital. And we have a conversation. And it turns out that my students were doing exactly what I had told them to do. And the hiring manager had never heard of the AAPA salary report. This was the hiring manager for every APP, not just PAs in the entire program or in the entire network. And in that conversation, she discovered that she was grossly underpaid herself. And so what actually wound up manifesting was she initiated a change system wide for salary review for all of the APPs and change the entry level salary for all of the incoming APPs as well. And so what started out as a story of kind of a whole system freaking out, thinking that the new grads were breaking the mold and were asking for ridiculous things led to reform for everybody, where everybody was getting paid more appropriately based on national salary trends. So by bringing up the fact that you're using these resources to advocate for yourselves, you're helping out not only yourself, but others in the system as well. What if you have multiple offers coming? It is absolutely fine to ask for more time to review your current offer. Seven to 10 days is customary. If you respond towards the end of that time, it may buy you a little bit more time. If you happen to be a student or early in your training, you can ask to respond closer to graduation to focus on your studies, completely reasonable. Same with if you have a board exam coming up or things like that. If compensation is equal, think hard about which job you'd rather take and then put your egg primarily in that basket when you're thinking about having to prioritize offers coming in. And again, use those extra offers to help you negotiate. Do you need legal counsel? So I encouraged you earlier to get a second set of eyes in your contract. Having your family, colleagues, or faculty review your contract is definitely not a substitute for a lawyer, as helpful as it may be. So reasons to seek legal counsel are if you feel more comfortable doing that, if there's a clause in your contract that makes you uncomfortable, especially if they won't negotiate it, or if you have considerable intellectual property. And the timeline to do this is after you receive your contract and before or during negotiation. So I want to give you an example of this and talk a little bit about what it's like to actually counsel legal help. So LA is an experienced NP of 10 years who has offered a full-time job with an annual salary of $170,000 in critical care for three 12s a week benefits and a big signing bonus. In addition to his patient care experience, he has a strong track record of scholarly activity. He teaches, publishes, edits, writes, has a big social media presence, and he wants to continue and expand on that in the future because he gets paid money for it. When he got his contract, he noticed an intellectual property clause that he found concerning, which essentially said that the provider agrees that any inventions, ideas, concepts, or other works created by the provider during the term of this agreement are works for hire and belong to the employer. Well, this was really concerning because the type of work he was doing in his own free time had absolutely nothing to do with taking care of patients in the hospital, and so he didn't think his educational work should be the property of the hospital. So what happened next? Because the employer would not negotiate. He went to a lawyer, and this was really helpful in terms of being able to talk through what things could look like in the contract. So if you want to obtain legal counsel, some things to look for. You want an employer or employment contract attorney who's licensed in your state and ideally knowledgeable about healthcare. It tends to not be wildly expensive in the grand scope of things. Usually, an initial review, an initial overview of the contract that you have in writing a letter will be somewhere along the lines of $750 to $1,000, which when you think about your intellectual property, you could be at risk of losing a whole lot more than that. So L.A. paid $750 for initial contract for review, counsel, and redraft of the language, which he sent to the hospital. The employer did not accept the revised language, but they wound up drafting an additional addendum that further protected his intellectual property. He paid another $500 for the employment lawyer to review that again, and the lawyer redrafted some edits to that. The hospital didn't wind up accepting those edits, but L.A. ultimately decided to take the job knowing there was some potential for risk, but that it was way less than where they started. And in his words, the money was absolutely worth the clarification, peace of mind, and additional protection. So I just want you to know that talking to a lawyer doesn't have to be overly expensive, overly time-consuming, or overly stressful. We can kind of think about that when we think about lawyers, but it can be really helpful. Two more things. What if there's no formal contract? Some employers use an offer letter only, which may be okay. Offer letters tend to be non-binding, and they very frequently have very few terms and terminations, so it can be easier to depart, less likely to have restrictive clauses. The negatives, though, is that there are many verbally discussed details that aren't in writing, and your job duties might not be as clearly defined. So you want to make sure your offer letter has at least a written and signed document that outlines the basic responsibilities, job title, salary benefits, CME allowance, PTO, and malpractice insurance. And do I need to worry about offending my future employer during negotiation? As long as you're reasonable about this, and as long as you continue to move forward once you agree to something in your collegial, you do not need to worry about offending your employer. They expect you to negotiate. That's part of the game. They're always going to offer you the least amount of money possible because that's the first move in that chess game, and they expect you to respond, so don't leave money on the table. If they won't negotiate, and sometimes they won't, sometimes they won't negotiate salary, you can still try and negotiate other aspects of a job. But please keep in mind, what's the minimum for you need your life to work? How are you going to feel about your perceived worth and value if you accept it as it? And what is the likelihood that there's more jobs available in the time frame that I need one? Remember, there might be a job just right around the corner, that would be a better fit for you. And so sometimes being able to walk away, or having that mindset can be really helpful if your employer won't negotiate, and it's not going to work for you. I want to leave you with this, and then I have a minute or two to answer questions. My why for talking about this is your why. I want people to be satisfied in healthcare and satisfied with their work. Someone that I worked with for a former student that I had that I worked with for years, shared this with me recently after going through contract negotiation. She said, Annie, my boss scheduled a meeting with the contract manager, and they let me know I got a $4,000 raise before I even started, because they did their annual salary review. And so I came in at a higher salary. They also told me I didn't need to take short term disability to navigate an emergent medical treatment and that they'd work with me and that they'd give me a year to make up any mis-shifts. My boss shifted my 7-on-7-off schedule so I could have a day for these appointments. She said she's not going to nickel and dime my hours, so just let her know what I need. And I can't stress enough how much I love this place. It's the biggest blessing not to have to schedule my life around work right now. And so as you're going through this process of contract negotiation, find a place that will support you like this. Think about the people, think about the culture, and think about the minimum that you need for your life to work, because you are the commodity here, and the healthcare system won't work without you. So with that, I will wrap up and know that you are worth, value, and power, and I wish you luck in this process. Please reach out to me and tell me about how your next negotiation goes. If you have any questions, I've got about three minutes to answer them, but also I'm happy for you to reach out to me individually, and I'll do my best to get you the resources that you need. Thank you so much.

job negotiation

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