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By Joseph Ahn, MD, MS, FACG, AGAF

As you returned from The Liver Meeting®, some of you may have anxiously replayed the interviews you had at the meeting with prospective hepatology programs, wondering how you did and how to negotiate the next steps. This brief guide will highlight the key principles of negotiating an academic hepatology position and prepare you for the next steps in this process. This information is based on my experience in academic negotiations over the last eleven years, feedback from colleagues on their academic job negotiations, and Dr. J. Keith Murnigan’s work on managing successful negotiations (Northwestern University - Kellogg School of Management). Although as a rule, “Good decisions come from experience, and experience comes from bad decisions” – the following guide will hopefully help you make good decisions by learning from others’ experiences.

As we start, we must understand that the goal of academic hepatology contract negotiations is not a zero sum game where the goal is to win or beat the other side. The goal is to obtain a suitable position at an academic institution while maintaining a collegial relationship with your future colleagues and institution. Negotiation is the process of getting there successfully by sharing information and coming to mutually agreeable terms. On the other side of the table will usually be the division chief or section chief and the division administrator. Keep in mind that departmental and institutional rules usually dictate academic contracts and may limit their flexibility in some of the negotiating terms. On your side will be your fellowship mentors who have helped previous fellows through the negotiation process and your friends and colleagues in the field who may have more recent information regarding market conditions through their own negotiation experiences. Don’t be afraid to ask friends and mentors for their input and share with them the necessary information to get an honest assessment of the terms being negotiated. Of course, this is harder if you are negotiating with your own fellowship program, which is why external interviews and negotiations are critical to give you a sense of perspective and information to guide these internal negotiations. In general, involving lawyers is usually unnecessary, and if you feel you need one, it may be a sign that it’s best to move on to another opportunity.

When does the negotiation process begin? Actually, it begins immediately or even prior to establishing contact with the hepatology program. Remember that the hepatology world is relatively small, and it is likely that your candidacy has already been initially assessed through informal communications or references. Final negotiations begin after formal interviews have been completed, but whether by email, phone, or in person, negotiations are constantly ongoing as information and preferences of priorities are being evaluated throughout the entire process.

So how should you negotiate? First, you need to know what the variables are that are being negotiated. Second, you need to know yourself, specifically your preferences and priorities in these variables. Finally, you need to know the other side’s preferences and priorities. The variables being negotiated can, of course, be endless, but come down to several key factors as outlined in the checklist below. This is by no means a comprehensive or exhaustive list, but a beginning point for you to note key variables such as salary, weekly workload, call duties, academic title, support staff, and start date.

Negotiation Checklist

As you review this checklist, think about what is most important for you and be honest about your preferences. Add your unique needs to the above list and prioritize what you are willing to make concessions on and what you cannot. This will also help you to ask for the things that are important to you and signals to the other party what your priorities and preferences are. Most people will not know what is most important to you unless you tell them. It does not hurt to ask for what you need.

As you approach the negotiations, you should obtain as much information as possible on the prospective program and its members. Coming into the meeting with at least a rudimentary understanding of the program’s members and history will help you to be better prepared to understand what is most important to them and what they are looking for. A program that has recently had turnover and is shorthanded will obviously have a different approach than one that is looking to strategically expand from a basis of stability. At the meeting, ask direct questions to obtain information, but also with an ear to understand their priorities and preferences. Search for differences in priority and preferences in the variables between you and the other party. It is in this give and take of sharing honest information that builds trust and sets the foundation for success. If you understand what is important to them, what they need, and their expectations for you as the new hire, you can determine whether you can give what they need to get what you want. You may find that your priority to have a three month delay in starting date for a much-needed vacation dovetails well with their priority to have you start at a reasonable salary. Or you may find that the starting date is an important variable for both parties, at which point you can focus on coming to a mutually acceptable time point.

Knowing the situation, yourself, and your negotiating partner will help you avoid the pitfalls of being overly aggressive or making unwarranted concessions with no return value. A fundamental point here is to strive for a win-win solution with assertiveness balanced with appropriate humility. Remember that this negotiation is possibly the beginning of a long-term relationship; this point will be helpful to provide perspective. If everything works out, you’ll be working with your negotiators and the current discussions will lay the groundwork for future negotiations on issues such as promotions and contract re-negotiations. Even if you don’t take the position, your conduct and handling of the negotiation will contribute to your reputation in the field of hepatology.

Some last notes:

So don’t give up, but do persevere with the long-view in mind. Best wishes and success.

  • Clinical service
    • Number of half-day clinics and endoscopy sessions per week
      • Is the schedule fixed, or on a variable rotation?
    • Number of weeks of inpatient service/call
    • GI/endoscopy call coverage
    • Outreach clinics (often requiring travel)
      • Number per month; coverage of travel costs (transportation, lodging)
    • Clinical nurse, medical assistant support in the:
      • Hepatology
      • Transplant clinic
      • Endoscopy session
    • Academic
      • Title: Instructor or Assistant Professor
      • Protected time (will correlate with clinics/endoscopy sessions per week)
      • Career mentorship
        • Mentor identification and mentorship program availability
      • Teaching responsibilities
        • Medical school
        • Residency program
        • Fellowship program
      • Promotion track
        • Clinical, Educator, Research
          • Ability to switch tracks
        • “Up or out” policy
      • Start-up package and support
        • Research funding
          • Amount, duration of support guaranteed
          • May require budget submission
        • Research nurse, Research coordinator support
        • Statistical, grant writing support
      • Leadership opportunities to grow in the division and department
    • Financial
      • Salary
        • Signing bonus (if any)
        • Incentive, bonus program details
      • Start date
      • Support for further educational/research training:
        • Board examination review course expenses
        • Master’s degree courses- MPH, MS tuition support
        • Leadership training, etc.
      • Relocation costs
      • Institutional loans/mortgage assistance
      • Educational fund-society dues, meeting expenses
      • Confirm benefits package: usually standard
        • Maternity, paternity leave
      • Ability to provide outside consultations: legal, industry, CME, advisory board, etc.
    • Other
      • Office space
        • Accouterments (desk, computer, printer, etc.)
        • Shared office space or private office
      • Secretarial support
    • Legal
      • Malpractice tail coverage: confirm there is no minimum number of years you must work at the institution to guarantee follow-up coverage
      • Presence of non-compete clauses
      • This is the only part where a lawyer may be helpful if there is significant restrictive language and you are concerned or uncertain regarding interpretation
    • It does not hurt to interview broadly. At the very least, it will help you obtain market information on current salary conditions, job conditions, and provide further networking opportunities.
    • Most people will not intuitively know what is most important to you unless you tell them.
    • Don’t jump at the first offer. There is always room for some negotiation.
    • Recruitment resources available at the time of hiring are unlikely to be available afterward -- so don’t be afraid to ask for what you need.
    • Remember that if negotiations are successful, you will work there afterwards. So be mindful of how you come across during negotiations.
    • Recognize that you are unlikely to be the only candidate. Programs need to have backups and multiple candidates for the position.
    • Don’t take it personally if you don’t get everything you want.
    • Remember Simone’s maxim: “The longer, and more detailed the written offer to a new recruit, the more both sides are likely to end up unhappy.” Read Understanding Academic Medical Centers: Simone’s Maxims.