All surgical trainees eventually have to take on the challenge of finding the right fit for themselves within the workforce. Our training typically lacks a step-by-step guidance for entering the workforce. The first article of this three-part series on the Art of Negotiation (ACS Surgery News, 2015, p. 13) gave us a 30,000-foot view. Now let’s take a more granular look at the necessary components needed to get a competitive compensation package.
The process can be overwhelming, and so it is vital that you have a graduated approach to accomplishing the necessary tasks. You should begin by gathering the relevant information so that you can be prepared to negotiate and eventually make the most informed decision.
Understanding the base salary
The majority of us will focus on how much direct compensation or base salary we should ask for. While I don’t want to minimize the importance of this one number, it is far from the only thing that needs to be considered, as many variables play a role when deciding whether or not to accept a position.
Dr. Joseph Sakran
There are two resources that should be used to give you a frame of reference. The first is the Association of American Medical Colleges (AAMC) report of medical school faculty salaries, which provides us with academic salary information. The second is data regarding private practice salaries that is from the MGMA physician compensation survey. These resources can be expensive to purchase on your own; however, nearly every institute will have a copy that you should be able to use.
When determining the competitiveness of base salary, one must take the following into consideration: Specialty, Practice Setting, Professional Level, and Geography.
Specialty – A wide range of salary support exists between surgeons based on specialty with neurosurgery at the top of the spectrum and other surgical specialties somewhere below. You will need to look closely at the AAMC and MGMA data to get a good idea of what salary range to expect in your specialty.
Practice Setting/Professional Level – This category is divided into two sections, academic and private practice. These can be further broken down into professional levels: assistant professor and associate/full professor in the academic setting, and starting salaries, 1-2 years in a specialty, and all physicians in the private practice setting.
The differences between salaries for these groups can vary depending upon level of experience and geography. For those that are fresh out of training it is important to notice that salaries early on in one’s career can be similar between the academic and private practice setting yet become widely disparate as surgeons become more seasoned. An example of this can be seen in neurosurgery where if you look at the physician compensation in 2011, the median starting salary for private practice is $400,000. The equivalent academic median salary is $408,000. You might look at this and think it is more beneficial from a purely monetary standpoint to be in an academic job; however, when you look at what happens after 1-2 years in private practice, that median salary jumps significantly to $634,884. Even as an associate professor, which is five or more years out, the median salary is $487,000.
Geography – Location can be important, considering the significant differences in compensation across the country. Imagine the following two opportunities: One is employment in the DMV (D.C., Maryland, Virginia), at an academically affiliated medical center just outside our nation’s capital. The other is in the rural Midwest at a comparable medical center. Taking into consideration the same professional level, which base salary is going to be higher? In the majority of circumstances it will be the rural Midwest, as they attempt to recruit candidates that might not otherwise have an attachment to the area. This can be important during the negotiation process, as it provides you with a bit of insight when it comes to how far you might be able to push the envelope. It also is important to note that in areas that are highly saturated with surgeons, or “attractive” cities that people want to live in, this will ultimately diminish your negotiating ability.
Retirement packages
One other aspect that is not typically included in these resources has to do with retirement packages. These can vary widely and should be looked at carefully. For example, there are some institutes that will put $20,000 toward your retirement while others will contribute $55,000 annually. Everything else being equal, even if the base salary is higher by $25,000 at the institute contributing $20,000 toward retirement, the other offer is still advantageous. While almost everything in a contract is negotiable, the one exception is typically the retirement package. The majority of centers have a standard that is across the board for all faculty. Therefore, focus your time and energy in other areas that can be negotiated.