Earning What You Are Worth: Guide to Salary Negotiations for Healthcare Professionals

As medical professionals, you have chosen a career that is rooted in the desire to serve others and to advocate for patients. Naturally, that could make the thought of promoting one’s worth in a business-like setting a stressful and uncomfortable experience. But industry reports have shown a clear correlation between those clinicians who are “confident enough” to ask for more money and those who actually get paid more for the work that they do. A 2017 study conducted by the recruitment software company Jobvite reported that employees (of all career types) who negotiate for a higher salary can earn 10-20% more than those who do not.¹ Negotiation clearly works, but the same study showed that only 29% of new hires follow through with it. One mistake that many professionals across all industries make is thinking about salary negotiation as something that only happens during an annual performance review or when evaluating a job change. The most successful negotiators see the process of financial advancement as an ongoing initiative that requires planning and strategy.

The following five-step outline will assist professionals with engaging in these types of negotiations, whether that be for those who are changing jobs or those who are looking to earn more money with their current employer. By preparing appropriately, professionals can minimize the angst commonly associated with these negotiations and increase their chances of financially rewarding outcomes.

Step 1: Know Your Limits (And Your Options)

It’s important to acknowledge that, depending on your role and where you work, your ability to negotiate a higher salary may have a few realistic limitations. Generally, the more rungs you have climbed on your career ladder, the greater the opportunity to influence your salary.

Before walking into a room with your current superiors, consider opening a conversation with the human resources department and take the time to learn how compensation bands work within the organization. Certain organizations, such as government or public-health systems, have specific guidelines for salary levels based on the role or level of experience and/or the certifications an individual holds. In these cases, think through what non-monetary benefits might help close the gap between what you are earning and how much you’d like to earn. Negotiating for a learning-and-development allowance on top of one’s current certification requirements or asking for tuition for ongoing education can increase your marketability and help you earn more in the future. 

Step 2: Know Your TRUE Value 

When asking for more money, it is important to let facts (not emotions) drive the conversation. Understanding what others in your field — as well as others within your company — are earning for similar work is mission critical. If your employer does not have published salary bands, it may be difficult to get a baseline on what other colleagues are earning. Traditionally, organizations discourage their employees from disclosing their salaries with their peers. However, the federal government and several states have laws in place that protect the right to have these conversations. So-called “pay secrecy” policies that prohibit employees from sharing information about salary are increasingly coming under fire.^2-4New York, for example, has legislation in place that prohibits employers from taking action against an employee for discussing or disclosing his or her wages, and the list of states with similar legislation is growing. That said, it is wise to be knowledgeable of whom you ask about salary earnings and how you ask them. Consider approaching only those people you trust and be sure to research any respective state laws that may exist. (For details on pay gaps related to gender, see the sidebar on page 18.)

Understanding one’s value in the marketplace at large is a more straightforward task. Gather industry benchmark data to provide an objective view of salary expectations for your job description and experience level, and set the foundation for a productive conversation with your employer. Most professional organizations publish annual salary survey data that are publicly available (or available to members). If you aren’t already active with the professional associations in your field, get involved. Networking with peers outside of your hospital or health system can provide a safe place to share details about what others at your professional level can expect to earn. Association-sponsored mentoring programs can also be extremely beneficial when planning your next step on the financial career ladder. For the past several years, this author has been involved in a leadership role with the Healthcare Businesswomen’s Association (HBA) in Philadelphia. In 2017, more than 10% of mentees enrolled in the HBA’s Mid-Atlantic Regional Mentoring Program reported receiving a promotion or a job offer as a result of participating in the program. The American Nurses Association and the American Academy of Nurse Practitioners, as examples, both also have strong mentoring programs that match tenured professionals to members with specific career goals. Independent of where you are in your career or how long you have been in your field, having a network of professionals who serve as mentors, sponsors, and confidants will help you to make advancements. 

Step 3: Build Your Business Case

Throughout the year, keep a written log of your professional accomplishments and contributions. It’s most effective if you make a commitment to do this ongoing rather than trying to recall everything several months later. Wherever possible, place a quantitative or monetary value on the impact you have made to any organization(s). If you participated on or led a team that reduced secondary infection rates in your unit, for example, use these realized financial benefits to justify your personal value as well as your value as a team contributor. While it might be convenient to do this at work, keep these records at home where you can control access to them. 

Once you’ve collected objective data, prepare your presentation in advance and determine what you want to earn, what you need to earn, and set limits for when you might need to walk away. 

This might feel awkward at first, but roleplaying and rehearsing the conversation in front of a mirror and/or with a colleague, spouse, or trusted friend can be extremely effective in helping stay in control during real negotiations. 

Step 4: Be Calm, Confident, & Collaborative 

When the time comes to meet with your manager, approach the conversation as a two-sided dialogue where both sides “win.” Focusing on the value that you bring to the organization rather than your personal financial goals will help to keep the conversation productive. Remember that your boss is a person too; try to find a win-win proposition that gets you what you want without leaving the other side feeling like they made a concession or lost a battle.  

Step 5: Get it in Writing

This last step seems obvious, but don’t overlook it. Make certain to get all verbal agreements documented in writing as soon as possible after the conversation takes place while the details are still fresh in everyone’s mind. Having everything in writing clarifies expectations about exactly what was agreed to on both sides and documents when any new terms and conditions will go into effect. While written offers don’t legally hold the same weight as employment contracts, having a documented record of the conversation can be very helpful if your boss leaves the company before the new plan goes into effect or if the person(s) involved in the negotiation were not truly authorized to agree to any new terms or conditions. Whether you are actively seeking a raise or a new job, keep these steps in mind as you plan your strategy to increase your earnings. Being prepared and empowered with objective data and documentation can provide the confidence you need to justify and earn what you are worth. 

Amy Turnquist is president of the Philadelphia chapter of the Healthcare Businesswomen’s Association. 

References 

1. 2017 job seeker nation study. Jobvite. 2017. Accessed online: www.jobvite.com/wp-content/uploads/2017/05/2017_job_seeker_nation_survey.pdf

2. Pay secrecy fact sheet. U.S. Department of Labor Women’s Bureau. 2014. Accessed online: www.dol.gov/wb/media/pay_secrecy.pdf 

3. ‘Pay secrecy’ policies at work: often illegal, and misunderstood. NPR. 2014. Accessed online: www.npr.org/2014/04/13/301989789/pay-secrecy-policies-at-work-often-illegal-and-misunderstood

4. Lutz J. Millennials are slowly killing salary secrecy - and that’s a good thing. Forbes. 2017. Accessed online: www.forbes.com/sites/jessicalutz/2017/11/30/millennials-are-slowly-killing-salary-secrecy-and-thats-a-good-thing

5. Current population survey, annual social and economic (ASEC) supplement: table PINC-05: work experience in 2016 – people 15 years old and over by total money earnings in 2016, age, race, hispanic origin, sex, and disability status. U.S. Census Bureau. 2017. Accessed online: www.census.gov/data/tables/time-series/demo/income-poverty/cps-pinc/pinc-01.html

Diagnosing the Gender Pay Gap in Healthcare

In the wake of the #MeToo movement, increasing attention is being given to efforts to close the pay gap that exists between men and women in the workplace. Nationwide, across all professional sectors, women earned 79.6 cents for every dollar men earned in 2015, according to data from the Census Bureau released in 2017. Meanwhile, data from the United States Department of Labor show a woman earned about 82 cents for every dollar a man earned in 2016. For women of color, the disparity is reported to be more significant: Among women who hold full-time, year-round jobs in the U.S., black women are typically paid 63 cents and Latinas 54 cents for every dollar paid to white, non-Hispanic men.⁵White, non-Hispanic women are paid 79 cents and Asian women 87 cents for every dollar paid to white, non-Hispanic men, although some ethnic subgroups of Asian women fare much worse.⁵

In healthcare, however, the numbers tell a much more varied story, with pockets of progress being made even while disparities in some areas are growing. In nursing, while women still outnumber men 7:1, male nurses earn an average of $6,000 more per year, according to an online study of 4,520 nurses released in 2018 by Nurse.com. (The survey results were controlled to eliminate pay differences due to education level, job description, tenure, and hours worked.) The social media site Doximity surveyed 65,000 physicians for a recent salary report, which estimates that, on average, female physicians earn $105,000 less per year than male physicians. Medscape interviewed 20,000 physicians across 29 specialties for its 2018 Physician Compensation Report. According to the research, male specialty physicians earn about 36% more than female specialists, on average. In primary care, the picture is more positive, with women earning 85 cents for every dollar that men earn. Leaders within the healthcare industry are taking steps to identify and address the root causes of these disparities. The American Academy of Physician Assistants, for example, has launched its Wage PArity initiative that provides negotiation tips and resources for women and their employers in an effort to close the pay gap for physician assistants (PAs). The group’s 2018 Salary Report indicates progress: Female PAs earn 94 cents for every $1that male PAs are paid, which is well above national norms in other professions. 

WHY ARE PAY DISPARITIES PERSISTENT?

We know that women tend to enter the workforce at lower starting salaries and tend to get promoted at lower rates than their male peers, which highlights the importance of empowering new graduates with tools and resources to guide their employment decisions early in their careers. A compounding factor is that men traditionally are more aggressive negotiators when evaluating promotions or compensation offers. In the traditional human resources model, employment offers and salary decisions are often made based on prior salary history. For women, this means pay inequity can be inadvertently propagated from job to job and employer to employer throughout their careers. In an effort to break this cycle of pay discrimination, many states and cities are passing legislation that prohibits employers from asking job candidates to disclose how much they have earned in past positions. As of July 2018, 10 states have passed legislation banning employers from asking job candidates about their prior salary history. These programs are intended to help level the field by focusing salary discussions on the value of the job being performed and the experience that each employee brings to the role. Some states are taking more dramatic steps to close the gender gap. On July 1, 2018, New Jersey enacted what is currently considered to be the most aggressive pay-equity legislation in the country. The new law, which applies to all public and private employers in the state (independent of the size of the company), makes it illegal for employers to pay men and women different salaries for “substantially similar” work and allows for awards of up to six years of back salary for proven cases of discrimination. For more information about active or pending legislation in your area, visit the Department of Labor’s website for your respective state.