Know Your Worth: Negotiating a Job Offer

Don S. Dizon, MD


December 10, 2019

When I received my first job offer to be an attending oncologist, it was for a dream job: I was asked to join the faculty at Memorial Sloan Kettering Cancer Center. I greatly admired the department chair, Dr George Bosl; and my boss, Dr David Spriggs, would become my mentor (and he still is, in many ways).

I was so excited that I was ready to sign the first contract that came across my desk—I wanted it that badly. Fortunately I had some really great friends who pulled me aside and proverbially slapped my idealistic face.

"Look, this will be your first real job. Make sure you read the offer letter," one said.

Then I panicked. What if they rescinded the offer?

I couldn't imagine that the letter would be unfair. And besides, it would be my first real paycheck as an oncologist. I figured I didn't need much; my partner had a great job and we didn't have kids. We were used to living on a shoestring, and with a fellow's salary we even had a little extra that allowed a splurge every now and then, perhaps eating out at one of New York City's five-star restaurants.

"I'm sure it'll be fine. I've no reason to doubt that," I replied.

That's when I was told something that has remained with me all these years later. "Institutions aren't people," my friend said. "It's not about them offering you what they think is fair. It's about making sure your definition of the work—the scope, responsibilities, and commitments—align with what you are worth. Not what you think you're worth, but what you are worth."

These friends then took me through the contract process, explaining aspects of negotiation that were never covered in medical school, residency, or fellowship. I had learned how to interview, how to prepare a curriculum vitae, even how to deliver an academic talk. But the nitty gritty of negotiation? No one taught me that.

"Make sure you understand how promotion works. Make sure you understand what rank you're going to be hired at and the timelines for advancement," one said.

"Ask about mentoring," another said.

"Ask for a private office, a new laptop for work, and for a nurse or advanced practice provider that will help your practice," another suggested.

"Get specifics about clinics and inpatient care. How often will you be in clinic? How much time will you spend as an inpatient attending?" another asked.

"Ask about teaching responsibilities and about opportunities at the medical school."

"Ask for moving costs."

My head was spinning—it seemed weird to get so specific. I mean, it was an offer to join the faculty of a prestigious medical center. Wouldn't all of this come later?

Ultimately, I took their advice. With help, I reviewed the offer, made edits, and submitted a list of amendments to the administration that I felt I deserved in my contract.

Then I panicked. What if they rescinded the offer? What if they think less of me for "demanding" anything at all? Maybe I should just be grateful, go upstairs, and take back my requests while apologizing vociferously.

To my surprise, I received a very thoughtful response. Some of my requests were granted and placed in my revised offer letter. Others were not, but instead of the hand of God coming down to strike me, we had a conversation in which I was listened to and assurances were provided by the institution.

I ended up staying at Memorial Sloan Kettering Cancer Center for 3 years as an attending before I felt the itch to explore a new opportunity. By then my partner and I had a daughter and we wanted to move back to Massachusetts. I explored multiple opportunities in academia, private practice, and industry. I narrowed it to two positions.

I am forever in debt to those colleagues who looked out for me when I was starting.

This time around, I was not naive. One offer had me coming in as an instructor, splitting time between an academic center and a community hospital, as well as taking a pay cut. The other had me coming in as an assistant professor embedded in a women's cancers program. The salary would be higher than what I was currently making. Still, there was more prestige with the institution that would pay less. I let both know that I was entertaining two offers and began negotiating a job that I could take.

I sent my list of "asks" to both institutions. The responses were quite different. One pretty much said no to everything I requested. "It is the standard agreement offered to all new faculty. No exceptions," they replied. The other institution worked with me and then revised the offer, addressing much of what I had requested—which is not to say that they said yes to everything.

With that, I joined the women's oncology program at Women & Infants Hospital in Providence, Rhode Island. This process has since repeated twice, the last of which brought me to Lifespan Cancer Institute, where I am so happy to have landed.

I am forever in debt to those colleagues who looked out for me when I was first starting. The persuasive power of being asked to join an incredible institution can be hypnotic, so much so that one might see it as the chance of a lifetime. That these colleagues helped me to refocus on the present was a lifesaver, which I have since paid forward.

I've made it clear that my door is open to anyone who wants to talk about their future, their prospects, or a specific job offer, whether it be in private practice or an academic dream job.

We all have expectations for our work life and we should be empowered to express them. We are in an era of widespread, even epidemic, physician burnout; perhaps we should all ensure that our trainees and colleagues recognize their power to negotiate as early as possible.

What have your experiences been like when negotiating professional contracts? What advice would you give to younger colleagues just starting out in their careers? Please let us know in the comments section of this article.

Don S. Dizon, MD, is an oncologist who specializes in women's cancers. He is the director of women's cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital.

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