Contract negotiations can be stressful. Understanding the value you bring and focusing on your priorities can help you achieve a fair, equitable contract without negatively impacting your work relationships, according to Amy Oxentenko, MD, professor of medicine and vice dean of practice at Mayo Clinic, who spoke on the topic at Digestive Disease Week® (DDW) 2023.

DDW News spoke with Dr. Oxentenko about what clinicians should consider when negotiating their contract.

DDW: How can clinicians know whether the terms of their contract are fair?

Oxentenko: Engaging a contract lawyer is essential to ensure you understand what you are agreeing to and to help negotiate things that may seem too narrow or inappropriate. You may also consider speaking with a local financial advisor who may be able to give you insights into salaries and benefits as well as any tax implications in the state or region. Finally, there are a lot of online resources, such as the Medical Group Management Association and the Association of American Medical Colleges data tables.

DDW: What parts of a contract are typically up for negotiation?

Oxentenko: So many people focus on salary, but it is crucial to examine the entire scope of benefits and other items. Those can make or break your work life.

We often like to think that everything is negotiable, but this may differ based on the setting. There is likely a handful of benefits that come out of human resources that are templated for all and may be less negotiable (e.g., vacation days, health plan, leave policies, pension, disability or malpractice coverage). There are other things that may or may not be negotiable, such as non-compete clauses or details on exclusive services, but the terms of those issues are critical.

Some things to consider that are negotiable include:

• Salary (including details on whether it is fixed, relative value unit (RVU)-based or if you will have a chance to buy in)
• Bonuses (and details on payback if you terminate early)
• Relocation expenses
• Roles and titles
• Work location (onsite, remote and number of clinics)
• Schedule and scheduling flexibility
• Career development and/or leadership training
• Coaching resources
• Space and support staff needs
• Research or clinical equipment
• Funding for research or projects

DDW: Are there any risks to negotiating?

Oxentenko: People may be afraid that negotiating can come across as greedy or aggressive or that it could affect their relationship with their future boss. Those are not unreasonable concerns. If you are asking for something that far exceeds the realm of possibility, you may be off-putting. This is where preparedness is important to help you identify what is fair, reasonable and most important to you. Controlling emotion and ensuring positive emotion can both go a long way to building trust.

The biggest risk, however, is not asking for what you need or want. If you don’t ask for something important to you, it is unlikely to be simply offered. This may lead to feeling undervalued if the offer is accepted and you did not bring something up. Being prepared in advance of that discussion is key. Putting all negotiables on the table from the start is important.

DDW: Do you have any advice for clinicians initiating negotiation discussions?

Oxentenko: Data is powerful. Know your metrics—whether they include RVUs, practice targets, research output, quality metrics or patient satisfaction—to highlight your accomplishments and value. Also, obtain metrics from inside or outside your practice for people doing work similar to yours to provide a basis for comparison. You also need to have a “why” for your ask. Is more being asked of you or are you bringing something novel to the practice? Show your value so they can see why it will be important for your retention.

Dr. Oxentenko presented “Negotiating and renegotiating your contract” on Tuesday, May 9, at 8 a.m. CDT as part of the session “ASGE Achieving Success: Lessons from Women in Endoscopy – Sponsored by Women In Endoscopy SIG.”