5 Salary Negotiation Secrets for ER Doctors

Successfully negotiating an emergency medicine physician employment contract rests mainly on two factors: knowing your priorities and being prepared.

Before you even begin negotiating your salary for an emergency medicine position, take the time to determine what’s most important to you. For example, you might prioritize:

• Money: Your ideal salary, plus bonuses and benefits
• Geography: Commute time and location of employer
• Work-life balance: Your work schedule and paid time off
• Environment: An emergency department with strong leadership and good relationships among doctors, other providers, and staff
• Professional opportunities: Continuing education, mentorship, career advancement

Make note of your non-negotiables—get specific—as well as your nice-to-haves.

ER Doctor Salary Negotiation: Be Prepared

Now that you’ve determined your priorities, you must know what to look for and what to ask about in an emergency medicine physician contract.

There are four key elements to negotiating a new employment contract: compensation, scheduling, benefits, and terms and termination provisions. Here’s a rundown of each.

Compensation

Pay is the big one. First, it’s important to understand that ER doctors are hired as either employees or independent contractors.

• W-2 employee: You’ll be employed by the hospital and receive a regular salary, with taxes withheld by your employer. Being an employee usually includes benefits such as health insurance, paid time off, and retirement plans—and it comes with a level of job security because you’ll be protected by employment laws.
• 1099 contractor: You’ll work as a contractor for the hospital and typically get paid on an hourly basis. You’ll be responsible for paying your own income, Social Security, and Medicare taxes, and you won’t receive benefits. Because of these additional expenses, you should expect higher compensation as a 1099 contractor than as a W-2 employee. Additionally, you can deduct business-related expenses on your tax return.

Next, research the market rate for emergency medicine doctors in your area using a site like Health eCareers. This will help you determine if your compensation is comparable to that of other ER physicians with the same skill set in the same region.

Other factors to consider:

• Length of the guaranteed salary: If you’re a physician coming straight from your emergency medicine residency, this may be only one year. Other scenarios may allow three to five years of guaranteed pay without an adjustment.
• Incentive compensation: If this is an option on the table in addition to a base salary, make sure the contract spells out exactly how they calculate incentive payments and how you would qualify.
• Staffing strategies: In general, emergency departments have low profit margins for hospitals. Many cut costs by hiring midlevel practitioners to do the work of physicians. If you feel your compensation offer is too low, ask for more—but know what’s reasonable. This is where having third-party data is crucial.

Scheduling

Make sure your schedule expectations align with the employer’s requirements. While many employers like to leave scheduling provisions loose so emergency medicine physicians can meet the needs of the practice, it’s vital that the following logistics be stipulated in your contract:

• Any specific promises: For example, if you’re only working one Sunday morning a month, make sure it’s in writing.
• Part-time hours: If you’ll be paid on a salary basis and working part-time, double-check that the total number of monthly hours is listed in your contract.
• Workload: Your call and coverage obligations should be in alignment with other emergency medicine physicians. Now is also a good time to figure out compensation for taking an additional call.

Benefits

Many employers provide at least some of the following for their W-2 ER doctors:

• Health insurance for you and possibly your family
• License fees
• Malpractice insurance
• Stipend for continuing medical education
• Medical staff dues
• Three to four weeks of paid time off

Many employers combine sick leave, personal days, and vacation time into one lump “paid time off” sum.  If that’s not the case, be sure the amount of time off for each category is clearly specified.

Additional benefits offered may include:

• A retirement plan with company matching, meaning the hospital donates a percentage on top of your contribution, often 1 to 5 percent
• A moving expense allowance if you’re relocating, which may cover the cost of movers, travel expenses, short-term housing, and more
• Educational loan forgiveness

Terms and Termination Provisions

You want to be sure these two provisions are spelled out.

• Termination without cause: Many employers incorporate a provision allowing either you or your employer to terminate your employment without cause, typically with written notice 30 to 90 days prior to termination.
• Termination for cause: Almost all agreements permit the employer to terminate for cause.

Additionally, check if there are any restrictive covenants, such as geographic or hospital non-compete clauses that restrict your ability to work for a competitor for a certain period of time after leaving the hospital. You want them to be reasonable and realistic. Is it a year wait to work for a competing hospital, or is it ten years?

Salary Negotiation for ER Doctors: Additional Tips

• Say what you want: Don’t be afraid to communicate what you desire during the interview process. Ask questions to show interest and to build a relationship, such as telling the recruiter you’re looking for the best long-term fit for you and your family.
• Be open, honest, and trustworthy during the process: Keep negotiations positive and truthful at all times. Don’t feel like you have to play your cards so “close to the vest” that you can’t be yourself.
• Show your value: Perhaps bringing you on board might increase the patient base. If so, would your pay increase?
• Time it right: Once the offer letter arrives, you’ll want to start discussing terms right away. That way when the contract follows, you’ll be able to double-check that everything discussed is in writing.
• When an offer comes in for one facility, keep things in motion with all potential employers: If you receive a job offer from one employer while in the midst of negotiating with another, it’s perfectly acceptable to let the second employer know one has been extended. Explain that you’re still excited about their opportunity and let them know your decision timeline. It may line up with theirs and you might just nudge a second offer into place.

Signing the ER Physician Contract: Still Unsure?

Before you sign on the dotted line, hire a healthcare transactional attorney or employment lawyer to review the details of your employment agreement to be sure it represents your best interests.

Additionally, contract review team Resolve can look at your contract, let you know if it’s fair, and provide tips on how to successfully negotiate.

Author Bio

Stephanie Davis, M.A. is a content marketer with over 8 years of experience. As the current content manager at Health eCareers, she creates a content strategy to help physicians, physician assistants, nurse practitioners, and nurses on their healthcare job search and life on the job.