I'm going to welcome Dr. Kim Skelding for the next lecture. Dr. Skelding, I'm a personal fan. She is a very talented interventional cardiologist. She's also a phenomenal program developer, division chief for CV services, and chief of cardiology, Barbana's Health. Dr. Kim Skelding. My one disclosure is that now I'm on the other end of having the negotiations. We're actually in the process of hiring people. I hope they don't watch this. I'm just kidding. But I think that it's important. I'm going to try to go over some important points that have been helpful to me. I have had four jobs in 25 years and have made some errors in negotiation, and I hope that by seeing my slides, you'll maybe not make those errors as you move forward. Before the interviews even begin, you really need to have things ironed out in your mind. You really need to know what kind of job you're looking for. Are you looking for something academic? Are you looking for private practice? Are you looking for a hybrid model? Are you looking for some protected time or not? What exactly are you planning on doing for the next several years? Know your skill set. Make sure that you are at least somewhat adequately prepared for the job. That being said, there is data on the list of requirements that women will likely not apply for that job until they've had all 10, whereas men will apply for that job when they might have five or six. It's okay to have a little bit of a stretch. It's okay to apply for jobs that you don't check all the boxes. Just have an answer and a plan in mind how you're going to get the skills that you may not already have. You need to know your strengths and know your weaknesses. If you're not good at having direct conversations, then you shouldn't take a leadership position at least at this time. Know what you're strong at. If you're really good and you're efficient, then taking a job that might be RVU-based might not be as bad as taking a salary job. Know what makes you happy and know what you cannot tolerate. Just as important as knowing the one or two things that you must have that are non-negotiable for you, you need to know the one or two things that you will not tolerate and are also non-negotiable for you. Important points as a foundation, when you're looking at a job and thinking about what the job is, it's really important to know the cost of living. If you are taking a job in downtown Chicago and your salary is going to be $150,000 a year, know that you're likely going to be living on ramen noodles. Make a plan for what you want to be doing and how you want to be living. Have a basic understanding of what other jobs are like where you're going. Talk to other people, find out if they have protected time or they don't have protected time. Have a basic idea of where their salaries are if you can, if you know people that you can trust, or if it's a university setting, you can usually find this online because it's publicly reported. You need to always consider walking away and know what that means. If you go into a position, I think the biggest mistake you can make is trying to fit a square peg into a round hole. If you know that you are an upfront, very transparent person and want to work in that situation, then be thoughtful about where you are in the country and where you are in what type of institution. That leads to my next point, which is understanding the culture. I have worked East Coast. I've worked in the Midwest. I've worked on the West Coast and I've worked in the Deep South. Geography matters. Know what the city or town or the place you're going to, what it's like. If you're going to be the only woman in the 100 mile radius, know what that's like. Also know how your personality fits with the demographics of people there. Also, you need to understand your hospital's risk tolerance. I cannot underestimate this enough, especially in interventional cardiology. Try to ask people about their mortality and morbidity conferences. Do people look forward to it? Do people hide from it? Are people scared to go to it? What is it like? Is it supportive and a growth experience or is it just a way to berate the young faculty? It happens. Know about the lifestyle. My job before this job was in a very hiking, biking, running, skiing, ultimate sports type of region. Although I like to hike and I like to go for walks, I'm not in that ultimate sport community. And so when all of my friends and partners were doing this, I didn't really have people who had similar things to what I enjoyed doing on my time off. And they weren't really available in my region. Really try to identify work-life balance. A job can have a huge amount of vacation. There are some jobs out there you will see interventionally that have four-day work weeks. Some of them have 10, 11 weeks off a year. But find out what the rest of the time is like. Because if those jobs are being publicized, then there's generally something wrong with it. Whether it's that people don't want to live in the region or the people there that you would work with are toxic. But if it looks too good to be true, it may be. And you need to investigate the place as much as you can, realizing that many people who leave institutions will not air their dirty laundry. And sometimes if people leave under duress, they might have a non-disclosure agreement and can't speak about the bad things there. So if people are hedgy, thank them for their time and move on to somebody who is willing to be a little more transparent with you. Salary. Salary is usually the first thing we consider. But for longevity, people will generally stay in their job that they're happy, more so than a job that they're overpaid. Consider what you need and what you want and see if there's a standardized scale. There's some institutions, large institutions, some of them in the Midwest, that have standardized scales and it's considered sort of bad form to negotiate salary because there is no negotiation. It just is what it is. Consider your worth. If you have a skill set that they don't have and that they need, you are definitely worth some extra dollars. And think about if you're looking at a high salary, what price do you pay for that salary? Are you going to be working 14-hour days every day? Then it might not be worth it. Maybe you don't have a family and it might be worth it to do it for a few years, to pay your loans off or get a nest egg together. But nothing comes without some cost. You should try to identify your MGMA scale for your specialty and your region and know what sort of the 50th percentile is in payment so that you kind of have an idea of where your negotiations should be. And really ask for what you deserve and advocate yourself. The other side is doing the same. One big mistake is that people will often say, so how much are you looking for? What are you looking to make? You absolutely, positively, 100% can't say this enough, do not want to put the first number out there. Let them put the first number out there and you negotiate from there. What makes the job more palatable? Time. Time off, time working, time in the lab, time doing general cardiology stuff that you may not enjoy as much. Your support. Do you have a secretary? Even if you share one, it's better than having no one, especially if you want to plan meetings and do things like that. If you're going to be someone in academics, see if there's help writing grants. Look for mentorship, whether that's clinically or academically. Look for someone who you will be able to bounce ideas off of. Talk to the other people in your group and say, if you have a tough case, who do you go to? CME money, CME time. You need to really stay pertinent. And so you will find that there are places where there are private practice folks who have not been to a CME in-person in eons that may not be where you want to be. Yes, some people learn well online, but there's nothing that really can substitute for being in a place with other colleagues asking questions and interacting. RVU targets. Find out whether they're reasonable or not. Know about the people. Know if there's an airport nearby, whether you have family nearby, and if you plan on having children. It's important. Your allocation of time and the stability of the practice, how much turnover there is. What you may not hear about, a mutual understanding of success. What does that mean? You should ask people, what does it mean? What would it mean to you for me to be successful? Is it bringing new practice, new devices, new things? Is it just bringing volume? And if you're interested in leadership, what are the roads to leadership? How many of the people in your group have risen to the top from starting out where you would be starting? Look at the salary structure over the years to make sure there's appropriate times when this will increase. Contract changes, do you do those personally or are they institutionally driven? And the possibility for coaching. That's really important, especially early in your career. You might want to have somebody to go to outside to vent and to get advice for important meetings and emails, things like that. Don't be too eager, but don't be too laid back. But take your time and have thoughtful follow-ups and hold your places very helpful. What you don't want to be doing is literally finishing your interviews, get back after dinner and start sending out thank yous. Give it some time and don't seem too eager, but also don't wait a week. And when you say no to a job, be honest, be thoughtful, and being clear is kind. Don't be hedgy, don't ghost people. That really doesn't bode well for you. Let's see, I'm trying to get to the next slide. Be factual. I want X because of Y and I deserve it because of Z. And find out if you're talking to the person who makes the decisions or an intermediary. Sometimes you're negotiating with someone who you think can make a difference, but they're really not the person. So you tell them all this stuff and then they translate what you've said to someone else. And things get lost in translation. This goes back to what Mr. Cotton said, or Dr. Cotton. What are you willing to let go of? You know, maybe you have 10 things that you want. You negotiate, you get eight, you might not get two, that's fine. What are the non-negotiables? What things will you not do without? And what would be your stretch goal? So you should put down what you want, what would be a pie in the sky that you want, and what would be something you would settle for. And you should do that for all of the things and make a little Excel spreadsheet of all the things that you want to do when you negotiate. Be willing to market yourself. Women are not terribly good at speaking up and tooting their own horn, and you need to do that. And understand what parts of the negotiation are better in email, by phone, and in person. Some things you want in writing. Some things you want to talk about in person because you want to see their body language, which Susan Childs is going to talk to you after. And so these are really important things. Be confident, but not arrogant. You really don't want to just fit in, but you want to excel. One of the most important things that I have learned through this last job I took, I interviewed at 20 places. I got 17 offers, which means I turned 16 places down. But you need to be unapologetically yourself. If you're going to have longevity, you need to say, this is me. This is what I do. This is how I am. Essentially, are you ready for it? This is what you want. And I am in a job now where I have never been happier. But it is the first time that I didn't go into a negotiation thinking, what do they want? And can I be that person? Rather than thinking, is this place for me? Which is really what you should be doing. They will see who you are soon enough, but it's better to be upfront about it. There are a few that are free. Some of them are costly. There's a lot of free things on podcast, TedCast, things like this. So there are free options out there. Contract lawyers are vital. They're not a nicety. You absolutely, positively need one. They can be the bad guy in your negotiations, so your relationship with the entity does not get tarnished in the negotiation. They'll think of things you don't think of. They'll likely have you set your sights a little bit higher. My last lawyer, although they were in Florida and my job was on the New York, New Jersey border, really was absolutely phenomenal. And she also gave me valuable insight into the entity I was considering, because she works with people all around the country. And so she was able to tell me what other people were doing in that situation. So make a good choice. In summary, plan ahead for what you want. Sit down and write it out. Sounds sort of Mickey Mouse, but you really need to think about what you want, what you're willing to give up on, prioritize your things, and also what you will not do without. Know yourself and understand that nearly everything is negotiable. And what you can't get in salary, maybe you can make up in qual life. Use online tools. Use a coach. Get a great lawyer. Use all the things that you can. And do not compromise your values, most important. Thank you. Thanks, Dr. Skelding. That was great. And I particularly liked how you highlighted that with this go around and sort of job negotiations, it was more about whether the place was a good fit for you and not trying to make yourself a good fit necessarily for the place. I think that was a great highlight and something we all should think about as women potentially going into new job opportunities.

interventional cardiologist

job negotiations

workplace culture

salary negotiation

negotiation strategy