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Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills

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to build their own research program, whether or not they have a mentor.

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As clinicians, we spend a decade or more as trainees learning to take care of patients.

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When we finally start our careers, we want to build research programs, but then we find

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that our years of clinical training did not adequately prepare us to lead our research

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program.

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Through no fault of our own, we struggle to find mentors, and when we can't, we quit.

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However, clinicians hold the keys to the greatest research breakthroughs.

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For this reason, the Clinician Researcher podcast exists to give academic clinicians

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the tools to build their own research program, whether or not they have a mentor.

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Now introducing your host, Toyosi Owuemene.

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Welcome to the Clinician Researcher podcast.

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I'm your host, Toyosi Owuemene, and it is an absolute pleasure to be talking with you

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today.

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Thank you so much for tuning in.

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I am excited to bring you this episode titled, Salary, Why It Matters.

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Okay, that episode title again is Salary and Why It Matters.

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And the reason I bring you this episode today is because of my...

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I literally just got off a coaching call with my clients, and I asked them to rank in order

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of priority, what was the most important in selecting their next or first academic job

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or first faculty job.

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And I listed geography, activities of the job, and salary.

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And 100%, 100%, these were 10 people in this meeting, 100% said salary was the least important

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consideration, 100%.

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Okay.

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Now, I have to say that even though that didn't surprise me, I was 100%.

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I was surprised because I thought it couldn't be 100%.

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I was sure at least one person, at least it would be 10%.

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But 100% said it was the least important consideration.

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And so I thought that was important for me to create an episode that helps academic faculty

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think about why salary actually matters more than we want it to.

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What was number one?

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Number one was the kind of activity they would be doing in their job.

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And number two is the geography was geography.

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Okay.

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So here's the spoiler alert for the seven things I'm going to tell you, seven reasons

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why early career faculty should be thinking about their salary, should care significantly

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about their salary.

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It's because salary affects your ability to do the things you want to do.

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And it also sometimes affects where you live.

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But all right, that's the spoiler alert.

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But why do I think it's important for you to care about salary?

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Now, I will say that this is me 11 years from my first faculty position job hunting, right?

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I didn't care about salary either.

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It was the least important of all considerations to me.

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And in retrospect, now I would say, wow, it absolutely should have been important to me.

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And I want to share now why.

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The first and most important thing about salary is that even if it doesn't matter to you,

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it matters to so many other people, including people who are hiring you.

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Have you ever heard the phrase, whoever dies with the most toys wins?

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Yeah.

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I don't believe it.

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I don't even endorse it.

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But people are keeping score with money.

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And for whatever reason, money is an indicator of value.

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Now you can be like, well, no, my value is not wrapped up in my salary.

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And that's great.

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You are so awesome and so altruistic, but everybody else is not thinking about.

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People are equating value with salary.

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The lower salary you get, the lower value is associated with the activities that you

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do.

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Now, every institution is different in terms of what they prioritize.

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But I will tell you that when you look across the board of new recruits coming in, value

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depends on how much salary is offered.

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And that when we think about the salary equity gap, right, which exists, let's just call

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it out, there is a pay equity gap in salary and it affects gender.

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So women are more likely to be affected and underrepresented minorities are likely to

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be affected as well.

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And in that inherently is a suggestion of value.

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Because if everything, everyone was valued equally, then why would there be a pay disparity?

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Right?

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So it matters because people are valuing what you do based on the salary they give you.

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Now if everybody got the same salary, we wouldn't even need to have this conversation.

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It would just be like, oh, okay, everybody gets the same thing.

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Why does it matter?

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But there is a significant differential, even looking at the same position, the same academic

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position, the same job description.

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So now we're not talking about orthopedic surgeon compared to pediatric infectious disease.

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We're talking about, okay, all pediatric infectious disease doctors of all comers, right?

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All genders and all races and ethnicities, there is pay disparity.

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And so salary, for better or for worse, is often a reflection of the value you bring.

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Now here's the challenge.

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People are happy to offer you a lower salary.

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And sometimes the rhetoric is that people who are underrepresented or women tend not

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to negotiate, and that may be true to some extent, but also what is first offered tends

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to be disparity in that.

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Now I have that based on anecdotal evidence, based on people sharing what they were initially

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offered, and there's disparity in that as well.

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So if you're starting out with a very low ball offer, you're not likely to negotiate

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to a much higher amount.

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So I remember that whole idea about women don't negotiate, women don't negotiate, and

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that filled my mind.

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And so when I went to negotiate my salary, I did negotiate, but I started from such a

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low position there was nowhere I was negotiating with too, because I didn't understand anchoring,

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right?

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I didn't understand how to negotiate well.

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And that's not a deficit.

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It's not what we're taught to do in medicine.

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And for many of us, before we get to our first faculty positions, we've never negotiated

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a job.

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For many of us who've just gone straight through, right?

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We've never done that.

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And so it's not a skill we've built, and it's a skill that can be built over time.

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So anyway, when you don't get appropriate value for the work that you put in, you actually

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don't get it.

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Your work is recognized as less valuable.

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The more somebody has to cough up out of pocket to pay for something, the more they value

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what they paid for, even if they don't think it's worth that much.

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Now, I'm not even sure you're worth that, but I paid this much, so I expect to get this

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much out, right?

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So even when people are not trying to equate salary with value, the person who gets paid

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more is perceived to bring more value than the person who gets paid less.

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That's the way it is.

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So I'm not telling you what you should negotiate, but I'm letting you know that you should be

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careful about it, because if you don't think carefully enough about it, you may be signaling

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to your institution that your work is of lower value before you even had a chance to declare

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the value of your work.

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So salary, whether we like it or not, is often a reflection of how an institution values

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that position, values the work that is done, you should pay attention so that your compensation

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speaks to the value of your work.

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That's number one.

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Number two is sustainability.

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Now here's what I didn't recognize when I did not really think too critically about

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salary when I first started.

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I was a young mother of two children.

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I needed full-time childcare to be able to do my faculty job well.

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But because my salary did not support my ability to find full-time help, guess who was doing

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all the additional running around?

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I'm very fortunate.

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I have a very supportive spouse who was so helpful.

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I had help.

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And so if I didn't have that help, I would be stuck.

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So many times when faculty are thinking about how, oh, salary is not so important to me,

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they forget that if they're going to work as hard as they need to, so I hope you're

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not thinking that you're going to finish your training and then life is going to get easier.

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You're going to work less hard.

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If anything, you're going to work very, very hard, especially in your early career faculty

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years.

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And probably I don't know that working hard ever really ends in academic medicine, but

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you're going to be investing a lot of time in your job.

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Who's going to help you take care of all the other needs that you have?

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You might have student loan debt that you need to retire.

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What if your salary doesn't even allow you to pay that student loan debt off?

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How do you manage all the other activities?

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So now then you have to go get a moonlighting job that keeps you from excelling in the research

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and scholarship that you went to this academic institution to do.

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That is a problem.

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If you don't earn enough to meet your other needs, including childcare needs, elder care

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needs, supporting or retiring your student loan debt, paying for your mortgage, if you

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don't have enough salary to cover even the basic and beyond the basics, then it becomes

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a distraction from the academic value that you say you want to bring.

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Salary matters so that you do not have a burden and now that now distracts you from the work

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that you actually came to do.

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Number two is career sustainability.

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Number three has to do with opportunities for professional growth.

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Okay, I know you made a lot of investment into getting your medical degree and congratulations.

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It was absolutely worth it.

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You were worth the investment even if you have not finished paying off your student

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loans.

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That is not the end of your professional development.

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You may be like, oh no, I'm only interested in the professional development offered by

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my institution.

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Think again, you are someone who must continue to grow and expand and build skill.

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Professional development is part of your life forever.

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I'm not just talking about CME.

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Please go get those CME hours.

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In fact, you're not going to be able to renew your license without the CME hours.

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So that kind of is required.

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Professional development on the other hand is optional, but it costs money to do professional

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development activities.

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All of these activities, especially those that are outside of your institution, take

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time and investment and energy and effort.

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If you are struggling even just to meet all your other basic needs and you don't even

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have enough money tucked away for some of these professional development activities,

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that is a challenge.

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I've done professional development activities that cost a couple of tens of thousands of

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dollars and my institution doesn't want to pay it, or at least they want to pay only

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a partial amount.

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I need to be able to support myself to be able to do that.

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Attending conferences is important, whether or not they're going to cover you.

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Imagine if you're like, oh, my institution only covers $3,000 worth of a conference,

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therefore I can't go to this other conference.

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Why would you limit the number of conferences and opportunities you have for networking,

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expanding your career to just whatever is in the budget?

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Why wouldn't you be able to have more than that?

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So I am saying that if you are interested in salary only as like, oh, I just need the

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bare minimum to get by, I want you to think again about the opportunities a higher salary

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brings you.

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Now, not just opportunities for professional growth, but opportunities for investment,

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opportunities for you to ultimately one day be able to be financially independent, which

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you may not be as focused on when you are in your early career days because you're like,

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I just got to get those grants out.

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I just got to get those scholarship.

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I've just got to do all the scholarship things.

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And I'm saying, please do all of that.

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And while you're doing that, make sure you have enough of a cushion to meet your financial

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needs so that you can advance both professionally and financially.

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Okay.

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Number four is increased flexibility.

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Okay.

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Okay.

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Flexibility.

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Now, let's go back to the example of childcare.

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If you don't have enough money to support the childcare needs that you have, guess who

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does not have very much flexibility?

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You don't.

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And maybe you're like, well, children are not my challenge.

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I'm like, okay, great.

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But if you don't have enough money to support your going away on your dream vacation, you're

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working so hard, what is the point?

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Or if you don't have enough financial flexibility that you have to go into debt every time you

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have a major demand on your income, what are you going to do?

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And so you may be thinking, oh, I don't have to worry about finances because I have a

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significant other who is equally well paid.

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And I'm going to say, that's great.

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And consider if for whatever reason, this second income doesn't come in, are you going

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to be able to sustain the entire ship?

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And those are the things you want to think about.

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You want to be independent.

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And sometimes that's the challenge, especially for women, I think, who are in other significant

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relationships or finances are coming in from a partner.

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Sometimes it's like, well, I don't have to make very much because the other person is

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making up more than enough for both of us.

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And I would say that if you were not able to access that income for whatever reason,

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would you be able to independently support the entire family?

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And I think that's an important question to consider when you're considering your salary.

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Okay.

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Number five is compensation for your time and effort.

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Now, I don't want you to do this math.

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Actually, maybe you should do it, but I want you to go in and for a week, keep track of

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how much time you're actually spending investing in your job activities as an academic physician.

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Now, I know we all talk about, oh, yes, the 40 hour work week or it's a 50 hour work week.

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Maybe it's a 70 hour work week.

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How many hours are you actually putting in relative to what you're compensated?

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And that's an important question.

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Salary is a beautiful thing.

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I love to see the paycheck come in every month.

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And at the end of the day, when you tally those hours, are you actually being fairly

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compensated for the work you do?

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Now, in every academic environment, there tends to be a range of salaries that faculty

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are paid based on their position, based on their role, based on their specialty.

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So there is a range.

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And I'm not suggesting that you're going to go and be way outside of that range, be an

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outlier.

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If you can be an outlier, go be an outlier.

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But what you want to do is make sure that you are as close to the ceiling as you can

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be, as reasonably can be.

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But you don't want to be, at the minimum you should be average, right?

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But what you don't want to be is at the bottom.

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You want to make sure that you are well compensated for your time and effort.

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Because if you're not, and you actually have to go do a second job moonlighting just to

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be able to make up for your lack of compensation, then that's also a drain on your time and

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your energy.

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Okay?

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Number six is equity and negotiation practice.

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Okay.

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Negotiation is all we do primarily, though we're very good advocates for our patients

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and we negotiate well for them.

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But we should be able to negotiate at least minimally for ourselves.

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You can't negotiate what you don't understand.

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You can't negotiate what you don't do.

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Now I will tell you that the faculty in my group were so, they were so apathetic about

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salary that no one even looked up what's the expected salary for their position.

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You've got to know these numbers because if somebody comes in with a low ball offer that's

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too little to support your needs, you don't even know it's a low ball offer.

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How can you negotiate it?

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Negotiation is about having information, having access to information.

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If you know that the median salary is 250,000 and someone says, we're willing to pay you

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150,000, you want to be able to say, hmm, I would like to understand why this is not

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at the median for academic medical centers in the Southeast.

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It's a question.

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You don't even really have to be a hardcore negotiator to ask questions.

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And at the end of the day, negotiation is a lot about asking and answering questions

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or asking questions in curiosity.

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But if I didn't know that the median salary is 250,000 for this area and for my specialty,

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then how can I know where I should be negotiating to?

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I might just start with 150 and say, oh, well, let me negotiate up to 170,000 and feel like

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I've done well negotiating and not realize that I'm totally out of range because I lacked

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information.

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So this is the point at which I pause and say, for those of you who are early career

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thinking about your first or next faculty job, please go find out what the salary is.

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Go find out.

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Don't guess.

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Don't imagine.

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Don't say, wow, it's greater than my residency salary.

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It must be amazing.

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Go find out the numbers.

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In one way you can do that is look at the AAMC faculty compensation report.

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And for any academic institution, if you're a member of an academic institution that contributes

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data to that report, you can get it for $60 in today's dollars.

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As of today, you can get it for $60, at least the last time I checked.

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Hopefully it hasn't changed.

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And if you are part of an academic institution that does not contribute data, then it's $1,500.

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So it's not cheap.

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So if you don't have access to it or you can't cough up the dollars or you don't have the

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dollars to be able to pay for at either end of that spectrum, I would say that you can

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go to your library and ask them.

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And it's a document that usually sits in the reference side of the library, at least in

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my library, and someone can look at the pages and give you access to the information you

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need.

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Or you can show up at the reservation desk and get that information yourself.

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But the number exists.

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It's out there.

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And at a minimum, even if you're like, I don't want to negotiate, I don't care, you should

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know the number so you understand how close to it you are, how far you are from it.

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You want to know.

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Okay.

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All right.

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Finally, long-term financial help.

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This is so important.

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And I wasn't thinking about this at all.

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In fact, I wasn't thinking about any of the things I'm just sharing with you.

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But your long-term financial help matters.

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Because as a physician, when you compare yourself to your classmates who graduated college and

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went off and found their entry-level jobs, they've had 10 years longer than you have

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for the most part to build up their savings or to build up their investments in their

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401k or their 403b or whatever investment vehicle that they chose.

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Whenever it comes to investment and thinking about long-term finances, especially with

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regard to retirement, time in the market matters most.

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I remember whenever people would come talk to us about finances at the end of medical

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school and they would show us the same two graphs of the people who started saving when

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they were 25.

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And I would always look at those graphs and say, well, why didn't you come talk to me?

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Oh, no, they would start at 18, I think.

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It was like, Jerry started when he was 18 and he contributed until he was 18.

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He was 30 and he stopped contributing forever.

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And then the other person starts at age 40 and then contributes for 30 years.

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And when they compare the two, the person who started will always have more than the

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person who started late.

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Right?

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The person who started early will always have more than the person who started late.

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So already, if you are a physician who spent most of your life in training, not really

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contributing to retirement, not really making significant investments, you started out late.

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And so you need to catch up.

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You need to catch up because I hope you're not planning to work forever.

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You're not.

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But you want to have a plan for your retirement.

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You want to have a plan to become financially independent.

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And that does involve investing.

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And the more time you have to invest, the more you're able to meet your goals more easily,

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at least in a reasonable amount of time.

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And so salary matters in those decisions because your salary is the seed that allows you to

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make those investments.

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All right.

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I've given you seven reasons now why you should be thinking about your salary, even if it's

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not the most important thing for you in your next or first academic job.

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Number one, whether you like it or not, salary is a reflection of value.

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Number two, career sustainability.

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Number three, opportunities for professional and financial growth.

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And before increased flexibility.

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Number five, compensation for your time and effort.

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Number six, equity and negotiation practice.

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And number seven, your long term financial health.

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And I'm inviting you this week to go figure out what is the median salary for your specialty

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based on the academic, the part of the country that you're in, based on whether it's a private

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or a public academic institution.

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Do you know those numbers?

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I challenge you to find out what they are this week.

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And I'll be curious to know your thoughts.

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Someone who did this exercise in my group was like, I am totally surprised.

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How can a specialist make less than a generalist?

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And it was one of those, I mean, it wasn't funny, but I was in that place.

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I was like, yeah, that is exactly me.

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I was like, why did I spend this extra time and I make less than a generalist?

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And I tell you that is not an unusual finding, but she wouldn't have known that if she hadn't

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looked it up.

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And so I invite you to do the same this week.

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Go look it up.

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Share your surprises or maybe you're not surprised.

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You're like, yeah, I knew that all along.

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I would be interested to hear.

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Reach out to me on LinkedIn.

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I look forward to hearing from you.

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All right.

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It's been a pleasure talking with you today.

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Thank you so much for tuning in and I look forward to talking with you again the next

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time on the Clinician Researcher podcast.

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Thank you for listening.

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Thanks for listening to this episode of the Clinician Researcher podcast where academic

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clinicians learn the skills to build their own research program, whether or not they

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have a mentor.

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If you found the information in this episode to be helpful, don't keep it all to yourself.

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Someone else needs to hear it.

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So take a minute right now and share it.

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As you share this episode, you become part of our mission to help launch a new generation

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