Negotiations_ Women in Laryngology
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[00:00:00] I am really excited to talk about this topic. So I think mastering negotiation skills is something you can't learn enough about. I would love to hear where people are from. So if you don't mind throwing in the chat, just give us an idea of location or institution, or metaverse, whatever you're from right now, I can tell you that I'm in Cincinnati, Ohio.
And people oftentimes ask me if you can see my background where I am. This is what a house in Cincinnati, Ohio looks like, and this is actually the room that maybe buy this house and it will get darker over the next hour. But I think the beauty of life is you get to live in a place that you like, whether it is the house or the city.
Or the institution. And so I am excited to hear everybody's from, I see some University of Chicago, Louisiana, live in Chicago, but work community based in northwest Indiana. I actually live in Cincinnati, but I work in Indiana also, so it turns out we can all work in Indiana. So please show where you're from in the chat and I am gonna jump in and just [00:01:00] occasionally have some things to talk to you guys about.
Oh, San Antonio, Texas. Thanks, Sarah. And we're gonna talk today. Here's my disclosures. Let's start with that. I do have a business called the Academic Medicine Strategy Group that does faculty development and coaching, and so I do get some salary from them. I am the CMO for an insurance company. I get some salary from them, and I have a real estate syndication and investment business, which I get some salary from.
Yay, everybody. Get salary. I also do some consulting work for Nick soa, which is a hypoglossal nerve stimulator company. I'm on their data safety monitoring board, and I do some educational consulting for Inspire Medical, where I talk about things like negotiation. So I'm excited today to talk to you guys about how to think about a structured negotiation framework and then explore some gender specific challenges in negotiation, and then use some high yield questions to operationalize negotiation.
So one of the reasons negotiation is important for us to recognize is that many of us think I'm not good at it. I don't have the skillset, but it's a [00:02:00] skill that you can learn. It's not a personality trait. Nobody walks outta the womb who knows how to negotiate, although. I've met a lot of toddlers who seem very good at it, but if you think at all about where you started and where you are now, you've already grown in this skill and there's plenty more to learn.
So we're gonna talk a little bit about a structured negotiation framework and some of the challenges and then some case studies and some prompts. And so the reason this is important, especially for women. Is that we know that men make more. This is not new news to anybody on here, whether you're male or female.
So there's a gender pay gap in medicine. What's super interesting is that ENT has shown one of the highest disparities between male and female salaries, and in fact, I don't know if anybody follows Jennifer Grandis on LinkedIn, but she literally posted something today about how it takes 85 days into 2026 for women to make the same amount that men made in 2025, which.
It is an interesting statistics to keep in mind, but if you look at the 2022 numbers, it's [00:03:00] that male physicians earn 24.6% more on average relative to a women's baseline. And this is when they have gone back and they've controlled for the time you work and the roles that you play in your academic institution.
So it's interesting, and some of that we think is because only 7%. Of women negotiated their first offer, whereas 57% of men did. And I will tell you, this is from a book called Women Don't Ask, which I love, and then also from the 2022 MA Women in Medicine report. But I'm gonna tell you in my own experience, so I'm currently Chief Medical Officer at an insurance company, but before this I was the medical director.
A utilization management group at a children's hospital, and I hired four physicians and five actually, and four of them were women and one of them was a man. And I gave the lowest end of the range salary. It wasn't a big range. I had a little bit of room to play and every single woman said, great, thank you.
And the only man said, I need to make more money than that. How much can [00:04:00] I negotiate it? And he negotiated. 10% more than everybody else off the bat because he asked, and I'm gonna tell you, I have ever since that time had this giant regret that maybe what I should have done has gone back and told everybody like you should have asked.
And I did subsequently tell all of them like this was negotiable and you should ask for more your next negotiation. But in real time, I was trying to manage a budget and some of the other things, and I was being managed and how well I did and his hiring and. I have the same motivation as others do. It's just to make it at a reasonable price, but it literally, if anyone had asked me, I was ready to go up in price, I was ready to give them whatever was the 10% more number or somewhere in between, but none of the women asked.
And so it was interesting to look at it that way. Am I showing you something crazy? No, I'm only the one. I'm the one seeing something crazy on my screen and you are not. Let's see if I can get outta this. Let's see if I can go back to my slides. Fun. Okay, I'm slowing. Are you guys seeing the [00:05:00] slides as a slideshow?
Okay, I'm gonna assume you are because I finally found the slides again. Okay, thanks. Yeah, we were, and then it went off for a sec, but it's back. Okay, thanks. So one of the things that's important here is the impact of not negotiating, which many of us have done. I did not negotiate my first job, thank God.
One of my male partners started six months later and he literally negotiated all of us up to the 25th percentile for the double A MC, which. It is not a high bar, but at the time I wasn't even making that. I wasn't close to that. I think I was at the fifth and I didn't even negotiate for myself. He said we should all be making at least the 25th.
And then, quite honestly, it was a $50,000 raise for me. I said, what do I, what am I, what gift am I supposed to give you for a $50,000 raise? And I think I gave him a very terrible bottle of Mo and David as a joke. But even that, he said his minimum for drinking wine was $15 and I had to write a $15 price tag on it.
'cause it didn't cost that much. But. The important thing about that is we oftentimes are so happy to get the first job or do the first thing that we don't ask, or the [00:06:00] third job or the 10th job. And so a thousand dollars a month of money in terms of difference is $500,000 over a year. So if somebody else made $12,000 more a year, and I'm gonna tell you that negotiation I just talked about.
It was $2,000 a month, a million dollars loss over a career just from that one negotiation. And that compounds over time as to what you think you're worth over time. And then there's other things to negotiate. It's not all about money. There's plenty of other things that are important, and they may be things that negate to institutional status.
It could be titles, it could be funding startup funds. It could be money for your grant, it could be time for administration. It could be. The office that you want in the building, that you want with the people that you wanna be near. And all of that leads to a slower path to leadership. And so one of my favorite quotes here is you don't get what you deserve.
You get what you negotiate. And one of the problems that many of us have. And I had it for sure was I was waiting for somebody to notice how great I was and [00:07:00] then just reward me with it instead of asking for what I thought I needed or what I deserved. And so what I'm gonna ask people if they can, is to throw into the chat what's one ask you wish you'd made earlier in your career or you wish you already had.
So what is one thing that you wish you had asked for that maybe you thought was gonna come to you or somebody would notice? I'm gonna tell you, I was coaching somebody yesterday and she's involved in an organization. She has been. Uber working in this organization. If you look at how much she's putting in the committee versus somebody else on the committee, more than almost anybody of the founding members.
And she just expected that they would ask her to become the next chair of the committee. And it turns out when she said, they said, would you be the head of the nominating committee? She rightfully said, oh my gosh, I would love to be the head of the organization. And they said, oh, we already asked somebody else to do that.
So she didn't even get the opportunity to ask for that next thing because she didn't ask early enough. And so there's another committee that she's on that she's, I'm assuming I'm be the chair of that. And we had the [00:08:00] conversation. Did you ask, do they know? Because my guess is some of the men who are getting these jobs are asking, or some of the women who are getting these jobs are asking so that they know.
One, that there are people that they're like working on giving them the skills, but also they recognize that this is something they're interested in. So if you can think of something, I would love it. Throw it in your in there and say. Something you wish you had asked for, whether it's time, is it money, is it a title?
I can tell you for me, I wish I'd asked for more protected time upfront, and I also wished I understood what was gonna turn into promotion. I asked for some goofy things that I thought made a difference, including some time, but not time with mentorship or time with sponsorship. So I love here, Karina just said, I wish I'd asked for a mid-level.
So important. I never even thought to do that in any, quite honestly. I think any of my jobs, I just assumed I'd get everybody else had, which is ridiculous because there are definitely people who said, this is the way for me to be productive. [00:09:00] And her comment is, by the time I realized every other attending had a mid-level provider working with them, it was too late to ask.
And that's oftentimes it happens, is it's much easier to get those things in your opening package than it is as you work along. But I also wanna tell you, if you didn't ask and you realize it later, please don't. Keep yourself from asking. Subsequently it may it come as easily, but it is still worth asking.
So I'm gonna talk a little bit about some of the gender specific challenges. And many of us may be living this, and this seems obvious, but I will tell you I do this talk with men and women and it's not obvious to everyone. And there are absolutely some things that come from us being assertive and there is a social backlash that can happen, especially if we lead with being assertive.
And if anybody here has read Likable Badass, please send me an emoji of any kind. But I'm gonna tell you a whole bunch of really amazing badass women told me they had read Likable Badass. We did a WIO coaching session last year, and I hadn't read the book. And so a whole bunch of people told me about it, and I finally read the [00:10:00] book and it was amazing.
And here's the two key things that she talks about in that book. And the first is that you need to lead with warmth. Before you go to assertiveness, but warmth alone will not get you enough unless you're both warm and assertive. And I don't know about you, but I walk in the room with guns blazing, oftentimes assertive.
And I forget to start off with warm. And it's not because I don't have the warm sentiments, it's just that I'm so like, oh, I gotta get this done. I gotta work on this. I gotta, it's like getting the thing out of your mind and then you can. Whew, relax and have the social conversation, but people look for the warmth.
And when they see the warmth, they can actually appreciate the assertiveness. And so I highly recommend the book. Looks like Priya is using the workbook, which is really helpful. I haven't tried the workbook, but the book is amazing and so I highly recommend it. But one of the things that's most important about this is that if you don't lead with the warmth, people think that you're too assertive.
How many of us have heard that she's ambitious? [00:11:00] Not usually a compliment. And if you and I have met a woman who's ambitious, we're like, that's great. We wanna help those people. But it isn't something that's always understood unless we start with the warmth. So it's something I want to tell. Definitely say there's ways to negotiate around this, but there's also this internal fear that we're being ungrateful when we're asking for something.
I'm so excited I get to work at this great place and do this great job and do the thing I've always dreamed about doing. But you are not ungrateful for asking things. And maybe if you realize other people are asking for them too. It feels less ungrateful and more just like the status quo. This is what's expected.
And quite honestly, the favorite thing I ever learned is that women look at negotiation as a relationship. Men look at it as a game. So when they walk in the room, and I'm gonna ask for this, I'm gonna ask for that. And the end of this conversation, I haven't ruined our relationship. If you said no to everything I asked for, it was a game.
I played it. I tried to win. Maybe you won. Maybe I won. Maybe we both won. As women, we walk in the room and we think, oh, if I ask for this, is this, are they gonna think [00:12:00] less of me? They're gonna think I'm ungrateful. Is there some imposter syndrome? I don't really, I don't really deserve this, and I'm not perfect, so I don't know that I deserve the next thing.
We have this perfectionism and we have this impression that everything is supposed to show up in a different way than it really does because we do not understand that. In fact, we don't have to be perfect. In order to do any of this. So when we think about negotiations because of some of these factors, we negotiate less and less frequently and less aggressively than men.
And the example I gave is a perfect one. None of those women asked for any extra money. They all would've loved it. None of them thought they deserved it or that they needed it or that it was possible. And more interestingly, they didn't think it was part of a normal job negotiation, whereas all the men thought it was.
And while I started with an example of one man, every subsequent man that I actually hired asked for something else, whether it was a title or time or schedule or money. [00:13:00] And when they do receive negotiate, like women do negotiate it, they usually receive smaller increases and it's 20 to 30% less on average than salary negotiation.
And this is not usually the fault of the women who are asking, although we may not be asking for enough. But often, oftentimes too, there is a bias on the other side, whether it's male or female, that we're negotiating with. That's not what's gonna happen. And the other thing that we're worried about and that sometimes happens is there's an organizational backlash that women are perceived as less likable when we negotiate assertively, and this is why we have to start with the warmth in order to be assertive.
Now the other thing is to be worried about when assertive becomes aggressive. And it's not really that we're aggressive, it's that the perception of how we are assertive is seen as aggressive. There's a lot of research that shows that men can ask for something and be seen as assertive. We ask for the same exact thing and the same exact situation.
And as perceived as aggressive. And so it's this double bind. If we don't negotiate strongly, we're not really very likable or [00:14:00] they don't think we're very competent. But if we don't negotiate aggressively, then they, we risk lower pay, and they actually don't think we're very competent at what we're gonna do.
So strategies like self, like direct confrontation or self-promotion. While effective for men often trigger social penalties for us, and so this is where we have to lead with that warmth, build the relationship, and then have the conversation. The other thing we often have to do is to frame it in the broader good.
So it's good for my team if I'm negotiating something for my team or this is important for my family, or this is gonna be allow me to be better for the team. We oftentimes have to frame it in more of a community structure than it is an individual structure than men do, and we're often evaluated negatively for violating these gender norms of warmth and communal behavior.
So you do still need to lead with them, even if you're like, gosh darn it, I know I deserve this and this is what everybody else is getting. Now the other thing that's important is that there is like a self-advocacy gap too. We are more likely to underestimate our market value and [00:15:00] internalize some organizational limits.
I talk to people all the time who are like, people told me you can't negotiate. So I walked in, they told me what I could get and I didn't negotiate 'cause I was told I couldn't. And there's a lot of the men in the same places, in the same institution given the same instructions. Who say, what's the harm in asking?
And again, because we oftentimes think this is gonna harm a relationship, we don't ask. We don't wanna harm that relationship. Whereas men are like, Hey, this is a game I'm gonna ask, and if I don't get anything, I had nothing to lose. And then we also have to worry about this perception difference that we anticipate higher social cost when there's a ne negotiation failure.
We're worried that if we asked for something and didn't get it, it makes us look bad. But in fact, we have nothing to lose by walking in the room and asking for something. And there are some positions, especially leadership positions, where they expect you to be able to be. Hard nosed and negotiate. I am currently the CMO of an insurance company, and my boss asked me about somebody who I'd put forward for a job, and one of the things she had said to him was, [00:16:00] oh, I was worried about negotiating with the big uppity ups, and he's, I need her to be aggressive.
I need her to advocate for us. She's gonna do all those things. What she did was she gave him the opportunity to hear her real feelings, and what I told him was, no. This was her giving her honest concerns. Everyone has them. She's a little bit of imposter syndrome, most of us do. And this was a gift that she trusted you enough to say that not a sign that she wasn't aggressive enough or she was too aggressive, that she leads with too much assertiveness or she's got too much warmth, which is exactly where she was being misinterpreted.
Now when we look at gender differences in negotiation styles, men are much more likely to have a direct ask, Hey, I would love to get my salary. Minimum is 10,000 more than you just said, or a hundred thousand more than you just said. And they oftentimes say, this is a benefit. I know that I'm worth it.
I've done the job. I can show you my experience, and if you negotiation again as a game. For women, we oftentimes will use indirect language and we should to some degree because the direct ask doesn't work as [00:17:00] well for us. And we have to be seen as somebody who's focusing on the team or focusing on harmony or how this is gonna make the greater good, or there's some kind of equity piece that you know, will make it so that we will be on even footing where somebody else, where we need to be on evil footing and we oftentimes feel like it's confrontational and view it as uncomfortable.
Now, some of the key miscon conceptions that happen all the time, I've literally heard this twice this week, is they'll recognize my value if I work hard. And I'm gonna give you again the example of the warm woman that I worked with earlier this week doing the work, doing more work than actually the men on the committee.
And she said, they're gonna see what I'm doing. They're gonna ask me. They didn't ask her. And even now I said, okay, what did you do in follow up? Did you let 'em know you were interested that you wanted that job? And she said, I still didn't do it. So we talked about how do you frame things so they understand.
One, it's not politicking to tell somebody I'm doing the work 'cause I love this organization. I'm committed to what we're doing and I am very interested in leading it. 'cause I think that's something to contribute. Absolutely. That's the warm, assertive version. [00:18:00] The key thing we don't do is do it early enough so that when people are making decisions, which is oftentimes the meeting before the meeting, so she got invited to be on the nominating committee.
What was, what important was the meeting before the nominating committee where they'd already asked somebody to take the top role. So as soon as you realize, I think I wanna do this, it's okay to frame this as a conversation about. Hey, can you tell me about this role and what I would need to do and how am I looking?
How am I positioned? Is this something that I would be good at? And if it's not the right time, it is okay to ask. People worry. It's not the right time to ask. There's a lot going on. There's always a lot going on. I've not been in the job yet where we just had a lot of free time. 'cause if we did, I don't think it's the job that I've had, but it's okay to say this may not be the right time to talk about this, but I'd love to know when it is and just throw it out there and someone else might say, no, this is a great time.
We're actually thinking about who the next chair is gonna be. Or, you're right, let's talk about it next week when we get back to that and we're done with this other thing. But it's okay. To let people know that this is where your interests are. And then the other thing [00:19:00] is negotiating can feel disloyal to some people.
Hey, I'm not, I'm self-promoting. But it's not a problem to tell somebody you're interested in somebody, especially if you frame it in the greater good, but also in your contributions and what you can do for the team. And while it's annoying to know that a man can walk in and just say, I like this and I want this and I wanna do it, and he's perceived as, as assertive and leaders.
We can't always do it as easily. So find a way that you can say it early and not wait to be recognized, but to tell them what you're interested in and even sometimes tell them what you've done so they understand how much work you've put into this. And negotiation's part of delivering better care and ensuring, ensuring sustainability.
And most of us know that when we are negotiating for somebody else or something else, but not as well when we're negotiating for ourselves. Now this is the framework that I want everybody to learn. So it's to present, to negotiate, to follow up. Ooh, and I forgot. Prepare. So we're gonna start at the bottom and work our way around.
So the first is to prepare. Now, if we're [00:20:00] talking about a job, it's oftentimes to look at benchmarks. So whether that's ENT salaries or the mc, the MGMA salary levels, or you look at the American Academy of Otolaryngology or your subspecialty, whatever it is, look at the number of RVs you should have. Look at the salaries.
You should have. Look at the job descriptions. Maybe you're looking at things on LinkedIn and figuring out what's normal, or you're talking to people in other institutions who do the same work, but clarify what you should be receiving as a benchmark. What's the standard? And then clarify your must-haves versus your nice haves.
So one of my favorite stories is I worked with somebody who was preparing for a negotiation and she cared about the money, but she also wanted a title. She wanted to work in a specific specialty area that she hadn't had a lot of opportunity. There was a few things, but she said, the thing I really want is to make sure I have the opportunity to work in this area.
And then we came up with a few other things, quite honestly. And so we came up with a title that she wanted. We came up with some [00:21:00] research support that she wanted. We came up with the opportunity to do a leadership program, and these were all things that she cared about, but the one thing she cared about the most was getting the title and the role, and with the associated increase in salary that should have come with it.
And she walked in the room and she had five or six things, but she cared about two. And she gave all of those, she presented them and she framed her requests around patient care and the team benefit. This is how it be good for patients. This will be how good for the group. This is how I can lead the audiologist.
She was looking for a neurology role and it turned out in the end they said yes. They said yes to all five things. Like she called me. She couldn't have been more excited. She's I didn't even really care about those three things. But in the end, she loved having all those things and they actually framed her career and they moved it forward, and they helped her understand that they valued her.
But the key thing is that they don't all have to be about salary, and they don't all have to be like everything you ever looked at. So say she, let's say she'd gotten the two things and she hadn't gotten the other three, she [00:22:00] would've walked out perfectly happy and felt good about our negotiation. So walk in the room with both your must-haves and your nice haves and have both.
Let them know these are the important things. I can tell you I'm doing a job right now where working remotely was one of the most important things to me. But sure, I wanted to get paid what I thought I needed to get paid. And then there were some other things in terms of vacation and benefits and framing of the team and what the leadership structure would look like, and all those things were part of the negotiation.
So here's an example I give about expanded clinic hours, improve access for sleep patients. Sure. That might be something that's important. I wanna make sure I can work till six. I don't, by the way, there are people who wanna make sure they can start at 7:00 AM I just talked to somebody yesterday who's negotiating a new job and he wants to make sure his clinic can start early 'cause he wants to leave by three.
'cause his family lives three hours away and he's only seeing him on the weekends and walk in the door thinking about the things that are important and then negotiate. So stay open and ask clarifying questions. Really talk about what's needed for the [00:23:00] role, what's most important to them, and figure out ways to frame what you are looking for.
With what's gonna make them happy so that you make it a win-win. And this is the ideal thing to do. And one example here is to trade call burden for academic time. But it might be that the most important thing for them is to have adequate coverage for the patients five days a week. And the most important thing for me is to make sure that I can leave at three o'clock on Friday and make the salary I think I need to make.
So I walk in the door and I say, great, I'm willing. To work a little bit extra on these days or to make sure one Saturday a month is called, so I can leave at three o'clock on Fridays and make sure I get this salary or make sure I have this RVU target or make sure I have this academic day. Whatever those things are that are important to you.
And then follow up. So summarize whatever you took from that negotiation. I haven't, I can't even tell you the number of people who've walked out of a negotiation, told me it was great, told me they agreed on everything. There was nothing on paper. And then a month later, they're still waiting for that written negotiation and it comes back to them and it looks different than what they thought they [00:24:00] agreed on in real time.
So my recommendation to you is to finish that meeting and send a summary of the agreements that you think you've come to in real time. Thank them. And then reinforce shared goals. Really continue to do the communal thing. But make sure that you say, like we talked about this RVU goal and this timeframe, and if there's things that are not yet agreed upon, these are next steps.
And see if you can get a set time to jump back on the schedule and make sure you're talking about it so it's not just rolling out for a long period of time. And people will tell you, I won't know about this till I talk to the dean. Great. How long do you think it'll take to talk to the dean? I'd be happy to get back on your schedule.
Three weeks. Okay. I'll set it for three and a half. Let me know if that doesn't work. And oftentimes. I think you and I both know whatever has to happen in three and a half weeks happens at three weeks, two days, and we make sure it gets done and people we negotiate are no different. So as we work our way through those items I just talked about, the first one was to gather data.
Those are benchmarks. You can get 'em for a lot of different things and on a lot of different areas. What do your colleagues have at institutions or the same institution? If you're going somewhere, does [00:25:00] everybody have an MA and you don't have an ma? Does everybody have a mid-level provider and you didn't realize it?
Talk to your peers, whether they're internal or external, and then know your worth and what only you can bring to the situation. There's a reason that they're asking you to be part of their organization. There's a reason that you are on their list of people they're interviewing. And then define your goals and your bad note or best alternative to a negotiated agreement.
So what are the must have things I need to be, for my last job, I needed to be somebody who's working remotely or it wasn't gonna work for me. Obviously that's not common in academic medicine or private practice, but it is not uncommon in the insurance field. And so that was one of the most important things for.
As I worked towards, I worked one week a month in clinical and I made sure my day job knew I was gonna work a week a month in clinical, and that my clinical job knew I needed to batch it in a month altogether. I wasn't gonna be coming one day a week, although I did that in a different job. But in fact, I wanted to be there for five days in a row so I could actually line everything up [00:26:00] to fit with my life and my schedule, and then know what's gonna make you walk away.
Are there things that they're gonna say, yes, we're happy to do this, but this is an absolute no go. And that no-go thing is something you're like, I actually can't live without it. So if they told me, we need you to be in the office every week, I would've been like, I think this is a great opportunity for somebody else.
It just doesn't fit what I need right now. So know those things ahead of time, whether it's block time or administrative time, or thinking time. It's smart to think about whether you need an MA or do you need. A mid-level provider who helps you and how often do they help you? How about people who help with the phone calls for patients?
Do you need a scribe or do you need an AI agent in order to help you? Do you need a computer on wheels or do you need something else? These are not huge things, right? Do you need to make sure the tray that you need for your signature procedure you're gonna do clinically is available in the or? I can't tell you how many people I've talked to.
Who are like, I was told they would get this and this. Then I got there and none of it was there, but they don't have it written down. It was just a handshake. And so if you can get it written down, that's absolutely the best [00:27:00] way to do it. There are things we can do on handshakes, but you should talk to the people who already worked there who have negotiated previously and make sure those handshakes usually turn into the things that were agreed upon.
Now one of the things to think about is how you frame the ask around value. So a lot of times you can do is things like language in order to increase access for patients. So it's not just about yourself, but you can frame around patients or colleagues or trainees use data if you have it. So here's RVU numbers, here's referral metrics.
Here's what I've done for downstream revenue and the current position that I'm in. Or give examples. With increased or time, I'll be able to improve throughput. I'll be able to do more cases, get more rvu. And one of the sleep examples, 'cause I'm a sleep physician, is with MA support. I can help tell open telehealth, consult slots.
So there's lots of different ways that you can frame your ask around value. The other thing I'm gonna tell you is practice makes perfect. I have a lovely colleague that I work with who was on the Today Show not that long ago, and she practiced like crazy. I was so impressed. [00:28:00] She knew what she wanted to say.
She knew how to pivot. We did some media training and she thought about, what do I say if they go here, what do I say if they go there? But it doesn't matter what you're doing. Practice makes perfect and think about what your points are. Rehearse them, maybe role play them. My, my colleague actually role played them with her husband, who is a physician also, and was able to give us some feedback on how it sounded, and then consider your audience what you're gonna say to your colleague might be different than a vice president or the head of HR or your chair.
And then plan your opening. I'd like to revisit my contract to align with my impact. The other thing I think you should practice is if they say no. I hear what you're saying. I appreciate that. I'd love to revisit this. This is really important to me or this, thank you for giving me this aspect. I'd love to re-talk about this after we get to this point, or what do you need in order for us to rediscuss this and at what time interval is reasonable so that you actually give yourself an opening?
Because just 'cause you had one conversation doesn't mean that negotiation is over and then conducting the ask. [00:29:00] One of the things I really recommend is to manage the silence. Oftentimes, we'll put out what we're looking for, and it's quiet, and we don't know what to do with that, and it's hard, and we'll oftentimes rush into saying something or backtracking even.
I literally had a con conversation with somebody today who was having a negotiation with her chair, and she's, I'm worried that I'm gonna back down, and so we put everything in writing so he knew what her. Agenda was, and that way it was much easier for her to say, okay, I'm not gonna back down on this.
This is actually what I want. But manage the silence. Give it a, what's gonna feel like 10 minutes? It's 10 seconds. And just let the other person think. Give them a chance to respond. Do not back off on what you're saying, but just lead with curiosity and listen to what they have to say. And if they say, can they have pushback?
I don't think it's gonna work. It doesn't make sense for our system. Use things like, can you tell me more about that concern? Instead of just agreeing with it or equivocating understand, because sometimes there's things you can work around that they haven't thought [00:30:00] about and then show flexibility. I hear what you're saying.
Let me think about that and let's meet again so we can figure out if there might be some way that we can meet in the middle. The other thing is when you think about handling resistance, there's some comic tactics. Oftentimes you'll hear there's no budget, and so there may be some non-air monetary things that'll help you.
So you may not be able to pay me more, but maybe you can give me some time to work on things that are making me promotion ready or sponsor my travel for me to go talk at promotion meetings or meetings where I can get national reputation. Or you can ask for a timeline. Hey, what's the budget timeline?
When can we talk about putting this in next year's budget? And then this is a comment I've already made, but I really recommend documenting it before the close. So let them know to summarize our conversation, say it in real time. Hopefully you've got something written down or you're taking notes, or you have an AI note taker and you say, Hey, to summarize what we've said, this is what I think our next step is, or This is what we need to do, or You need this data so I can show you why this is important.
Then set a timeline for your next check-in and keep it [00:31:00] professional. If you do not agree with anything they're saying, it's okay. But let them know that you respect them. You're willing to go and have conversations both ways. And I love the conversation that Sarah mentioned. There's lots of other things you can ask for admin support, PTO, referral control, lots of things on the table.
I think that referral control is important too. Think about the fact, hey, I don't wanna see X condition in my clinic, or I only wanna have a clinic that's focused on something. One of the people I work with was very excited to create a dysphagia clinic. And slowly he built that over time and he had several of those clinics and all of a sudden he was like, gosh, I need to get some of this other stuff off my plate that is no longer fitting with my niche because it doesn't make sense for me to see for him as dizziness or some other things because that is not gonna move my clinic and my time forward, and I no longer have time from it.
But oftentimes, our referral templates will still reflect the things that we used to do, but not what we want to do or what we're doing in the future. And then when we think a about long-term strategies, I want you to track [00:32:00] metrics so you can think about what you're gonna show later and explain to people how this has been so important.
I want you to think about how you maintain visibility, whether that's a Com committee on something or talks or clinical work, and then coaching others so that you can normalize the ass. So if you've had this experience. You can tell people who are coming in to talk to the same chair, or you can talk to people who are talking to the chair somewhere else and negotiating the next big leadership thing.
Or maybe it's the dean or all kinds of folks. Maybe it's the people in the insurance company, but coach them so that asking for what you need in a way that it can be heard is something that's normalized. So one of the things I wanna ask you if you'll throw something in the chat is how do you balance assertiveness with relationship building?
And I think so many of us worry that this is about a relationship that we're gonna destroy. And so the assertiveness feels uncomfortable. And it's funny because I don't think I realized until I started working in some of this negotiation space, and quite honestly, my wife, when I mentioned that I show up guns blazing.
[00:33:00] We have a whole bunch of teenage and high school kids. I know I'd walk in the room and be like, did you do your homework? And did, how'd this go? And did you get a roommate? Did you sign up for your classes? And she's like, how was your day? I am like, oh, and they would, you know what? They would tell her how the day was and a lot of the stuff I cared about would come out in the conversation and I would walk in the room guns blazing, and I would ask the question, they would answer the one question, but it didn't facilitate a conversation.
It was just too assertive, not showing the warmth. And it wasn't that it wasn't there, it was like me just trying to get the stuff outta my head. And I've really learned since then, starting off with that can be really valuable. So for me. Balance. The assertiveness with the relationship building has been, I wanna build a relationship anyway.
So if I walk in the room and remind myself, just start with that. Let's give our names. Let's talk about what we care about. What was your morning like? What motivated you? Why do you love this job? Those are the kinds of conversations that help prime and frame people. When I talk to people about what they want their ideal career to look at, I [00:34:00] start with what made you go into medicine?
Yeah. Not because that's the most important thing in the long run of that personal negotiation, but it helps frame you in the fact that, oh yeah, I love this. I spent my whole career getting here. The person I'm talking to did the same thing. So let's figure out where our commonality is, and then let's figure out as we build this relationship, how we can both get to something that's useful for us.
Now, here's an example. I frame try and frame asks around a shared goal rather than a personal demand or want. So if it's something that's gonna make it better for my team, oftentimes I'm asking for resources. Sometimes they make my life easier, sometimes saying my whole team's life easier. And examples I was looking to increase my admin support.
Would it make my life better? Absolutely. Like I'm not very good at scheduling meetings. It turns out I know what I'm bad at. Admin. I'm a terrible admin. When people are like, oh, it didn't get scheduled. I'm like, oh, that was a me problem. But when I talked about the fact that my whole team needed this and that it was distracting them from some of the other things we're doing.[00:35:00]
And honestly we were missing some meetings. It had a lot more impact than when I said, it's just for me. And another example is instead of saying, I need more o time, our time, it's that I've been tracking my case volume and what I think is that we could be more productive and increase our throughput if I had a dedicated block on Thursdays.
Here's the data. So sometimes walking in the room with the information that makes it seem inevitable to us is more useful than just making it sound like a personal goal. So here's some real world examples, and this is one case study where somebody asks for a dedicated or block or for call reduction.
And one of the key things like that last example I give is to really link it to case volume or burnout data. And even more important, if you are the person who's feeling like, Hey, I'm really feeling burnt out. I need some time. I was working with somebody today whose colleague had left. So there was an ask for everybody to have more call volume to take over some clinics that.
Weren't gonna be staffed anymore, maybe even to do more, or of patients that were left in the queue. And what she realized is, I can [00:36:00] do some of that, but there's certain patient populations I do not like working with. And so she said, I just can't do that. I'm gonna, I'm gonna say I'm happy to help with this.
I'm not happy to help with that, but also talk about the fact that I really don't wanna get as burnt out as he was, which is why he just walked out the door. And it puts it in the context so people understand it. And in some of these cases, people have gotten really great results, just framing it that way.
The second is something like a title upgrade or administrative time. So it's different than asking for money. It's a little bit easier for people to give as long as you can cover the money. And so if you walk in the door and you say, here's my clinical output. I can tell you when I was maybe three years into my career, I wanted a research assistant and I was making the money, I was seeing the patients, and I walked in the door and I said.
I know we don't have a lot of money. I just got this great offer to work somewhere else. Always a great way to negotiate. I don't wanna leave. I wanna stay, but here's what I need to be able to stay. I would love to take some, instead of excess money going towards what was very, a very teeny productivity bonus for me.
I would love to take my [00:37:00] money. And pay for a 0.5 research assistant, which will level up my game and will come out of my overage, and I realize that'll decrease my bonus by not much to be honest by some. And they absolutely went for it. And it really leveled up my career to go from having no research assistant to having a halftime research assistant.
And it was a game changer. It was the worst, the best thing I ever did. It was so much more important than getting, I don't know, 30,000 more dollars or whatever it was I put toward a research assistant. It actually gave me an innumerable amount of time and a relationship that turned into a mentorship relationship as he became a doctor down the road.
So tie it to things like clinical growth, to productivity, to teaching, to research. And then oftentimes you'll find that if you can give a good case or example like that, oftentimes it'll be granted immediately or built into the budget so that it can be done as you work your way further along, and this is another example for someone asked for a research assistant, not the one I gave, and they highlighted the department wide benefits, they'd be happy to manage that [00:38:00] person, and it was shared across multiple faculty and made it much easier and a much easier, yes.
So here I want everybody to just think about what you can do. So when we think about a negotiation checklist, I want you, as you're thinking about your own job, if it's for a job to research your salary band, whether that's looking at national data or specialty data, or just talking to people at the institution, I think we often feel weird about that, but it is absolutely an important thing to do because.
Those salary levels really differ by institution and practice out loud. Talk to somebody who you will give you real feedback. I want you to write what you value. What are my must haves? What are my nice to haves so that I know when I walk in, what's the minimal thing I'm willing to walk out with? Or what are the things that are my absolute nos if they don't happen?
And then draft your email and feel free to show it to somebody, show it to your mentor, show it to a sponsor, show it to a coach. I looked at one, like two literally today of people saying, I'm looking for this. How does this sound? And oftentimes what you'll find when you look at those letters, as we've [00:39:00] undervalued ourselves a little bit in those letters, or we've said, I know I didn't do this, but if there's any buts in that letter asking for something, please take them out.
Or if you've used the word, should take it out. Go back and think, what would I give advice to somebody else who was sending this letter to me? What would I give advice? To a man who was sending this to me, who was asking another man, because I think sometimes we can advocate for others so much more than we can advocate for ourselves, and then set a follow up reminder.
Now, there are programs out there that will circle back and be like, you sent this email five days ago. You haven't gotten a response. Look for a response. Or just set up a time so that you can say, here's my agenda. I had somebody who was meeting with her chair today and she actually wrote the email and said, this is my agenda for the chair meeting.
Obviously her follow-up was at the meeting and they went through a whole bunch of things. She let me know how everything went, and she said, okay, my follow-up's gonna be, and she's had a timeframe so that the, whatever the unresolved things were are made sure that she's got a timeframe to make sure that they get [00:40:00] done.
Now, one of the things I think it makes it easier for us to negotiate is to think at how we'd encourage a mentee to negotiate, because we are fantastic at helping other people do hard things and not always as good about telling ourselves what hard things we need to do. So if you're stuck and you're not sure what to do, think about how you'd encourage a peer or a mentee to do the same thing.
Now, some of the things I always ask is, have you talked to anybody about how you negotiate your offer? Have you practiced, try the role play or share your benchmark knowledge? And then my question to you, this is not something you have to throw in the chat, but just to think for yourself, is there any specific thing that you've been putting out there?
And what's one step that you wanna take to move forward on that today? So is it a title change? Is it an RVU change? Do you wanna stop seeing. Dizziness or start seeing dizziness if that's what you love doing. And so almost always we can think, what's the one thing that would make things better? And I'm gonna give this example, which everybody used to laugh at, but I had a day where I said, what are like [00:41:00] five things I could do that would make my life better?
And one of 'em was I parked in a garage that when it was raining, I got rained on and there was a garage, like one garage over that if I got switched, had covered walkways. So I asked if I could switch garages. And then I unsubscribed from a whole bunch of email I didn't wanna receive, and there was a committee that I'd been on for a long time and I didn't feel was valuing me anymore and that I could pass off.
And I said, I need to rotate off this committee. It can be all kinds of different things. It doesn't have to be these big like negotiations with your boss. Maybe one of the best things that ever happened is when I got to go park in that garage with the covered walkway, to be totally honest. But think about some of those things, like it can be little things that'll make your life better.
What if you had your admin keep track of all the talks you gave, put 'em on your cv. Even if they're not perfect, the benchmark is there and you can go fix 'em later. And so find some of those things that'll make. Your life better with just one step that you can start with this week. So some of my wrap in my resources here is that [00:42:00] the common questions I get asked is I told we don't negotiate.
What do we do now? And I'm gonna tell you in so many places where people have been told we don't negotiate, they found out later that somebody else did negotiate. It's almost always a guy who said, I'm just gonna try and they got something for it. So don't take, we don't negotiate as absolute truth, especially maybe it's we don't negotiate on salary or we don't negotiate on vacation, but they can negotiate on time or.
Whether you get an MA or what kind of referrals you take, or what your clinic schedule looks like, there's so many things to negotiate. And then how do I ask for more without seeming ungrateful? One of the easiest ways is to frame that for the greater good, whether that's for the good of the patients or the good of the division, and it comes better from women if it's not just for the good of yourself.
But it's okay to say, I've worked really hard for this and this would make it easier for me to do. More research, which will make the division look good. Like you can find all ways to frame it. And then one of 'em is, what if I'm in early career, not in academics. None of this is specific to academics. If you [00:43:00] walk in the door and you're like, I wanna have Friday afternoons off, I wanna have an Ma I, all of those things don't matter whether you're in private practice or you're in academics.
If you wanna talk about, hey. I'm gonna walk in the door. I wanna take this job. I wanna know when we're gonna talk about me being partner, or I wanna understand the criteria for being partner. I wanna make sure that we've agreed on the buy-in for partner when I walk in the door. And if you're early career, it does not mean you're too early to understand what you want.
You just need to take the time to think about what's next. And this is why in the Kickstarter course I have, which talks about early career. The first thing we do is talk about identifying your ideal career. You look at your values, you look at where you wanna spend your time, and you make sure that your time matches your values.
And if you're not early career and you're in mid-career, I absolutely challenge you to think about the most important things in the filter that you should be using to say yeses and nos and see if that's what your yeses and nos really line up with in your time audit. So my key takeaways today are that women deserve to [00:44:00] negotiate with confidence.
But you have to walk in the room with warmth and then assertiveness. And quite honestly, if you have just warmth, which many of us do, it actually doesn't give us the respect we need because without the assertiveness, people will actually assign us a whole bunch of things. They don't think all that important, knowing that we'll do them.
And if we walk in assertive but not warm, we don't actually get the buy-in from the beginning. So walk in warm and then be assertive and medicine and surgery evolving. So be the example. Help people that work with you, give them the benchmark data, tell 'em that everybody has an MA or that everybody has a mid-level provider so that when they're negotiating, they know to negotiate for the same thing.
And you're advocating for your value, but you're also advocating for your patients. And your colleagues and your trainees and all of the people in your life, because when you are happy with what you're doing, it makes everything better. Now, these are some helpful resources that I love. One of them is ask for more 10 questions that you can [00:45:00] use to negotiate anything.
Getting to Yes is also really useful. And then Women Don't Ask is one that I especially love and it's specifically focused on how women negotiate. And then there's also an A MA. Women in Medicine Toolkit, which you might find really useful. So I'm gonna leave you with this thought, which is that when women negotiate successfully, they don't just lift themselves up, but they clear a path for others to follow.
And so if nothing makes you feel comfortable in advocating for yourself, I hope this thought will, which is that you can help the people walking behind us, whether they're colleagues or medical students, or people we haven't even met yet. Now if this stuff is useful, we do actually build on this in our own practice.
I have the academic medicine strategy group where we can work with people on one-on-one coaching. We also, and I'm very excited to be doing this, are working with entire departments where we spend 12 months and we have. A individual strategy session with every single faculty member where you can come up with your own [00:46:00] plan, where you can figure out how to get promoted or how to move ahead, or how to now negotiate for yourself or how to get that leadership position.
We do individual strategy sessions. We have that Kickstarter course I talked about to make sure that you're aligned with what you wanna do, and then we have workshops for the entire department to make sure that everybody gets a common language and understands how to do things like coach each other. Or optimize their time management or turn all of their clinical work into scholarship.
So if you're interested in bringing this conversation for your department please join us and talk to your chairs or the head of faculty development, your institutions. We would love to come and bring this conversation to you, whether it's as a grand rounds or as a conversation. And if you're interested, please come visit me online.
But we have a few minutes left, so I would love to take any questions if anybody has any.
Karuna, anything burning on your side?
That was fantastic. I really learned a lot, honestly, and I think I also identified some of the pitfalls that I have, patterns that I've fallen into as well. I don't [00:47:00] know if Priya also wanted to add anything, but can you tell us a little bit, what is one of the pitfalls that you think you've fallen into?
Like I said, in that first job, I didn't a, I literally didn't ask for anything I was told. This is your contract. And the chair said, this is a boiler plate contract. We don't negotiate. And I said, okay, thanks. I have a job now. Thank you to everybody. I love it. This is the perfect example. Yeah. Yeah. I didn't ask for a mid-level.
I found out I'd been there like a month and I found out every other attending had a mid-level and I didn't. So I backtracked and I tried to ask for a mid-level, and they were like, maybe you can have a scribe. And in the end, I got. What was the beta version of the AI scribe we're using now? It was very bad, a mal laryngologist, and 30% of my patients can't actually be heard by the AI scribe.
It was very bad. Yeah, no, a really good point I hadn't thought about. Yeah. But I think I learned from that experience. I learned from a lot of white. You had to say in that when it came time to look for a job again, I asked for specific things. I did try to negotiate. There was one place that offered me a position that didn't wanna [00:48:00] buy any dysphagia equipment upfront.
The chair said, come work here for a year and build a business plan, and then we'll buy you t and e scopes and then we'll buy you. And I was like, that doesn't sound like I'm gonna make any RVU that first year. So I was like, that doesn't sound like a plan. So it's, I think. I think this kind of group that we've tried to put together here for laryngology, the Ologists have a group and the female head and neck surgeons have a group.
And so I think it's important that we all talk about our experiences and what it's like. To look for a job and even to negotiate. I just recently negotiated for a new speech therapist and to figure out what her package was gonna look like and what equipment that she needed and how to ask for that before she arrived.
I think it's really important to talk to our colleagues about that because it's things that we don't necessarily talk about. I actually have a question that's very relevant to my life right now as I'm losing two partners. And basically taking on my entire division. It's not really a time for contract renegotiation, but I honestly [00:49:00] feel like this dis deserves a discussion with my chair.
If I'm gonna be expected to manage more work than I'm already doing, I don't know. How do I approach that? Yeah, it's interesting you said that. I literally had a coaching session with somebody today whose partner just left, and part of what we talked about is what are your boundaries? Just because they left doesn't mean that you're responsible to take on the entire division's patients, but there can be a conversation about what you are willing and able to do because burning you out because two partners decided they had to go is not the solution.
So do we need. Somebody else to come in. Do we need per diem or locums people? Do we need to just which, yeah, defer people to somewhere else, right? But you get to decide what am I willing to do and what am I not willing to do? And those are important conversations and those are exactly the kind of conversations that I have with my coaches is like, where are my boundaries?
[00:50:00] Because it feels overwhelming, right? Like you, I hear you saying, I feel like I have to take on the whole division. And it feels like that because I think many of us are told that, that we aren't necessarily supposed to have boundaries. I'm gonna tell you, the woman I talked to today walked in the room like, Ugh.
She literally told me she was gonna take over the clinic that the person had who vacated just left. And I was like, do you like seeing those patients? She's, no, I hate them. Don't take over that clinic. Don't tell 'em that's what you're gonna do for the rest of your life. Figure out a solution. Maybe a mid-level covers it.
Maybe nobody covers it. Like maybe that clinic is gone for two months. So I do think that we have to also expand what we think is possible because. In real time, it feels overwhelming and you feel like you have to do everything, but you don't. You get to still set boundaries and you also get to recognize that just 'cause the department's in a hard place doesn't mean you have to be the savior for it.
That's true. I think a lot of us, a lot of us think about it in terms of patients too, right? Like we are trained to think about the patient first. And so if no one is tending to that clinic, what's gonna happen to those patients? And it's really hard to put yourself in a mindset [00:51:00] that's not necessarily my responsibility.
That's the chair's responsibility, but not like I'm not here to save it. Absolutely. And I tell people like, you cannot fix. A system problem by giving up your personal time. I had somebody who was like, we are six months out. She was giving up all her administrative time and I said, how far outta you now?
Five months and 30 days. Like it didn't fix the system problem and she gave away all her time and felt terrible and was burning out. And so me burning out isn't gonna fix the problem. I had this problem at Johns Hopkins. I ran the only sleep clinic and I was six months out and I kept adding on patients and finally I was so overwhelmed and so burnt out.
And my giving away my personal time just made me worse for the people I was saying on an everyday basis than saying, okay, this is a system problem. We either need another person doing this, or we need to tell people they need to go somewhere else. If they're not, they can't wait six months. But my giving away my time, that was important for promotion time, academic time, breathing room, seeing my family, it wasn't gonna [00:52:00] fix the problem.
Going from six months to five months and 30 days is not gonna fix the problem except to make me so burnt out that I'm gonna be the next person who wants to go.
Thank you guys very much for in inviting me and I think we've taped this so if people want this in replay, we can absolutely hand this out. Thank you so much for doing this, Stacy. We're very grateful and thank you. Congratulations on the latest in Laryngology. Very cool that you guys are doing this.
Thank you. And if I can help anybody, please get in touch with us. We would love to talk and. We have a podcast and a blog, all of which are totally free and give you a lot of this information too. So please join us. Thank you. Thank you Stacy, and thank you everyone who joined us on the, it's Not a podcast on the webinar today.
And our next ladies of Laryngology in person event will be at the Fall Voice this year. So we look forward to seeing everyone in person. Everyone. Have a good evening. Okay, thanks. Bye-bye. Bye.
