Saturday Morning Rounds August 8, 2020 - The most important variable in a negotiation

Posted by BossB, MD on August 8, 2020
BossB, MD

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

We've had a number of conversations this past week about what we like to call the "pay:time" ratio.

It's a simple and essential fact that almost all of us are trading our time for money at work. Most people just focus on total pay, but once we shift our paradigm to focus on the pay:time ratio as the most important variable in a negotiation, we gain the ability to think clearly and creatively about how to achieve the outcome we want.

Given the importance and ubiquity of this topic, we're going to repost an article from our archives that covers it in greater detail:

Women Did Everything Right. Then Work Got ‘Greedy.’ - How America’s Obsession with Long Hours Has Widened the Gender Gap

This article, written by Clair Cain Miller from the New York Times, presents a compelling narrative about what drives the typically large pay gaps within white-collar couples. A few trends that have been increasing for decades now have come to a head, creating an environment that often limits women's earning potential - namely:

  • Work - Particularly compensation for working long hours
    • "Being willing to work 50 percent more doesn’t mean you make 50 percent more, you make like 100 percent more.. The trade-off between time and money is not linear."
    • "Four decades ago, people who worked at least 50 hours a week were paid 15 percent less, on an hourly basis, than those who worked traditional full-time schedules. By 2000, though, the wage penalty for overwork became a premium. Today, people who work 50 hours or more earn up to 8 percent more an hour than similar people working 35 to 49 hours"
  •  Coupling
  • Parenting
    • "Highly educated women are more likely to have children than they recently were. Eighty percent of women in their early 40s with doctorates or professional degrees are mothers, up from 65 percent two decades ago"
    • "Being a parent, particularly a mother, has become more intensive. Working mothers today spend as much time with their children as stay-at-home mothers did in the 1970s. The number of hours that college-educated parents spend with their children has doubled since the early 1980s"
  • The bottom line (with a little good news mixed in!)
    • "There’s no gender gap in the financial rewards for working extra long hours. For the most part, women who work extreme hours get paid as much as men who do. But far fewer women do it, particularly mothers. Twenty percent of fathers now work at least 50 hours a week, and just 6 percent of mothers do... There has always been a pay gap between mothers and fathers, but it would be 15 percent smaller today if the financial returns to long hours hadn’t increased"

Here at BBMD, we talk often about the tension between (a) the fact that these problems are systemic in nature, and (b) the reality that we can't afford to wait for the system to change itself. For the "systems-based" side of things, the author offers some solutions that would be great to see raised in a legislative session or a board meeting: 

  • "Certain changes would lighten parents’ demands at home, like universal public preschool, longer school days, free afterschool care and shorter school breaks. But the ultimate solution, researchers say, is not to make it possible for mothers to work crazy hours, too. It’s to reorganize work so that nobody has to. The most effective way to do that, Ms. Goldin’s research has found, is for employers to give workers more predictable hours and flexibility on where and when work gets done."

  • "Conventional wisdom... is that this is impossible — certain people are too valuable and need to be available to clients anytime. But some professions have successfully challenged that notion. Obstetricians, for instance, used to be on call when patients went into labor. Now it’s much more common for them to work eight-hour shifts in a hospital — and many more women do the job."

For the "can't afford to wait" side of things, see our tip of the week ;)

Who we're following 

One of our favorite Tweeps, Dr. Kimberly Manning, MD (@gradydoctor), is crossing a couple of big milestones next month and could use your help celebrating!

BBMD tip of the week

If you're reading this, you're almost certainly a physician. And if you're a physician, you're almost certainly employed in a model that trades your time for money.

People tend to think that because they're not paid an hourly wage, that because they have some mix of "fixed" salary and/or variable (RVU, bonus, etc) compensation, they have flexibility. But really, that just obfuscates the fact that there's a hard cap on your pay, and it's directly related to 3 variables:

  1. How much "doctoring" you can fit into every minute (increases with efficiency, support staff, etc)
  2. How many minutes per year you can spend "doctoring" (the focus of the article we shared this week)
  3. How much money you get paid per minute of "doctoring"

However, most of our clients come into the "negotiations" phase of our curriculum thinking that we'll be focusing most of our energies on how to maximize their total income - e.g. how to go from $100,000 per year to $125,000 per year.

In reality, the more important number to focus on (and maximize) is #3 - your pay:time ratio.

And that's great news! Because institutions often have a lot more flexibility to offer time (and time-saving resources) than they do money. While getting "pay" as high as possible certainly helps the equation, getting "time" as low as possible is oft-neglected and offers far more viable routes to success.

Here are a few examples of variables you can negotiate (or tweak in your own life) to maximize your pay:time ratio:

  • Paid time off
  • Parental leave
  • Commute time (this one gets you on both ends - it's essentially uncompensated work time, AND increasing your commute is the most reliable way to tank your quality of life/happiness)
    • One way to get your employer to help with this is a moving/relocation stipend - instead of thinking of that money as money saved on costs you would have incurred anyway, consider rolling it into a home that gets you closer to work
  • Productivity-based compensation (higher $ per RVU generated, lower RVU thresholds to achieving bonus, etc)
  • Call shifts/night shifts/schedule in general
  • Support staff (esp. a scribe and/or a mid-level)
  • Admin/research time
  • Dedicated office space (if that would help you work more efficiently)

There are even some more unconventional ideas that you can propose which (a) the private sector already offers so there's precedent + social pressure and (b) might actually be lower-cost to your employer and higher-impact to you, such as:

  • Childcare (onsite, subsidized, etc)
  • Laundry service
  • Free meals
  • Pumping room for nursing mothers
  • Legal aid from their counsel if you've got any issues with your previous employer
    • This is actually a situation we see often that can really add up quickly if you deal with it yourself - just remember that these institutions often have retainers with law firms or employ internal counsel, meaning a much lower cost to them for the same result
At the end of the day, the real goal for most of our clients is to operate at the top of your license and to get paid at the top of what's possible for doing so. Once you realize that time is often a more malleable variable in that equation than money, it provides a lot of creative solutions to achieve what you want.
Quote we're contemplating

All this talk about the cost of family planning and pay:time ratios can make it very difficult for a physician with children to avoid calculating the monetary loss from every game or recital or field trip they attend. And that can be a dangerous thinking trap to fall into, because humans are powerfully loss-averse by nature. So while we can't afford to ignore these economic realities, we should also strive to keep them in perspective and remember what it's all in service of. Antoine de Saint-Exupéry says it best in The Little Prince (chapter 21 - if you don't know the book read the whole chapter, it's beautiful):

"It is the time you have wasted for your rose that makes your rose so important."


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PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!