Expert Consult

By Julie A. Freischlag, M.D., FACS, FRCSEd(Hon)

Published January 20, 2022


At the end of medical training, residents know so much about their chosen specialties, but little about negotiating their first job. The process is typically unfamiliar and daunting. As someone who has had many jobs in my career, I can say that being well-prepared — both practically and emotionally — is key.

I did a less-than-stellar job of negotiating my first academic role at UCSD. Since my first husband was doing his fellowship at UCSD, I thought I knew everything about the process. I did not prepare myself as well as I could have, and it turns out, I could have asked for more. This experience served as a good lesson a decade later when I was exploring the role of Chief of Vascular Surgery at UCLA. By then, I had more experience under my belt and was able to negotiate my needs more effectively.

Later in my career, when Johns Hopkins was looking for a Chair of Surgery, I initially declined the call to interview because they also were considering an inside candidate. Based on my experience with three other jobs that had hired inside candidates, I didn’t want to make the effort only to be turned down yet again. But, Johns Hopkins pleaded with me to interview and I gave in … only to be hired as the first female Chair and Surgeon-in-Chief of the Department of Surgery. I stayed in that position for 11 years. To think that I initially turned down the interview! This experience taught me to face my fears.

Think Beyond the Salary

Although money is always the first thing people think about when exploring new positions, it’s the least important aspect of the negotiation. Before you start the negotiation process — indeed, before you even apply for a job — make sure you know what you want and need to ask for. This involves mapping out a clear career plan with goals and a realistic timeframe to achieve them.

While salary, bonuses, housing expenses, and health benefits are typical needs that can be negotiated, there are other factors to consider. For example, moving a family can be challenging, particularly when it comes to employment for spouses and partners. Definitely inquire about spousal and partner hire within the organization. If you want to preserve time with your family, consider negotiating flexible on-call hours. If one of your goals is to build an academic career, ask for protected time to teach or conduct research and time off to attend national meetings. If you will have a research lab, outline the kinds of support you need (e.g., supplies, technology, and equipment). If you will be conducting clinical research, ask about access to databases, statisticians, and epidemiologists.

I also recommend that your contract include specific language about scope of work and expectations. You don’t want “other duties as assigned by the employer” to involve daily tasks that do not align with your career goals. A contract lawyer can help you with these types of details. In my opinion, a contract lawyer is a must for negotiating positions in private practice.

The details of contracts can be overwhelming, especially for residents securing their first positions. In addition to contract lawyers, mentors can be excellent resources when considering a particular job and contract. Program directors and division chiefs also can be extremely helpful, particularly if you are looking to move to a different institution.

Practical and Emotional Checkpoints

Whether you are negotiating your first academic role or one later in your career, honestly ask yourself if your vision matches that of the leader above If your visions do not match, determine to what extent, if at all, you are willing to compromise.  Will you have sufficient resources to assure your success? If the position does not work out for the long-term, will you still gain great experience? For greatest professional and personal satisfaction, you want to make sure the opportunity matches your intellectual curiosity, passion, and entrepreneurial spirit.

Throughout the negotiation process, keep in mind the following checkpoints:

Practical checkpoints:

  • Know why you want the job and what you can accomplish in that position.

  • Know who works in the organization.

  • Know why you are best suited for the position.

  • Know your competition.

  • Know what you need to be successful.

  • Know when you need to learn something new.

Emotional checkpoints:

  • Do not want the job too much.

  • Do not assume the job is good or bad.

  • Do not eliminate schools, location, or opportunities.

Own the Process

While your credentials, experience, skills, and reputation influence the negotiation process, project your best self by genuinely conveying your passion for your work, creativity, and energy. Attitude has a lot to do with success. Don’t be afraid to take chances. If I had given into my reticence about interviewing at Johns Hopkins, I wouldn’t have become the first female Chair of Surgery! Don’t be afraid to go outside of your comfort zone for your future. As Oprah Winfrey said, “Do the one thing you think you cannot do. Fail at it. Try again. Do better the second time. The only people who never tumble are those who never mount the high wire. This is your moment. Own it.”

Dr. Julie Freischlag is the CEO of Wake Forest Baptist Medical Center and the Dean of the Wake Forest School of Medicine. Previously, Freischlag was Vice Chancellor for Human Health Sciences and Dean of the School of Medicine at UC Davis. Freischlag has helped to drive change in academic medicine with a deep commitment to diversity and inclusion. For more than 15 years, she has led education and training programs at top medical schools in her role as professor and chair of surgery and vascular surgery departments.