"If I had to boil down the advice, I would say that the most important thing that I did not know, that I've learned over time, is that you have to be prepared," says Stephanie Dukhovny, MD.
Societal pressures and inherent biases make contract negotiations particularly challenging for women. In this interview, Stephanie Dukhovny, MD, discusses key points from her recent presentation on negotiation at the Society of Women in Urology (SWIU) Annual Clinical Mentoring Conference in Scottsdale, Arizona.Dukhovny is an associate professor of obstetrics and gynecology at the Oregon Health & Science University School of Medicine in Portland.
I've given versions of this negotiation talk to a number of different audiences. But I had given it at Oregon Health & Science University, which is where I work. Somebody noticed it on Twitter, and so I was invited to talk. The main goal of this presentation is to really empower women physicians, so people who identify as women, to lean into having more challenging conversations with their leadership about everything from their schedule to promotion to pay equity, [basically] whatever it is that they need in order to make their jobs manageable, so that they're less likely to burn out in the long run. Women physicians, and especially women surgeons, are very at risk for burnout and for leaving medicine and academic medicine specifically.
There is a lot of inherent bias that is present for females in medicine. I think the one that we tend to run into very frequently is that when you ask for something as a female physician, you're interpreted as being aggressive or not being a "team player." It's much easier for male physicians to advocate for themselves and come across as somebody who is a real go getter or advocating for their patients. When women negotiate in the same way, their behavior is instead interpreted as “aggressive “or “pushy.”. There are some common things that women hear. One is, "I’m surprised to hear you ask for this, I always rely on you to be more of a team player." It's much harder to come into a situation where you're just advocating for yourself. That's one of the biggest challenges.
Another is just the societal pressure on women. We tend to wait for people to notice our efforts, rather than highlighting them. Women tend to be more uncomfortable saying, "This is what I've done." These are obviously big generalizations, but women are much more likely to sit back and assume that somebody will notice the work that they've done, and men are just socialized to be more comfortable saying, "In the past year, I had 8 publications, and I'm mentoring 6 residents." That's definitely challenging. There are a lot of biases that are present in the workplace that, I think in the 1950s, 60s, and even 70s, were very out in the open, like the show "Mad Men." Now, it's much more subtle. A lot of men think of themselves as feminists, so they really don't think that the workplace is biased toward women, but you can't get around the fact that there's a pay gap in every medical subspecialty that's formally evaluated it. It's hard for a woman to come into a negotiation and point that out, because oftentimes the person on the other side of the table feels like they're a feminist. It's hard to tell somebody that they or their organization is sexist. Organizations are not gender neutral; they are biased, and there's a lot of second-generation bias that still exists at all parts of organizations. When I gave my talk at the SWIU meeting, I heard a lot of women say they have been told, "You seem angry." I don't know a female physician who has not heard some version of that in their career.
If I had to boil down the advice, I would say that the most important thing that I did not know, that I've learned over time, is that you have to be prepared. These meetings are not casual conversations; you need to come in with data and a plan. And that preparation is something that we're very good at, right? We've all studied for boards, and we've all taken a million exams. So it's actually not that hard to do the work in advance.
Another piece of advice to try to make it a little less intimidating is to really think about it as like a conversation. It's like a problem-solving session; don't come into it throwing your ask down on the table and expecting a big fight. What you want to do is think about the person on the other side of the table. What is this person's interests and goals? What are their values? What are the most important things to them? Line those up with your list of values, try to figure out where they match, and then start out at that location. For example, say something like, "I know we both highly value the research mission." Try to find that common ground right away, and then work from there to make it feel a little bit more like a conversation and a little bit less like a conflict.
And going back to doing the research, you should research not just the people that you're negotiating with, but the issue itself. Let's say in your contract, you want more protected time than they're offering for research. You’ll want to know, what does the institution generally offer for research? What do other people in the group have for research? When is it reevaluated? What is the expectation for grants? You really want all that data when you're coming into it; you don't want to come in and just say, "This is what I want," without any evidence to back it. That way, if they say, "No," you have that evidence behind you to present. Preparation is key.
The other piece of advice I give people that I think is very undervalued is that you really want to make sure that all the right people are in the room. The last thing you want to hear from the person across the table is, "It's a great idea, but I have to talk to so-and-so about it," because now you're all a sudden not in the conversation anymore. You want to make sure that if you're going to have this negotiation, this conversation, all the decision makers are in 1 place, so that you avoid that situation. Ideally, it should be in person. It should also be at a good time for everybody. You don't want your department chair getting paged out, right? You want to make sure that it's a good time for everybody, even if that means it delays the conversation a little bit. You want to make sure that everybody's in a good space to have this conversation.
I think the most important thing in these conversations is trying to figure out the “why.” If I was the boss, and somebody came to me with an ask, and they just throw it out there, what I would want to know is why? Why do you think you need more protected time? Why do you need that title? Why do you need more PTO? Because I think that the other thing that can happen in these conversations is that although the more junior person thinks they've figured out a good strategy, the person in charge may actually have a better plan. The example that I always give in my talk is a person came to a negotiation and said, "I want this title." But what she didn't say to the people in the room is the reason she wanted the title was because she was worried about her CV and a delay in promotion. Because if she didn't have the title, she wouldn't get promoted in the time frame she was hoping for, which leads to a pay gap, because promotion is tied to salary. If the people across the table had known that, they might have had a different solution. Let's say she said, "I'm worried about promotion." And what if they said, "We were thinking about putting together a promotion and tenure committee that evaluates everybody at year 2 to avoid delays in promotion." She might not need the title if she has that reassurance that she's going to get promoted. You should always coming to the table with not just the [ask] but also, what is the reason they wanted to meet?
One of the things that I always talk about that I think is a huge problem for women especially, if these conversations become contentious, is that it's very easy to get emotional. Classically, people do not make good decisions when they feel emotional—either angry or upset, or tearful, or defensive, or guilty, or whatever the emotion is. Even in the most malicious situations, the person on the other side of the table knows that, right? They might say, "I'm surprised you're asking for this. I always rely on you to be so reasonable." And now you feel so guilty. I went to a talk at the Association of American Medical Colleges Early Women's Career Conference, where they mentioned a concept I haven't heard anywhere else called the "emotional basement." When you feel emotional, you're in the basement part of the house, and you cannot make any good decisions there. You need to get to the ground floor. And the way to get out of your emotional basement and onto the ground floor is basically with facts. So you've come in with all these data and facts. You can feel your heart rate, you feel the tears, you know what's happening. So you look back at your sheet and use these stock phrases: "I'm surprised to hear you say that," or, "Can you clarify?" or, "Can you elaborate?" Give yourself a minute, and then go back to your facts and say, "I have been here for 7 years; I have done the following things." Go back to those facts to bring your heart rate down so that you're back on the ground floor and in a good place where you can have the conversation. And then worst-case scenario, if that is not working, instead of agreeing to anything, say, "You know, I really wasn't prepared to have this conversation. I'm surprised to hear such a negative response. And I'd like to stop the meeting now and resume this conversation at another time." And just get yourself out of there.