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Deeply ingrained gender traits make it difficult for many female emergency physicians to successfully negotiate their contracts. Here are five negotiating pitfalls, and strategies for breaking the cycle.

Whether you are a senior resident looking for your first job or a senior researcher looking for tenure, as you dust off your interview suit don’t forget to brush up on your negotiation skills. And while good negotiation skills are important for everyone, they may be especially critical for women. Babcock’s infamous Harvard Business Review study (2003) showed that male graduating business students were far more likely than females to negotiate the salary of their new jobs (57% versus 7%). As those who negotiated increased their base salary an average of 7%, it is easy to see how a 10 minute process can impact long term earnings. Of course an individual’s personality, qualifications and specific circumstances can clearly impact their negotiation style and success, but women in general – even high powered and outwardly successful ones – often struggle at the negotiating table (see inset on page 25 for examples).

To understand why negotiation can be such a different experience for women and men let’s walk through a fictional case. Meet Carolyn and Mark: two smart and hard working chief residents at a prestigious residency who are looking for their first jobs.

Ideally, both Mark and Carolyn are interested in staying on at their training program. Mark started talking to his program director and chief at the beginning of his third year to explore possibilities. Carolyn took on an extra administrative project and volunteered to do resident scheduling. She hoped that if she did these two jobs well, her residency director and chief would take notice and ask her to stay.

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Gender Difference #1 Getting to the negotiation table in the first place.
Many business schools teach the 80/20 maxim: spend 80% of your job doing the task at hand well, and the other 20% making sure the right people are aware of your brilliant efforts. In general, men are more comfortable self- promoting and accepting responsibility for their own career development (Myers, Why Women Should Rule the World 2008.) Successful men often take credit for their success and attribute it to a specific talent or work ethic while successful women often downplay their skill sets and claim that they were simply “lucky” or part of a talented “team”. Men are also more likely to put their names in the hat for a promotion even if they have not yet mastered all the prerequisites for the new position (Women Matter, McKinsey & Company 2007).

If Mark is not hired by his residency program, he has now placed himself squarely on his chief’s radar and this in itself may lead to additional projects that will help him be more competitive to other programs. Carolyn, on the other hand, is waiting to be asked. She is betting that high quality work in and by itself will get her noticed and that if her department really wanted her to stay that they would approach her. Unfortunately, Carolyn, and women like her, may unknowingly concede too much of their own professional development to someone else. A harried boss may simply overlook a qualified woman or assume that she is content with her current position especially if her competition is more forth coming and assertive.

Solution: Don’t wait for an invitation, develop one and five year career plans, chunk it down to action steps and share them with your boss.

Their chief announces that he is hiring someone with fellowship training so Mark and Carolyn start looking for jobs in a competitive middle-sized city. There are two hospitals they are both interested in with the County Hospital having a significantly lower salary than Midtown Central. At her second County interview Carolyn hesitantly tries to determine whether the starting salary is negotiable and is curtly told that salaries are standardized and non-negotiable but that she is eligible for a bonus after she passes her boards. Mark is told the same thing but then successfully negotiates moving costs, ACEP professional dues, and a two weeks Christmas vacation for his wedding.

Gender Difference #2 Concept of what is actually negotiable.
Men are four times more likely than women to negotiate (Babcock, Ask For It 2008). There are certain situations like buying a car where most women expect to negotiate. But there is a whole other universe of things, like upgrading a hotel room or swapping a rental car, that many women simply fail to recognize as negotiable. When interviewing it is important to consider salary and non-salary items for negotiation, such as: protected non clinical time, moving costs, CME time/costs, scheduling, administrative help, office space, computers/software, committee assignment and mentorship. Women can miss out on these perks because they may be oblivious to their existence and not privy to causal conversations where they are discussed.

Solution: Find data. Start by networking with colleagues and searching national salary databases and begin to consciously meet new people at regional and national conferences. At job interviews, ask for the contact information of recent hires and ask them what they had, or wished they had, negotiated for prior to signing.

Fast forward, both Carolyn and Mark are going back for second interviews at the higher paying Midtown Hospital. Mark goes into the interview knowing that he is likely going to get an offer and fully expecting to negotiate. Carolyn feels grateful to be asked for another interview but is undecided about potential negotiation. She reasons that simply getting the job would be an incredible opportunity and that she would already be making a lot more money than she did as a resident and 10,000 more than at County. Furthermore, she figures she would be in a better position to negotiate if she waited until she had proven her value.

Gender Difference #3 Threshold to initiate negotiation.
Small (Journal of Personality and Social Psychology 2007) did an elegant series of negotiation experiments and concluded that women tend to need a little extra nudge to initiate a negotiation. In their experiments when there was a clear suggestion that negotiation was possible only 17% of women versus 59% of men negotiated. But when they subtly manipulated the wording to suggest that negotiation was not only possible but also quite acceptable, the amount of negotiators increased to 58% and 83% of women and men respectively.

Solution: Practice!

Many women simply feel that negotiation is not worth the hassle because they believe whatever benefit they might gain is offset by the potential awkwardness of the interaction and their anxiety over the anticipation of being told “NO!” (Arch Psychological Reports 1993). Interestingly, however, many of these same women can quickly channel their inner Henry Kissinger when they are asked to negotiate for the needs of someone else. The trick is to desensitize the negotiation experience by practice. Start with low stress/low consequence situations like asking to get a supermarket discount without a membership card or exchanging a clothing item without a receipt, then work up to bigger things like asking the mechanic to throw in a free oil change with a car inspection. Most people who do these exercises quickly realize two things: that they can successfully negotiate for a lot more than they ever imagined, and that even when unsuccessful it’s usually not such a big deal.

During their respective interviews both Mark and Carolyn are officially offered jobs. Mark graciously smiles and thanks the group for the offer and then quickly moves on to see if they can compete with the offer from County. Over the next hour they hammer out a deal. When the director of the new group comments on what a tough negotiator he is, Mark jokes that it’s because he’s financing his upcoming wedding and deftly switches the conversation to the city’s professional sports team.

Carolyn’s thrilled with her offer and also realizes the time is right to negotiate but somehow she can’t seem to bring it up. She doesn’t want to get taken advantage of, but she is acutely aware of making a good impression. She is worried that if she tries to get a better deal she might appear entitled or “high maintenance” to her new colleagues. Plus, she’s is a little gun shy after sensing the County’s director’s irritation when she asked about salary during her interview there. Ultimately, she decides to stall and asks for a few days to look over the contract.

Gender Difference #4 Potential consequences of negotiation
The Achilles heel for many professional women is their concern that negotiation will jeopardize their being “liked”. Unfortunately this is a real possibility. To understand why, we need to do a quick primer in social psychology. There are two predominant male prescriptive stereotypes: competence and dominance. It is relatively easy for women to adapt to “competency”, especially if they do so while aligning themselves with other stereotypical female traits. In English, a good female charge nurse successfully keeps the flow of the emergency department moving and is an empathetic and effective communicator.

 “Dominance,” however, is a little trickier for women to pull off, as it is at direct odds with another female prescriptive of “deference”. Dominant females tend to have a hard time because they buck ingrained unconscious societal expectations (The Double-Bind Dilemma for Women In Leadership, Catalyst 2007.) This is why so many first generation female surgeons got dinged when they tried to adopt the mannerisms of their male mentors. As traditional negotiation falls under this “dominance” umbrella it can carry potential negative consequences for women. Bowles (Organizational Behavior and Human Decision Processes 2007) showed this experimentally by asking men and women to compare interviews of job applicants whose gender and attempt of negotiation were controlled. They found that male evaluators were more critical of women who negotiated and rated them as less likeable and more demanding. The ideal way to address this issue is to change societal expectations, but until then . . .

Solution: Modify how you negotiate.

Traditional male negotiation is often referred to as distributive or “dividing up the pie” negotiation. It assumes that there are finite resources (the pie) and that everyone is competing for a slice. An alternative type of negotiation is “log rolling”, a term originating from when neighbors used to help each other clear their fields. In this collaborative approach each party tries to understand the needs and values of the other party so that when a deal is made the outcome is optimized for both parties. The classic example used to describe the different styles is that of two parties negotiating over a bunch of oranges. In distributive negotiation each party ends up with ½ the oranges. In logrolling, it is determined that one party is interested in making juice from the pulp and the other spices from the rind. After understanding this, the groups decide to divide the oranges up such that one party gets all the pulp and the other all the rinds.

Women (and men) can capitalize on logrolling by prioritizing their own personal needs and potential concessions and then exploring the needs of the other party (Kray, Research in Organanizational Behavior 2004). The key to logrolling is identifying common ground. For example, if Carolyn is broke and needs money for state licensing fees she could negotiate with, “I am very excited to join your group and I know it is important to you that I start as soon as possible, as I have a great deal of medical school debt it would help me avoid potential credentialing delays if I were able to get assistance for state licensing fees in lieu of moving costs.”

As Mark is planning his honeymoon with a signed contract, Carolyn’s still playing phone tag with Midtown’s director. After the fourth message she starts getting worried that the group might be reconsidering their offer. When she finally makes contact (just as the director is rushing into a meeting) she feels so flustered that she not only agrees to the original offer but also to starting two weeks earlier than anticipated just to “help the group out”. When she hangs up she is just relieved to have it all over.

Gender Difference #5 Mindset going into negotiation.
As many men assume that work-related conflict is part of getting things done, they often approach negotiation with a “bring it on” attitude, almost as if they are competing in a sports event or betting on horses. Women usually carry a slightly different mindset and, given the choice of professional negotiation or a colonoscopy, would happily grab the Golytely. Because of this aversion and their desire to simply be “done with it”, women can unknowingly harm their chances for successful negotiation with haphazard timing and apologetic buffered wording.

Solution: Prepare and positively prime.

No chief likes to be blindsided in the hallway about salaries or protected time. Give your boss advance notice by setting up a meeting to discuss your professional development and have your data ready. As you walk into your meeting positively “prime” yourself by recalling a personal empowering event such as receiving an award or a professional accomplishment. Yeah, it sounds hokey but believe it or not, Al Franken’s Stuart Smalley character on Saturday Night Live was actually on to something with his “I’m good enough, I’m smart enough and doggone it, people like me!” mantra. Behavioral psychology is full of research showing that an individual’s performance can be subtly manipulated after being positively or negatively primed. (Small, Journal of Personality and Social Psychology 2007.) Conscious positive priming offsets physiological arousal that can lead to anxiety, cognitive impairment and underperformance (Shin, Psychological Science 1999). For an “Aha!” study on this topic, see Maas’s Italian internet chess study (European Journal of Social Psychology 2008). Here, men and women were matched for their chess ability and then blinded to the gender of their opponent. They were then subtly “primed” that the purpose of the study was to figure out why international chess was so male dominant and were told they would play a series of games against individuals of their same and opposite sex (when in fact they were playing several games with the same opposite sex partner). When women thought they were playing women they split the games, when they thought they were playing men they lost 75% of the time! Chess move strategic analysis suggested that the men’s approach remained relatively consistent regardless of their opponent’s gender but that the women subtly altered their approach from an offensive to defensive strategy when they thought they were playing men.

OK, so Carolyn and Mark’s experiences are purely fictional, but unfortunately gender differences in physician salary and professional development are quite real. LoSasso (2010 Health Affair) studied the salaries of 8000 NY graduating residents. After location, type of practice and anticipated work hours were factored men were paid 16,000 dollars more. Similarly, a recent JAMA article (Jagsi 2012) looked at mid-career medical researchers and found that even after adjusting for hours worked, academic rank, academic productivity and specialty that there was still an unexplained 13,000 dollar discrepancy between male and female researchers. And in our own specialty, Society of Academic Emergency Medicine just published salary data suggesting that female faculty are paid 10-13% less and female chairs 11% less than comparable male peers. (Watts, Academic Emergency Medicine 2012). Although the reasons for this are multi-factorial, gender negotiation differences likely play a significant role. So as this year’s interview season approaches, it’s time to take game show host Monty Hall’s infamous words to heart and learn how to say, “Let’s Make a Deal!”

 

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