Transcript

SPEAKER_05
0:04

Hi Denise, how are you?

SPEAKER_02
0:06

Hi, Ginger. Good to see you again. I'm great. Um doing well, I can't complain. And you?

SPEAKER_05
0:12

Doing fine. You know, I can't tell if it's spring or summer, but I know there's no more snow.

SPEAKER_02
0:17

Mm-hmm. Well, be careful.

SPEAKER_05
0:21

You know, I was gone almost the entire month of May, and I finally yesterday spent a couple hours in the heat planting a bunch of flowers on our patio.

SPEAKER_03
0:33

In your raised garden bed, did you did you get that rolling?

SPEAKER_05
0:36

I I ha I have planted a couple things in there, but I'm a little nervous because it doesn't get a lot of sun. Anyway, we'll we'll see. Um you know, the possiblest midwives, we're getting we're getting more we're getting more recognition. Uh just people knowing we're out there, you know.

SPEAKER_02
0:56

Not complaining about that. Thank you everyone for listening. Spread the word.

SPEAKER_05
1:00

Yeah, so I think we're we're picking up more listeners. You know what I think would be great is if people sent us questions. Absolutely. To the possiblest midwives. We have we have our uh email up there on the Buzz Sprout website. Also leaving comments if you're watching on YouTube. We would love for you to share your comments. These are these are all ways, as people know, to increase um the viewership. So today we're gonna talk about an issue, just you and I, um, that is that has been percolating, it seems like more in the season of graduation where you get a lot of people who are reaching out seeking help. And the new news is gonna connect to what we're gonna talk about. So I went to a source, Denise, that's gonna surprise you.

SPEAKER_02
1:49

Oh no. Are you serious? You're you but you never surprise me, actually. Never surprised me. So you can try, but what what's your source, Ginger?

SPEAKER_05
2:00

Well, you know, one of one of the big things that the individual midwives come to us for is helping them with their contracts or with their offers and feeling vulnerable, even people who who are trying to renegotiate. And I decided, just like I looked at Reddit, you know, a couple podcasts ago, what are they saying about midwives? I decided to see what the AMA says to physicians about job offers.

SPEAKER_02
2:27

Oh, okay. Is that a vowel? Are you shocked? No, I'm absolutely not shocked. Um, you you can try again, but you're searching all over everywhere. So I think it's a good idea.

SPEAKER_05
2:41

Is that is what I discovered is totally open source and it even links to a podcast series they have for physicians on jobs.

SPEAKER_02
2:52

Really? Who's um who's actually the who's doing the podcast?

SPEAKER_05
2:58

Physicians who are part of the American Medical Association resource packet that guides them through a lot of different topics.

SPEAKER_03
3:06

The possible physicians?

SPEAKER_02
3:08

No.

SPEAKER_05
3:08

No, no, they wouldn't, they wouldn't be that cool. Okay. Well, what'd you find out? What I what I decided to pull off of many, many linked URLs that I could have just gone on all night looking around. Was this one thing about be exacting? I love that word, be exacting about your contract. It's a little, it's like what Isaac said. Don't go with the trust me pro model, right? Right. So I'm I'm gonna read verbatim, some of which on the website. I will link it to our podcast so people can go look and browse around like I did. They're talking about two types of compensation models. So we're just talking about compensation right now.

SPEAKER_00
3:54

Okay.

SPEAKER_05
3:55

One called fixed compensation and one called variable compensation. So these are HR terms. A fixed compensation is a set salary not dependent upon the physician's performance, a model often used for new physicians. Sounding familiar.

unknown
4:12

Yes.

SPEAKER_05
4:13

Variable compensation, using formulas to account for a physician's performance. When determining salary, more experienced physicians typically receive variable compensation with benchmarks. Does that sound familiar? It does, absolutely. You should fully understand and be comfortable with how your compensation is structured. If not, ask someone to walk you through it using numeric examples. I love that. Before you agree to an employment contract, you should be familiar with what the median salary range is in that geographic location. If you do not know what your skills are worth in the local market, you will not know if compensation is offered by the practice or employer being fair. So you should calculate your annual earnings. Sounds check whether your compensation is tied to performance metrics such as patient visits, productivity, billing, or collections, and make sure you have a clear understanding of what is expected to you and factors that might affect your income for paybacks. Oh my God.

SPEAKER_02
5:22

Sounds very familiar, right?

SPEAKER_05
5:24

Does it does it not sound very familiar?

SPEAKER_02
5:27

Sounds like what we talk about all the time.

SPEAKER_05
5:30

All the time. And here's the last one, which is what I think holds up a lot in midwives. The physicians. A prospective employer will not retract an offer if you try to negotiate. If they've gone through the trouble to make you the offer, and trouble means a background check, all the information, reference check, everything. They've gone through all of that. If they've gone through the trouble to make you an offer, they value you and want you to come on board. And the most important part of this paragraph, if an offer is rescinded because you raise some questions about the employment agreement, ask yourself this question. Do you really want to work for that organization anyway? Love it.

SPEAKER_02
6:18

Absolutely, absolutely. That we t we say that. Is there a red flag then? You know? Can you if there's Yeah, I mean, they're getting good information, right, Ginger?

SPEAKER_05
6:30

They are. And yeah, it's widely available in the public domain if you search hard enough.

SPEAKER_02
6:37

I do think that last one that you brought up, really the fear of um they'll rescind the offer is really what holds a lot of people up. Um I I mean, I think that fear part, like they need to stay in the area. But the second part of that follow-up question is do you really want to work for them anyway? Where would you be a year from now? Would you regret things uh two years from now? Like, is it really worth it to, you know, put yourself on the line for things that are not clear or be to be undervalued?

SPEAKER_04
7:10

Yeah.

SPEAKER_02
7:11

I also say, I also say, Ginger, sometimes like you know what you're getting into, and you decide I can do it for two years to make my CV, my resume look well, I'm to get some experience, and then I can move on. So sometimes you're aware of the price you're paying for this lack of clarity or obscurity.

SPEAKER_05
7:33

Well, and what's important about what you're saying, Denise, is that you're aware that yes, you're going in to to the job with full transparency. Correct, absolutely.

SPEAKER_00
7:43

Commit to doing it, right?

SPEAKER_02
7:45

Absolutely.

SPEAKER_00
7:46

You can't be bitching about it, sorry.

SPEAKER_02
7:47

No, no, no, you I mean you can, but you you're if you're choosing it with wise eyes wide open, then I think it's fine.

SPEAKER_05
7:56

So why did I why did I decide to to extrapolate that from the AMA? Because what I have said a lot in the last month or so, and it is a season of graduation, so we have a lot of new grads reaching out, is I just got this offer letter. And I wanted to prove the point to myself of what I've been saying for a very long time, which is an employer would never give just an offer letter to a physician. Never. Yeah. And and prove my point. And so when we get this message, my dog wants to go under the desk, that um that we that I just got an offer letter, then what we will say is, are you sure that it's the only document that you will sign?

SPEAKER_02
8:52

Right, right. Is there something else that will follow? Is there a contract that follows the offer letter?

SPEAKER_01
8:57

And if not, ask the question.

SPEAKER_05
9:00

And if not, then you know what you have before you to think about. And what's happening lately, Denise, is they're just getting these one and a half page offer letters. That's it.

SPEAKER_02
9:13

It's always interesting to wonder why institutions or places of employment offer just an offer letter.

SPEAKER_05
9:21

Um, got any ideas as to why?

SPEAKER_02
9:24

I mean, I think there's a lot of um, you know, things that can be altered and changed when it's not written.

SPEAKER_05
9:31

I also think it's a it's a tactic, intentional tactic, for a non-physici provider to be labeled as a lesser van and sort of Oh, yes, that feels like a given. You know, they don't make you clock in and out, at least most of them don't, but they're controlling you by this very nebulous piece of paper that means nothing. Pretty much. It means nothing. You're at will anyway.

SPEAKER_02
9:58

Right, right. They also just don't really talk about what's not written in the offer letter, um, which is, I think, part of what you know we want to talk about today is the things that you have to do based on policies, procedures, and all the other things that you're not aware of when you're just given a little bit of an offer letter.

SPEAKER_05
10:18

So it's like what the AMA document did go into was when you get your offer letter, be very careful not to sign it. We heard Isaac talk about this, in that in some states, which I didn't know until that podcast, Denise, in some states they can enforce the elements of the offer letter, knowing there is 40 pages that are going to come later. In some states they cannot. And in some situations, the way the offer letter is written may or may not commit you to those conditions of employment. So the AMA's position was if you know another document is coming, a contract is coming, don't sign the offer letter.

SPEAKER_02
11:05

Wait for it.

SPEAKER_05
11:07

Wait, wait, wait for it because you're losing negotiation power.

SPEAKER_02
11:11

And this is a probably a good time. It there's also like not agreeing verbally, correct? Um, to to the job, just saying thank you very much, uh, thank you for the offer, and holding out by saying, I'm gonna take it, I'm gonna sign it, um, agreeing anything verbally because that could be held up.

SPEAKER_04
11:31

Yeah.

SPEAKER_05
11:31

Especially if there's a witness, right?

SPEAKER_02
11:34

Well, sure. Right.

SPEAKER_05
11:36

But I I I mean it really it really has struck me the last few weeks to see the number of offer letters only that are coming in. And I am wondering if it's if it's a new tactic to sort of tamp down the ability for non-physician providers to feel comfortable negotiating.

SPEAKER_02
12:01

I see what you're saying. So taking away that that leverage piece.

SPEAKER_05
12:07

What are you gonna negotiate?

SPEAKER_02
12:09

Right. Taking away the leverage piece.

SPEAKER_05
12:12

Yeah. You know, you're not gonna negotiate an employee manual. I mean, those are pretty standard for all employees, right?

SPEAKER_02
12:20

I think so. So that's interesting, Ginger. Um, so there's nothing to negotiate. So in a way, you you have less of a voice to even understand what you're leveraging for in a job because you're not going through the process of seeing what they offer, seeing how valuable you are to them. Um they've basically told you this is your value. And there's no more further discussion, essentially.

SPEAKER_05
12:44

Yeah, I yeah.

SPEAKER_02
12:45

I mean, you could you could negotiate from an offer letter. Yes. You can't. There's just less things that come to mind when you don't have all the points that you're negotiating. Sure, there's a checklist.

SPEAKER_05
12:57

Yeah, let's talk, let's talk about what likely you can negotiate on. The first one I would go for is salary.

SPEAKER_02
13:03

The one that's uh everybody thinks about is salary. Yeah. Right.

SPEAKER_05
13:07

My next one is what's an FTE?

SPEAKER_02
13:09

Right. Like what is your hourly worth for that salary? And um, I think that part, Ginger, we I think we've mentioned it before, but that part is the one that I'm always, always amazed that people don't think about it in hourly terms. And if you don't know what your FTE, the percentage that you're working equals in hourly terms, at a minimum, um, not even think about all the other hours you're going to invest in that organization for meetings, um, time documenting, reviewing patient charts, um, lab reviews, um, I don't know, sometimes retreats, you know, sometimes grand rounds, committees that you're expected to be on. All those hours that go unaccounted for that the institution should reimburse you for um or compensate you for, I I we forget those, and that hourly rate can vary significantly.

SPEAKER_05
14:07

For sure. And then go into the subcategory of what if what if Dennings is out and somebody has to cover her clinic in her call?

SPEAKER_02
14:18

Oh my god. What happens? That happens constantly, Ginger. That happens constantly for every reason that I I've seen in more within my own practice this year than I've ever seen before.

SPEAKER_05
14:30

You know, things that you do that you think docs do that for free?

SPEAKER_02
14:33

Uh they do not. I do not think they do. If they do, then they should probably call Grow Midwives and have a talk. Because maybe they shouldn't.

SPEAKER_05
14:44

I don't think that's standard practice. I don't think right would be something they could try to fly by then to agree to. Uh it you know, time is money. We just had a brilliant conversation with Diana Jollis about this topic, and and uh yeah, it's a serious, it's a serious problem for sure.

SPEAKER_03
15:02

Right, right, right.

SPEAKER_05
15:04

Another another topic they could negotiate is not negotiate, but ask for is any document that is referenced that they will abide by or that they're benefited to have. They just sort of say it in a sentence. I guess agreement, if you don't know what that is.

SPEAKER_02
15:25

I mean, I think I think that's true. Like I work in a place where there is not a contract. And um, you know, you you take the job. I took the job. I never in my life thought about the fact that there are things um that could have been asked for um in addition to you, you know, the salary, like changing the salary, increasing the salary. But if, you know, it what how how is um things like continuing education? Um, you know, how is that paid out? I am trying so hard, like um, to figure out how to go to a certain conference, but there's not enough money to go and pay for the very expensive hotels associated with that conference, which you know, and the tuition registration and the airfare, even if you take a percentage that you roll over into the next year, still not enough money to go to some of the conferences. So then you decide to just lose, you know, your CME money because you just can't afford to go for the price that they charge now. And it really is, you know, you know, you just have to pick and choose. So CME is a very important one, not only the the money that they will allow you to have, and or but the number of days that you get off to attend those.

unknown
16:43

Yeah.

SPEAKER_02
16:44

That's one small one.

SPEAKER_05
16:46

Yeah, um you just mentioned some more. So, like PTO, um, CME time, you know, policies and procedures are you're supposed to abide by, but you're never given the policy and procedure manual to read. Those things are often in very simplistic sentences. Very um the term of the agreement. So if you sign that piece of paper today and you agree to a salary of $120,000, you've now signed it in perpetuity if there is no term on that. A lot of people don't realize that.

SPEAKER_02
17:22

Which means no increase in salary.

SPEAKER_05
17:25

That's right. Unless you guaranteed. Guaranteed. There you go. Guaranteed.

SPEAKER_02
17:29

Right.

SPEAKER_05
17:30

You know, all of those things are examples. We haven't exhausted them. But there is some good things, Denise, to not having a big conditional contract, like non-compete. Oh, absolutely. Non-compete. Denise, go in a business across the street and bring in the money to yourself.

SPEAKER_02
17:48

I can walk out the door um and I could start a new business.

SPEAKER_05
17:53

And have a notice period of 30 days, 180 days.

SPEAKER_02
17:56

You know, what's interesting is when I first started my job, there was no notice period. So there was a time of major dissatisfaction um, you know, with our group, and we lost, you know, we started losing midwives left and right because incidentally we were asked to work more hours, but there was no discussion about what an FTE was. So they just kept adding in more clinics and more hours, and it's like, hey, hey, and we were not getting our sick and vacation. We had to just like work them and swap with people. So we were actually kind of not, we were robbed of our of that benefit part. Um, and so um people were leaving and giving two weeks' notice. And you know, for midwives and for professionals that require credentialing and and the process that takes so long to do that, um, you know, employment they it's just very difficult for the midwives that are left behind and the patients and the hospital, you know, or birth center or whatever. So they now instituted, I I believe like a two or three month um one, but it was a policy that went into play after the fact. Yeah. So, and what's the repercussions for that? Probably in in just ineligible for rehire.

unknown
19:12

Yeah.

SPEAKER_02
19:13

Right. That's that's the only repercussion. But if you left, because at the end of the day it was done, you're done with that job, maybe that really holds no weight over your head.

unknown
19:22

Yeah.

SPEAKER_05
19:23

Which is which is generous. I'm we have seen some harsh contracts whereby every day you don't give notice that you are required and agreed to give notice, you pay your salary, your daily salary in payback.

SPEAKER_02
19:38

The liquidated damages. It's incredible. Yeah. Yeah. So there there is that benefit um for sure.

SPEAKER_05
19:45

Um how practice insurance in tail.

SPEAKER_02
19:49

Well, you I really think you have to ask, but what is covered, you know? Um, because ignorance is not bliss in this situation. Absolutely can work very much against you. So if you don't if you don't know how you're covered, and if you don't know if it's an occurrence-based or claims I made policy with or without tail, you can walk out and it can be quite financially devastating.

SPEAKER_04
20:13

Yeah, for sure.

SPEAKER_05
20:14

For sure.

SPEAKER_02
20:16

And those are never written on the offer letters, Jinto.

SPEAKER_05
20:20

Oh gosh, no. So, you know, which brings that we will take care of your bro sentence.

SPEAKER_02
20:25

Right. Which brings me to the point for those who are currently working. If this, you know, you're already in the job comfortably, it would behoove you, I think, to have a copy of your insurance policy, your face sheet to have with you if you would ever leave. So you actually are aware of what is happening if you were to leave. So you should have your annual declaration page, so to speak. Yeah. A copy of that in your files.

SPEAKER_04
20:53

With your name on it, the type of policy, the one.

SPEAKER_02
20:56

The limits.

SPEAKER_04
20:57

Everything's on it.

SPEAKER_02
20:59

Right. The dates that it covers from you know, this date to this date. So, you know, what if for some reason you were dropped and then you know you were never told? So Yeah. Oh, bringing up a lot of tidbits here, Ginger. This is fun.

unknown
21:11

We are.

SPEAKER_01
21:12

We are.

SPEAKER_05
21:16

So, you know, if you're if you're faced with just an offer letter, there can be pros. We've just mentioned those. Typically there's not a non-compete, non-disparagement's left out. All the all the restrictive covenant. Covenant clauses are typically left out. However, it doesn't mean they don't exist in a manual that's referenced within the body of the offer letter. Which is why it's so important, regardless of what you're given to sign, that if there's some mysterious manual or policy somewhere that they reference, you just ask to see it.

SPEAKER_02
22:00

Due diligence, right?

SPEAKER_05
22:01

Yeah. I mean you ask the questions that are important to know. Like, if there is no notice period, that means I don't have to give you notice to leave, but also I don't have to give you notice to say, hey Denise, I want to talk about raising my salary.

SPEAKER_02
22:18

Correct.

SPEAKER_05
22:18

Versus a term contract, which will have time-limited parameters on a lot of things like salary.

SPEAKER_00
22:28

Right, right.

SPEAKER_05
22:30

So how do we help people get savvy about this? We're not just talking about new grants. We're talking about people who have been out there in practice for a while and they maybe they've never had a contract of any kind. This is an example that's happened in the past week. All of a sudden they have an offer letter and they're told this is all you get, and the person's like, okay, is that all I need?

SPEAKER_02
22:54

Is this a new job, Ginger? Or a new job for an experienced midwife?

SPEAKER_05
22:59

Okay. Am I protected? And and you know, I read the offer letter and I'm like, well, I don't know. There's a lot of questions here that they didn't answer in this offer. So let's say you get an you get the offer letter and you feel like there's nothing to negotiate because you just don't, the context of it is too foreign. It's not a contract.

SPEAKER_03
23:23

Right, right.

SPEAKER_05
23:24

And yet, as Isaac said, it is an agreement. It's a formal agreement once you sign it. How do we help people move to a level of confidence and self self uh worth to begin to ask these questions that are important, just like we started with the AMA, right? Ask the questions. You don't have to say they're bad people.

SPEAKER_02
23:54

Right. It's um I always call it, I don't know if I I don't think I stole this from anybody, but I I always say ask with a spirit of intellectual curiosity. Like, do you have this available? Um, you know, do you have anything else that I would need to know about, you know, what is expected of me and what I should expect of you as an employer? Like, yeah, you know, just really create a sense of transparency moving into this place of employment because you want to respect all that they expect of you, but if you don't know, you would you need to know and and vice versa, like what do you expect from me?

SPEAKER_04
24:31

Yeah.

SPEAKER_02
24:32

What can I expect about working holidays? Or, you know, what can I expect about, you know, as you mentioned before, you know, sick time, vacation time. What can I expect about paying for benefits such as health insurance, vision dental?

unknown
24:48

Yeah.

SPEAKER_02
24:48

So I think really just asking the questions shouldn't be threatening to them. Um, just ask cheerfully, excitedly, and you know, just with the sense of I just need more information.

unknown
25:01

Yeah.

SPEAKER_05
25:02

Oftentimes um a phrase I will coach people is to ask, help me understand what this yes. Or can you provide me an example of what a 1.0 FTE would look like? It's clear if they're not going to document that in clinical and call hours, you can at least put it down, date it as a piece of trailed evidence that you can use retrospectively if you're going to go forward at a later time and you know have a conversation about something you want to change. I think, but I think asking enough of those questions for you to completely understand everything you need to know better is that's that's the same kind of negotiating as we say people should do for a 40-page contract.

SPEAKER_02
25:59

Correct. So, Ginger, um, you mentioned like ask the questions and you know, leave a paper trail. Would you recommend that be done via email then? Because how else will you have a paper trail, so to speak?

SPEAKER_05
26:13

Perfect. Okay. Or if it's on Zoom, maybe you record it. But at the end of the conversation, you s you send a letter back to whoever you're talking to. Hey, Denise, it was so great to talk to you. These are the things that I mentioned that were important to me that we talked about. This is what I heard you say. I have a few more questions I want to follow up with before I sign. When can I talk to you again? Because you don't want to get in the trap of thinking that's the last conversation if you just learned something that you want to think about more. But that is your paper trail. Right. Then you're going to get a response from them. Uh, and you just save it.

SPEAKER_02
26:57

Yeah, I think that's a good idea. And even if you didn't ask the questions then, because you know, interviewing and talking with people, and sometimes the information is, you know, overstimulating or frightening, you can get off the phone and you know, meditate upon it, go to sleep that night and send an email the next day with the same questions.

SPEAKER_05
27:17

You know what has been fascinating to me, and it it probably shows my age and just technology. I I get text negotiations that are going on between the midwife and the recruiter, and they're doing this by text. And I mean, I get the full text, and I'm just like, okay.

SPEAKER_02
27:38

Wow.

SPEAKER_05
27:38

I understand that, you know, that's what's been going on here, but I still believe to this day, and every negotiation theorist you you read will say in person or in a relational live conversation, you're going to get far more out of what you want.

SPEAKER_02
27:56

Well, every relation expert will tell you that texting really misses, you know, so much of the tone and the attitude. And um, you know, really like how recoverable are texts? I mean, like, are those really like a paper trail, so to speak? So of course, you know, um, even if you do an initial Zoom interview or discussion, um, you know, I think text texting is perhaps the least uh best way.

SPEAKER_05
28:27

Yeah, I mean they're gonna it's so easy to just say no.

SPEAKER_02
28:31

I mean, right. It's uh texting it's dangerous.

SPEAKER_05
28:37

You're not gonna text for like 10 minutes to give an answer, right? Right, right.

SPEAKER_02
28:43

Um everybody has emails, so I think moving to the text route is is you know perhaps not advantageous to the person asking about the job, but it may be for the person offering it.

SPEAKER_01
28:57

Yeah, because it adds a level of urgency.

SPEAKER_05
29:00

Well, heck correct. At least for me, when I get a text, I like look at it. If I get an email, I might wait till the meeting's over or something.

SPEAKER_02
29:09

I mean, and then you Yeah, you have the opposite feeling of I've been ghosted. They're not responding to my text, and then you get all panicky, and then you're like, well, maybe I shouldn't have asked, and then this whole emotional, psychosocial, like um, you know, response kicks in and and then you know, forget it. So just maybe avoid text and go right to email that can be well thought out. You can reread it twice. That's what William Urey says, right? Or somebody says that he references like the worst, you know, worst case scenario is sending a text that you can't, you know, that you'll regret.

unknown
29:43

Yeah.

SPEAKER_02
29:44

He says it much nicer, but yeah, yeah. Taking the time to, you know, really thoughtfully read, I mean, and tech write and then reread and edit before you send is a very good, you know, both response and initial inquiry. Pause.

SPEAKER_05
29:58

Like pause, go to go to the balcony, right? I think it'd be great to just sort of throw in some of the Yuri philosophy here because I think that especially for newer grads, they're in panic mode. For all the reasons we all know.

SPEAKER_03
30:15

Right.

SPEAKER_05
30:16

And to get the job offer you have been waiting for that isn't the fit job, your dream job, has got to be traumatic in and of itself. And then to feel like you're under a clock, sign in 48 hours is very common, especially with an offer letter that they don't think will take you two minutes to read. The pressure begins to build. And so how can we help people just pause? Pause. Pause.

SPEAKER_02
30:47

Yes, nothing wrong with that.

SPEAKER_05
30:48

What are you gonna do when they go to the balcony, Denise? We're gonna tell them to go to the balcony and do what? Or go for a walk.

SPEAKER_02
30:54

Right. I mean, first of all, you you want to think about how what your your perspective about all of it is, but what are what do you think that the job is offering you? What what is their stance? Like trying to understand what they need and what they want is really important to really kind of pause so that you can, you know, reformat your questions that might address their needs as well. Which quite likely is going to be some of your needs as well.

SPEAKER_05
31:23

So I mean they they are offering a job to someone who has the skills to provide care to the people that come to them, right? You are you are a conduit to their aim. And remember, they're a business. They're a business, they they want to make money off of you. Fair to say, it's not derogatory. So, you know, when you're thinking about, let's just put ourselves in their shoes, why might they offer a new grad $30,000 less a year than you, Denise?

SPEAKER_02
32:04

Um they're thinking, I I think sometimes they're thinking, well, they will take some time to orient, they'll take some time to be um, you know, greater revenue generators. Um, so the value that they give to me as an organization, like I'm the organization, is gonna be lower than somebody who's been here um for for 15 years. Um so they don't have that learning curve and and they'll take a lot longer to do things. Right. So, you know, so I I mean I I think that's a fair thing to think um on their end, although I don't, you know, I think is it really worth $30,000 difference? I'm not sure. But I mean the other, I think the other part is like the need for mentoring that will come from the more experienced person, um, I think is important to recognize as well that there is a little bit of a difference, but you know, not not so that they agree to be undervalued though going forward. But I think in that case, you um recognize the person that has more experience.

SPEAKER_05
33:07

And then I totally agree in Pang disagree. And all the things you said, all the things. I I'm not so sure about the 30,000 gradient, although if I'm in the balcony up there, what I'm gonna be thinking to myself that we preach all the time is how do I know what I'm worth?

SPEAKER_03
33:25

Right.

SPEAKER_05
33:25

You are now a revenue generator, and we preach this all the time. And Diana Joel would say, midwives have very little understanding of the revenue cycle management model and what they are charging. Correct. So if you're at balcony going, how do I figure out what I am worth, right? We talk about this to the programs that we lecture who are about to graduate, midwife students, this is how you do it. This is how you figure it out. So even if you don't get that salary you want, you have a better idea of your revenue generating capacity.

SPEAKER_01
34:07

Gives you a little confidence.

SPEAKER_02
34:09

I mean, I think I think you, you know, whether you're experienced midwife and it's your third job or somebody who's new, I do think there is a gap in knowledge about what you truly are generating as far as revenue for most people. Like most people have no idea what is billed, what is received for the work that they're doing. They just have absolutely no idea. They're going to work, they're doing their work as a great midwife taking care of people. They go home and they don't understand, you know, what is being generated on the efforts that they have put in. So I think it's hard. I I think it's the I think it would be worth, you know, every year or two figuring out really what you are, what type of revenue you are generating as you're moving forward, because you might be quite astounded as we know, Ginger.

SPEAKER_05
35:01

I I think it's I think it's more than that. I think it's annual. That's how a lot of these variable compensation plans are paid out to physicians, lawyers, other people.

SPEAKER_02
35:11

Annual is great. They do an annual performance, so why not do an annual revenue generation awareness? Okay, Ginger, there's there's this other case scenario that sometimes we see where you have a midwife, a new midwife, maybe, who's been working for this institution for a long time. Maybe maybe they're a labor into every nurse at this institution. Maybe they also did their um their clinicals at this institution, and they really know that they want to work there. And the institution has the great um, you know, they they know them. They it's like I say, every time every day you go for your clinicals or your job, that's a job interview. So, and then they um get the job offer when they're done and they're making the transition to this new role, and they're absolutely like astounded by the salary, the benefits, etc. And like almost the fear of what they really thought was the case scenario is very shifted. Again, I think reminding people like they know you, they don't have to like suss you out, they don't have to like necessarily get references, they know you so well. So understand that that is incredible leverage and pause for what is not written in the the cover letter that you thought was the you know the best case scenario, and go back and talk to the midwives you worked with and see like, is this you know, I've established a relationship with you, I've been working with you in many different ways now. Is this kind of what you're offered? And a lot of times you become the change agent for the entire practice when you go back, because they say to you, sometimes those midwives, well, go back and ask for this, or go back and ask for that. Like in a way, they may be more immobilized and you may become this new person joining the practice that can begin to, you know, create some change. And I think that's fine. Own own that position.

SPEAKER_05
37:12

Oh my god, Denise, what a great example. I think that we've seen it happen. I think what you're saying is absolutely true. They're they're they're not in a place of negotiation for whatever the reason is, but that the new incoming person is absolutely in that position. Yeah.

SPEAKER_01
37:31

Absolutely.

SPEAKER_02
37:32

So don't fear it, pause, again, go to the balcony, take some time, you know, get more information from all of the stakeholders.

SPEAKER_05
37:43

I mean, the whole the stuff AMA said, have you done your homework enough to be able to know what questions to ask and probe for what's really important?

SPEAKER_02
37:56

Right.

SPEAKER_05
37:57

Um it and it's very nerve-wracking. Yeah. It is nerve-wracking. I mean, how many times in your life have you negotiated for a job?

SPEAKER_02
38:11

Are you asking me?

SPEAKER_05
38:12

Yeah. How many times have you negotiated for a job?

SPEAKER_02
38:15

Oh, um I actually have to say not that many. Um I've been to many different jobs, but I didn't have the skill set that I have now. And I can tell you 1000% that I would do it differently. Yeah. You know, I would do I would do it differently. I'm happy, happy where I'm at, but I would, I would why, you know, if just having my eyes opened, um, I would do it differently.

SPEAKER_05
38:42

Yeah. I I would agree. And and I can recall with great distinction one one job I negotiated into and negotiated out of. That's a good point. I think both of both of those are points of time um that are equally important. Because, you know, we do see these folks who got caught by a by a you know, unexpected tail hit um or you know, losing their job without any cause and and you know now what, you know, being given one week's notice and we're closing the practice. That seems to be happening a lot of places right now. Um we could get talking about discovery packages and health insurance and things like that. But the it it's it's bi-directional, right? It's a compact. So there is opportunity to change it with negotiation opportunities. Yeah, the girl's offer letter.

SPEAKER_02
39:53

Just an offer letter is not is never just an offer letter.

SPEAKER_05
39:59

They want you to think it's just an offer letter, you know.

SPEAKER_02
40:05

Just sign on the dotted line, you know, it's all gonna be good. We'll take care of you, you know, no worries. We'll take care we're good people, we'll take care of you.

SPEAKER_05
40:13

But when I I don't know what honestly, I don't know what triggered me to go to the AMA website and start taking a deep dive into this. But when I when I read just a prolific amount, and then I didn't listen to the podcast, but I know where to find it, of how people are being prepared as they transition out of residency. And most of them have jobs before their residency is over, which is one of the things we say all the time. Get your resume out there six months in advance, because of what you mentioned, Denise, credentialing takes time. Right. And if they've got everything possible lined up, shy of your certification and license, they can expedite it if they're big institutions very quickly.

SPEAKER_02
40:57

And there's something about like on that on that line, there's something about like already being like moving when you're like you're finishing your education, you're preparing for boards or whatever exam that you take. There's something about that drive that is already there that somehow drops off, dips down when you're done with your education. Um, that spirit around you, and you know, just I think that that dips, there's a little lull that happens. So waiting for when you're done is I think very devastating for a lot of people to get the impetus to start over or to keep going, I think, is is really can fall. And then those months lead to months, lead to months, and then where do you find yourself?

SPEAKER_04
41:47

Yeah.

SPEAKER_02
41:48

You don't have a job offer, you don't have a, you know, you don't have a start date, and then it's six months, and then it's nine months, and then it's a year. So I think that's a very good point, Ginger. I think that is incredibly important to remember.

SPEAKER_05
42:01

Yeah. Not sure why. We're having a little bit of internet trouble here, but we're gonna we're gonna keep going. I think we're doing okay. Um trying to think if there's anything else around the idea of how to navigate an offer letter. I I do think, you know, it's important for people to really believe you can negotiate this this one page, one and a half page document. Yes. Maybe even say, you know what's interesting to me? I just have this question. A lot of most of my colleagues or a lot of my colleagues entering this first job get these 30, 40 page contracts. I'm wondering, can you help me understand why your organization is providing an offer letter?

SPEAKER_02
42:54

That's a good point.

SPEAKER_05
42:55

Just just ask the question.

SPEAKER_02
42:56

Yeah, you want to be like everyone else. Right. Yeah. Yeah. Yeah. Again, pros and cons of it. Maybe you maybe don't want to ask the question, but maybe you want all the information that you would need, you know, without that.

SPEAKER_05
43:10

Yeah. Um I I can't think of anything else other than when we provide services for folks, we and if what they're receiving is an offer letter, uh, people will uh ask for contract reviews, and we basically don't put them through the full legal review process because there isn't anything there that's really not to review. Right. Uh so what we often suggest is that people just sign up for a coaching session, which you've done a lot of those, Denise, both of us to talk about how do you take this offer letter and what do you do with it. So, what are some things that you remember, you know, saying to people? What do they need to get prepared to counter an offer? Letter.

SPEAKER_02
44:01

Well, I mean, I think first and foremost, and I mentioned it already, is um we meant is first of all like figure out what you have to leverage. Like you go into a job, you interview for the job, they know you a lot, or they don't know you very much. So this is the opportunity for you to introspectively take a look and say, what actually am I bringing to the job and what and why is this job a good job for me? Just making a list of those things that you can leverage, like the things that you bring to them experience-wise, things that you've specialized, any languages that you might speak, any, you know, any other type of you know, concordant factors that you share with the demographics of the of the population that you'll be taking care of. Um I think starting with that gives you some serious solid footing for then any of the asks that come after that, you know, and making a list of those things so that you A, stay on track and you don't forget, but things that you can in further inquire about, things that you want to clarify, verify, and then even in an offer letter, things that you might want to modify or things that you might want to add to that offer letter that you want more clarity before you do sign it. Um, just as a point of transparency, just to be extra sure.

unknown
45:23

Yeah.

SPEAKER_05
45:24

And it is possible if you're not going to get a robust contract, that they create an addendum, an appendix, an additional document that you sign together as clarifying agreements. Correct.

SPEAKER_02
45:42

I think another point that we always talk about is really to practice the discussion with a colleague or a partner, um, kind of playing both sides of the of the table, so to speak, just to be comfortable with the language of what you're gonna ask or what you're gonna clarify. Many a times when you're talking with anybody that's handing you an offer letter or sending you an offer letter, they don't always have a lot of idea of of what you're gonna ask for. They they're not always sure if you have a recruiter or an HR person. They do not know about the ins and outs and nuts and bolts of a midwifery job.

SPEAKER_05
46:21

Right.

SPEAKER_02
46:22

So they often assume it's eight eight to five.

SPEAKER_05
46:26

Yeah. The people you're talking to are typically not the physician recruiters. Right. They they they are they have a a service line. The physician recruiters are are are left up to other people, right? So they're not necessarily prepared to think about the fact that you're going to negotiate with them.

SPEAKER_02
46:50

Right. That's a good point. It's a very good point. Yeah.

SPEAKER_05
46:54

Different world for them. So you're teaching them at the same time you're asking and inquiring and appreciating. Whatever they're willing to share.

SPEAKER_02
47:04

Right. So having an awareness of that language and in practicing it in a very quick uh quick study is a good idea before you go into it.

SPEAKER_01
47:15

Well, you want to wrap it up, Denise?

SPEAKER_02
47:18

I never want to wrap it up, Ginger, because I think we could talk on and on. Um, but you know, let's wrap it up, Ginger.

SPEAKER_05
47:26

All right. Who should start with a call here? Call to action.

SPEAKER_02
47:30

Um I'll start with it. I always, you know, if you ask me, I always say you have to. But let's just say, I think, you know, simply, simply, I think it's this. Um, in regards to the content we talked about, I think I think it's good to do a reevaluation of what you have to leverage every couple of years. Um, make a list because every couple of years you become a different person. You transform into something more, something more valuable, um, more aware, more skills. And I think understanding what those things are is a is a good starting point. So make that list. Um, and then if I had to add to it, I would say then find out how much financially you're you're important to the organization because that changes with each year, too. So your homework is a lot of information about who you are, what you are, what you have to offer, and how valuable you are.

SPEAKER_04
48:31

I like that.

SPEAKER_05
48:32

So I'm I'm just gonna say, I'm gonna enhance one of those things that you that you said, which is write down your your leverage, right? I'm gonna I'm gonna say translate that to your resume development every year. Yes. Put it put it in your resume and describe it in such a way that there is value added to whatever it is. If it's management, if it's quality improvement, if you're the guru for data development, you know, and reporting. And if you put it on your calendar that you're gonna do this every year, you will keep your CV updated, which becomes the very first thing any new employer is going to look at before they even decide to interview you, is how does your resume look? And we work with some people that have been in the same job for a decade, all of a sudden the job's gone, and they got to go find a new one, and they never updated the resume.

SPEAKER_02
49:30

And it's terrifying.

SPEAKER_05
49:31

I mean, despite the fact C AQH requires that, you're usually not doing it for big employers. They're doing it for you. And they're not including things that maybe they're putting in your CME. I don't know what they're doing. But it that's so important to just assess and to own.

SPEAKER_02
49:53

Yes. So I like that. It's yeah, to own it. Own it. Yeah. Okay.

SPEAKER_05
50:00

Well, another another great uh podcast. We'll uh keep rolling out. I think we're gonna be focusing on some of our speakers for the July 23rd conference, which we're very excited about and hope people sign up for.

SPEAKER_02
50:14

Um it's gonna be a great one, everyone.

SPEAKER_05
50:17

Yeah.

SPEAKER_02
50:18

Virtual. Many of you asked for virtual. Um, this year we're offering it as a virtual way to reach a greater amount of people who can't travel or who don't have enough CME money to travel.

SPEAKER_04
50:30

You can very economic, very economic.

SPEAKER_02
50:32

Very very important information, very economical. So yeah.

SPEAKER_04
50:37

All right. Well, have a great day, Denise. Good to see you.

SPEAKER_02
50:40

Thank you, Ginger. Good to see you.

SPEAKER_04
50:42

Bye-bye.

SPEAKER_02
50:43

Bye now.

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