Transcript

SPEAKER_01
0:05

Good evening, hello ginger.

SPEAKER_00
0:08

How are you doing? Good.

SPEAKER_01
0:11

Man, we've decided that maybe the evening is the best time to do that.

SPEAKER_00
0:15

It is true. Evenings are good.

SPEAKER_01
0:18

So you can start to see the sun. It's still up here in Kansas City. We've still got light, and it's 6 38 in the evening. So uh we got we got more sunshine now. Hey, we all need some some sunshine, some vitamin D. I know. You know what it makes me think about? What? So, you know, we bought a new we bought a new camper.

SPEAKER_00
0:40

Yes. I can't wait to like crash it.

SPEAKER_01
0:43

We can we can we can have a big conference inside this thing.

SPEAKER_00
0:48

Maybe we should. We should have a lot of small group um, you know, sessions for yeah, brainstorming.

SPEAKER_01
0:54

I've I've told my two granddaughters they could they could have a dance-a-thon inside. Um, but we're really excited about taking it out on its first voyage in a in a couple weeks, and this weather just makes me despite the freezing weather, I'm I'm ready for spring. Yes.

SPEAKER_00
1:11

Go fly for spring. Maybe a week ago when it was here, and then it yeah, it lied to us.

SPEAKER_01
1:15

Surprised all surprised all of us, didn't it? Yes. All right. Well, you know, I decided because we've been having a lot of people reach out with questions about job offers, that maybe we you and I just need to get down to the nitty-gritty and talk about the the good, the bad, and the ugly, as I often say. And so you know what I decided to do today? Um, you're gonna tell me. I decided to look um just type in the word midwife job and look at what search engines popped up. And I will say that they are prolific. Okay. Um, of all kinds of of um options like LinkedIn and ZipRecruiter and Glassdoor, and there are even some health management ones. And I thought, you know what? I'm just gonna try in our PhD minds random selection of a job offer. And I just took it and and you know, we've done enough contract reviews now, we've we've seen just about everything, and I we've actually seen this one quite a few times, and I'm like, I was just gonna go with it. All right. So, Denise, I'm gonna give you a job offer that came came out today, and um, then we're gonna talk about it. All right. So um I'm gonna have to change my glasses because the glasses I have now are for my computer, and I I need to do some some better um examination here to read it to you. Okay, so Denise, this is for a full-time CNM job. I'm just gonna say in the south. I'm not gonna give you the state. I don't we want to be careful here. Okay. You could potentially work at two different office locations, okay. Deliveries performed at one hospital with a level two NICU. Okay. And the job is four days in the office a week with one night call per week.

SPEAKER_02
3:25

Okay.

SPEAKER_01
3:26

You're gonna see about a 50-50 blend of OBNGYN patients. Okay. You're also gonna be on call one weekend per month. Oh, okay, and see about 20 patients a day.

SPEAKER_00
3:40

Um, okay.

SPEAKER_01
3:41

I am going to offer you $120,000 with some CME and reimbursement. Oh, but there's benefits too. Come on, there's help vision, some kind of matching. Okay. A company paid malpractice insurance.

SPEAKER_00
4:00

Oh, that sounds good.

SPEAKER_01
4:01

And a supportive, appreciative culture.

SPEAKER_00
4:06

Oh, I wonder what that looks like.

SPEAKER_01
4:08

Now I'm gonna put my other glasses on. Okay. And and you know, just say 125. 125 No, no, no, 120. Okay, I heard 120, darn it. Okay. So getting hey sister, are you are you gonna look at this job?

SPEAKER_00
4:27

Well, I haven't let's see. Well, I've been currently working as a nurse. Um so I wonder what 120. I'm gonna have to I'm gonna have to do some I'm gonna have to do some exploring to figure out more about this job. Now, the support of appreciative culture, for them to mention that, that sounds really nice. I wonder what that looks like. Um, but yeah, it's kind of difficult. Well, now that I am a little bit more cynical than I used to be, so I definitely would have to explore each of these options.

SPEAKER_01
4:59

Well, let me tell you the bet the math the math I did. And this is a little bit of a logic tree into what we're gonna talk about today, which is how do you really analyze an offer and how do you think about the different things that they might put in an ad versus what you might want to talk about to for them to verify, right? Or clarify. So let you know what I do, Denise. I always say, and and look, I don't practice anymore, but I sure would never do an eight-hour patient-facing day and be done at eight hours.

SPEAKER_00
5:29

Uh, it's not possible.

SPEAKER_01
5:30

Okay. So I usually add one hour. So if you're in the office four days, eight-hour days, I made that 36. Mm-hmm. Okay. And a one-night call per week. And I'm just gonna guess and say that's 12.

SPEAKER_00
5:46

It could be 12, but it only could be like 5 p.m. till the next day, 7 or 8 a.m. We don't know what that actually means.

SPEAKER_01
5:55

We don't we don't really know what it is, but I I said I will just say I gave it 12, which equals 48 hours. Okay, 48 hours. Um and one week into month, which I did 48 divided by four, which would be an additional 12 hours per week. Okay, so makes it on average, not every week, but on average you would be working a 60-hour work week.

SPEAKER_00
6:21

Right. Okay.

SPEAKER_01
6:22

So I went to the salary hourly calculator, my favorite device to look up on the internet, and I put in $120,000 for a 60-hour work week. And do you know what that hourly salary is? Not gonna be great. Um $38.46.

SPEAKER_00
6:40

You're not you're you're hurting me here. $38.

SPEAKER_01
6:44

Okay, there we go.

SPEAKER_00
6:45

That's my math. Okay. Um, okay, so that's work hours. Um, will there be I wonder, you know, there are things that aren't really being discussed here, such as like meetings. Yeah. Um, you know, any expectation for committee work, any extra coverage? Um, what happens like if you know there's a m person at the job that can't do these? Are they going to keep the office open? Are they canceling those clinic days? Will there be expectation to pick up more?

SPEAKER_01
7:21

So before we get into these kinds of details, let's just talk about this as new news. Okay. This is a very common offer. Yes. It is. And when folks are out there looking for jobs, do you have do you have any advice for maybe how to sift through? If if I know it depends, right, if they can move, if they can't. But if they're trying to sift through job offers, what would you say?

SPEAKER_00
7:56

Well, I I do think the questions of, you know, if they can move is a big one. So I think you you first have to look for really what you want in a job. Like what scope of practice do you want to actually do? Do you want to do full scope? Do you want to do um work in a clinic and work in hospital and or a birth center? Like, are you finding the type of job that is good for your soul for what you're looking for? The type of practice. So that's that's kind of number one. And in my mind, and then the second one is like, how do you want that to look? How does that work with your life, your family, your other commitments? Yeah. Um, and by that I'm really looking at many things. It I'm looking at like hours that you're gonna going to be committed to this job. I'm looking at, you know, salary, of course. Um looking at other fringe benefits, which shouldn't necessarily be fringe, but things such as you know, loan repayment or even CME. Um, are you gonna be able to, you know, have some help with CME reimbursement and all the other benefits and the malpractice? So um, you know, it's not an easy, it's not a one-liner or a two-liner. It's just so many things to consider. But I think the first thing is are you going to be working at a job that is going to feed your soul?

SPEAKER_01
9:19

Yeah, I think that's a good point. And so maybe let's just set aside the work hours and the salary for now and talk for a minute about how you might find that out. And you know, we've had some guests on here talking about networking. I think Emily Portis talked about that a little bit, getting connected. Other things I often suggest is like look at their website. What's the mission, vision, and values? You know, what is a staff dynamic look like in the women's division? How many docs? How many midwives? How many NPs?

SPEAKER_00
9:54

Uh what services are they providing? Exactly. You know, like are they doing, you know, very basic? Are they doing a lot of different specialty um procedures or or you know, have have different specialty clinics or focus like that?

SPEAKER_01
10:10

What's what's the ratio of of doctors to midwives? I've seen some where there's one doctor and seven midwives, and I have seen six doctors and six midwives. Uh, the configuration of the types of providers. Are they AFMs? Are they CPMs? You know, what what what does it look like in terms of the types of providers you'll be working with?

SPEAKER_00
10:35

So many things, yeah, to really consider. So you you did talk about really like I looking at social media sites as well that might might discuss, you know, how the care is provided. And again, it goes back to what, but also how and patient satisfaction. And eventually you'll you're gonna get the mood for the provider satisfaction as well.

SPEAKER_01
10:56

You know, one of the things I do, Denise, when I'm coaching sometimes, if if something I don't do it all the time, but if I get the hint of uncertainty, I'll go look in Yelp, or I'll go look on uh social media and type in the organization and see what the reviews are.

SPEAKER_00
11:12

Sure.

SPEAKER_01
11:13

It may be commenting. I mean, it's amazing how people are brutally honest.

SPEAKER_00
11:18

And they're usually brutally honest when the care isn't great, right? Yeah, right. That's absolutely right. But you do want to know about those, like you can assume that the care is always good or the environment is always good, but you're gonna get the true flavor when you do delve into these reviews sometimes. So that's a great idea.

SPEAKER_01
11:36

So one of the things I think is important is before you even think about some of these details we led this conversation with is how much homework have you done about what you're walking into? Like, do you look more into purchasing a home in the community that the school's in or the kind of car and the service agreement that you're gonna get than your job?

SPEAKER_00
12:00

Right. I mean, it makes me think immediately about the people that you're dating, you know, also like I mean, sometimes you just date someone because it seems right, or there's this chemistry, but you're not always gonna know what the chemistry is for the job. And I don't know about you, Ginger, but as I get older, um, my criteria for any relationship that I have, you know, I you you begin to make a list of the things that you really are looking for or not looking for, whether it's a a partner or whether it's a friend group or whether it's a job. I mean, I think it's really important to make that list and not just take the first thing that comes um because you know, it might not be the greatest thing.

SPEAKER_01
12:42

Yeah. Yeah. So I other things you can do. I mean, Emily blew me away when she said she scheduled an appointment with a pro with a with a midwife in a practice and didn't tell them she was looking for the job.

SPEAKER_00
12:55

I love that story. I love that story. It's like if you want if you really want to get the into the inner sanctum of the practice, that is a great way to do it. There you go.

SPEAKER_01
13:05

See how they I know. Uh being involved in the affiliate. Uh you know, they're they're just, you know, talk to the doulas, childbirth educators. There's lots of ways to try to sort of get it, get a get the flavor.

SPEAKER_00
13:20

Get the flavor of it. Yeah. Because it's also the best way to network and find the jobs too. I mean, yeah. Of course, if you have a job offer, but it also is the way that you have are get you get known to other people.

SPEAKER_01
13:34

So let's let's just use this as kind of a template, but there probably will be more things we talk about. Um let's let's say we're interested in this job, you know, right? And one of my thoughts is man, if somebody gives you an offer, go through the process, even if you know you're not going to take it, because you learn a lot. You do. And you can practice.

SPEAKER_00
13:57

Yeah, you're practicing like just taking a microscope or a magnifying glass, which I I usually need anyway, because I'm getting older. But you take that magnifying glass and you start looking through this one, and then you begin, even if you're like, oh no, no, you get an idea, you can make a comparison chart um with the next one. Oh, what did they not offer? Oh, this one's offering this, and you begin to see gaps of what is out there, what is not, and then how varying they can be. Yeah. Yeah. I mean, I always kind of tell people if they have several options to create that, you know, Excel spreadsheet or whatever, and you have your columns. Yeah. And you sit and really compare things that each one will talk about or not talk about. And that sets the stage for really what to go back for to inquire. Are you well, uh are you offering this?

SPEAKER_02
14:48

Yeah.

SPEAKER_00
14:49

Or how much are you? Not are you, maybe not a yes or no answer, but how much are you offering for?

SPEAKER_01
14:54

Yeah. Well, one of the things that's sort of been going around um on some of the listservs I pay attention to is what kind of questions should I ask in an interview process? And I I think, look, if you've been given an offer, you're already past the interview process. Now you're you're at the negotiation table. What kind of questions might be strategic for you to gain more knowledge? And we talk about this a lot. Do you have a couple and I'll throw out a couple?

SPEAKER_00
15:26

Um, I think, you know, we I I I think one, I mean, I always I always go toward numbers, but I think actually, I think one thing that's really important is finding out kind of on the line of how many how many people are in the practice and what the ratio is, but how long, how long have people been there?

SPEAKER_01
15:46

Yeah.

SPEAKER_00
15:46

Like what is the longevity? Like, are people um staying at a job because they want to be there because they are treated well? So what is the retention rate, or are people flipping jobs frequently because it's not a good place to be? So I think it's it's a question that is often forgotten or isn't asked. Um, and I think asking that in an interview is you know very it will provide a lot of insight into what else is going on. Absolutely.

SPEAKER_01
16:14

One that um one that I think is important is to ask about compensation beyond the base salary. Okay. And I'm pausing a little bit because sometimes they'll offer you that, but not describe it very carefully or very clearly. And other times it's just a base salary, you're at will and you have this offer letter, and they're not going to give you a contract. But I think it's really important, especially people get all excited about oh my gosh, I have a three-year term, or I have a five-year term, that means I have job security. I'm like, ah, timeout, that might mean that's your salary for three or five years. Right. Is to ask the question, just like physician providers establish their panel of patients over time, I see my contract term or is at will, or it's, you know, for three years, how willing is the practice to consider adjusting my salary after we have more information about my productivity? Can you tell me about that?

SPEAKER_00
17:18

That's a really good point right there. It's not only it's it's also like you're gaining experience, you're gaining more patience, but also if you're stuck on a three-year salary, you don't even have any promise of any cost of living increase, let alone all that you bring over the years to the practice. Word of mouth, um, more skills that you develop, more revenue generating skills procedures that you might be doing. And so you're, you know, kind of sticking with uh the initial salary is really cutting yourself short.

SPEAKER_01
17:52

Yeah, I think a lot of people assume that cost of living is a given, because if they come from a nursing profession, that is typically what you get if if they're giving it, but but not in these relationships.

SPEAKER_00
18:07

And or they they often assume that you'll get a performance evaluation raise, which is not guaranteed, and it's the first thing to go out the window when there's any type of budget cuts. You might still get the cost of living, maybe not, can't guarantee it. But that performance, well, we couldn't just we couldn't give it this year, you know. How many times does that hurt? So not only is it not can't be expected, but it's the first to go typically.

SPEAKER_01
18:32

So let me take you back to this random job offer I saw today. It's out there, guys, if you want a job. Right. Um they this is a 1.0 FTE, and they this is their definition: four days in the office, and one we don't know how long that that night call is during the week. Right. We won't even add on the one in four call yet, but you could. Like, let's talk about definitions of FTE.

SPEAKER_00
19:01

I mean it's not banker's hours, right? Absolutely. Um, so that's a mistake. Like, I let me just say here, HR often just has this idea when midwives go to to ask questions, they're just under the assumption a lot of times that um that the midwife they're working 40 hours a week, that 40 hours is a 1.0 FTE.

SPEAKER_01
19:27

Um and you think that's because of the APP workforce different than midwives?

SPEAKER_00
19:33

I mean, I think that is generally what the world believes. I mean the US world believes, but then Okay, I know what you're saying. Yeah, so I think that's a a common thing that people believe. But of course, adding in or comparing to the APP workforce, the world, they do typically have a 40-hour work week. That's it. Yeah, no nights, no weekends, no, no call, no backup call, none of the other things. So immediately, yes, there is a a vast difference. So if they did have that idea, yes, that's a problem. Yeah. So I mean, we've seen Ginger, like, oh my gosh, we've seen that a 1.0 FTE could be the 40-hour work week. Could be 36. Could be a 32 or a 30-year-old. Could be a 32. Um, why am I getting tripped up there? Patient-facing hours will be 32 with eight hours of admin time, you know, kind of accommodating for that time that you're not spending with the patient, but you're you're doing work for the you know organization. Or it could be in this case, 60 hours, or it could be way more than that. Yeah, you you added in all the meetings. Or you, or it could be undefined where you have a situation where it's written that you will divide, evenly divide call with the number of providers. And they don't necessarily say how many providers there are. So it could be three people, it could be five, or it could be based on the month, um, whether people are on vacation, right, out on sick, out on extended leave for any reason. So, you know, you go from dividing it with five people to three, and nobody takes into consideration that all of a sudden your work hours have incrementally increased. And your contract happens to say you will work uh uh as needed.

SPEAKER_01
21:21

Right, right. To meet the patient, uh, to meet the patient needs. Yeah. So you're kind of trapped.

SPEAKER_00
21:27

Right. Um it's always it's exhausting. Just that one part of these contracts or job offers, that takes a long time to even to tease out sometimes. It's just mind mind blowing. And like correct me if I'm wrong, it's really one of the things that people don't take into consideration when they look at the salary and they compare what would what that would come out hourly. It's astounding. And I can't tell you the gasps that people you know that that they're. Express when you say, well, let's look at this hourly, and then then you have, well, I make more as a nurse, or that's exactly why I did the math on this one at 38.46 an hour.

SPEAKER_01
22:10

Right. The BLS for a midwife is 6326. So the Bureau of Labor Statistics is what she's referring to. Yeah, and the BLS for an RN, this is just data from today, is $45 an hour. So this is you know.

SPEAKER_00
22:27

Yeah. And so this is well below even the RN salary.

SPEAKER_01
22:31

So maybe a strategy here where we we will always want to give solutions is a couple questions. You know, one of them, one of the softer ones when you're negotiating might be, you know, I looked on the BLS website and the average salary for an RN is $45 an hour. When I calculate the amount of virus hours I think I'm being asked to work over a month, and the average is 60 hours a week with the salary you're offering me. That's that's barely over $38 an hour. Can you help me understand that? Is my math correct?

SPEAKER_00
23:08

Right. That is a very nice way to ask it. Um, it's very it you you don't want to be defensive, you don't want to be aggressive, you don't want to sound, you know, I guess ungrateful. Um but just I why I call this intellectual curiosity. Like, can you help me understand why is is such a great way to ask many of these questions, Ginger?

SPEAKER_01
23:29

Yeah. Because people are, first of all, unfamiliar with the art of negotiating. There's an automatic power differential that we put ourselves in, like we're not good enough to to defend our salary or we want the job so bad, we don't want them to rescind the offer, but but something we say over and over again in these nine years, uh two two people have had their offers rescinded that I am aware of, and they were asking for way out of the ballpark.

SPEAKER_00
24:02

Right.

SPEAKER_01
24:02

Of or or just not even willing to negotiate um what I would say is is a fair process. You have to give on both sides, right?

SPEAKER_00
24:12

Right, right. Absolutely. That's that does make both sides happy, is when there's you know a win-win on both sides, and also that sometimes means one side gives, right? Yeah.

SPEAKER_01
24:23

And I think fit in the world of research, they're looking for a good fit as much as you are looking for a good fit. And if they have, I can't tell you how many people will say to us, oh my gosh, the recruiter couldn't believe how much research I did. And I ask really great questions, and that is bringing a level of professionalism to the conversation.

SPEAKER_00
24:48

It really does. It really does. It's true. Like they don't, I think a lot of recruiters don't they don't always have the answers to. Um, so you're teaching them while you're asking them questions. Um, and that's that's pretty impressive.

SPEAKER_01
25:01

Yeah. Other thoughts about this software, Denise?

SPEAKER_00
25:06

What's well, I mean, we could dissect it every single part. Like how how deep do you want to go? So we we talked a lot about really considering what hours you're working, whether those work for you, how much you're compensated for those hours, how much you're not compensated or you're doing that is not included in this formula at all, which is often forgotten. Let's concept.

SPEAKER_01
25:30

Let's talk about let's talk about the line that says CME reimbursement. Oh, sure. There's no discussion about any anything about licensing or any of that kind of stuff, you know, right, right. Right.

SPEAKER_00
25:43

And, you know, okay, first of all, that line in and of itself doesn't give you information. It doesn't tell you how much. But you if you're like, oh, they're gonna reimburse me for CME, exactly. Um, are they gonna reimburse me for the cost or are they gonna also reimburse me for time to do the CMEs? And then what happens, Ginger, we see a lot, which is so bizarre to me, um, is what is actually included under this umbrella of CME, which is not has nothing to do with CME reimbursement.

SPEAKER_02
26:14

Exactly.

SPEAKER_00
26:15

And there's where you I think what you're alluding to is what about all the fees that it takes to be a professional in your organization to work for you? So professional license, credentialing, um, you know, certification, like your your annual certif recertification, your DEA number, your license, your, you know, re-licensure, you know, a couple years later. And um, am I missing anything? Um sometimes there's credentialing fees for medical staff and the payer plans. Oh, sure. Right. So there's a lot of things that they often will lump under this category, which has nothing to do with CME. Uh Denise, what hypothetically, I'm gonna give you $3,000 for your CME. Wow. Um okay, so if I'm paying my license in DEA out of that, I've just crossed over $1,000 um for that year alone. So I'm left with $2,000. And if anybody knows how much conferences cost and travel and transportation, I'm gonna be paying a lot of it out of pocket. Yeah. Um so Ginger, um, if you were the one offering me this job, Ginger, how much um, how many days of CME are you offering along with this? Three. Three. And this is a full-time position? Yes. Um okay. Well, I want to ask perhaps why it's okay. So we generally like to see like five days, um, a full week. Um, and you know, it takes time to get there, it takes time to do the conference, it takes.

SPEAKER_01
27:59

But Denise, it's it's part of the PTO uh days.

SPEAKER_00
28:03

And you get eight to you get 18. Okay, you get 18 days of PTO paid time off, which is usually just doesn't that cover like sick vacation exactly. Um, well, mental health days, but who talks about those, right? And does that also cover my holidays? Everything that I have that I might be working anyway. Yeah. So yeah. Anyway, you get the you get the idea, audience, here that these these do not necessarily describe what we might expect from other places that you come from. And maybe you came from places that didn't offer this, so this looks really great. Right. But it's not a bad idea to compare that to other places of employment. What is what is the national average for some of these?

SPEAKER_01
28:47

Yeah, we've seen some surveys, Denise, for advanced practice providers. We don't make this stuff up, although we do kind of know the average. We we know. I mean, do you want to share it or do you want me to? Um, just start sharing it. Yeah, I mean, we on average it's five, it's five CME days. Correct. In addition to PTO. Right, right. And the average CME for CME is $2,500, and the employer pays for all those other things Denise listed.

SPEAKER_00
29:17

Separately. Separately should not be part of that. So it, you know, basically you give them your receipts um and they will pay them dollar for dollar what they cost so that you're not having to really tally up an amount and take it out of, you know, other banks that they might have for you.

SPEAKER_01
29:35

Yeah. Yeah.

SPEAKER_00
29:36

Oh, so yeah, we I would say, you know, we've even seen, you know, much higher CMEs um reimbursement. You know, I've seen as much as like 7,000. That's not very common, but in in general, 2,500 is is what we what we do see. Yeah. Um and it I'll just say one thing. It shouldn't necessarily be prorated based on your FTE. You're like if you're 0.6 or 0.8. It you still require all these things to do the job. So, like you're you know, you don't get a pro rated DEA license, you don't get a pro rated license fee. So it really should not be prorated for for your FTE if you're 0.6 or 0.8.

SPEAKER_01
30:18

That is such a great point, Denise, because it typically is.

SPEAKER_00
30:22

Yeah.

SPEAKER_01
30:23

It typically is. I can't wait.

SPEAKER_00
30:25

Yeah. I think the CME days is maybe the only thing you might negotiate that you get a week's worth.

SPEAKER_01
30:30

Yeah.

SPEAKER_00
30:30

So if you work a 0.6 and that comes out to be 24 hours, if you're lucky at your job that a 24 hours um to 40, then you get, you know, you get three days or whatever.

SPEAKER_01
30:40

Yeah.

SPEAKER_00
30:42

Um so where are we at now, Ginger? What what else do we want to take a look at here?

SPEAKER_01
30:48

Yeah, there's one area I don't want to take a deep dive into because I think our next our next topic um we're gonna we're gonna invite Isaac Booth on to talk about contracts.

SPEAKER_02
30:58

Okay.

SPEAKER_01
30:59

And some of the pitfalls of of contracts. So um meaning, meaning sort of the the restrictive clauses. Oh, sure. More of the restrictive clauses. Yeah, the things that you want to sort of worry about.

SPEAKER_00
31:13

The things you have no idea when you're in like mid midwifery school what these things even mean. So exactly. Perfect.

SPEAKER_01
31:19

What what what do you expect out of a benefits plan? Because sometimes we see these contracts that say, you know, we're gonna give you benefits like the other staff, but they may not necessarily be as elevated as the physician benefits package.

SPEAKER_00
31:37

Oh, that's a good one. Well, I mean, you know, I I would say this benefits package is very, very variable among different types of practices. And it will depend on often the size of the practice, whether you're um private practice or academic practice. But then also, sure, the different tiers that go to the providers in the practice. Um again, it depends on who owns it, right? So if you are owned, if a physician owns it, they might make sure that their physician colleagues have a higher tier of benefits. But um, I mean, certainly the basics um we would expect of health insurance, um, vision, dental.

SPEAKER_01
32:21

Yeah.

SPEAKER_00
32:22

Um, and then it starts to get a little bit um interesting when it comes to you know, life insurance and then um oh matching, yes, disability and matching, retirement and and disability and all of those, yes. So you gotta really look at them. Right. And then it's not a bad idea to really inquire about what your simple things like what your co-pay is expected. So if you're thinking that you're gonna get um some type of health insurance, uh you you have to really look because it they're not always created equal. And so are you paying majority or are they paying majority? So how much is it worth? Again, when you're thinking about your your job and your life and you know, whether you need other have other people that you need to cover benefits for, maybe this isn't gonna even come near to what you need. Yeah. Or you know, or maybe, oh Ginger, here's another part. Maybe you do have a partner that's covering benefits, so you can use this benefit portion as a negotiating factor to say, I don't need benefits. Will you pay me a stipend instead for what you're not paying for my benefits?

SPEAKER_01
33:29

Yeah. You know, or or could they put it in an HSA?

SPEAKER_00
33:33

Yeah, or yeah, that's a good point. Yeah.

SPEAKER_01
33:36

All right, here's another one. You're gonna see, I think it was 18 to 20 patients per day. Oh, okay.

SPEAKER_00
33:45

Yes, I mean, that depending on the yeah, that again, are you working at the place that you want to be at? Are you spending enough time with the patients that you are seeing? Um, are you ex is that a across the board template that they've somewhat created for the time that you're seeing patients and how much you know revenue revenue you're expected to generate? Um, do you have any say, you know, any autonomy even about how those are scheduled?

SPEAKER_01
34:16

Um I it says it's about a 50-50 percent. I mean, they do say that, they do say that. And you know, do you think a new grad could handle that?

SPEAKER_00
34:26

Um I if they're coming in, you know, I I think that seeing a lot of GYN could be a bit of a challenge. Um, so yeah, I I can't speak to the individual, you know, capabilities of anything, anyone, but 50-50 is pretty heavy on.

SPEAKER_01
34:44

And they're giving them they're giving them five weeks of orientation in the office.

SPEAKER_00
34:48

Five, five, okay. Um I left that part out. You didn't talk about the five weeks of orientation being. No, I didn't. So there's are are we talking about like awareness of the medical records system they have? And are is their presence in the office of someone that can answer questions on the s on the spot? Do they have any other, you know, means to connect with a mentor? Yeah. Things that you often really don't think about when you're starting a new job, especially if you're a new graduate, or especially if you're coming up against even medical record systems that you've never used before. The frustrations that you have of all of those things that are built into a day when you're seeing 18 to 20 patients can be so thoroughly exhausting. The other thing that isn't really talked about here, Ginger, but um, on a real life um basis, who's answering the phone calls? Who's following up on the lab work? Yeah. Um, how when is that done and how is that built into your workday if you're seeing 18 to 20 patients? Is that something you're expected to come in early for?

SPEAKER_01
35:51

Yeah.

SPEAKER_00
35:52

Stay late for, of course, use your lunch hour because you know that's impossible to have a lunch hour if you're seeing that many patients and doing any type of good quality care. So well, I'm just really speaking off the of real life experience here now.

SPEAKER_01
36:07

Hey, but but as we know, with the workforce shortage and the demand for patients to be seen in a timely fashion, it's getting harder. Access to care, yeah. Maybe one of the questions could be do I get a scribe?

SPEAKER_00
36:23

Sure. Well, there's a scribe component, and now there's this whole AI. That's right. Right. That's right. Um, I you know, I I just haven't gotten comfortable with that idea yet. Um, but yeah, I mean, those are ideas that they're really beneficial beneficial to some people. Um, I haven't I haven't tried that yet. Um I kind of use more of a lot of smart phrases, but you just have to make sure that you're yeah, making sure they're accurate.

unknown
36:52

Yeah.

SPEAKER_00
36:54

Arden talks about that for billing, you know.

SPEAKER_01
36:57

Well, that was that was one of the things I was gonna say to you is you know, you're seeing you're seeing 18 to 20 patients a day. If we just kind of think back on some of the presentations we've done, I think I I pointed this out at the Chicago talk we did, Denise, that MGMA came out in 2020 or 2022 with an estimate of profit margin. By the time your provider, your APP, sees five patients in one day, it was 4.8 something. They're already at the profit side, right? Right. So you're seeing 18 to 20 a day. Um well, that's about 400% then, right? Yeah, well, even if we sort of took out the OBs and the global global fee right now, uh, they're still they're still making a profit. So the question would be how does the midwife know? Uh right. How do you how do you sort of start on on day one or the interview process and go, you know, I know a little bit about revenue generation. I learned a little bit in school, or I've watched some YouTube webinars, or whatever you want to say. How is my contribution to this practice evaluated related to revenue generation?

SPEAKER_00
38:12

I mean, I think that's something people really just don't think about. Right. They really, really don't think about that. Um, and better believe the docs do. I mean, I right, I I see that all the time where there are different this goes back to the the bonus or you know, incentive plans or compensation beyond your basic pay. Like, you know, we don't like I would say as nurse midwives, I would say there's such a thought of you go to work, you do your time, you you get paid, and you don't think about the fact that you have incredible value as revenue generators. So how do you get this information? Or, you know, I think it's worth asking. Um and we know that there is a way for you legally to have that information, you know, for things you know build under your NPI, but uh aside from that, it's like how can you use that to then come back to you know increase your value?

SPEAKER_01
39:14

So Arn Arden talks about that in her podcast. They can they can go listen to, but also the idea of asking the midwives that you're interviewing with, yeah, how do you we've talked about this too, how do you convey the story of what you all do? Who gets who gets to hear about the value of the midwife service and what frequency rate do you share all that information?

SPEAKER_00
39:38

Now, Ginger, do you think that's a good is that above and beyond like an interview question?

SPEAKER_01
39:46

I I think I think it's it's probably way before the offer. Uh I do think it's an interview question, uh, but it does directly tie into how you use that answer for leverage.

SPEAKER_00
39:58

Right.

SPEAKER_01
39:59

Um, and we're all about trying to figure out leverage in the middle of a negotiation. Right.

SPEAKER_00
40:05

Um is you want to gain as much information as you possibly can to see that one is I think probably a question that would surprise most people when you're interviewing with them. Because I don't think I again it goes back to I don't think a lot of if you're interviewing with your peers that you're gonna be working with, I think there's a a large knowledge gap for the most part with that bit of information.

SPEAKER_01
40:33

And I think that's one of the things we're trying to promote every single day. Yes, we are. Yes, every single day.

SPEAKER_00
40:38

Bring it.

SPEAKER_01
40:39

You know, let's let's start let's start learning these things so that you can share that story as many times and ways as you possibly can. Um state, is it is in one of the highest malpractice zones, premium zones in the nation. So cost. Oh yeah. And so this idea, and of course, we'll we will bring Isaac on about talking about professional malpractice insurance as well. But the question here that the fact that they say they're going to pay professional malpractice is absolutely meaningless.

SPEAKER_00
41:20

Right. Right. We know that, right. And be cautious when you hear that to because it sounds great. It sounds oh great, they're paying it. Great. I have nothing to worry about.

unknown
41:32

No questions.

SPEAKER_00
41:33

I have no questions, and I don't have to worry. I walk in, they pay my malpractice, I leave, and everything is great. Right. But the unsaid, the unspoken here. Yeah. And often completely conflicting and confusing within contracts itself, sometimes.

SPEAKER_01
41:51

Absolutely. Yeah.

SPEAKER_00
41:53

Right.

SPEAKER_01
41:54

Yeah.

SPEAKER_00
41:54

So are we gonna hold off on just talking about that?

SPEAKER_01
41:57

Because we're I think I think we will on Mount Pratt.

SPEAKER_00
41:59

It's its own topic. It's really its own topic.

SPEAKER_01
42:02

It is.

SPEAKER_00
42:03

Um but just be aware. Yeah.

SPEAKER_01
42:06

It's a definitely a so if somebody figures out what this job offer is and they go, Oh my god, I know what they were talking about. Um, and we say, we've said, go forward, man, do the interview. Uh, do not do the interview, do the negotiation, right? You got the offer. Um some strategies to approach negotiation. We talk about this in our coaching post-contract, right? So, Denise, how do we help, how can we help them get prepared to go negotiate this offer?

SPEAKER_00
42:39

Well, first of all, it's to well, we've already basically gone over be aware of what's in the contract. Okay. Be aware of what's in the contract, be aware of who you're gonna work for, be aware of what your own wants and needs are before you um so that you can really compare them to what's what they're offering you verbally, what they're offering written in the contract, and and to know whether this is even worth it. And again, it's still worth talking and negotiating just to learn and practice the skills. Um, then there's a lot of different things. Like you want to make a list of what you have to leverage going into a job. Like, who are you? What's your experience? Do you have special skills that you that are revenue generating? Do you have languages that um are helpful with the population you're taking care of? Do you have cultural concordance with the population you're taking care of? Um do you know the community? Um, have you been there a long time? Do you plan on being there a long time? Do you have some longevity that in loyalty that you would commit to a practice, which is really very important? Um like so many things that I'm not going to even remember, but you know, doing a deep dive into your own, you know, skill set and what you bring to a practice, the value. Value that you bring is is really important to start out with. You always want to start out with that story when you go back. Remind them of your story when you're going back to negotiate. You have a, you know, create a little storyboard, if you will. And it's and in the one one of the most important things is that you're doing it where they see your face.

SPEAKER_01
44:21

Yes.

SPEAKER_00
44:22

So I would say I think it was like Chris, who's the negotiator who says like 93%. Yeah. 93% of negotiation like strength comes from tone of voice, um, like expression, body, you know, body comportment, like how you hold yourself and hearing, hearing, seeing your face and in hearing everything that you are. Yes. Like the rest is non-verbal. Um that I mean, that's really that those things are very important. So um I think that starts it out. Um, those are important things to consider. Uh, do you have other things you want to add? I have so many I want to add.

SPEAKER_01
45:01

Yeah, I would I would add uh once you've made your list and you've got your storyboard ready, go role play with somebody. Yes. Practice it over and over and over and and practice both roles. It's like a language, right? It is. It's a no-like be all blotchy, you know, with red blotches going down your neck and being afraid. It this is this is a business interaction, it's not an emotional conversation.

SPEAKER_00
45:30

It's the it's theater right now. Like if you've ever done theater or drama, you're learning the the lines, you're learning the language, and you're presenting it as confidently as you're able to, and that only happens with a lot of practice. Yeah, and you're gonna and really honestly, like we've mentioned, you're gonna have to describe a lot of things or educate the people that you're negotiating with. A lot of times you have no idea what you're talking about, but you do because you've learned it and they will learn it from you.

SPEAKER_01
45:58

We've also talked we also we also talk about making a long list. Yes.

SPEAKER_00
46:03

Why is that? Yes. Well, not everything um in a negotiation, like a win-win is when um you know they give you some, but they don't give you everything that you're asking for. So um you you ask for more than what you want on all the parts, you prioritize what's most important to you. So your list starts out with the most important things, but we often save, you know, kind of salary things to the end, even if that's the most important. Like people are pretty skee-y, sketchy about money and numbers. And sometimes if you start talking about money first, they forget about everything else that you're asking for.

SPEAKER_01
46:41

That's right.

SPEAKER_00
46:41

So you kind of want to prioritize things first that you're very interested in more than what you want, so that they can counter with something a little less, and that's gonna be still more than what you need, you know. Yeah. And um, you know, so you you just make a list, and we use a lot of the terms of verify, clarify, and modify. Yeah. Um, a lot of times in the contracts, you want you're reading something and it doesn't make sense to you, or you don't know why it's there. There might be some history about why it was put in based off of maybe past employees or whatever. So you often want to verify or even just simply clarify, like clarify what is a what is a 1.0 FTE means. Exactly. And then the big one is always it's what, Ginger? What's our thing? Modify.

SPEAKER_01
47:26

Modify. And you can modify it not by the whole body of the contract, but just add an appendix or add an exhibit that says XYZ.

SPEAKER_00
47:36

Refer to appendix A or whatever. Exactly.

unknown
47:40

Yeah.

SPEAKER_01
47:40

Oh my God, we saw a contract this week that had it went through letter J of exhibits and appendices. And I'm like, this is just sorry, it's just bullshit. It was a second a lot sometimes. It was it was intended to be confusing and where you out.

SPEAKER_00
48:00

Yeah, before you even start working for them. So it was just ridiculous. What kind of place is that? They're wearing you out before you even start. Okay, maybe not. That's the one where you're seeing 25 patients a day.

SPEAKER_01
48:11

Yeah, there you go.

SPEAKER_00
48:12

How tenacious can you be?

SPEAKER_01
48:14

You know, we have we have sort of just touched the surface on things that you can find. We've got a lot of uh webinars on this information you can find on YouTube. Um we give this lecture to a lot of graduate midwifery education programs. I think we're up to, I don't know, 12, 13 now that we sort of give this talk to Denise and I. Annually, right? Yeah. Denise and I do a lot of coaching, whether it's with or without a contract, but mostly we want you to be informed. So, Denise, we're there. Do you want to do a call to action first or do you want me to?

SPEAKER_00
48:53

I mean, I think I'll I'll do my call to action. I've been having you do it, so I'll I'll take it on. I I really just really, really, you know, I I really want you to find the job that you love so that it doesn't seem like work. You love it so much that it doesn't seem like work, but more importantly, that you are valued, um, you are paid well, and that it's it's it sets you up for staying there for a long time. We need midwives, we need midwives to stay in their jobs for a long time. And we need to, you know, just keep ask everybody to do your to do what you can to to really ask to be valued, the whole profession, individually and then as a whole. And so my call to action is just uh don't settle if you can. Don't settle if you can. Find your value, ask for it. Yeah, I like that, Denise. I think I what do you have, Ginger?

SPEAKER_01
49:53

Yeah, I think I'm going to add slow down. Like take a take a pause. Yes. We know we know you're in a hurry. We we know you you may have student debt. We know somebody needs to start bringing money in, and you know, we know you're excited to start the job, a job. But to be rushed, which a lot of recruiters try to do, like sign, sign in two days or sign in a week, is a detriment to your ability to just think about the offer. If if you can have somebody else review it, whether that's an attorney or whether that's your a family friend, another set of eyes on the offer may see things you don't see. And it takes time to think about what we've been sharing. What are your wants and needs? What is the long list of things you're going to ask for? And have you practiced? And to do that takes a couple weeks. And to think that that is too long to give an answer, compare that to physicians who often take four months. I think we're forgetting the pause, you know. We're forgetting that if you've been offered a job, I want you, Denise. I offered you the job. You should be respected to take the time to seriously think about the job and not be in such a rush to think it will evaporate before you give an answer.

SPEAKER_00
51:23

It is a bit of a bit of a bit of a red flag if you get pushed in a corner. Absolutely.

SPEAKER_01
51:30

Yeah. You know, why where's the angst here? You can see my age in this example, but I still use it a lot. There used to be a lot of door-to-door salespeople. I was going to say salesman. Sell you a vacuum, sell you pots and pans, sell you knives, and books. Buy today or gone tomorrow. Well, I'll I'll be damned if the pots and pans are gone tomorrow, but they want your money today. That is a pressure tactic, and it is used on advanced practice providers all the time.

SPEAKER_00
51:58

Right. Right. So that is really good, really good points, Jinger.

SPEAKER_01
52:04

Well, I have invited uh an a new attorney who did an amazing job co-presenting with me, Denise, to a residency program in Flint, Michigan.

SPEAKER_02
52:17

Yes.

SPEAKER_01
52:18

Um, the two of us had, I don't know, about 30 residents in front of us for a couple hours, and he kind of blew their minds. And I thought, wouldn't it be great to have a young person, a lot younger than you and I, come on and talk about contract clauses that are restrictive or could be in some way uh not to your advantage. So Isaac Booth is going to be on with us on our on our next podcast as a guest. And fantastic. That'll be fun.

SPEAKER_00
52:50

In fact, I I think you were at his birth, Denise. I was. I was at his birth. And in fact, Ginger, a little bit of a little extra piece of information. That was the day that I applied for midwifery schools. Yes, it was. But that's a whole other story. So um we'll have to figure out how to embarrass him a little bit. Oh, we can do that. We can do that. We can do that. Yeah, we'll see him turn red. I've seen him do it before. So I hope he doesn't hear this because then he might not want to come on. He usually doesn't listen, even though he's our producer. Very good. Well, I think we have all still a lot to learn, and um, I hope this information was helpful.

SPEAKER_01
53:31

Yeah, it's great.

SPEAKER_00
53:32

If if nothing else, um, you know, thanks for spending time with us.

SPEAKER_01
53:37

Yeah. All right. Have a great evening, Denise. All right, take care, Tinder.

SPEAKER_00
53:42

Bye bye.

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