One thing is certain: There's nothing certain these days in the physician job market. Family practice residents can no longer assume they'll receive a handful of job offers after they finish their training; in fact, many are having difficulty finding that first job. Employed family physicians are now facing unemployment as their employers cut back, tighten up, or try to pass off to someone else the disaster of physician integration. In short, it's a buyer's market out there.

Behind the proverbial eight ball

All family physicians who are currently job hunting have at least one thing in common: shrinking opportunities coupled with shrinking offers. Instead of feeling defeated, family physicians need to empower themselves by focusing on leverage. Everyone has a certain amount of leverage to bring to the table during salary negotiations. The key is recognizing how much you have and using it to your advantage. If you're in the job market, the following indicators and the questionnaire below will help you determine what kind of leverage you have and how much of it you can exert during salary negotiation.

Salary

When it comes to negotiating salary, it's crucial to know your ideal salary range as well as your bottom line (that is, the point below which you will not go). Most physicians base these figures on a past or current salary or ask their accountant or financial planner for help. Some organizations, such as Merritt Hawkins & Associates (www.merritthawkins.com) and the Medical Group Management Association (www.mgma.org), publish the results of annual national and regional salary surveys.

But perhaps the most helpful measure is local precedent — what others in the area or in the practice you're interviewing with are making. The point here is simple: You'll get further in negotiations if you have an understanding of the local, regional and national markets. You can't merely insist that you be paid more than you made in your last job or, if it's your first job, a salary comparable to what your fellow resident will be making elsewhere. An appeal to fairness will usually give you leverage.

Supply and demand

Identifying the competition and the need for your services is another way to determine your leverage. It's not impertinent to have evidence in the form of a study. Historical trends in the practice (the appointment schedule), future events (retirement or relocation of a partner) or analysis of the availability of similar resources (other physicians and/or physician extenders) in the immediate area will serve the purpose.

If you discover a solid need, the next step is to consider your competition. It's good to know how many other physicians have applied for the job and, if possible, who they are and their qualifications. Of course, this is much easier said than done. The most direct approach is to ask either your potential employer or the recruiter you are working with and hope they are forthcoming with this vital piece of information. If there's a need for your services and little or no competition for the position, you've got leverage.

Strike while the iron is hot

Time can be on your side, especially if the position you're interested in needs to be filled yesterday or ASAP. If you're available immediately, then you're in a position of strength. Couple this with your employer's or future partner's need for someone who can remedy an urgent problem in the practice (for example, too many patients to care for, or the impending relocation of a partner) and you've got leverage.

Experience and expertise

It goes without saying that you need to know how well your credentials (education, training and experience) match the needs of your potential employer (e.g., patient volumes, managed care experience, prior employment in a specific type of practice setting). You should be able to ascertain this during the interview process. Your recruiter should also be able to tell you. If you have what they want, you're in a good position. You'll be in an even better position if you have a skill, interest or expertise that no one else in the practice or the immediate area has, particularly one that will attract patients or referrals. The more closely your experience matches what a potential employer needs and the more in demand your expertise is, the more leverage you've got during salary negotiations.

Goodwill hunting

Practicing medicine is a business, and like all businesses, a practice needs to generate income and keep it coming. If you have a patient following and no encumbrances, such as a previous non-compete agreement that would prevent you from bringing your patients to your new practice, or if you have a reputation that precedes you, you'll be in a stronger position to discuss salary, benefits, perquisites and relocation. Most newcomers don't provide incremental income to a practice, so any time you can, you've got leverage.

The all-important safety net

Imagine what it must feel like to walk a high wire without a net below you. It must feel a lot less risky if you know you have a safety net should you fail to reach the other side. Already having a job or having another job offer will give you the confidence to step out on that high wire and assert yourself during salary negotiation. Be careful, not foolhardy. Leverage comes from having alternatives and being flexible.

Know thyself and thy partner(s)

Knowledge is power. It helps to know your strengths and weaknesses, your qualities as a leader or a team player and, most of all, whether you'll fit into the culture of the practice. If you are unsure of your personal and professional goals, uncertain how you tend to behave in various situations, or doubtful about your future colleagues, staff and practice setting, it will show during the interview process and definitely weaken your leverage should you reach the salary negotiation stage. Leverage comes from being confident about who you are and knowing what you want.

Getting by with a little help

During any negotiation, particularly one for a salaried position with a corporation, you'll need competent advice. That advice may come from an attorney, an accountant or a business consultant experienced in providing guidance for physicians in transition. The reasons may be technical, financial, strategic or personal. Knowing that there's someone in your corner when the going gets tough will benefit you during salary negotiation. Beyond advice and counsel, it will give you a little breathing room during the negotiation stage. You can attribute some of your requests to your advisors' recommendations or promise closure of a deal pending review by any or all of them.

Job security is a thing of the past. To protect and prepare yourself, you need to sharpen your negotiating skills. One way to do that is to understand leverage, recognize that you have it, and learn how to use it to get what you want.