For academic clinicians or researchers taking a first faculty position or considering a move to broaden their skills or explore other interests, salary and compensation are important considerations, but they usually don't top the list. Most candidates set their sights first on the institution they would like to join or the department chair with whom they'd like to work and move "backward" from there, on the assumption that there's little wiggle room in most academic medical center employment packages.

In fact, with the exception of certain state institutions governed by rigid policies regarding compensation or employment packages, many academic centers can--and often do--offer appropriate financial and other incentives to highly sought candidates. And determining what's standard in a package and what might be available above and beyond the basics, may require both a bit of sleuthing and a willingness to negotiate.

"The moving van and related expenses are customary, but all else is negotiable--unless the [faculty position] candidate is moving to a policy-driven state institution," says Anne Zenzer, senior vice president of the Oakbrook, Ill., recruiting firm Witt Keifer. For example, if a diabetes researcher wants to move to another institution, but not without bringing a Ph.D. assistant with her, she should be prepared to start crucial negotiations in the initial conversation.

For the most part, the employment offer basics--beyond the salary and benefits package--include:

--Moving expenses, in the range of $10,000 to $15,000, in most cases. Some institutions may be willing to go a bit higher if unusual circumstances (such as the need to move a professional library collection or personal equipment requiring special handling) exist. But increasingly, institutions are "capping" the moving allowance to avoid open-ended moving expenses, notes Kurt Mosley, vice president of business development for the Irving, Texas, recruiting firm Merritt Hawkins & Associates.

--A guaranteed minimum salary, for the first year or two of employment, with the prospect of a merit- or production-based bonus, in the case of clinicians who will carry a significant patient load or researchers who are expected to bring in grants.

--Full- or half-time (if the support position is shared with another faculty member) secretarial or administrative assistant.

--House-hunting expenses, ranging from $3,500 to $5,000, when trips are made for the express purpose of finding a home in the new location.

--A modest sign-on bonus, on the order of $5,000 to $10,000, may be available (but isn't a guarantee), and more liberal CME (continuing medical education) allowances.

--Assistance in family-relocation issues such as school search assistance or spouse introductions to prospective hiring entities.

Other incentives or perks may be available, especially when the candidate is either highly sought or is in a high-demand-low-supply specialty. 

If not prohibited by hospital or academic center bylaws or policies--or nixed by legal counsel--prospective faculty members might be offered, or might negotiate for the following:

--A slightly larger sign-on bonus (especially if a comparable position elsewhere pays better), slightly higher (than standard) total relocation allowances, and guaranteed minimum salary for up to three years.

--A minimum amount of research "seed" money, for pre-identified projects or ventures.

--Medical school loan repayment, in a staggered structure. Mosley notes that institutions that are willing to repay education debt are moving toward three- to four-year plans, "which turns the loan payoff into a retention bonus of sorts," he says.

--Arrangements with lenders for low-cost or interest-only mortgages, to qualified buyers. This has become more common in high-cost areas such as San Francisco and Boston, where housing costs are so prohibitive that institutions have had to involve themselves in real estate "market mechanics" to entice junior faculty to move there, Mosley notes.

Zenzer thinks that junior faculty members and those eyeing a move from their current positions should negotiate for "reasonable" items above and beyond that standard package, if the institution isn't prevented from sweetening the deal. But she urges candidates to keep their focus on the important things and the long-term picture.

"The important issue in discussing a [prospective] employment package is to ensure that you negotiate for the resources you will need to make you successful in the organization--and that you discuss those needs early on in the process," she says. Adequate clinical and administrative staffing should rank high on that list, Zenzer suggests, as well as ample research support--both human and facility/laboratory, as appropriate.  "It's critical to discuss the support that will be available, especially in research positions," she adds, where insufficient support can hamper the progress of even the most talented researcher, or potentially doom an otherwise viable venture.

Mosley concurs, recommending that prospective faculty members who expect to have to recruit other researchers or clinicians to create a new department or substantially augment an existing service, ensure they'll have the resources they need before they make a move. "It's critical to ensure there will be enough in the way of salary funding and support staff, especially if the prospective faculty member is creating a new department," he says. Candidates who aren't sure just what will be needed in the way of funding or staffing, should consult with colleagues in other institutions or with faculty members in the prospective institution, who may have joined with the charge of creating or expanding a department or service.

Of course, even faculty members who have their pick of positions shouldn't try to shoot for the moon. For one, it might be considered bad form--a prospective hiring organization that senses a candidate is more interested in personal financial gain than in furthering the center's standing--and possibly a deal-breaker. The other real issue is the increased legal and regulatory-entity scrutiny many hospitals and academic centers face these days. Unfortunately, because of a few "bad apples," Mosley notes, institutions that recruit and relocate physicians are being watched much more carefully than in the past, to ensure they aren't offering unreasonable incentives to lure certain physician specialists for the primary purpose of improving their facility's financial bottom line.