Lesson 4: Demand good salaries.

While listening to a talk radio program several years ago, I recall Professor Walter E. Williams, an economics professor from George Mason University in Virginia, utter something that I thought was simple but incredibly profound.

He said, “Money equals appreciation.”

Our use of money is the measure by which we show we appreciate something, according to Professor Williams. For example, people collectively pay incredible sums of money to watch professional athletes play, and these athletes are compensated extremely well for their talents. Why? Because the public appreciates them greatly. Their talent is rare, so the admiring public is willing to pay vast sums of money to watch these talented individuals play sports.

Economics involves the allocation of scarce resources1. In a free market, money changes hands, and the prices paid dictate how scarce resources are allocated. People who desire something badly enough are willing to pay more money for it. If the commodity is not appreciated, people will pay little for it.

This thinking has permeated society. Like it or not, “money = appreciation” accurately predicts human behavior. There are two corollaries, in my opinion, that follow: High money, high appreciation. Low money, NO appreciation!

What does this have to do with medical examiner salaries? Everything!

A new chief medical examiner wants to be treated with respect. He or she wants his or her opinions to be carefully considered. The new chief wants the people in power to fund the office adequately.

Well, I have a news flash for all aspiring chief medical examiners. If the powerful pay you little, they will not listen to you. They will not fund your office. They will not give you what you need, much less what you demand.

“After all,” the thinking of most people goes, “if you, the medical doctor, are not asking to be compensated in a fashion commensurate with your fellow doctors, then your skills must not be worth much. You must not be a very good doctor.”

“Unfair!” you may protest. Well, protest all you want. Like it or not, that is the way it is.

The medical examiner’s salary is a test for the government seeking the services of a medical examiner. It is a measure of the value they put on what you do. If you believe you are providing an important and rare commodity, you have an obligation, perhaps even a moral obligation, to demand a good salary.

Now I recognize that becoming a medical examiner working for government is not the way to become wealthy. You are a public servant after all, and it is not appropriate to gouge the taxpayer (as if medical examiners ever had this problem!). Perhaps if you want to make a very high income, you should go into another lucrative field of medicine.

Those of us, however, who choose to do this for a living are not looking to become wealthy. We are looking to serve by doing something we enjoy and we believe is important. Still, we do no one any good by accepting to provide important expertise cheaply.

Nevertheless, many of our colleagues do exactly this. They accept low salaries and remain in squalid working environments year after year after year. When confronted with this situation, these poorly paid doctors make excuses. I have heard several over the years.

“The advertised government salary scale is fixed.”
When interviewing for a new position, many believe that the government scale for medical examiner positions is inflexible and unalterable. I would not let a salary scale prevent you from negotiating, because in the end, everything is negotiable. If they need your services badly enough, the government will consider whatever offer you are willing to make.

“I am not allowed to make more money than the boss.”
Without any intended disrespect toward the boss (the non-physician chief executive of the governmental entity you will work for), I make the following observations.

Most chief executive positions are elected positions. They draw from a large pool of local executive talent. Contrast that with the medical examiner’s situation. Board certified forensic pathologists are a rare commodity, and board certified forensic pathologists with leadership and management skills are even more scarce. When a government searches for a qualified medical examiner, the search typically has to be nationwide, not local, because of the scarcity of available talent. Consequently, in a free market, when the demand is high and the supply low, the price (or salary in this case) will go up. The chief executive will be more than happy to pay more to you than he or she receives in salary if the executive knows that you will be a credit to the government. If the chief executive does not understand this, you need to look for a job somewhere else.

“People in my state do not tolerate medical examiners making a lot of money.”
Then consider what the people of your state are saying. If “money = appreciation,” then they do not consider what you do to be important. It is only right then, and even inevitable, that the medical examiners they employ will also be ones who consider what they do to be unimportant. The people of your state should therefore be content to hire the incompetent and the unscrupulous. Hopefully, that is not you!

Let the people of your state get what they deserve!

“I want to live here.”
“I grew up here and I want to stay.”
“I am independently wealthy, so I have no need to move somewhere else.”
“My husband (or wife or family) does not want to move.”
This addresses those who are not willing to move for any reason. To them, geography trumps money. These are the contented souls who are happy to remain poorly-paid medical examiners in troubled systems because they are not willing to leave the area or work in another job.

What right does anyone have to tell these that they should live and work somewhere else! This is a free country, right?

I agree. Feel free to stay where you are. Be happy, but also consider this:

One day, the people in your county or state will have an office accredited by the National Association of Medical Examiners. One day, the government of your county or state will happily provide funding for a new state-of-the-art facility. One day, the newspapers in your locale will stop reporting the tales of scandal and mismanagement that come from your office. One day, the funding for the office budget will be more than adequate year after year after year. One day, high profile murder cases in your jurisdiction will be tried without the taint of improper evidence management or interpretation. One day, the office you currently serve will be able to retain highly qualified and content forensic pathologists.

All of these good things will probably happen one day, after you are gone!

“But I’ll persuade them!”
Do not count on it. If you accept a poorly-paid position with the hope of charming the powers that be into funding your office adequately, then you are on a fool’s errand!

Please understand this: governmental leaders do not give large sums of money to people they never appreciated in the first place!

I realize that what I am writing seems harsh. I do not intend any disrespect to anyone personally. I am simply tired of seeing what I have been seeing year after year with no end in sight. I am tired of the tales of scandal and incompetence that mark our profession. I am especially tired because I do not believe any of it is necessary. The solutions are not only possible but inevitable if we simply had the courage to do what we should have been doing all along: demanding good salaries.

Before I end this chapter, I have a few practical recommendations.

First of all, how do you determine what you will ask for in salary? Before a job interview, the candidate should become familiar with the salary ranges for similar jobs throughout the country. He or she should consider the cost of living in the parts of the country where the jobs are. After learning about the market, the candidate should ask for a salary above the top part of the range. This amount will likely be far below what your counterparts in hospital pathology make, so it does not constitute a major stretch, in my opinion.

In addition to the salary, the candidate should ask the new employer to pay relocation expenses. He or she should also ask the employer to pay malpractice insurance premiums. I realize that some employers, particularly state and local governments, claim they are self insured and that there is no need for them to pay for malpractice insurance. I believe there is a need. The government always defends their best interests and not yours in a dispute. You need to be protected fully.

What if you are currently in a position that is poorly paid? Do you ask for a raise? Should you join a union?

You should never ask for a raise or join a union. You do not need to. You should make an appointment with your employer and tell him something like the following:

“I have thoroughly enjoyed working for you over the past ________ years, but there is something you need to know. I do not believe I am being sufficiently compensated for my work. My family deserves better for all my long years of training and my expenses. We have significant expenses ahead, and I owe it to them to explore other employment options. I will use some of my leave time to interview for other positions, so do not be surprised if you receive requests for information about me from other places. Perhaps I will not find anything, but I believe I owe it to my family to explore other options.”

It is important not to “burn your bridges.” You should try to leave on the best possible terms, no matter how negative the situation has been. Every employer appreciates consideration for his or her needs, so informing your employer of your intentions is always a good idea. This gives the employer the opportunity to prepare for your possible (and likely eventual) replacement. You have also posited a challenge. Your employer might do what he or she can to renegotiate your salary. If not, you at least will leave on the best of terms.

Notice that I suggested mentioning “my family.” In a delicate or controversial situation, I believe it is always a good idea to invoke a third party. This reminds your employer that you have other needs to consider besides your own. It also puts your statements in a more reasonable and moral position, making your statements stronger.

Finally, do not ever bluff. Always be ready to leave your job. You may find that moving was the best professional decision you ever made!

1 Sowell T. Basic Economics. New York: Basic Books, 2004.