"Sink or Swim"-A National Qualitative Study Examining Negotiation Experiences of Early-Career Emergency Medicine...

To report on first-job compensation packages and negotiation practices among a sample of recent emergency medicine (EM) research fellowship graduates, describe gender differences in negotiation behaviors, and explore perceived barriers and facilitators to early research career success.

We conducted a national qualitative study using semi-structured interviews with EM research fellowship graduates from 2019 to 2023. Participants were recruited via the Society for Academic Emergency Medicine and National Clinician Scholars Program fellowship directories and alumni networks. Interviews focused on participants' first academic job search post-fellowship and were analyzed using thematic analysis with an inductive and deductive coding approach. Themes were developed through consensus coding and interviews continued until thematic saturation was reached.

Seventeen participants completed interviews of 30-60 min in duration; 53% were women, 53% identified as white, and 59% had a first job in the Northeast. Most received one to two job offers and reported varied start-up packages, clinical hours, and non-clinical effort. A majority (59%) did not negotiate their job offers. Participants cited lack of transparency about compensation and institutional expectations as the primary barrier to negotiation. Mentorship-particularly from senior researchers-was described as a key facilitator of early-career success and a major factor influencing job acceptance decisions. Negotiation, when it occurred, more commonly focused on non-clinical effort than salary or start-up funding. Participants emphasized that increased research effort and mentorship were essential to productivity and career sustainability.

Most EM fellowship graduates did not negotiate key elements of their first academic job offer, often due to a lack of accessible information. Mentorship and protected time for research were the two biggest drivers of job acceptance and perceived productivity. Greater transparency and standardized employment offers-or formal negotiation training in the absence of the latter-may help build a more productive and sustainable pipeline of EM physician-scientists.