The successful physician negotiator. (Career Management).

Every time you are asked to do something, you are in the middle of a negotiation, whether you realize it or not. If you say "yes" quickly without thinking about it, the other person has won. You will probably negotiate for one or more houses, numerous cars, and several jobs during your career. Daily you need to negotiate to get other people to do tasks. Learning how to assertively, calmly, confidently ask for what you want, while at the same time learning when it is appropriate to stay quiet, will help you in your professional and private life.

The Successful Physician Negotiator: How to Get What You Deserve is written by two lawyers and is worth reading for all the examples of negotiation situations that the authors describe. You will probably find the specific situation that you need to know about. Babitsky and Mangraviti describe both sides of the negotiation process and tell you what to do when you are on either side.

I have selected highlights from the book that I think will help physician executives, based on conversations I have had with many who were asking for advice as they prepared for salary negotiations. In each chapter, examples are provided for every recommendation with the lesson learned highlighted at the end of the negotiation conversation--a few of these examples are also included.

Cooperative negotiations

When I hear the word negotiation, my initial thoughts are: adversaries, conflict, energy wasted with arguing, there's nothing I want badly enough to haggle over the price, I will lose because someone will out-talk me. After some time passes, I get ready mentally knowing there are some things that must be negotiated and I prepare for them. The authors' concept of cooperative negotiation was enlightening. I hadn't thought such a viewpoint was possible.

Cooperative negotiation is important if you plan a long-term relationship with a person or group. It may not matter how the sales person feels after you purchase a car, but it does matter how your boss feels about you after you take a job. Asking the following questions of yourself, or out loud to the other person, can set the stage for a cooperative negotiation:

* "How do we come up with a better deal for both of us?"

* "What would work best for you?

* "How can we get you what you need?"

Need to be liked

Even though I find the concept of cooperative negotiation appealing, it's best not to let people think that it is the only way you can negotiate. "One reason physicians are poor negotiators Is their mindset, which many times includes the need to be liked....A need to be liked is understandable, but it can be extremely detrimental when negotiating....Courteous and professional disagreement is a necessary part of most, if not all, negotiations."

Despite the introduction on cooperative negotiation, the authors regularly use the word opponent when naming the other person in the negotiation. You need to understand your opponent by gathering Information about his or her values and work situation.

Ask questions to determine their values

"The successful physician negotiator sincerely wants to understand her opponent's values and what her opponent feels Is important. Look for two things: first, an insight into your opponent and second a method of bonding with that person. Areas to probe gingerly include the following:

* Values: What does he or she find important?

* Family life: Children, pets, and spouse (in that order)

* Professional achievements: The living CV

* Art

* Films

* Hobbies 

* Athletic achievements

* Volunteer work

* Travel

* The X factor-the one single factor that is the driving force behind your opponent's personality." (These are also great suggestions for topics to discuss when networking at cocktail parties.)

"The people you negotiate with will go to extraordinary lengths to help and assist you if they truly like you." If you have listened carefully to their discussion of some of the suggested areas, you create the possibility that they will like you.

Do the research

You can gather information when talking to your opponent, but you also need to do some "behind the scenes" preparation before the encounter begins. "Physician negotiators make a serious mistake when they assume that due to their intelligence, education, and experience they can sit in their office and figure out the needs, desires, objectives, motives, and interests of their opponents....If you do not have the time to devote to the preparation, get some help or have someone else negotiate for you.

There are many sources of information. "As a successful physician negotiator, you or a member of your staff can use specialized business or medical libraries, online services, inside reports, or articles written by or papers delivered by your opponent. The depth of your information gathering should depend upon the amount at stake in the negotiation.

When lawyers prepare for a significant case, they frequently obtain and read everything their opponent and/or experts have ever written or delivered orally."

Example--gathering information

You are negotiating an employment agreement for yourself at a group practice. You want to know how busy the practice is. You call up and tell the receptionist that you are a new patient and would like to get an appointment. She informs you that it will take five weeks.

Lesson: By going to the receptionist for information, you have learned that the group is very busy This is important because it means that they may be desperate to make a hire. It is also important because you may suspect that you may be overworked if you take the job."

You may keep some of your research to yourself, but other times you would share it with your opponent. It may be useful to demonstrate that your proposal or terms are the industry standard or accepted practice....It is best to bring in the documents, facts, and figures and to have them available to lay on the table." If you are negotiating a salary, having one or more compensation surveys in your brief case could be useful. You would only take them out if you were asked to produce evidence of the industry standard.

The best place to negotiate-not your office

"The information your opponents can gather from simply sitting in your waiting room for 15 minutes may provide them with powerful tools that they can use against you during the negotiation." Your opponent can find Out if patients are waiting too long, if a receptionist is rude, or if they like their doctor.

Example--don't negotiate in your office

Opponent: (to patient in the waiting room) How do you like the doctor and staff?

Patient Well, the doctor herself is a great doctor, but it takes three weeks to get an appointment. I almost always see the nurse practitioner and the billing system is often inaccurate, Let me tell you what happened to my friend Pam last week...

Lesson: Important information has been revealed. It is likely that the purchaser will offer less money to the selling physician."

Another reason not to negotiate in your office is that sometimes you need to put off making a decision. You can delay making a decision by checking with your partners, your spouse, and your board. However, "in your office, due to the availability of your records, staff, computer, and partners, it is more difficult to use lack of information as an excuse to postpone or deflect a decision. This Inability to delay a decision can be a distinct disadvantage. This is particularly so when time is on your side."

Timing

Whoever is in the greatest hurry to finish the negotiation is at the greatest disadvantage. If your opponent knows that you have a deadline, they can more easily force you to give in on important issues because you want to get the process over with. "A direct and effective method for continuing the negotiation on another date is to reply, 'I need to sleep on that.' Any business person understands that this is a good, accepted practice. We have all learned that things frequently look completely different the next day. What was seemingly an insurmountable problem is sometimes resolved easily the next day with a creative solution."

Silence

"You will need to be able to keep silent when necessary. Silence is a potent strategic weapon... .Just as nature abhors a vacuum, a weak negotiator abhors silence... but...when you do not speak often, your words take on heightened significance. Above all, you need to avoid the temptation to prove how smart you are by continuously talking."

Options

"You should always walk into negotiations with several options, and ...be prepared to walk away from a deal."

Example--be willing to walk away

Example--Attorney: Unless we are able to work out this new retainer agreement, our firm will not be able to continue to represent your medical group.

Doctor: I understand.

Attorney: Will you agree to our $250 per hour partner time, $175 per hour associate time, and $100 per hour paralegal time?

Doctor: As I mentioned previously, It is too high.

Attorney: I guess we are at an impasse.

Doctor: (calm and ignoring the last comment) How long will it take you to pull our files together and transfer them to the new firm, Cost-Yu-Less?

Attorney: Let's not be impetuous. I am sure we can work something out.

Lesson: The doctor did not agree to a bad deal just to get any deal. More importantly, by giving the impression that she was willing to walk away, the doctor will probably be able to gain concessions."

Saying no

Every time someone asks you to do something, you are entering a negotiation that requires you to give up some of your time if you say yes. "The ability to just say no or to deflect and postpone a decision until you are provided with the details and do a little thinking is crucial if you want to be a superior physician negotiator.. . .Be very careful about agreeing to requests without first determining:

1. The effort that will be involved

2. Whether the work will have to be done at home and at night

3. If you will have to give up or postpone more important or lucrative work to accomplish the tasks involved

4. If you really have the time to do this project

5. If you will have to give up family time or much-needed recreation or vacation time to complete the task

6. Whether or not you really want to do this project"

In the "Career Choices" program that I teach for the American College of Physician Executives with my husband George Linney, MD, we have a significant number of people tell us that they are practicing their specialty 75 percent of the time and doing management 50 percent of the time. If you continue to do such things, something will suffer--your health, your family, your practice, your management duties. With that in mind, I thought it would be helpful to list the authors' suggestions for polite ways to say no.

Ten polite ways to say no

1. "I would love to, buy my plate is full.

2. That sounds great. but I'm swamped.

3. I am honored, but I'm now focusing on other areas.

4. Sounds interesting, could you please send me a written proposal?

5. I think I understand what you're looking for. I'm going to refer you to my colleague, Doctor Swensen; he is the real guru in that area.

6. Let me check my travel schedule and get back to you.

7. I'm sorry, but I have a previous family commitment. I'm (planning a wedding, caring for an elderly parent, traveling to a graduation, moving a daughter to college, etc.)

8. I can't. Ever since my (insert medical condition such as hypertension) was diagnosed, I'm under strict orders from my doctor not to take on any additional work.

9. I wish I could, but I'm so busy now that I'm just trying to keep my head above water.

10. I'm sorry, but that's out of the question. I've been out of the office and I'm just trying to dig out here."

What to say when you are giving in 

The very definition of a negotiation means both sides need to give a little. It can sometimes feel shameful as if you are losing everything when you give in on any of your issues. If you need to compromise, you might say, "You may have a point. Let me talk to my boss (spouse.colleague) and get back to you later."

Keep your cool

"It is important to try not to lose your temper during a negotiation. Losing your temper could easily result in saying or doing something that you might later regret. If you feel you are getting close to the edge, ask for and take a break."

Take notes

"Taking notes is an opportunity for you to clarify your opponent's proposal during the negotiation. You should consider turning your written notes into a memorandum of agreement and sending it to your opponent after the negotiation." Be careful when you are taking notes that you don't leave them lying around to be easily read during a break.

When do you need a lawyer?

The last chapter helps you decide when you need a lawyer to look over a contract. "You need to appreciate and recognize the need to retain and involve a lawyer during many negotiations that involve formal written contracts. The law of contracts is state specific; that is, it varies from state to state. Generally speaking, contract law is founded in the common law, which is precedent from previously decided cases.

You can ask a lawyer to review a contract without telling the hiring organization. Sometimes the mention of a lawyer makes people hostile and may make them rethink hiring you. If the lawyer points out areas of concern, you can bring them up as if you discovered them. If the negotiation involves elaborate contracts, both sides will recognize lawyers are a necessary part of the process.

Conclusion

Most physicians don't like to haggle over the purchase of a car, the ordering of tests, the coaxing and persuading of administrators or other physicians to change behavior patterns. However, the need for such behavior some of the time will not go away. This book gives useful examples of how to negotiate and helps you get in the proper mindset to get it done effectively.

Barbara J. Linney, MA, is the Director of Career Development at the American College of Physician Executives in Tampa, Florida and a member of its faculty. She can be reached by calling 800/562-8088 or via email at [e-mail].

AUTFIOR'S BOOK PICK

Babitsky, Esq., Steven and James J. Mangraviti, Jr., Esq. The Successful Physician Negotiator: How to Get What You Deserve, Falmouth, Massachusetts: SEAK. Inc., 1998. This book is available from the American College of Physician Executives to members for $59.95 and to nonmembers for $64.95. Please call 800/562-8088 or visit our website at www.acpe.org to order a copy.