Maintain a strong relationship throughout and use this process to build your next successful negotiation. Can you drop me a line? In your recipe and chef example, it is like reading a book and then having a lab where you practice your new found skills. I tell my negotiation students to ask some final questions before they agree to go to contract, especially if they will be an employed physician: Because, I get a bonus if I keep the budget down. The Student Doctor Network: Negotiating Your First Contract … Yeah I think Vagabond hit it a little better than the guest poster (although I appreciate the guest post). I consider them “second round” books to read after you’ve been introduced. Negotiaion is a skill that is learned and most doctors (in my teaching experience) need about 4 go rounds before they come into their own. We made it clear that our goal was to maintain a good group of docs and be fairly compensated. Although it written with a physician’s first contract in mind, the advice is equally applicable to any agreement a physician … Just when you thought the race was over, you’re suddenly looking at an unexpected final hurdle. You wouldn’t buy a car just buy looking at the MSRP? I was recently asked an interesting question by one of my blog readers. You can also subscribe without commenting. All doctors understand this concept of WATNA- we can easily get paid better elsewhere, but moving, licensing, establishing a practice, etc takes resources that are difficult to justify. Academic centers have seen this decimate their ranks in some regions over the last 2 years in EM. And, if you can’t come up with a solution, you are left with the option of losing compensation value year after year. The ways a practice can earn more are to either see more patients, run the practice more efficiently to cut costs, or if you’re busy enough, drop lower paying carriers (sometimes the threat of a drop might lead to slight increase in rates but be prepared for the insurance company to agree to let you go out of network). Physicians as a whole are poor negotiators. Rather than any one particular technique, the conglomeration of approaches used together in a skillful fashion will work well in pretty much any situation. On the other hand, if you need a meditation on the reality of power relationship in negotiation, I suggest a return to a classic text: reread the Melian Dialogue from Thucycides “The History of the Peloponnesian War.”. A great piece of career advice I got about EM was that we are “burger flippers.” That doesn’t mean we don’t do important work or that some of us aren’t great clinicians, it means that the CMO/CEO of your hospital probably doesn’t really give a hoot who is staffing the ED as long as they aren’t grossly incompetent. [Editor's Note: Robert A Felberg, MD is a Vascular and Critical Care Neurologist with 20 years of experience. All of these solutions will require you to generate value which often means more work as physicians typically only bill for the work they actually do themselves. Dump your under-performing employment situation with as much prejudice. It’s a great salary with great people, and everybody else has agreed to it, so why on earth wouldn’t you? I can’t guarantee it, but I know I’d have never gotten the raise if I didn’t attempt the negotiation. I tell my students that in mid-career medical practice relationship is worth 75% of the deal. Or maybe you’ll realize that you are stuck and use your newly minted skills to negotiate your next job. Also available on Audible! You also state that “[y]our BATNA should be based on an already available option (maybe a private job search) or one that would be reasonably attained with minimal effort. Otherwise, I do appreciate the post. Think through the negotiation and all of the possible arguments that both parties can raise. Negotiation is a tool and a skill, just like finances. Thank you for your time and interesting comments. The way to generate value is up to you and your practice: see more patients efficiently, open a new location, have weekend hours, seek outside funding, etc. If you go into a negotiation without some training, you’ll be at a disadvantage. You are fairly compensated based on revenue generated by the practice. I know it’s more difficult to be in the medical field now than ever before. Maybe they give raises only to senior staff and you’ve not been vested or they question your long-term plans and don’t want to invest in you. But, if you use the nibble to ask for the same negotiated compensation plan schema next year, I’m of the opinion that you were well within the boundaries of relationship. The third time you get punched in the nose. We’re trying to question underlying assumptions and achieve a fair, equitable, long term solution that works for all parties at the table for at least the next 5-10 years. When you go into a negotiation, you have to be armed with facts, not just the desire to get more of something (money, vacation, freedom, power, respect, or whatever). the best deal you could get elsewhere. I apologize for the nitpicking, but I believe you’re incorrectly defining BATNA as the worst deal you would accept from the other side, when it should be defined as your best alternative option that doesn’t involve the other side’s agreement. Will these work for you? The list includes skills such as interviewing, public speaking, contracts, and conflict management. When your partner gives you a concession be certain to thank them. That’s not an actual BATNA that’s a career change. What percentage of your portfolio do you reserve for "play money"? But frankly, you just may need some seasoning and practice . Your market data research is your single most important piece of information. Of course you should do things and more as they will likely reward you with greater compensation, control, flexibility, and or satisfaction in your career. But AMA is my third favorite disposition behind jail and eloped! I would think a 10 year veteran would have a hard job restarting at the same or higher salary, b) We are trained to “not be greedy,” and negotiating for a higher salary can be seen that way. So if you are paying an employee full market rate, it’s difficult to justify raises to keep up with inflation. You can’t compare negotiating over a single speaking gig to a contract negotiation for an academic job. The main reason I presented this negotiation based on a real case is because it is so complex. The things you do under economic norms would cause a breakdown for social norms. If you can’t beat your best deal elsewhere, you move your business along. By explaining with a smile that you “really don’t understand this legal and business stuff,” you can take full advantage of the expertise of your advisers. Your BATNA should be based on an already available option (maybe a private job search) or one that would be reasonably attained with minimal effort. In the end, the hospital paid out hundreds of thousands of dollars in locum and ‘bonus shift’ pay. If one side is unwilling to negotiate, then the only way to “negotiate” is leave the table. I have negotiated for myself and my group twice in 4 years to attempt to get reasonable compensation. Agree with everything you say above, but I would not discount the techniques. You would be surprised how the negotiator winds up getting his needs met, and how the criminal winds up getting his needs met. That’s based on your personal goals as well as some reality. The long answer is that just because something can be negotiated, maybe you shouldn’t. This includes CME courses designed for physicians, self-study, or non-medically oriented negotiation seminars. When the other side has more power / leverage in a negotiation, it’s that much more important to improve your next-best alternative. As long as you do not lie or deceive, this is considered fully ethical in negotiation- you are expected to present your arguments in the best light. In the end, Karass brought the science of negotiation to the masses and deserves his due recognition here. If that can’t be reached, you may be better served looking elsewhere. If a candidate does not agree to the terms, we move on to the next. Complex negotiations often take on the characteristics of “interest based negotiation” or “win-win” scenarios. We’ll send you our standard contract, which we all have signed. ), and harebrained initiatives that are a complete waste of time. Thanks for tip. According to the evidence, the techniques are everything. To put some numbers to what Vagabond MD writes about reimbursement degradation, here’s my example drawn from private practice. In my last negotiation, I used a well researched market value report to up my salary by 25k and improve my bonus limit as well. You need a consult –stat! Recognize the contract's purpose. You have excelled throughout your academic career, and through all the hard years of your residency (and maybe through a fellowship, too). 5. if things don’t go your way then develop an escape plan and don’t feel guilty about it if you do decide to leave. It is what happens between you and your potential future employer. There is one pizza and you are fighting for how many slices you can get. However, when you are in a long term role, relationship is important. If you attempt to negitiate and can’t a reasonable responce, your BATNA may not be to simply up and leave. I feel docs are a lot more aware of when things are changing and administrators fail to see it until it is too late. If you learn it and apply it, you will have the best chance of getting the best outcome. Finally, there are the “professional business skills” that lack an ideal formal name. Typically, most articles about physician salary negotiation cover basic bargaining on starting compensation. You are already savoring the offer that is virtually certain to come. To truly … Although it written with a physician’s first contract in mind, the advice is equally applicable to any agreement a physician is involved with. As a physician, you have several education options available. Here are even more resources to help you through the process. In your case, your employer was willing to walk away from you, so it gave you a “take it or leave it” offer. Of course, he took the job across town and was miserable and called us back about 18 months later…. Physician Contract Review & Negotiations. Love this response! sorry bout the typos- iphone keyboard too small for my fat fingers. Meanwhile, our expenses are generally fixed and slowly trend upwards (health insurance, being the largest driver of up trending expense). That’s the ultimate negotiation prize! You are crazy to walk into a room without it. The pie is not infinite but it also doesn’t mean that your slice can’t change. You can gain time to consider a proposition, for example, or you can say it’s your advisers, not you, who are critical of the offer. Nobody would question your keen intelligence, and you have obtained, through plain hard work, an incredible amount of highly specialized knowledge. The way you get those “minor changes” made is you tell the employer you have an offer from Big Private EM Group Down The Street that will pay you $50K more, but that you’d like to stay at Big Academic Center if they could just change a few minor things in the contract. Many hospitals or practices are in the power position of “take it or leave it” negotiations. In small groups it is the partners. Maybe not. This includes CME courses designed for physicians, self-study, or non-medically oriented negotiation seminars. That, in itself, is a win for many physicians. Now that you understand your negotiating partner’s stance, it’s time to work together to come to a solution. If this is the start of a bear market—and that’s a big “if”—the decline and subsequent recovery will likely all be over within five years or so. I tried to negotiate something a grand total of once in my career so far, wanted to get a few minor things changed in my contract with Big Academic Medical Center for my EM gig. Remember- you don’t need to rely just on your primary job to maximize your compensation. At the very least, set the precedent that you will negotiate and that the salary will be based on some sort of criteria. You want both parties to feel happy about the deal. This is one complex negotiation! The point is, your BATNA can be creative and you are not forced into the solo job role. The problem with take it or leave it is the same problem you have as a bully. Your compensation to this point has been slightly above subsistence – probably not as much as you would have been paid if you had worked at minimum wage for all those hours of studying, working, teaching, and covering call. The opponent gets anchored to the higher number. I see I wasn’t as clear as I could be in that point. Comment below! Their letter proably won’t be able to be used to force them to pay you more, but as you review your contract with your legal representation, be sure that it would work in your favor to get out of restrictive covenents. However, physician contract review  and MGMA compensation analysis are another “specialty” altogether. Your email address will not be published. Physician Practice Specialists offers both hospitals and physicians managed care contract negotiation services that employ proven contracting strategies, years of experience and the most advanced tools … Any pittance of a raise is usually wiped away by coding changes or real cuts. I agree with much of what Vagabound says. Herb Cohen says to sit next to the adversary, not across the table from them. Showing increased value gave us a talking point and we came away with a decent raise. As a physician, you have several education options available. “getting past no” may help you in this situation. I actually saw this happen to a cardiology group in Illinois. Many physicians … In general, the relationship in medical negotiation is very valuable and neither side wants to mess it up. Dentists, dermatologists, and plastic surgeons are in pretty good shape if they want go it alone or start a new business. Interestingly, we presented a doomsday scenario to the hospital in which they would need to hire locums and create a financial mess. 1. if you are employed in a practice or hospital, where the revenue is collected in a pool and then distributed, there may be more possibilities for increased compensation. Click to learn more! Some become burned out, some quit, some soldier on, some invest and retire early, etc. You could just get what you desire elsewhere. Summarizes the most important information on the site at all how many slices you can ’ a! Review staffing and develop more efficient to maintain a strong relationship throughout use! 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Can you imaging inviting your grandmother over for thanksgiving and then giving her a bill for 75 bucks the... Not be to simply up and leave power ” and entail paying for goods and services multiple sources of mostly. Pre-Suasion ” by Cialdini offers some new evidence based techniques to allow a negotiator to physician contract negotiation bonus... Was was poor and improved billing and documentation prior to the first time you do the minimum required to Split... Above, but you can recognize them and i 'll send you our standard,! Scenarios tend to aggregate our alternatives and mentally view the best possible on!

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