Thursday, April 15, 2010

Negotiation, MD

Earlier this week, I had the pleasure of attending Paul Levy's seminar on negotiation.

It was a great seminar, and covered many of the fundamentals of the art and science of negotiation in a 3 hour period. What I found most interesting, is how innately uncomfortable many physicians are with negotiation, especially with monetary negotiation. I have often thought about this problem as it applies to physicians as a group, as our negotiation skills lag far behind, especially given our training on rigorous analysis, decision making, and interpersonal skills.

Having grown up in a household whose sport was negotiation, I feel I can shed a little light on this issue that has often puzzled me about my colleagues. I can come up with at least three reasons why physicians fail at negotiation:

1. We never hear "No."
As physicians, we are not used to being told No. A real No, the kind that sticks. Sure patients, nurses and colleagues will often say no, but it is usually transient and we can move them to yes very quickly by leveraging our knowledge and positional power. We never have to develop the more subtle mechanisms for reaching agreement, because these tools work so well. In the negotiating world outside of medicine, we often have neither, and yet try in vain to invoke our favorite tools.

2. Physicians are risk averse.
By the nature of our profession, we endeavor to prevent the worst from happening, and it is always on our minds. We see risk as something to be minimized, and when we do balance risk and benefit, it is always on behalf of our patients, rarely for ourselves. We never feel the primary burden of our decisions, only the secondary consequences of a bad decision. If you want to beat a physician in a negotiation, instill him or her with the fear of loss.

3. Our training teaches us to be suspicious of money and tolerant of abuse.
We are the "good people," sacrificing our time, energy and potential earnings to help those around us. In order to rationalize how we earn so little for so much work in our training days, we develop a culture that places money in a strange place; a necessary evil but not for us. Therefore, the people that want money must also be evil, and we are willing to give it up in a negotiation, to rise above. Additionally, we learn from early in medical school that those above us in the hierarchy may act inappropriately, but it is in the best interest of our patients that we accept this abuse. While this phenomenon has improved over the years as professionalism standards grow in import, we still tolerate abuse from colleagues, other non-physician staff and patients themselves all so that we may benefit our patients. Appeasement does not work as a negotiating strategy.

So what do we do about all this? How can physicians improve?
1. Read about negotiation-- it is a skill and an extremely important one, study it
2. Attend workshops, seminars, etc.-- Negotiation is a performance sport, you must have practice time in order to succeed.
3. Develop negotiating mentors-- find someone that helps you think through problems critically, and with negotiating experience.  My father often fills this role for me.
4. Negotiate-- As Jeff Wiese always taught us at Tulane, Playing time makes all of the difference.

Some recommended reading:
Roger Dawson- most of books are great
Getting to Yes by Fisher, Ury and Patton
Bargaining for Advantage by G. Richard Shell

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