Published in the November 2007 issue of Today’s Hospitalist
You’re going in tomorrow to renegotiate your salary. Are you excited about the prospect of bargaining, or have you stopped eating because you’re so anxious?
Unfortunately, many of us panic when we have to negotiate “a reaction that we need to shake, given that negotiating is a personal and professional constant. That’s according to Linda Snelling, MD, chief of pediatric critical care at Rhode Island Hospital in Providence, R.I., and division leader for career development of hospitalist faculty.
In a presentation on the art of negotiation at the Pediatric Hospital Medicine 2007 meeting held this summer, Dr. Snelling pointed out that negotiating is an integral part of career evolution, one that affects your salary, your ability to advance and your effectiveness in securing program support.
But hospitalists may start out at a disadvantage, in part because they have a hard time figuring out “and asking for “what they want.
Negotiating skills can be learned, Dr. Snelling assured her audience. But those skills won’t flourish without what she called “the negotiating persona.”
“While negotiation is a skill set,” she said, “the most important part of negotiation is the mindset.”
The right mindset
The proper mindset, Dr. Snelling explained, allows you to “understand or at least deal with the part of negotiation that is not rational.”
That’s important, she pointed out, because the “irrational” parts of negotiations “those aspects that have nothing to do with the subject at hand “are underappreciated. They include “who we are, who people think we are, who the other people are and who we think they are.”
Those assumptions affect the discussion in significant ways. While it may take days or weeks to conclude a negotiation, she pointed out, “the time it takes for someone to make an opinion of us is two seconds, based on preconceived notions of who we look like and who we are.”
Who are we?
How do those assumptions play out during negotiations? Consider the fact that many senior members of a medical staff, hospital administration or academic faculty tend to be older, male and white.
Hospitalists, on the other hand, “are often young,” Dr. Snelling said. They are also engaged in a specialty that is so new that “a lot of people have no idea what it really takes to provide comprehensive inpatient care.”
A full 50% of pediatric hospitalists are women, she pointed out, while pediatric medicine has a higher proportion of international medicine graduates and physicians of color than most other specialties. These groups tend to be under-represented among senior administrators and specialties like orthopedics, ENT, plastic surgery and neurosurgery.
“This is some of the basis of the two-second opinion,” Dr. Snelling said. “We don’t look like some of the people we’re going to be negotiating with.” At the same time, she said, pediatric hospitalists are up against a preconceived bias that pediatricians are altruistic, deeply engaged with the children they treat “and pushovers.
The good news, she added, is that the medical landscape is slowly changing. The ranks of surgical specialties are growing at a slower rate, while those of primary care and medical and pediatric subspecialties are on the rise.
“That’s very good for us,” she pointed out. “Surgeons and subspecialists are going to be more in need of our help, so that improves our leverage.”
The first stage of negotiating is preparation, which, according to Dr. Snelling, is 90% of the process. The first order of business when preparing is to ask yourself several questions.
The first question to pose? “What’s in it for me?” she said. “Many pediatricians have a lot of trouble with that because it’s selfish. But if you don’t know the answer, you don’t know what you want to negotiate.”
To answer that question, weigh the effect of what you’re negotiating for on your personal and professional life. “If it’s an add-on to what you’re already doing, something has to be given up in your personal or work life,” she said. “If you don’t recognize that before you start negotiating, you will end up, by default, taking a hit in your personal life.”
You next task is what Dr. Snelling called the cardinal rule of negotiation: Figure out what the other party wants. To do so, you need to understand several elements that are usually at play.
First, there are positions, which is the rational part of what you want. The example she gave is one from her own division: We want to create a sedation service because it’s better for children.
The next component to consider is issues, which are the rationales for your position. A sedation service, for instance, would deliver higher quality imaging and improve patient satisfaction.
“The real agenda”
But third, and most important, are the interests. “The interests,” Dr. Snelling said, “are the real agenda.” While you sometimes need to know only positions and issues to successfully negotiate, there are many times when, “unless you understand the interests, you can’t push it through.”
That was the case when she was negotiating to create the sedation service. Typically, pediatric sedation was inefficient and variably successful, and it wrecked havoc with the imaging schedule.
Her “a-ha” moment, she said, occurred when she realized that while no one was happy with existing radiation procedures, key administrators feared that providing more services to children would lose money.
“I had heard a leader in radiology say that pediatric radiology doesn’t make money,” she pointed out. “When I assured him that our service would be able to shorten scan times and allow more patients to be studied, he figured out what that was worth, and we had an agreement the next week.”
Your strongest position
When the negotiations finally begin, “the strongest position you can have is to let other people do the talking,” said Dr. Snelling. “Let them put their cards on the table first.”
While you’re bargaining, she explained, what you’re really looking for is common ground. If none is readily apparent, “just keep people talking and asking questions. This is where you point out your leverage not as a threat, but as bait: ‘This satisfies Joint Commission requirements,’ or ‘This improves patient satisfaction or lowers costs.’ ”
While it’s important to point out opportunities for others, she added, do not tell other people what’s good for them. “That usually means what’s good for you.”
Be sure to write down points as they’re agreed to. And when you do concede something, get something in return. Dr. Snelling recalled the time when the salaries of the physicians in her group were 10% below market, a jump that the department chair thought was too high to make at one time.
“He said, ‘I can’t do it all in one year, but I’ll give you 5%,’ ” she reported. “I said, ‘How about 6% this year and 6% next year?’ I made a concession, but got an overall gain for my group.”
Sometimes, she said, negotiations just don’t go well. “Get out of the room, save some face and give yourself time to process,” she advised. “A bad deal is much worse than no deal at all.”
And there are times when an offer just won’t work for you or your program. “Saying ‘no’ isn’t necessarily a problem, it’s how you say ‘no,’ ” she said. “If you can say ‘no,’ give a couple good reasons and end it there, that’s very powerful.”
Even when you’re getting to “yes,” consider the first round as just a session to identify common goals. “You do not have to go on to make the bargain,” Dr. Snelling suggested. “Instead, say, ‘Let’s reschedule a meeting to finish this up,’ so you have time to think about what you’re about to agree to.”
And if the absolute final offer from the party you’re negotiating with “for salaries, program support or infrastructure “still falls short, take a direct approach. “Ask them how much money they have, and let them know what you can do for that,” she said. “If there’s enough money to support only part of the program, then figure out together what part that will be.”
If someone can pay only 90% of your salary, for instance, determine how to do 90% of the job. “It’s not a threat, it’s a fact,” she pointed out. “Who in their right mind would do 100% of a job for 50% pay?”
Phyllis Maguire is Executive Editor of Today’s Hospitalist.
For more negotiating tips, read How to get what you want when you’re negotiating.