1. Negotiation

2. Society for Academic Emergency Medicine Definition of Negotiation u Compromise: concessions on the part of both parties u Confer and discuss to reach an agreement

3. Society for Academic Emergency Medicine Why Physicians Dont Negotiate: Excuses u No time u Embarrassed u Not comfortable u Dont like conflict u Feel that asserting themselves during negotiations isnt professional u Physicians want to be liked

4. Society for Academic Emergency Medicine What type of things have you negotiated for in the past?

5. Society for Academic Emergency Medicine Typical Physician Negotiations during their Career u Salary u Home u Car u Legal/financial/accounting fees u Equipment Purchases u Consumer goods Purpose: Empower you to save 5-10% when negotiating

6. Society for Academic Emergency Medicine Negotiation Case u While on vacation you go into a jewelry store and see an attractive looking watch. You ask the stores owner how much it costs and he replies $495.67. How much would you offer to pay for this watch?

7. Society for Academic Emergency Medicine Two Types of Negotiations u Cooperative: Long term relationship u Competitive Negotiation: One time deal

8. Society for Academic Emergency Medicine Cooperative Negotiation u Search for a Win-Win solution *Find best deal for both parties *Find ways to make a bigger pie to divide *Invent options for mutual gain u Sensitive to the others needs: listen u Build trust: integrity u Stress looking for a long term relationship

9. Society for Academic Emergency Medicine Competitive Negotiation u Opponent wishes to: WIN * Discloses little information as possible *Shows little concern for you *Manipulates you *Uses variety of negotiating tactics to win

10. Society for Academic Emergency Medicine Principles of Negotiation u You negotiate all of the time u Willing to practice u Negotiation skills dont change as the negotiation gets bigger & more important u Avoid thinking you have the weaker position u Options give you power: BATNA u Worst thing you can do: let the other side know how much you care u Point of time decision at time it exists

11. Society for Academic Emergency Medicine Principles of Negotiation u Two way affair u Understand cultural differences of negotiation u Concentrate on the issues u Remove the personal from the issue u Dont be confrontational u Avoid positional negotiation u Allow the other side to save face

12. Society for Academic Emergency Medicine Principles of Negotiation u People believe in what they see in writing more than what they hear u Specific numbers have credibility u Follow the law of probabilities u Find person who can make the decision

13. Society for Academic Emergency Medicine Principles of Negotiation u Body language: watch CHANGES in body language u Dumb is smart: *If too smart: want to compete against you *If dumb: people want to help and educate you u Never change your offer *Except in response to specific counter proposal *Preferable in writing u Dont close deal until all of the issues are settled u Contract rules: *Read ENTIRE contract every time it is returned *Write the contract

14. Society for Academic Emergency Medicine Personal Power: Dont let it intimidate you u Legitimate: power of the title, position in he marketplace u Reward: power to reward you u Coercive: power to punish you u Reverent: consistent set of values u Charismatic: power of the personality u Expertise power u Information power: side with the most information usually does better u Situational power: if you have to make the concession anyway, do it immediately & nicely; maintain goodwill

15. Society for Academic Emergency Medicine Informational Power: Active Listening u Active Listening *Ability to hear u What is said u What is omitted u Equivocal statements u Verbal leaks *Prevent misunderstandings

16. Society for Academic Emergency Medicine Informational Power: Want your Opponent to Like You u Needs: *What are they looking for *Need to be successful u Interests: Find compatible interests to build on *Values *Family (children, pets, spouse) *Professional achievements *Hobbies *Athletic achievements *Travel

17. Society for Academic Emergency Medicine Informational Power u Ask tough questions: they may answer them u People are reluctant to admit they dont know u Most people like to talk about themselves u Appear ignorant of certain matters: people love to teach u Chance to judge their reaction u Ask away from the workplace u Search for commonality: people share information across: *Peer groups *Professions u Dont be elitist: obtain information from clerks, secretaries, janitors, patients, peers, former workers

18. Society for Academic Emergency Medicine Informational Power: Do your homework u Search the internet, public filings, company catalog, annual reports u Ask for informational packet from the other negotiation teams representative u Have facts, documents, figures available u Demonstrate that your proposal or terms are the industry standard or accepted practice u Power of precedents and policies

19. Society for Academic Emergency Medicine How to Deal with Difficult Questions u Defer u Defect u Delay u Decline u Rule the question out as improper u Ignore the question u Respond generally to a specific inquiry u Plead ignorance u Plead irrelevance u State the question is too personal u Answer with or answer a different question

20. Society for Academic Emergency Medicine Three Stages of Negotiation u Develop a relationship of trust * Dont offer anything you cannot follow through on *Let them air their options *Focus on mutual interests 1. What do they want? 2. Gather information 3. Win/Win negotiation

21. Society for Academic Emergency Medicine Beginning Moves u Never jump at the first offer u Ask for more than you expect to get u Flinch at the other sides proposal u Avoid confrontational negotiation

22. Society for Academic Emergency Medicine Beginning Move: Never Jump at the first offer u Want the other side to feel they won u Otherwise the other side wonders whats wrong u Dont form opinion how the other side will respond

23. Society for Academic Emergency Medicine Beginning Move: Ask for more than you expect : Bracket your objective u Probably will end up with less than you ask for u You may just get it u You dont know what the bottom line is u Raises perceived value of your service u Creates a climate where the other side can win u Prevents deadlocks when dealing with an egotistical person

24. Society for Academic Emergency Medicine Beginning Move: Asking more than you expect : Bracket your objective u How much more should be asked for than we expect to get? Assume that you will end up midway between your and their opening positions -Must get them to commit first to their very best position: bracket them so the midpoint is what you really want -If they get you to commit to your best position: they bracket you so the midpoint is what they want

25. Society for Academic Emergency Medicine Beginning Move: Flinch at their proposal u React visually = shock at their proposal u Often other side is watching for reaction u Visual reaction overrides auditory in most people Exercise: picture your medical school graduation

26. Society for Academic Emergency Medicine Beginning Move: Avoid Confrontational Negotiation u Arguing increases peoples wish to prove themselves right u Forcing them to defend their position u Use instead: feel/felt/found

27. Society for Academic Emergency Medicine Middle Negotiating Moves u Time Pressure u Remove their resort to higher authority u Decision at point of time u Patience is a virtue u Silence is golden u Information power

28. Society for Academic Emergency Medicine Middle Negotiating Moves u Never be pushed into making a decision *Vague higher authority u I have to check with the board or committee *I have to check to see if this creates conflicts of interest for me *I want to avoid even the appearance of impropriety *Offer to make decision but let them know it will be negative if you have to make it now

29. Society for Academic Emergency Medicine Middle Negotiating Moves u Remove their resort to higher authority *Appeal to their ego *Get their commitment that they will recommend it to a higher authority

30. Society for Academic Emergency Medicine Middle Negotiating Moves u Never offer to split the difference *Encourage other side to split difference u If you make a concession, get reciprocal concession immediately u Handling an impasse: set aside technique

31. Society for Academic Emergency Medicine Middle Negotiating Moves u Deadlock: neither side sees any point in talking to each other because its not going anywhere any more *To Resolve: Third party: must appear neutral u Arbitration: Winner, loser u Mediator: Facilitates solution: no power

32. Society for Academic Emergency Medicine Middle Negotiating Moves: Concessions u Everything you give up is a concession u Need to understand the value of any concession to your opponent u Try to get something of equal or better value in return for every concession you make u Try to get opponent to make first concession u Start with the largest concessions first and reduce the size u Story of concessions: make the opponent look like a hero to their organization

33. Society for Academic Emergency Medicine Middle Negotiating Moves u Trading Off: If we do this for you what can you do for us? *Reasons to do this: u May get something u Elevated the value of the concession u Stops grinding away process *

34. Society for Academic Emergency Medicine Ending Moves u Defense *Good guy/bad guy: u Try to equal size of negotiating team u Identify the tactic to the other side *Nibbling: make them feel cheap *Be prepared to walk away: Have options

35. Society for Academic Emergency Medicine How to Say NO Politely u I would love to but Im swamped u I am honored, but I am focusing on other areas u Sounds interesting, could you send me a written proposal u I am not an expert in this area, but I can refer you to Dr. X u Let me check my schedule & get back to you u Im sorry but I have a previous commitment

36. Society for Academic Emergency Medicine Negotiation Case u Divide into 2 groups u Take a yellow or blue sheet depending on your assigned role u Paper and pen required

37. Society for Academic Emergency Medicine Negotiating Case u Division Director *You are looking to hire a junior faculty member for a position in your Division. *You need to hire a physician to work as a clinician educator in your Division as your current faculty members feel clinically overworked. *You have plenty of senior faculty members in your Division that are in administrative and research positions. *Your facility is not located in an attractive area of the country but the area is family friendly and the cost of living is low. *You are competing for subspecialty physicians with two other institutions within a 50 mile radius. u Your institution has a better academic reputation than the other two institutions and there is low turnover of faculty as the institution is known to be physician friendly. u Your institution pays less than the other two institutions. * You are interviewing an excellent candidate who will complete fellowship training in 6 months. *The Chairman of your Department has permitted you to hire only one physician and you feel that your Division will still be understaffed. *The institution will not allow you to pay this new physician more than $150,000 per year. *All salaried physicians working for the institution receive 4 weeks of paid vacation time and are given $3,000 and one week off for CME per year.

38. Society for Academic Emergency Medicine Negotiation Case u Junior faculty candidate *You are completing your fellowship training in a few months and looking for a junior faculty position. *Your spouse plans on not working outside of the home to care for your infant son. *You have $150,000 in medical school debts. *You are an excellent candidate as you have published 2 clinical research articles and have an outstanding reputation as a clinician at your training institution. *You are interviewing at Institution X: u Your spouses entire family lives in the region and you have agreed to move there. u The institution has an excellent academic reputation and is known to be physician friendly. *There are two other hospitals in the region that are actively recruiting for physicians in your field. Both hospitals are non-academic institutions but pay a higher salary. One institution advertises a starting salary of $160,000 per year. The other two institutions are unable to provide you with any clinical research opportunities. *You would like a position that would give you 80% of protected research time as you enjoy research and wish to advance professionally in your field. *You cannot support your family or pay off your medical student debts if your salary is less than $130,000 per year.

39. Society for Academic Emergency Medicine Bibliography u The Successful Physician Negotiator: How to Get What You Deserve by Babitsky and Mangraviti, S.E.A.K, Inc. Legal and Medical Information System, Falmouth, MA, 2001 u ACPE: Negotiation Course by Roger Dawson

40. Society for Academic Emergency Medicine Author Credit – Negotiation: Maria Ramundo Questions

41. Society for Academic Emergency Medicine Postresidency Tools of the Trade CD 1) Career Planning – Garmel 2) Careers in Academic EM – Sokolove 3) Private Practice Career Options - Holliman 4) Fellowship/EM Organizations – Coates/Cheng 5) CV – Garmel 6) Interviewing – Garmel 7) Contracts for Emergency Physicians – Franks 8) Salary & Benefits – Hevia 9) Malpractice – Derse/Cheng 10) Clinical Teaching in the ED – Wald 11) Teaching Tips – Ankel 12) Mentoring - Ramundo 13) Negotiation – Ramundo 14) ABEM Certifications – Cheng 15) Patient Satisfaction – Cheng 16) Billing, Coding & Documenting – Cheng/Hall 17) Financial Planning – Hevia 18) Time Management – Promes 19) Balancing Work & Family – Promes & Datner 20) Physician Wellness & Burnout – Conrad /Wadman 21) Professionalism – Fredrick 22) Cases for professionalism & ethics – SAEM 23) Medical Directorship – Proctor 24) Academic Career Guide Chapter 1-8 – Nottingham 25) Academic career Guide Chapter 9-16 – Noeller