When Doctor Contract Negotiations Go Bad (Part Two)- Avoid the Behavior Mistakes that Sour the Relationship.

Every time you negotiate, you run a risk. Learn the advanced techniques to avoid the negative actions that have the potential to worsen the outcome.

Author: Robert A Felberg MD 

Topic: Negotiation, Conflict management

Keywords: Physician Negotiation, Doctor contract negotiation tips, conflict management for doctors, physician employment checklist Paying off student loans through negotiation

When it comes time to negotiate, it’s every doctor’s greatest fear. You want to negotiate a fair compensation package based upon your well-researched market value report, but instead you end up getting so emotional that the deal is withdrawn, or the relationship is forever soured or harmed.  Most of the time, if a physician contract negotiation goes bad it’s a good thing, as covered in another post.  But sometimes, the fault lays squarely in your lap.

[Editor’s Note: To truly succeed in your medical career you’ll need three complementary skill sets.  Of course, you need to be skilled in the practice of medicine.  Secondly, you’ll need to understand physician personal finance.   Finally, you’ll need a well-developed Professional and Medical Business skillset.   Of all the professional skills, negotiation is the most important.  This is one of an ongoing series from Physician Advocates and Medical Success Central introducing the science and practice of negotiation to healthcare professionals.  Sign up for our newsletter to be kept up to date.]

How you act will have a direct role on the negotiated outcome.   As discussed in another post, Doctors tend to have very poor conflict management styles.  Some physicians tend to be immature and border on childish in their responses. They are also quick towards brinksmanship, and don’t understand the long-term role of relationship as a vital part of the final outcome.

You want the negotiation to focus on the mutual benefit and increased value of the parties involved, not on your negative actions.

One simple screening process is to ask yourself, “Am I removing the focus off the deal and onto my personal qualities in a negative way?”  Are you representing your desired brand? Or, are you going to make your future boss wonder how much time they’ll need to spend defending you?   It may be as simple as applying the golden rule– how would you judge the other party if they acted this way?

Now, I need to halt the discussion here and bring up the fact that sometimes you may feel you are being treated poorly and believe you must reply in kind.  This form of conflict response is called “retribution or revenge” and it is considered a highly dysfunctional conflict resolution technique.  Unfortunately, I see many physicians turn to this as a standard response.  They believe they are being abused by the ED doc and abuse them back.  They feel they have been insulted by a low initial offer and insult the other party back in a direct manner i.e.; “Your stupid little hospital can shove it if you think I’ll work for that little!”

The proper response to perceived abuse is to point out the action, express why it is abusive, and explain in a non-aggressive manner that you will not tolerate this type of behavior.  Then, ask them to supply a proper behavior.  If they do not act properly, state that negotiations can not continue as they are, and we will take a break.  Then leave the table.  They will come back and will understand the message.  In the rare case they don’t, you’ve avoided a disaster and you move on with your BATNA  [Editor note: I’ll discuss BATNA in a future post. Please be sign up for our newsletter and check on our blog posts frequently].

 

 

Here are some hints to help you avoid negatively affecting your negotiation:

  • Always thank the other party when they offer a concession.  Gaining a concession in a negotiation is a positive step to achieving your desired agreement.  Always be gracious.
  • Be wary of using “you” in an accusing way.  Don’t put the other party on the defensive or make them feel unappreciated.  Instead of saying, “You need to pay me more” try, “Can we do a little better?”  Be certain to say “you” in a positive flattering manner as in, “I really like your program.”
    • Bonus hint- If you really want to move a negotiation along use the word “our” to describe the negotiation, “I’m really looking forward to seeing how we can improve our clinic throughput.”  Use this sparingly and with discretion.  You don’t want to come across as disingenuous or manipulative.
  •  Avoid threats. Threats, even when backed up will almost always backfire. Your long-term relationship will sour, and you will come across as shrill. Eventually, the other party will tire of the threats and call you on them. No one likes to be held hostage to a demand. Try this- instead of, “If you can’t come up with something better, I’m going to walk”, consider , “I really like your program, but the compensation is not what I’m being offered at other programs. Is there any way to improve the salary offer?” The message is clear- I have other offers, but it’s not presented as a threat, rather as a fact that we will work through together to mutual solution.
  • Avoid Brinksmanship. Do not push a situation to the edge on purpose with the hope of gaining a big concession. Avoid pushing to the point of deadline or collapse of a deal. If you are buying a house and you know the other party must sell by a certain day to get the mortgage on their new house, then go ahead and use that leverage to your best advantage. But, if you expect to maintain a relationship afterwards, this type of technique must be used with caution or avoided altogether.
  • Be Honest. Do not lie about the services you can provide.  Expect the same from the other party.  Remember, everything related to duty will be included in the doctor contract and you will be held accountable if you are in breach. Be up front if there are any issues- credentialing, license, start date, hours, call schedule, physical limitations, etc.
  • Do not get overly emotional.  Becoming visually angry, anxious, tearful, or distraught will only harm your negotiation and give you a reputation as a bully, pushover, or another less than ideal characterization. Remember, It’s OK to have emotions.  It not OK to let emotions have you.  If you find yourself running into an issue of controlling your emotions, call for a break.  You can ask for a bathroom or water break. You can just say, “I need to take a few minutes break here. This is going a little longer than I thought, and I have a quick call to make.” Whatever you do, don’t return to the table until you are in control.  Don’t worry about how the other party will react. Chances are, they will be sitting there in silence for a few anxious minutes thinking that they soured the deal.  They may even offer you an apology or concession the second you come back.
  • Learn how to step away from the table with grace and without prematurely ending the negotiation.  We all know how to do this.  Your cousin calls you and insists you come over for his bowling team awards dinner.  You’ve got other things you’d rather do, but you still may decide to go.  So, you say, “sounds good, but I need to check with my wife first.” Then later, after considering other options, you finalize plans.

 

You can do the same with your offer. If you come to a deadlock, walk away from the table in a polite manner.  Imagine you are looking at a great practice, but you want to earn more.  However, even if they don’t up the offer, you’d still like to take the job.  You can say, “Thanks for discussing the position. I’m excited by it. I have another offer on the table and they will be calling me on Tuesday.”  Then later that week you call and say “I really like your program and want to join your organization. But, the other program is offering 15k more.  Is there anyway we can improve the salary offer?” Even if the offer is not matched, you set a gracious way to concede earlier in the conversation.  You can say, “I’m disappointed that we’re not able to come up with a better salary, but I really like your program and I’m willing to join at the salary we discussed.”

There are certain standards of behavior that are expected when the negotiation goal includes strengthening the long-term relationship.  These will differ significantly from other bargaining scenarios like selling a used car or haggling at a flea market.  Keep in mind to always screen your behaviors and consider the “golden rule.” Also, watch for the behaviors listed above and try the techniques suggested to correct any issues. Certainly, this is something that improves with experience and you will get better at it with practice.  Remember, the negotiation goes both ways and you should not tolerate bad faith or bad actions from your negotiating partner.

The great thing about negotiation, just like other physician professional and business skills, is that they can be learned and mastered.  As you plan your next negotiation, be certain to learn your market value, up your skill set, and consider taking a CME approved negotiation course designed for physicians. With study, hard work, and practice you can become a great physician negotiator. You will be able to reach your dreams and succeed… really succeed.

What do you think? Should I even care this much about what the other side thinks? Have you ever gone over the line in a negotiation and caused it to go bad? What did you do to recover? How have you dealt with bad behaviors from the other side? Share your thoughts in the comment section below.

 

 

When your Best Doctors Go Quiet – an Ominous Sign: Part One

Sometimes a confluence of events comes together in a strange way. This was one of those weeks.

Author: Robert A Felberg MD

Topic: Conflict management, Negotiation, Physician leadership

Keywords: difficult discussion in the workplace, how to manage a team, employee silence, medical leadership.

First–  Richard Thaler wins the Nobel Prize in economics. Richard Thaler has long been a hero of mine. If you don’t know his work, he basically showed that humans are not rational economic agents, in opposition to what was first proposed by Adam Smith. It’s his work that led to the change in retirement funding where people are automatically signed up into their 401ks and have to opt out. I’ve been advocating the findings of Thaler and others like him as a leadership and marketing model for years.

[Editor Note: physician leadership is a complex skillset. This post is part of a series produced by physician advocates LLC and Medical Success Central discussing physician professional and business skills– the things you weren’t taught in medical school, but define your career success. Please sign up for our newsletter to be kept informed.]

Second- I hear about a disappointing interaction from one of my colleagues with the upper leadership at their institution. My friend tells me they are implementing a new Antibiotic Use policy. There is mandated educational class prior to implementation.  An email goes out to the staff, “Everyone must sign up for a class. So far, only 15% have signed up. If you don’t sign up, you’ll be suspended, etc.” Knowing the findings of Thaler, my friend sent an email recommending that everyone be assigned a date for training with the option to reschedule. That will get everyone past the first step and have 100% assigned. After a professional exchange discussing Thaler’s work in education, finance, and medicine she got a disheartening response: “I’ve launched five Antibiotic Programs. How many have you launched? We’ll ask you for advice when we want it.” Can you believe it? And yet, so typical of the poor leadership that dominates the field of medicine, even at the highest levels.

Third- This article on candor in the workplace is published in the WSJ. Being able to be honest without being penalty is one of the most pressing problems in medicine. Jack Welch, the former CEO of GE was one of the leading proponents. What do we mean by candor? The ability to honestly discuss failures, problems, and even personality issues- in a professional manner- without facing backlash or career harm.   In medicine, it’s often the case that the we are silent over the big glaring problems and verbose about the meaningless ones. The honest are usually “whacked”, while the meek get promoted. Physician leaders are especially guilty of this- the people below you are discussing problems they have with current policies. Since the leaders set the policies, they are in the firing line. If their egos are bruised easily, they respond with oppression rather than discussion.

Which gets me to my point. How you deal with your thought leaders and change agents defines your success.  Maybe, you weren’t interested in an idea sent your way. The smart reply would be along the lines of “Thanks for your input. You raise some great ideas. It’s too late to use them now, but I could really use somebody with your interests on the Antibiotic stewardship committee.”  Now the ball is in my court. If I was talented and motivated, this would be a big break for me and the leadership could add an interested and vested team player. If I’m not competent, I’d screen myself out. Instead, I have now gone silent. I will not offer any new innovations, even if directly asked. I ‘ve learned the penalty of giving advice- I get “whacked”.  When your best people go silent, you’re in trouble. My friend called me looking for a reference- she knows that she is smarter, works harder, and can get treated better somewhere else, all with a bigger paycheck. The administrator who sent the email reply described above probably thought himself witty, but it was a very costly response. Chance are, if you lose a top-performing employee it’s because of poor leadership.

In part two, I’ll discuss what I call my Physician Leadership Credo.  Certainly, there are a lot of excellent books, courses, and seminars on Physician Leadership- I’ll just share my own style. In the meanwhile, consider the role of employee silence in the harm of your healthcare organization’s success, how well your organization encourages candor, and consider joining us for the Negotiation and Professional Skills for Physician Seminar.

What do you think? Have you left a good job because of poor leadership? Do you work someplace where you can be honest without fear of reprisal? What is your leadership credo? Share your thoughts in the comment section below.

 

Physician Conflict Management- How You Deal with Conflict Matters

Take a guess how many google entries there are for the search term “disruptive doctor”? Did you guess 21.2 MILLION in 0.7 seconds?  Sounds crazy, right?

Author: Robert A Felberg MD

Topic: Conflict Management, Physician Leadership

Keywords: conflict resolution in medicine examples, conflict management in healthcare setting, Disruptive physician program

We’ve all seen the rude doctor who responds like an immature child or abuses the staff, but did you realize that the issue is this widespread?  Maybe, just maybe, we’ve all been a little (or a lot) guilty of this offense as well… But who can blame us?   We’re working crazy hours on no sleep, we get abused every day from all angles, everyone else gets to treat us poorly, but the second we even raise our voice to complain about the 22nd peer-to-peer call that afternoon, we get labeled “disruptive”.     Sometimes it’s seems like everyone else is making my environment hostile, but we’re the only ones who get in trouble for it!

[Introduction: This is part of a series delving into complicated professional and medical business skills that are vital to physician success, but are not covered as part of your training. Presented by physician advocates and medical success central, this is not intended to replace legal advice. Please sign up for our newsletter to keep informed. Please consider joining us for our upcoming CME approved seminar.]

Ok. You’ve had your chance to vent… Remember- It’s OK to have emotions, it’s not OK to allow emotions to have you. Especially when you are in an asymmetrical relationship and hold more power.

Conflict Defined: Conflict is a disagreement about the use of shared resources, between interdependent parties, and involving negative emotions. 

Delving into this definition of reveals a lot  about how conflict occurs and how it can be addressed.

  • You can only really be in conflict about shared “resources”- the term resources can be used loosely here. These resources can include obvious things like finances, materials, staff, or time. It can also involve “relationships” or “persons” if you think of relationship in the strictly economic sense- you can easily enter a conflict about the treatment of another person or groups of people. The closer that person is to you or your identity, the stronger the pull to jump in.
    • Consider this- The other party may not truly understand the nature of your concern. Sometimes you aren’t even aware why you are getting emotionally charged. We’ve all experienced a person “blowing-up” over something seemingly minor and not understanding why they are so upset.  Before you escalate a conflict- are you aware of why they are upset and have you calmly let the other party express their concerns? Maybe the resource has little value to you and you can readily concede it, once you understand the issue.
      • For instance, your nurse must pick up his son at soccer practice in twenty minutes.  You need him to assist in a procedure.   He starts to get visibly upset.   Rather than responding like you often do at the end of a rough day by escalating the conflict, you ask him to take a break, calm down, and explain why he is upset.   After you learn the reason, you offer to pay for a taxi for his son if he can supply the receipt.

 

  • You are interdependent or rely on the other party. That means, that even if there is a power difference– think you and a nurse or you and the president of the hospital- there is more to be lost than just the direct disagreement. You also risk souring the relationship.  In most health care related conflicts, the relationship is worth 75% percent of the final agreement.  (note: I’ll cover the role of relationship in another post.   Please sign up to the newsletter to be kept up-to-date) You need to keep a few things in mind when you enter a conflict
    • You are rarely just at odds about the immediate issue at hand. You are also conflicted about the nature of the relationship. If the relationship breaks down the harm can be considerable, far worse than you initially believe, and can harm more than just the parties involved.
    • Because of the interdependence of the two parties, the role of power gets magnified. If a physician gets into a conflict with a lab tech, the perceived power difference- real or not- gives you the appearance of a 6’4” football linebacker picking on a kid in a wheelchair.  You will always be the bad guy, even if you think your response was appropriate. The counter argument will always be, “you are a doctor, you are not permitted to lose your cool at any time.”  Unfortunately, it doesn’t work the other way- The president of the hospital may have more power, but if you respond poorly to his abuse, as a physician have little recourse because your power is considerably higher than the average person. Think of the world’s smallest violin joke as the common reply when you complain.

 

  • Conflict is associated with negative emotions. This is the most important defining characteristic of conflict. We interact with people all day long about the use of resources and different behaviors, without getting overly emotional. If we both want pizza for lunch, we get along swimmingly.  If you want pizza and I want Chinese take-out, and I accuse you of always making demands and never caring about what I want, suddenly we have a problem.
    • Conflict minus Emotions equals Negotiation.  As a physician, negotiation is the single most vital professional skillset you can learn. If you can avoid or defuse the emotional aspect of the disagreement, focus on the actual issue at hand, be honest with each other, and keep the relationship in mind, you’ll find most work conflicts can be managed- sometimes more easily than you can imagine.
    • Emotions are internal “facts”. The emotional state of yourself or the other party is as real as any other “fact” of the negotiation. The price of a dozen oranges is $3.25 is just as relevant as “I am worried” when it comes to resolving a conflict. Keep this in mind as you move forward.
      1. Do not belittle the other’s persons emotional state. Doctors do this often. They hear that OR nurse is tearful after you humiliate her and you respond, “They need to toughen up. This is medicine, not a beauty pageant!” Instead, you should consider saying, “Wow. I had no idea they were so upset. I’d really like a chance to apologize when she feels better.” You don’t need to “give in” on the disagreement, but rather apologize for worsening the harmful emotional state. Or at the very least recognize it – “I see you are very upset. That wasn’t my intention. I hope you’ll see that I am interested in working this problem out.”
      2. Consider your emotional state and the emotional state of the other party. If you are too angry to discuss an issue, say so- call a “time out”.  When someone else is too emotional to negotiate, call for a break and reconvene when they’ve had a chance to cool down.   If the other person is getting abusive, tell them you will not negotiate with someone who is acting this way, that you will return to the table when they can behave professionally, and walk out.  Don’t just threaten to walk out- do it.
      3. Don’t make the error of fundamental attribution the tendency to allow your perception of another person’s actions or beliefs reflect on who they are.  You overhear someone arguing against a raise for the nursing staff and label them as “greedy” and “selfish”.   This attribution to their character is based on your perception of how they acted and taints your relationship and dealings with them. What you don’t know is that the hospital is facing a reduction in revenue and a review of the bond issue.   A cash crunch from a nursing raise would bankrupt the hospital.
      4. Fundamental attribution errors can be made worse when people who have trouble communicating their reasons behind their actions or the need to keep information confidential.Your ancestors had to make snap judgements to survive- is that a shadow or a tiger? A delayed choice could be fatal. The same tendency to judge others rapidly leads to conflict.Before you judge a persons’ character based on their actions, try to understand their reasons.

Everyone will face conflict in their medical career. Whether it’s fair or not, as a physician you will be constantly under the microscope. If you respond to conflict poorly it may harm your reputation and career irreparably.  The good news is that conflict, like other physician professional and business skills are straightforward to learn and most doctors can master them with study and practice.   Much like learning to break bad news, there are techniques that can help you get through an emotionally charged situation and conclude a satisfying solution.  Doctors who have mastered conflict management are often considered “sages”, “wise”, or “peacemakers”.   This is a very positive association and can only help your career.   Being branded “immature”, “disruptive” or “a jerk” is the opposite.

Future posts will explore techniques and style of conflict management including how to “vaccinate” yourself against career destroying conflict before it happens. In the interim, think about the conflicts you’ve had in the past and how you might approach them differently, practice techniques to help you call a “time out” before the real damage occurs, and consider a formal CME approved course designed for physicians to help master the conflicts you will inevitably face.   With the proper skillset and training you will be able to reach your dreams and succeed… really succeed.

 

What do you think? Are the JC disruptive physician requirements helpful or harmful? Are doctors the bad guys or the scapegoats? Have you ever had a conflict where you responded to so poorly that you’d give anything to take it back? Do you have any advice for avoiding unnecessary conflict? Let us know your thoughts in the comment section below.