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based upon your well-researched market value report, but instead you end up getting so emotional that the deal is withdrawn, or the relationship is forever soured or harmed.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 Doctor Contract Negotiations Go Bad (Part One)- Usually it’s a Good Thing

You worry that negotiating your doctor contract for higher salary may go badly. The reality is that it may be the best thing that could happen for your career.

Author: Robert A Felberg MD

Topic: Negotiation, Professional and Business Skills

Keywords: Physician soft skills, negotiating for a higher doctor salary, doctor negotiation mistakes, difficult negotiations

[Editor’s note: THANKS to White Coat Investor for naming this post of one the “Best of the Web” for November 2017! Welcome White Coat Investor readers- We Love the WCI Blog. Thanks again for visiting!]

It’s a common fear. You want to get a fair compensation package, but you worry that by bargaining you will upset your future boss and they will withdraw the offer. This anxiety may prevent applicants from even attempting to get a better deal.  You realize that you are expected to negotiate and that if you don’t, you’ll lose respect and be branded as a pushover. You just don’t want to sour the deal and lose the job offer altogether.

[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 also need to understand finance.   Finally, you need Professional and Medical Business skills.   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.]

The simple fact is, sometimes a negotiation going badly is the best thing that could ever happen to your career.

When you negotiate, you are “interviewing” your future bosses. Think about it this way. When you are looking at a new job, you are brought in for an interview.   The job interview process is purposefully designed to be a bit stressful. They question you all day, maybe ask you to give grand rounds, and then have you go out to dinner.  It is all designed to see how you respond. Will you breakdown? Become unable to function like a “deer in the headlights”?  Perhaps, you start getting angry or defensive? Your future organization is observing you closely during the visit. If you can hold it together and come across as cool, competent, confident, and charismatic under the wilting pressure of a 12-hour interview, it’s a pretty good indication that you’ll be able to handle the strains of the job.

But, when do you get to interview your bosses?  Before you commit, you’ll want to know how they respond and what are their true core values? Do they treat their staff with respect or do they place monetary concerns first? Do they value fairness? Will they reward hard work and excellence with monetary compensation, recognition, and increased voice in decision making? How do they handle conflict? Do they look for solutions with collaboration, create new value, use recognized national standards, or just coerce? Are they open and transparent?

How your future bosses act during the negotiation will be a very strong indicator on how they will act as your employer.

For this reason alone, it is absolutely vital that you negotiate your physician contract. Consider this- you wouldn’t get married without some sort of vetting process. In many cultures, that involves courtship, dating, and engagement prior to actual marriage. It’s a pretty good sign that how your future spouse treats you during this time is how they will act after marriage.   And, as painful as it may seem at the time, it is worlds better to realize your match is less than perfect before you get married than afterwards.

Your negotiation is the ideal time to examine your future employer. Closely watch how they act and reflect thoughtfully about whether their style is right for you.


Here are some tips to consider as you enter your negotiation

  • Do they act respectfully when negotiating? Do they get angry, use hard tactics, bully you or threaten you? Chances are, they’ll act even worse when they are no longer trying to entice you. Remember, you can always treat others with respect and courtesy, even when you disagree. Accept nothing less.
  • Do they use recognized standards? The trait of reaching for a recognized external or third-party standard, like using a market value report as a base for salary disagreement, is a desired characteristic in a negotiating party. It generally means they value fairness and compromise. It also sets an excellent precedent for future collaborations.
  • Do they try to over-reach on items like restrictive covenant, malpractice tails, or lengths of contracts to pay-off signing bonuses or student loan assistance? Many employers are aware of the naivety of freshly minted doctors and will try to take advantage of them through the more complex aspects of contract design. Although, these types of ploys are usually easily reversed after a high-quality legal review, you do need to think about whether your wish to work with a group that considers such tactics acceptable.
  • Are they open with data and information about the practice? Will they willingly turn over billing or patient care metrics? If they quote salary norms from an obscure database, will they freely give you access to confirm? Negotiations that are data or information rich require a fair exchange of information. Not sharing this type of information suggests a lack of trustworthiness.
  • Determine their negotiating style. Do they create mutually beneficial solutions, compromise readily, accommodate when appropriate? Or is their thought processes rigid and their solutions one-sided or interest based. Do they value relationship over short-term solution? Are they able to work effectively within the organization to obtain resources and agreement?
  • Remember: there are much worse things than having a negotiation coming to deadlock (note: I will write about the concept of deadlock in a future post. Please sign up for our newsletter and check back at medical success central.) Walking away now is far more desirable than signing a contract, buying a house, and then dealing with the monetary, stress, health, and reputational hits that comes from learning too late that your dream job has become a nightmare.

Approach your negotiation as an unparalleled opportunity to observe your future employers in a high-stake relationship based interaction. Of course, you’ll can’t expect perfection, but you should be able to get a good idea of their core values, styles of management, and conflict resolution skills. Don’t worry unnecessarily that your attempt to obtain a better physician salary will sour the job offer. This is unlikely to happen and if it does it was probably a good thing- who wants to work for a boss who doesn’t offer you a fair package?

Learning how to negotiate in respectful manner with emphasis on the relationship will be the subject of part two of this post. In the meanwhile, think about negotiations you’ve had in the past where the other party gave you warnings you just didn’t pay enough attention to at the time. As you prepare your next negotiation, be sure to obtain a solidly researched market value report, upgrade your skill set, work on your brand to present yourself in the best light, and consider taking a CME approved course designed for doctors. The great thing about negotiation, like all professional skillsets, is that they can be mastered with study and practice. With proper educational and training you’ll be able to reach your dreams and succeed… really succeed.



What do you think? I am crazy to suggest risking your job over trying to get a better deal? Have you ever missed the warning signs during a negotiation and signed anyway only to be left with expensive regret? Do you have any advice for newly minted doctors entering into this situation? Please share your thoughts in the comment section.







Knowing your Market Value is Just the Start of Your Doctor Contract Negotiation Strategy.

Your market value report will get you about 65% of the way to a great deal on your physician salary. The remaining 35% will require some leg work.

Author: Robert A Felberg MD

Topic: Negotiation, Professional and medical business skills

Keywords: Doctor negotiation, Health care negotiation, Doctor salary

It’s your single most important number in any negotiation. Before you can begin to bargain on your worth, you need to know what you are worth! Getting a solid, well-researched market value report will help you understand the market and develop your negotiation strategy. You can develop an Anchor number or counter-offer, BATNA, and concession strategies. In fact, the market value report is so valuable, you’d be crazy to even sit down at the table without one!  But, like any dataset, if you aren’t careful it can lead you astray.

[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 also need to understand finance. Finally, you need Professional and Medical Business skills.   Of all of 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.]

The main problem with relying 100% on your market value report is that the compensation values listed are derivative to economic conditions in the region and do not completely reflect the environment of the individual practice you are joining.  OK, long and complex sentence. I get it- don’t give up on the idea quite yet. Let me walk you through it.

  • Something is considered “derivative” if it’s value depends or is “derived” by the value of something else. For instance, you get a personalized autograph from a rookie professional baseball player.   The value of that piece of paper is essentially zero, unless that player makes it to the hall of fame.  Then, suddenly it’s quite valuable! The value of the autograph is based or “derived” on the performance numbers of the player’s stint in major league baseball.
  • Now, let’s imagine you go to sell that autograph.  You investigate the 30 most recent sales and the current conditions on Ebay- your market value report. However, since there is little intrinsic value to paper and ink you are selling, all the value has to do with the perceived value of the player who gave you the autograph. And like nearly all derivatives, the value is leveraged and may fluctuate dramatically based on initial conditions.
  • To further explain, here’s a few possible scenarios. Consider how each starting condition may alter the value of the autograph:
    • The player is elected to the hall of fame that morning
    • The player rescues a bald eagle from a burning building on live TV
    • The player gets caught in a tawdry scandal involving twitter
    • The player is suspended for using performance enhancing drugs
  • The above is publicly available information. There may also be some irrational or unknown values that could affect the value
    • The player’s son wants to buy the autograph and give it to the player for Christmas
    • The buyer went to the game where the autograph was signed with his school class and highly desires to purchase it as a keepsake.
    • The company that made the paper that was used for the autograph is putting together a travelling market event called “great moment in sports” and needs your autograph as the centerpiece.
    • The player’s wife wants to get a copy of his thumbprint from the autograph to open his smart phone starter screen

As you can see, your market value report gives you a good idea of the current compensation package based on or “derivative” to economic conditions. But, it does not give you a breakdown of the starting conditions of your negotiation that could greatly affect the final compensation package – like the many examples listed above can affect the value of your autograph.

Even if you knew every single salary of every single physician in a region, you still would not have the ability to 100% accurately predict your final compensation package.   You’d have a good idea of the upper and lower ranges, but you wouldn’t be able to know exactly where you’ll land.  Small details in the starting conditions of the negotiation could lead to dramatic changes in the final package.  For instance, they might be facing the emergent retirement of a busy partner due to an unforeseen medical issue, a major competitor could be moving into town and building a hospital across the street, or they could be willing to pay more to avoid losing you to the competing practice across town.   Any one of these conditions could lead to a superior package far beyond the market value median.

There is also the common situation where your negotiating partner is aware of the market data and “hides” behind it. For instance, they run a busy practice where your collections will easily exceed the 80th percentile. To get more return on their investment, they gladly offer you salary at the 60th percentile. You’re overjoyed at the above average offer… for now.   Or, maybe they want to avoid negotiation altogether and quote a policy that they pay everyone the same.

Here are some tips to help use your market value report to the best advantage

  • Use the market value report to develop a BATNA or best alternative to negotiated agreement. This is your walk away point. (note: I’ll post about BATNA in the future. Please sign up for our newsletter to keep informed and keep checking back at medical success central)
  • Develop an Anchor number or counter offer from the market value report. Remember to aim high and use the report as an objective criteria source.
  • Spend time thinking about the other party and their interests.  Is there an information you’ve gathered that can be used to gain concessions?   Can you work together to mutually create value?
  • Obtain at least three competing job offers. Use these offers to get a feel for the market. You can also question different negotiating parties to learn about economic and other intangible conditions in the market.
  • Use your competing offers to set new BATNAs as the negotiations move forward. Use the competing offers as leverage to gain concessions.    Anyone who has been involved in a bidding war on a house will be familiar with this concept.
  • Don’t forget to master some basic negotiation techniques.

Obtaining your market value report if the first and most important step in your doctor contract negotiation. Although this information is extremely valuable in determining the starting point and ranges of a negotiation, they can lead you astray if you don’t pay attention to the individual starting conditions. Be certain to take these into account and don’t let your negotiating partner talk you into a salary based solely on regional or national norms.   In simple terms- if they are willing to pay the national average, they are probably willing to pay a little to a lot more.

Negotiation is the most vital of all of the of physician professional and medical business skills.   The good news is that most doctors can become excellent at negotiation with study, training and practice. Obtain your market value report, develop your negotiation strategy, and consider taking a CME approved course designed for physicians. Soon, you’ll become a master negotiator and succeed… really succeed.

So what do you think? Do you just wing it? Do you go with the average salary and pray for the best? Do you set a goal and go for it? Share your thoughts.

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.