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									Negotiation
     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
     Society for Academic Emergency Medicine


     Why Physicians Don’t Negotiate: Excuses

u   No time
u   Embarrassed
u   Not comfortable
u   Don’t like conflict
u   Feel that asserting themselves during
       negotiations isn’t professional
u   Physicians want to be liked
Society for Academic Emergency Medicine

What type of things have you
negotiated for in the past?
     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
     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 store’s owner how much it
    costs and he replies $495.67. How much
    would you offer to pay for this watch?
     Society for Academic Emergency Medicine


     Two Types of Negotiations

u   Cooperative: Long term relationship
u   Competitive Negotiation: One time deal
     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 other’s needs: listen
u   Build trust: integrity
u   Stress looking for a long term relationship
        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
     Society for Academic Emergency Medicine


     Principles of Negotiation

u   You negotiate all of the time
u   Willing to practice
u   Negotiation skills don’t 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
     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   Don’t be confrontational
u   Avoid positional negotiation
u   Allow the other side to save face
     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
     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   Don’t close deal until all of the issues are settled
u   Contract rules:
    *Read ENTIRE contract every time it is returned
    *Write the contract
     Society for Academic Emergency Medicine


      Personal Power: Don’t 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
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
    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
     Society for Academic Emergency Medicine


      Informational Power
u   Ask tough questions: they may answer them
u   People are reluctant to admit they don’t 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   Don’t be elitist: obtain information from clerks,
    secretaries, janitors, patients, peers, former workers
     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 team’s 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
     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
     Society for Academic Emergency Medicine

     Three Stages of Negotiation
u   Develop a relationship of trust
    *Don’t 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
       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 side’s
        proposal
u   Avoid confrontational
        negotiation
    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 “what’s wrong”
u   Don’t form opinion how the other side will
       respond
       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 don’t’ 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
     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
     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
     Society for Academic Emergency Medicine

     Beginning Move: Avoid
     Confrontational Negotiation

u   Arguing increases
    people’s wish to prove
    themselves right

u   Forcing them to
    defend their position

u   Use instead:
    feel/felt/found
     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
     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
     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
     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
     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
     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
     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 *
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
     Society for Academic Emergency Medicine


      How to Say “NO” Politely
u   I would love to but I’m 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   I’m sorry but I have a previous commitment
     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
      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.
      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 spouse’s 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.
     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
Society for Academic Emergency Medicine


Author Credit – Negotiation:
Maria Ramundo




              Questions
            Society for Academic Emergency Medicine


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

								
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