We often have questions in our physician communities about how to negotiate, whether it be for job contracts or for side gig opportunities. While we do a really good job at training doctors to be good clinicians, we do an admittedly poor job as a profession in preparing trainee physicians for the business aspects of life in medicine. Additionally, negotiations play into every aspect of your life, both personally and professionally, and are key to creating the life in medicine that you want. One of our big goals at Physician Side Gigs is to change this. Whether you’re negotiating your physician job contract, negotiating with your significant other about what to have for dinner, or negotiating your first physician influencer contract, the skills and negotiation tactics we discuss below are key to getting what you want, and you should practice them regularly. Negotiation is an art, and one that you will become more skilled with - and comfortable with - the more intentional you are in your approach.
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Key negotiation tips and strategies all physicians should know
Of course, the first step of negotiating is showing up at the table and even realizing that you’re in a negotiation. Whether you realize it or not, you probably negotiate 100x a day - essentially every time you ask for something. Ever meet those people who seem to get everything that they want? Consciously or unconsciously, they’ve likely honed a system for approaching asks in a way that results in the desired outcome. Below, we discuss several tactics that master negotiators utilize on a daily basis, and tips for how to utilize them.
Know your worth, and ask for it
This is probably the singular most important thing that physicians need to change about their mindset. We have been groomed to be givers, but what we don’t often realize is that chronically being undervalued is actually detrimental to both doctors and patients. Not getting paid your worth is demoralizing, and a key contributor to physician burnout. While doctors don’t often strike, they are quitting in record numbers because of this sentiment that “it’s not worth it anymore.” This exacerbates the physician shortage, and dramatically decreases access to care. You have spent years of your life to qualify to do the job that you do, so don’t sell yourself short. Bottom line, it’s important to feel that you are adequately compensated for anything that you do, professionally or personally.
Knowing your worth will help you set and manage your objectives and expectations. It is important to know where you compare in terms of how unique your skillset is or how badly someone needs you in a particular situation. Think about what qualifications or experiences you have that the other person wants, and leverage those when conveying your value.
We have several PSG resources for both job and side gig compensation based on data from members of our physician communities.
Related PSG resources
If you don’t ask for something, you won’t get it
Know that the first offer is almost never the best offer. Your goal is to get the best offer you can get, even if the initial one is pretty good. If you don’t ask for anything more, you won’t get anything more. Most of the time, people will give only what they absolutely have to give, and won’t offer you something out of the goodness of their heart if it means more trouble or expense for them.
In most cases, the worst thing that can happen is that the other person will say no. As long as you approach the conversation with emotional intelligence so as not to offend anyone and don’t ask for something completely ridiculous, you may be pleasantly surprised with the extra things that you are able to secure that could have a huge impact on either your compensation or overall happiness with the result of the negotiations.
Which brings us to our next point…
Set realistic objectives, but don’t sell yourself short
An interesting fact to tuck away into your headspace for your salary negotiations:
People who expect more get more
When you’ve decided what your worth and value is, you know what to fight for. This will come across in every interaction that you have. Ask yourself these questions:
What is the baseline that I should expect and deserve?
What is my reach goal?
What are my dealbreakers where I will absolutely walk away?
In order of priorities, what do I want the most?
This will help you frame what to prioritize in your discussions, and not only set your own objectives and priorities, but also show the other party what you hope or intend to accomplish during negotiations. This prevents a situation where you waste time talking about or negotiating things that are not going to lead to an agreement or cause frustration for either party that leads to the other negotiating in bad faith or walking away from the negotiating table. It also shows them that you are confident in your ability to get those things, regardless of whether they are the one to give it to you.
Know your competition and what other options they have
While it’s important here not to come across as a bully or have the other person feeling as though they’re being taken advantage of or blackmailed, you should put yourself in the shoes of the other party and determine what their position at the bargaining table is. Ask yourself:
Who is your competition?
Does the other party have lots of other options? How else can they get done whatever they are asking you for?
Never throw out the first number or offer if possible
While you’ll have your research done ahead of time to have a better idea of your negotiating power, wait for them to make the first offer. The worst thing you can do is come to the table with what you think is a good deal and lose out on a better offer because you didn’t realize it was available.
You can negotiate what you know is offered, but you can’t negotiate what you don’t know they’re willing to provide. As an example, in a locums negotiation process, the employer might be short staffed and in a huge pinch, thus willing to pay a premium to secure coverage ASAP.
If they ask you to start with your offer, politely decline by throwing the ball back in their court. Using phrases like, “It would be hard for me to make a salary proposal without understanding the rest of the compensation package and everything that goes into it, so I’d prefer to see a contract delineating all of these things before telling you whether the proposed compensation is fair” can be a great way to avoid the situation in a productive way.
Maybe don’t make the second offer either
If their first offer is nowhere near your objectives or where you think the target should be, consider making them counteroffer themselves with the second offer as well. Negotiating on a low ball offer may make it seem like you’re willing to take a lot less than you should just by entertaining the offer. For one, you don’t want to waste a lot of time if the other party is never going to get you to your target goals. Secondly, the power of walking away can quickly make the other party change their tune. Lines like, “It sounds like our goals are too far apart at this time, but I’d love to reconsider this if and when the situation changes” can be very powerful.
Of course, you have to be willing to take the chance that they will also walk away.
Never say yes right away
Another little negotiation nugget to tuck into memory for negotiations with long standing relationships or consequences:
Never say yes right away
The desire to close a deal once you have achieved the results you were hoping to arrive at is real, and it’s tempting to say, “deal!” and be done with it. That’s fine when you’re negotiating with your child for more Xbox time. However, for bigger things like physician contract negotiations, sometimes in the midst of negotiations you don’t have the insight to see things from the 30,000 foot view. It’s better to take a minute and reflect before you agree to put pen to paper, just so you can ensure you didn’t miss little details that may actually make a big difference. Saying something like, “I’m so glad we were able to come to terms that tentatively work for both of us. Let’s each take a minute to ensure these terms make sense, and I have to run this by my ___ to ensure we’re on the same page. I’ll get back to you in [insert short time frame] so that we can officially move forward. Excited!” can give you the space to make sure that you’ve made a good deal and that any other party affected by the decision is okay with the agreement you made before entering into it. You may realize you forgot to ask about the details of the moving expenses or how many hours were considered a full work day, etc., or confirm if the numbers you calculated on the fly were actually appropriate when you run them in your pro forma.
Everything is negotiable
If you’ve ever purchased a car from a dealership, you’ve likely heard that they are a “no haggle” company and that the price you see is what you get. Dealers are always willing to negotiate, no matter what they say.
Similarly, most things in life are negotiable, to varying extent. There may be certain components that are hard nos, like a ceiling on monetary compensation or an inability to give a certain benefit, but there are other things you can ask for when you hit a brick wall with one, like a delayed start or end time on a set day that you would like to have some flexibility on, or a budget to make some changes in your office or buy a new device. You should go into a negotiation thinking about all the things that could be better about a situation and prioritize them in order, thus giving you the ability to pivot effortlessly during a negotiation instead of stalling on the no. This applies to negotiations outside of work as well - if your kid really has too much homework to do their chores on a given night but also wants to play Xbox with their friends later to decompress, your gut instinct is likely going to be to give in, which is appropriate in that moment. But instead of being exasperated that you now have to do the dishes instead of reading for fun, you may want to throw in an ask for another day while you are at the negotiating table anyways.
While you should be mindful of pushing too hard or negotiating every little thing, especially on items that aren’t deal breakers or that important to you, don’t be afraid to test the waters. A no at first doesn’t necessarily mean a no each time–just like your unwillingness to take the first low offer they provide isn’t a no to their job offer. In some cases it just sets the ground for future negotiations or concessions by letting the other party know this is something that is a goal for you.
Know your deal breakers and when to walk away
While everything is negotiable, you likely won’t be able to get everything on your wishlist when it comes to your objectives. Negotiating is a give and take between you and the other party.
When balancing your ideal situation and the offer you’re happy to accept, it’s important to know what items are deal breakers for you that you absolutely aren’t willing to compromise on and would walk away from negotiations with, and make sure they know it too. The last thing you want to do is give up something in the moment out of exasperation or desperation and then regret it later. When you’ve outlined for yourself what those dealbreakers are ahead of time, you’re more likely to take a pause when things aren’t going your way - and also signal to the other party without having to say much that they need to back down a little as well. Additionally, not having boundaries is a key contributor to unhappiness, so you need to know yours.
Additionally, your deal breaker doesn’t have to be an entire category (for instance, no on call), but can be limits for each item you are negotiating. For example, a deal breaker may be that you won’t work on call for the same rate as your regular salaried coverage.
Some examples of some common deal breakers you may want to consider in physician contract negotiations from our red flags in physician contracts article:
Always have other options - this gives you LEVERAGE
One of the biggest bargaining chips you can have is options, which bring you leverage. Many people make the mistake of getting their heart so set on one outcome that they put all their chips out on the table. This is a horrible position to be negotiating from. You want to have other options that are acceptable to you so that you have the ability to walk away. Letting the other party know you have other options will also prioritize to them that they can’t mess around, delay or stall, or take the risk of offending you with a bad offer.
Additionally, having options in hand allows you to bring better offers to your top choice to make them counteroffer. Often, you can get a better offer than just a match.
What are some specific key negotiation tactics or phrases?
Many of these techniques are from the book Never Split the Difference, by Chris Voss, which we highly recommend reading (or even better listening to on audiobook, as it allows you to hear the tactics and voice inflections) if you are interested in diving deeper into learning to be a good negotiator. Not only does it offer additional tips, it expands upon each of these in very concrete ways. We were fortunate enough to have Chris Voss come speak to our physician communities a few years ago, and everyone agreed that his input was so valuable, both in their personal and professional lives!
Conversational mirroring
Chris Voss has essentially coined the phrase mirroring, and it’s a powerful negotiation tool to get more information. It involves repeating back a part of the phrase that the other party just said. This accomplishes a few things - they know you’re listening and interested in what they’re saying, and they feel the need to expand on the part of the sentence that is of interest to you without you having to ask a direct question. As an example, if you’re interested in buying a house and the realtor says, “Make an offer, the sellers are eager to sell,” you may respond, “Eager to sell?” They then will have to expand on that, which may give you valuable information about exactly how eager they are and what your leverage is, without having to directly ask a question that may put the other party on the defensive, like “How motivated are your sellers?,” which may encourage them to keep the info close to the chest to avoid a low ball offer. The same thing happens with budgets or salary offers.
Put a label on it
A great technique encouraged by Voss and other master negotiators is the idea of utilizing phrases like, “It sounds like ____” or “It seems like ____” or “I’m getting the sense that ____” to get the other person to offer more information or have to contradict themselves on something that you don’t believe. Much like mirroring, it will get the other person to further define what they said to you, and put more cards on the table. Saying something like, “It sounds like $x would be out of your budget?” will force them to give you more clarity. Similarly, saying, “From what I’m hearing from you, I’m getting the sense that the budget is a real challenge to getting this deal done” will force them to further elucidate what their budgetary constraints are.
Throw contradictions or arguments back at the other person
This is one we often encourage doctors to use, as there are always parties looking to take advantage of the altruism of physicians or ask them to do more with less resources. Saying things like, “I recognize you’re saying that the goal is to improve the patient experience. However, saying yes to this will actually interfere with my ability to spend time on ___ that is necessary for good patient care. What should I do about that?” will force the other party to acknowledge the ridiculousness of their request and hopefully come back with a better offer.
Kill them with kindness
You may have heard the saying “you catch more flies with honey than with vinegar.” While you should be firm in your negotiations, be polite as well. You’ll get way further in a collaborative and amicable conversation than one where the other person feels attacked or just wants to get out of as soon as possible. If you’ve ever been on the phone with a customer service representative, you’ll likely know that giving them compliments and gratitude for how they are helping you will make them more inclined to help you than yelling at them.
As an aside, don’t be fooled by someone else’s sweet honey persona. No matter how nice they are throughout the process, they are incentivized to get the best deal for themselves, just as you are.
Put yourself in their shoes
Chris Voss talks a lot about the concept of employing tactical empathy to set the stage for a productive negotiation and put the other person at ease. It also puts you in a mindset where you have to listen to what the other person’s needs are instead of just thinking of your own, and makes you collaborators instead of opponents at the negotiating table. This is much more likely to lead to a mutually acceptable outcome as well as encourage future collaboration and building together. The reason he calls it tactical empathy and not just empathy is because he also cautions about being so empathetic that you get taken advantage of. You want them to also understand that you expect your objectives to be met as well.
Putting yourself in their shoes will also help you realize what realistic expectations for the negotiation are, so that you don’t overshoot your asks and end up with nothing.
Ask them to put themselves in your shoes
Just as acknowledging someone else’s needs makes them more engaged, don’t be afraid to ask them to put themselves in your shoes. “You say you want me to expand my clinic hours by another 1.5 hours a day but don’t want to pay me more. What would you or your family say if you were asked the same thing?”
This forces them to acknowledge the absurdity of a request and/or have more empathy for you. Even if it isn’t genuine, they’ll often be forced into a position of concession or negotiation.
Master the element of surprise
If you have information that you know will help you, you don’t necessarily want them to know it right away. Let them give you all the information they’re willing to offer, and then counter with, “Interestingly, [insert data or evidence that contradicts what they said or lets them know you have a particular piece of information.” This doesn’t give them time to frame a different setting or have a counterargument handy, and may result in them having to acknowledge or concede something they wouldn’t have otherwise.
Pregnant pauses and Intentional Inflections
The way you speak and the body language that you convey go a long way in influencing how the other party reacts to you. They are going to be paying attention to you and reading your cues. When you inflect your voice upwards or downwards or pause just long enough to be uncomfortable, they’ll get a sense of what’s important to you or where they need to back off.
Nobody likes awkward pauses, and many will rush to fill the silence. In doing so, they may offer information that you can use to your advantage. Even if they don’t, you’ve signaled to them that you’re not enthusiastic about whatever’s on the table, which may cause them to back down on a point of contention or increase an offer.
Chris Voss says that downward inflections are a little stern, signaling to them that they’re irritating you and may want to concede something without having to make a statement that sounds like you’re making a threat. Conversely, upward inflections will invite them to engage and signals a friendly “let’s work together” by ending your train of thought with a question where they can build or contribute. In a negotiations setting, it may also encourage them to give up information that they were holding close to the chest because they’re caught up in responding to the question and engaging in conversation.
How not why
This is a very important distinction stressed by Voss. When you ask a why question, people are immediately on the defensive. Imagine asking a child, “Why didn’t you make your bed?” Now they think they’re in trouble and will start making excuses. Instead, saying, “How can we make sure that your bed is made every day?” Now this is a conversation where their opinions and preferences are being taken into account. You’re much more likely to achieve a result.
The word how implies collaboration and willingness to solve a problem together. If a prospective employer gives you a lowball offer, instead of asking them why you aren’t worth more or why they didn’t offer you more and potentially antagonizing them, asking them, “I want to work here, but how am I supposed to make this work when my market value is ___ and my family needs ____, and I know there are other jobs out there that will pay that?” will get them back into a conversation / negotiation mode.
Say no or trigger a no
Most negotiators swear by the power of walking away from the table or using “no” to trigger a “yes.” We’ve talked about that above. But what you may not realize is that forcing them to say no is also powerful. You can make the other person feel empowered by letting them say no as well, as it gives them agency or makes them feel it’s a conversation rather than an ask. You can force them into a compromise by making them feel guilty saying no. Sometimes asking for a yes or a commitment is hard, but saying, “Is it a bad idea” or “Is this a bad time” will actually trigger the other person to say something like, “Well, it’s not ideal, but how about _____?” instead of asking, “Can we move forward with ___?” and giving them a sense that they are agreeing to exactly what you want.
And if they do just say no, then at least you know not to waste your time!
Conclusion
Negotiations don’t come naturally to most physicians, but can actually be very fun once you learn the game! These skills are actively taught to people in other professions, so you want to make sure you learn them as well to level (or even take the higher position on) the playing field. We hope these tools help you reshape how you approach negotiations, whether they be for your job or with the handyman giving you a quote on some home repairs!
Additional resources for negotiations
Negotiation databases for contract negotiations
Professional services
If you need your contract reviewed by an attorney, we have an attorney database for physicians, with local attorneys organized by state, as well as a national partnership if you don’t find a local attorney. Many can help you during the negotiation process.
Resources for learning more about contract negotiations
We have links to previous events on various aspects of contract negotiations on our free educational virtual events page.
Visit the physicians career resources and education page and the physician side gigs and nonclinical careers page for several popular resources on contracts and assessing potential job offers.
Graduating residents and fellows should explore our guide to your first physician employment contract review and negotiation.
If you haven't read Never Split the Difference (Amazon affiliate link), it's a great read to get you into the negotiating mindset that is good for all aspects of life, not just jobs!