Negotiating: How to get what you want

If you're like many doctors, your negotiating skills leave something to be desired. But when would you have learned such skills? Medical school? Internship? Residency? Yeah, right. At Harvard Business School, a course in negotiating skills is mandatory. Harvard Medical School doesn't even offer one as an elective.

"Physicians are not good negotiators," observes attorney Steven Babitsky, co-author of The Successful Physician Negotiator: How to Get What You Deserve. Among the reasons Babitsky cites: lack of time, lack of training, and discomfort with the very idea of negotiating, which attorney Steven P. Cohen, author of Negotiating Skills for Managers, defines simply as "a process that yields an agreement that each party will willingly fulfill."

Indeed, a major reason why doctors join groups or become hospital employees is to leave the negotiating-with landlords, suppliers, malpractice insurers, and health plans-to others. Even a solo practitioner like San Marcos, CA, family physician Jeffrey K. Pearson confesses: "Doctors don't like conflict. We want everyone to like us. We want everyone to be happy. One way I got out of negotiating was to join IPAs. They negotiated for me."

Adds Babitsky, "Physicians who negotiate well do better financially. But negotiation isn't just about money. It can also be about time off-family time. Don't just do it for yourself. Do it for your loved ones."

Pearson, who recently completed a hospital-sponsored workshop in honing negotiating skills, seconds that. "You learn that everything in life is a negotiation," he says-and that patients, employees, colleagues, and your family often depend on you to negotiate effectively on their behalf as well as your own. Want to know how? Follow these seven steps:

1. Lay the groundwork for success. Most negotiations occur within the context of ongoing relationships rather than being one-shot deals, experts insist. Kenneth Cohn, a director of the Cambridge Management Group in Cambridge, MA ( http://www.cmg625.com) which specializes in physician-physician and physician-hospital communication issues, urges doctors to "be proactive. Don't wait for a crisis to get to know the other party."

This could mean holding periodic staff meetings to enable employees to air their gripes and concerns, driving to a community conclave with a hospital administrator to foster communication, lingering in the hospital lounge to exchange views with colleagues, or asking patients their concerns about a regimen you've prescribed.

This way, if there's a thunderstorm on the horizon, it doesn't catch you off-guard. Equally important, you get to know the people with whom you regularly negotiate. Such knowledge is crucial to negotiating "an agreement that each party will willingly fulfill."

2. Learn to respect divergent viewpoints. Understand that your perspective on the issue at hand may not be universally shared. The aim of negotiations, says Cohn, "is to learn other people's needs and how to meet them."

For example, physicians and hospital leaders rarely view the world from the same perspective. A group practice is typically organized horizontally, like a fraternity, with members more or less equal. A hospital is organized vertically, like a military organization.

Similarly, "physicians tend to be more entrepreneurial," Cohn observes, "so they're willing to proceed more rapidly, act on more limited information, and make decisions on their own. Hospital administrators make them by consensus, which takes longer," Cohn asserts. "A physician's time frame might be hours or days; an administrator's might be months or years. How to get administrators to implement doctors' recommendations in 'physician time' is a real challenge."