Three Keys to Physician Negotiation

One of the most important career skills in any industry is the art of negotiation. There have been many books and articles written on this topic, and it is not my intention to cover negotiation in its entirety. 

Based on my experience negotiating things from service line agreements to compensation packages, there are three aspects of physician negotiation that I’d like to cover today. These apply to physician negotiations in any setting from private practice to military medicine (or negotiating with any other professional for that matter). Use them and you too can write a best selling negotiating book and become President (the reference was too good to pass up). Ignore them, and, as our esteemed President says, you’re fired!

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Good Faith

The fine folks over at Harvard Law School define good faith negotiation as “to deal honestly and fairly with one another so that each party will receive the benefits of your negotiated contract.” In short, negotiating in good faith means that both parties negotiate honestly with one another with the intention of reaching a mutually acceptable agreement.

You will find many instances of career blogs or journals suggesting that job candidates of all stripes, including physicians, should negotiate a job offer with an employer solely for the purpose of learning about the job market or using the offer as leverage in another negotiation. As the guy often sitting on the other side of the table during that negotiation, I can tell you that is bad idea. 

I’m not suggesting that you have to talk to one potential employer at a time or that you can’t use another offer you’ve received when sincerely negotiating with someone else. I can absolutely tell you, though, that it is not that difficult to spot someone who is going through the motions with no real intent of considering the position.

Not only is it flat out rude to waste everyone’s time and energy negotiating an agreement that you have no intention of considering, it is also detrimental to your professional reputation. Physicians managers absolutely talk to each other, especially in our local community. I have seen it happen where a physician has been found out trying to do this. Even if you are not found out during the negotiations, your reputation will follow you in the future.

This becomes even more true if you are negotiating with private practices about joining their group. As someone who hires for a larger organization, I may be annoyed with you but I will usually move on to the next candidate that my HR department has found for me. A private practice, however, who has spent considerable time, money, and effort recruiting you and getting you to the negotiating table, will likely be much more vindictive if you go all the way through the process to the end just to sign with the rival group in town.


Know What You Want

There is nothing more frustrating then trying to pick a restaurant for dinner with someone who has no clue what they want. Well, I take that back. The only thing more frustrating is someone who constantly changes their mind after supposedly making a decision.

Negotiation is no different. A good negotiation is contingent on both sides coming to the table knowing what you want. Not only does this make the process faster, but it also helps both sides get what they want out of the deal.

I’ve been a part of negotiations with physicians that have left me wondering if they had thought about what we were discussing at all before the conversation began. While negotiating with a new hire, I have had a physician literally try to figure out if they wanted to work part time or full time while negotiating salary. After providing two separate packages for part time for full time work, the physician began to negotiate each one separately, bouncing back and forth depending on which was the flavor of the minute.

Needless to say, I have no intention of negotiating two compensation packages for the price of one, and I halted the process until they could definitively tell me what they were after. I never hired that person, and have not heard from them again.

Even if I had remember them, however, it is very unlikely that they would have gotten the best deal out of me. I had already spent so much of my time and energy, that I was not inclined to haggle with them much more. There is only so much capital you have to spend in each negotiation. Know what you want and you can spend wisely to get what you want. Walk in clueless, and prepare to hear that a lot of things have suddenly become non-negotiable.


Show Your Ethos

While my first two keys can be used by anyone when negotiating, this last one is specific to physicians and handful of other professions. As a physician myself, there is a certain ethos or characteristic spirit I expect to see in other physicians. A negotiation with a physician should be palpably different from a negotiation with a CEO, accountant or any other person.

I see physicians all the time that try to mimic some of the negotiation tactics they see other professionals use. I always tell anyone that will listen that your best tactic as a physician is to insist from the beginning that you are different from all of these other people. No one else has signed up to do the job you do. No one else will gladly be stopped in the grocery store for medical advice for free. No one else will sit at a patient’s bedside for as long as needed until they are cared for.

The way you conduct yourself at the negotiation table should reflect this inherently honorable aspect of being a physician. This should not only manifest itself in how you treat your negotiating partner, but it should also affect the subject matter that you discuss.

Everyone wants to discuss compensation when negotiating a new job, and physicians should absolutely strive to be paid what they are worth. No one expects less. The best hires I have ever made, however, never started with compensation. The best physician negotiators always started with something that displayed their ethos first.

I have seen one physician start out by negotiating how much free care he could provide if he had patients in need. He suggested a reasonable amount and then asked for a percentage of his own salary that he could throw in to help patients if needed. I hired him.

I had a physician ask if he could take a certain amount of his salary and pay it out to his staff as bonuses for excellent patient care. I hired him.

I had another physician negotiate a set amount of time where he could provide free lectures at events to benefit the local community. I hired him.

In many of those cases, these physicians asked me for more money above my initial offer. In each case, I gave it to them with minimal discussion. They were so impressive in how they conducted themselves and displayed their professional ethos that I had no doubt the extra money would be worth it to retain them. And so far, that has held true.

I’m interested to hear your stories about your negotiation experiences. What are your best negotiation tactics? What are your most awkward or strange experiences? Leave a comment below so we can talk further. Many become unnerved when the time to negotiate comes but if you keep a keep a clear head and represent what you stand for, then you will be just fine. Now, go out and get what you want!


  • I find that some doctors (me at times) are not trusting of administration or other physicians because of past experience or friend experiences. I can be difficult to blindly trust someone in a community you’ve never lived in. I feel like I should always keep “what are they after besides a new doctor” in the back of my mind. That colors the entire interview process. Physician job searching is like marriage after a first date. She is interesting, interested and you find her attractive, you just hope it works.

    • thebossmd

      I’d say that’s the importance of the entire interview process. In my experience, most physicians don’t ask enough questions. Ask everything you can think of. Ask to talk to other physicians in the group and try to talk to people outside of what administration sets up. No job is perfect, but if you’ve done your due diligence, then hopefully you don’t have to blindly trust anyone.

  • This is some great insight. I work in an university/academic environment where the negotiation structure/approach is quite different.

    There is often a very asymmetric availability of information, and it is common to interview at different places just to get more information about what is out there even if you have only a small chance of going to that location. For someone fresh out of training, there may be very little that CAN be negotiated — small tweaks at most unless you were a superstar with a clear ability to do something impressive quickly.

    Perhaps the biggest similarity is the prospective employee needs to come in knowing what they want and to be able to make a good case for it.

    • thebossmd

      For new grads, I agree that knowing what you want is half the battle. Many don’t. Many new grads also don’t recognize that the negotiating starts from the moment you say hello. They are extracting information the whole time; you should be as well.

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