13 May 2008


Paul Levy, TBTAM, and GruntDoc are having an interesting three-way (conversation!) about doctors and their negotiating skills, or lack thereof. It's worth a read -- interesting back-and-forth in the comments. My initial take is to agree that docs, by and large, are an embarrassing crowd when it come to the ability to negotiate effectively. I know that I was never taught in medical school about negotiating (and why would I be?), but once physicians start to segue into administrative careers or leadership positions, all of a sudden these mysterious skills become mission-critical, and woe unto the doctor who doesn't have or can't acquire these skills.

Like these guys:

Seattle Hospital Fires its Anesthesiologists

I meant to blog about that back in January when it happened, but never got around to it. It's always hard to read the tea leaves when you weren't in the room, but it sounded to me (and local rumor mill was) that the docs over-reached and put their demand forward too aggressively. This is in exactly the same vein as Paul Levy's statement that, faced with a doctor who begins with an ultimatum, his response would be, "Great, when are you leaving? We could use the office space."

I've been negotiating professionally for about five years now, mostly with insurance companies, but also with our hospitals and some other vendors. It really is an art. No two discussions are ever the same. I wish I could share some with you, but they do tend to be covered by NDAs once completed.

For my part, I had to learn through trial and error -- a lot of error, though fortunately none fatal. Also, my facility put on a series of workshops hosted by The Advisory Board on Physician leadership development. I can't say enough good things about educational offerings like those. It's almost like a mini-MBA for physicians, and the fact that it's sponsored (read: paid for) by the hospital helps a lot in building strong alliances between the medical staff leaders and hospital administration. The best seminar we ever had was on breakthrough negotiation. It contained a lot of material which seemed intuitively obvious, but maybe not for everybody, and helped to really formalize a way of thinking about how to negotiate.

The take-home point in this case is that when you are sitting at the table, brinksmanship and ultimatums rarely work, often backfire, and even if they do work tend to poison future discussions. I avoid them at all costs.


  1. I agree with the general point you make. Nobody teaches docs how to negotiate contracts.

    However, there is a lot more to the Northwest Anesthesiologists story. I know one of the anesthesiologists who was involved.

    The hospital, Northwest hospital, wasn't paying the anesthesiologists for the 24 hour obstetric coverage that they were providing. The anesthesiologists wanted to be paid for what they were doing, so they hired a negotiations consultant. In the middle of that, the three anesthesiologists put together a coup d'etat and offered to provide anesthesia services at a cut rate, with the three anesthesiologists profiting a great deal from the agreement. They then took over the hospital contract (because the hospital took them up on their cut-rate offer), and none of the anesthesiologists trusted them enough to work with them (and particularly not enough to work for them) after they had betrayed their colleagues like that.

    It hasn't worked out so well for the hospital, because as it turns out, locums docs are expensive.

    I do think that often hospitals treat docs like they're expendable, and while we would do well to only threaten to leave when we really would consider it, sometimes it's worth it to risk it and to leave.

  2. Prestidigitorium5/14/2008 11:01 PM

    Any thoughts on how to pick up such skills during an EM residency (and still make it under the 80 hour work-week)?

  3. I tend to view docs like engineers...they see the world in black and white...diagnose problem...come up with solution...fix problem.

    As a lawyer, I live in a world of gray....and that's really what a negotiation is...alot of ass-sniffing and ring-circling before you eventually reach an agreement.

    (re: the world of gray....non-intended pun, but applicable nonetheless)

  4. If these doctors really think they need to be making more than 400,000 per year, I think they are really over reaching. The gap between procedural doctors and primary care doctors grows ever wider. Many doctors work much harder than them for much less.


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