Negotiation: You Can Do It


Four steps to better negotiation

"I'm a terrible negotiator!"

So says every physician I have worked with. What they generally mean is that negotiation makes them feel uncomfortable. In fact, they'll go to great lengths, even absorb significant losses, just to save themselves from the emotional discomfort of conflict or confrontation.

But avoiding conflict is not an effective long-term approach considering how often you will have to negotiate employment contracts, consulting proposals, business alliances, and performance goals for team members, to name just a few examples. The next time you find yourself at the negotiating table, try the following four steps to increase your comfort level and improve your chances of achieving what you want:

Broaden your position

Begin by knowing what you want to accomplish, but learn to separate your position or proposed solution from the larger issue that brings you to the table in the first place. For example, let's say you are negotiating a business alliance with another physician or consulting group. Start by jotting down why you want to enter into this agreement. Is it falling income? Not enough time for family? Lack of intellectual stimulation? Be open to the possibility that your goal can be satisfied in a way that you may not have originally envisioned.

Listen first. Most negotiations break down because we feel the other person just didn't listen to our point of view -- they were too ready to butt in with an objection or a solution. Agree with the other party that each of you will have an equal amount of time to listen to the other -- without interruptions, without problem-solving. Remember, listening does not imply agreement, it merely communicates respect. Once you've both presented, then let the creative solutions emerge.

Know your BATNA. BATNA is a concept created by Robert Fisher and William Ury, authors of Getting to Yes: Negotiating Agreement Without Giving In. It stands for Best Alternative To a Negotiated Agreement -- your fall-back position. In discussions with a potential alliance partner, say your BATNA is to stop covering the most distant of three hospitals where you see patients. The slight drop in income would be offset by extending clinic hours at the other two locations. If this is satisfactory to you, then you can enter into discussions without feeling desperate. The more comfortable you are beforehand that your BATNA will do just fine, the stronger you'll be at the negotiation table.

Make concessions together. Each party should be prepared to make concessions in equivalent increments. If you are asked to scale back your requests, ask for and expect a concession from the other side in turn. As you create alternatives and options, evaluate each against your original "what is my challenge?" question, and against your BATNA: Will this alternative resolve the issue I was faced with? Is this alternative better than my BATNA?

The most satisfying negotiations occur when each party moves toward agreement, rather than those where one party feels "I won!" or "Oh, well, at least it's over." Victory and defeat are to be expected on the playing field, but you'll gain a better reputation for fairness if both you and your negotiation partner come away from the table in good spirits, looking forward to the new business arrangement. After all, negotiation is a means to an end, an avenue toward a better working environment, and a sensible strategy for physicians who want to be in business for the long haul.

Francine R. Gaillour, MD, MBA, FACPE, is president of The Gaillour Group, an executive coaching resource for physicians who want to develop their potential as leaders, entrepreneurs, and business professionals. Her transition into business management came after 10 years of practicing in internal medicine. She can be reached at, (888)562-7289,, or at 

This article originally appeared in the January 2005 issue of Physicians Practice.


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