From Residency to Reality

1. From Residency to Reality Your Future Practice: Options & Opportunities AAFP Practice Management Teaching Tools, Series I Session D-1

2. Practice Options • How to Negotiate an Employment Contract • Tricks, Traps, & Techniques

3. Becoming an Effective Negotiator • Note: Negotiating 101 is not a required course in most U.S. medical schools.

4. Before You Negotiate • Who are the decision-makers? • What background information have they given you? • What are their key interests in negotiation?

5. Before You Negotiate • What additional information could you legitimately obtain from outside sources?

6. Opening the Negotiations • Defining your interests and their interests • Finding areas of mutual interest • Affirming key principles and values to be honored in the negotiations • Agreeing on the negotiating process (who, what, when, where, and how)

7. The Middle Game: In the Heat of Negotiations • Stick to your negotiating principles • Be collaborative, but watch out for your own interests (they’ll watch out for their own). • If the variables are shifting, keep your eye on the bottom line.

8. The Middle Game: In the Heat of Negotiations Key Concepts: • Principles & Priorities • Anchors & Targets • Upper & Lower Limits • BATNA & “walk-away”

9. The Middle Game: In the Heat of Negotiations Don’t • Don’t talk more than you listen. • Don’t legitimize a bad offer with a counter-offer. • Don’t give out your best and final offer prematurely. • Don’t make an ultimatum. • Don’t burn any bridges -- you may negotiate with these folks again someday. Do • Select your opening bid carefully (modestly high, but not outrageous) • Bring written materials to support your position (MGMA income surveys) • Know your “walk-away” (BATNA) position • Have alternative or competing offers in mind

10. The Middle Game: In the Heat of Negotiations Monitor Your Emotions: • Angry or Frustrated? • Too Eager? • Insecure?

11. The End Game: Coming to Closure • ABC -- always be closing • What further information could I provide to help you make your decision? • When will the board ( search committee, etc.) meet to make their final decision? • When should I tell my spouse (partner, friends, other potential employers) that we will be able to come to a final decision?

12. The End Game: Coming to Closure • NBD -- never be desperate. • Make your initial commitment conditional. • (the contract looks okay to me, but I just need to run it by my lawyer, accountant, spouse, mentor, etc.) • Keep your “walk-away” options open until both parties have signed the contract. • Otherwise you’ve lost your bargaining power -- you have no option but to accept any last-minute changes they demand.

13. Negotiating Tricks & Traps • Ambiguous Authority • I’m sure my partners will be happy to cover for you when your baby’s born. Adapted from “Getting to Yes: Negotiating Agreement without Giving In” (Authors, Roger Fisher and William Ury)

14. Negotiating Tricks & Traps • Watch out for last-minute deal changes • (one little thing -- we had to go with the 5-mile no-compete clause after all; that’s not a real problem,is it?) Adapted from “Getting to Yes: Negotiating Agreement without Giving In” (Authors, Roger Fisher and William Ury)

15. Negotiating Tricks & Traps • Dubious Intentions • After two years you can buy into the practice -- I’ll be retiring soon, and this will all be yours! Adapted from “Getting to Yes: Negotiating Agreement without Giving In” (Authors, Roger Fisher and William Ury)

16. Negotiating Tricks & Traps • Phony Facts • Even without a guarantee you’ll make $200,000 in your first year -- EASY! Adapted from “Getting to Yes: Negotiating Agreement without Giving In” (Authors, Roger Fisher and William Ury)

17. Negotiating Tricks & Traps • Good Guy / Bad Guy • I’d offer you more, but my partner is pretty conservative; Let’s just get you here and once he gets comfortable with you we can re-look at things. Adapted from “Getting to Yes: Negotiating Agreement without Giving In” (Authors, Roger Fisher and William Ury)

18. Negotiating Tricks & Traps • Less than full disclosure • Once this new kid gets here we can offer evening and Saturday hours and open that satellite clinic we’ve been thinking about. Adapted from “Getting to Yes: Negotiating Agreement without Giving In” (Authors, Roger Fisher and William Ury)

19. Negotiating Tricks & Traps • Dubious Delays • Since you’re asking for more than our standard salary I’ll have to take it to the PHO board -- they meet again in June. When did you say you want to start work? Adapted from “Getting to Yes: Negotiating Agreement without Giving In” (Authors, Roger Fisher and William Ury)

20. Negotiating Tricks & Traps • The Standard Contract • Everybody signs it! • If we changed it for you, we’d have to change it for all the doctors. • Gee, nobody ever questioned it before. • You don’t need a lawyer. • Don’t you trust us? Adapted from “Getting to Yes: Negotiating Agreement without Giving In” (Authors, Roger Fisher and William Ury)

21. Final thoughts • Remember -- it’s not just about money. • Did you get the job you wanted? • Are these the colleagues you want to work with? • Did you maintain your personal values and priorities?