Career Planning, Administration & Operations, Administration and Operations Committee

The Art of Negotiation: Workshop Reflections for the EM Physician

Emergency physicians use negotiation skills everyday — with both patients and peers. Building strong negotiation skills early can make long-term impacts on career progression.

EMRA’s Administration and Operations Committee hosted a panel discussion on “Negotiation for the EM Physician” at CORD Academic Academy 2023 in Las Vegas. The goal of the workshop was to give physicians, residents, and medical students a basic framework to consider when engaging in a negotiation.

Negotiation experts leading the workshop included:

  • Nicholas Stark, MD, MBA, UCSF faculty associate emergency medicine attending physician and clinical instructor
  • Savanah Harshbarger, MD, MBA, Harvard-affiliated emergency medicine resident physician
  • Jaskaran Bains, MD, MBA, UCSF emergency medicine resident physician

To begin the workshop, Dr. Stark led a discussion to teach an important lesson: Negotiation is a skill that can be practiced. The discussion was followed by a real-world simulation of a negotiation encounter led by Drs. Harshbarger and Bains.

Dr. Stark provided guidance on how to put your best foot forward prior to obtaining and negotiating a job offer.

Curriculum vitae (CV): Maintain two separate CVs: running and job-specific. A running CV is longer and continuously edited over time, whereas a job-specific CV is shorter, around two to three pages, and is tailored to fit the specific role or job opportunity. Position your name, contact information, and earned degrees at the top of the document. Create different sections to highlight various strengths and experiences — such as a section for leadership or operations experiences. Lastly, remove high school and undergraduate accomplishments.

Cover letter: Include the position you’re applying for, a personal connection to the specific job or location, relevant skills, and how your experience fits with the desired role. Cover letters should be brief — roughly three to four paragraphs — and should maintain a positive and professional tone throughout.

Digital footprint: Be aware of your online presence and all search results that exist under your name, as employers likely will review them in advance.

As part of the workshop, Dr. Stark also discussed various negotiation styles and general tactics to deploy during a negotiation.

One form of negotiation is positional negotiation, which is position-focused and more adversarial, with two sides: hard versus soft. The hard position focuses on aspects such as being adversarial, victorious, misleading, pressuring, and gain-seeking; the soft side focuses on friendship, agreement, disclosure, flexibility, and acceptance of losses.

In contrast to positional negotiation, principled negotiation is interest-focused and seeks to maximize benefit for all parties involved. This kind of negotiation focuses on solving problems, seeking wise outcomes, avoiding bottom lines, remaining open to reason, and inventing options for mutual gain. Principled negotiation centers upon objective criteria, such as market value, precedent, professional standards, and costs. Those who focus on principled negotiation build relationships with open communication and trust over time.

In a situation with positional negotiation, focus on developing your relationship with the other person, ask open-ended questions, and humanize the other party. Asking for a phone call or video conference is more effective in building relationships than email communication. Generally, understanding the other party’s values, goals, and desires is vital. Thinking outside the box and involving your mentors to obtain feedback can help you negotiate an ideal position.

When considering potential attending jobs, use both hard and soft factors. Hard factors can include criteria such as hours worked and shift buy-down. Soft factors can include time and financial support to attend conferences and professional society meetings, titles to bolster your résumé, and office space.

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Target price: Each party (recruiter or physician) has an ideal target range.

Walk-away price: Each party has a walk-away price at which they would not be willing to go higher (recruiter) or lower (physician). 

Zone of possible agreement (ZOPA) is the range at which a recruiter and physician can potentially agree. The difference between the recruiter’s and physician’s walk-away price is known as the ZOPA. For example, if the highest price a recruiter is willing to pay is $10, and the lowest price the physician is willing to accept is $5, then the ZOPA would be the difference: $10-$5 = $5.

Best alternative to a negotiated agreement (BATNA) is what you should do if both parties fail to reach an agreement. Thinking about this before the negotiation can help you resist any pressures in real time. You can leverage factors such as other job offers or opportunities to best position yourself in a negotiation.

Dr. Stark described cognitive traps that are obstacles to a successful negotiation. Being mindful of these traps and thinking through potential pitfalls are excellent ways to address this issue. If you encounter these cognitive traps, it’s helpful to try to reframe your thinking and view things differently. Getting outside perspectives from trusted mentors and research resources are also great ways to overcome cognitive traps.

Implicit bias: a cognitive trap where one maintains attitudes and stereotypes toward others without conscious knowledge. Examples can include gender, race, sexual orientation, and other identity factors. Awareness is the first step in dismantling these biases and can have a great impact on one’s relationship with others.

Anchoring: occurs when one gives disproportionate weight to the first information that is received. Anchoring biases can be minimized by viewing the problem through as many perspectives as possible and by thinking through problems before asking others for help.

Status quo trap: a cognitive trap in which the decision-maker is biased toward options that are similar to the current situation. Sometimes, the status quo may or may not be the best choice. It is important to think through and consider other potentially viable options.

Framing: It is important to be mindful of how information is presented to your audience, as this can greatly impact behavior. Dr. Stark recommends framing consequences as gains that incentivize behavior and as losses that disincentivize behaviors. Presenting problems as neutral is another method that could work.

To close out the negotiations workshop, participants engaged in a hands-on session to put some of the principles outlined above into practice.

Participants were split into two groups: interviewees and hiring managers. Both groups were given specific parameters and preferences for negotiation. For example, hiring managers could only offer salaries up to 80 percent of the candidates’ ask, but could give concessions on geographic location — and interviewees were able to negotiate more attractive practice settings or paid-time-off (PTO) days if they were willing to give up a higher salary.

By engaging in this exercise, each group balanced different negotiation styles and leveraged techniques to help arrive at an agreement.

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