Many of us did not go into medicine to negotiate, and so feel uncomfortable with negotiations. However, we negotiate more often in our day-to-day lives than we realize (those with children definitely negotiate, but we also negotiate with patients and colleagues). There are a few principles that are important to understand to be a successful negotiator.
Principle #1: Focus on interests, not positions1
Positions are specific requests or asks; interests are the desires and concerns behind each ask. To understand your interests, ask yourself why you are asking for what you are asking for. We often get stuck on our position (“I will not work nights”) instead of our interests (“I need a predictable schedule so I can arrange childcare”). Taking the time to think about why you are negotiating helps you and the person you are negotiating with consider other options. It can be easy to fall back into your position, so this one takes some practice.
Principle #2: BATNA, or “best alternative to a negotiated agreement”1
A BATNA is a list of options available to you if your negotiation is not successful. Get creative—list all the potential options that could meet your interests, then choose the best. You may even find you like one of your other options better! You may have lots of options and have a strong position in the negotiation. Sometimes, you have limited options, and that is also important to consider. Your goal is to have a BATNA that you feel good about and that is as much in your control as possible—you shouldn’t rely on another negotiation if you don’t succeed in the first one. As an example, if your BATNA is to resign or leave, you should make certain that you can resign in a way that doesn’t derail your career and/or that there is another position or job you are certain you can take. If you plan to switch institutions, do your research on the job market and even do some interviews.
Principle #3: Remember the relationship goals
It is important to remember that in medicine, we often work together and negotiate with the same people around many things over time. For this reason, it is important to think about how to negotiate effectively while also considering the importance of maintaining good relationships with colleagues and leaders. Effective negotiations can even improve relationships by finding mutually beneficial solutions. It is important to balance your goals for the negotiation so you achieve your outcomes, but don’t get so focused on maximizing your gain that you ruin the relationship. Taking time to consider the perspectives of those you are negotiating with can help you achieve your goals.
With these principles in mind, the following steps will help you prepare and navigate your next negotiation. The most important steps require some homework. Preparing is the most critical piece of any negotiation and will likely take far longer than the negotiation itself. However, putting the time into preparation will reduce your stress and increase the chance of success (and, in many cases, may lead to a solution without tough negotiation). As we walk you through the steps, we will use negotiating for protected time for an administrative role as an example.
Step One: Identify your interests
Understanding your interests will allow a wider range of possibilities for negotiation and allow you to determine your BATNA. In our example, the desire for protected time is a position. Do you want administrative time because you want to feel more valued, and this would be a recognition of your work? Are you feeling burned out from clinical work and want to reduce your clinical time? Is your role taking far more administrative time than you anticipated? Each of these interests presents different alternative negotiations and different BATNAs. Keep asking why until you get to the core of what you want. The same applies if you are negotiating not to do something. Why, exactly, do you not want to do it?
Step Two: Establish your BATNA
Once you have clarified your interests, you should develop your BATNA. What are all the possible alternatives that will still address your interests? In our example, if the reason that you are asking for more administrative time is that you don’t have time to do the work, can you spread the work among other people? If you are feeling burned out from clinical work, can you reasonably afford to take a temporary salary reduction and cut back on your clinical FTE? List all the potential alternatives and then pick the best one(s).
At the end of these two steps, you should have a clear understanding of why you want what you want and have a BATNA that you are comfortable with. Achieving this will allow you to negotiate from a position of strength and allow you to feel more relaxed when entering the negotiation—you are clear about your needs, and you have a backup plan.
Step Three: Identify the interests and potential BATNAs of the people with whom you’re negotiating
Understanding the interests and potential BATNAs of the people you are negotiating with will allow you to reach solutions that may be mutually beneficial and will prevent the negotiation from being a “yes” or “no” conversation. You also may be able to reframe your negotiation in a way that highlights the value of what you’re asking for.2 Consider a different example of proposing the creation of a procedure team. Your group may want a procedure team because they enjoy doing procedures and want to spend focused time on this type of work. This argument may not be meaningful to the institution, but decreasing lengths of stay and increasing patient safety outcomes might be. In this case, you could frame your proposal as an improvement to patient safety rather than focusing on the desires of your group. In many situations, the “BATNA” is the status quo—how is what you’re proposing better for the institution than the status quo?
Step Four: What do you ask for? Is there a mutually beneficial solution?
Whatever you ask for should be fair to yourself and to the people you are negotiating with, as well as support your success. Rely on industry standards as much as possible—this can help provide some support to your requests. If you can’t find industry standards, use your professional organizations to identify other people or groups who are working in similar environments. Consider what else you may need to support what you are asking for. In our example, how much administrative time do other people get in similar roles? In addition to more time, do you need different office space? Other administrative support?
After considering what you might request, explore additional solutions that might be mutually beneficial. Applying creativity to come up with solutions that were not originally presented can add value to both parties. Working together, can you create something more than either party would have had alone? Can you get your protected time and bring even more value to the institution?
Step Five: The negotiation
While you may be anxious to make your pitch, your first focus in the negotiation should not be to get your point across. Rather, your focus should be on truly understanding the other party’s point of view and interests.1-3 Specifically, you are listening for any areas of agreement and areas where you can create value for the other party.2 You’re also listening to understand why they may say no. Finding areas of agreement can help provide an anchor for the conversation, and finding areas of value can help you find easy wins. To accomplish these goals, make sure you’re not making assumptions about what the other party’s interests are, and during the conversation, avoid focusing on what you are going to say next.3 Instead, use active listening techniques like asking open-ended questions and reflecting back what the other party is saying.3 Any tools that help you understand the other party’s interests will improve your chances of success—everyone is more open to ideas if they feel they are being listened to and understood.
During the discussion, continue to refocus yourself on your interests (rather than on your position) and continue internally to compare what is being offered with your BATNA. It may be helpful to avoid coming to an agreement at the time of the first conversation and allow everyone involved to think through the issues. If you intentionally set up the first meeting as an exploratory meeting rather than as a conclusive meeting, you may remove some pressure on both sides and make it easier for you to explore the other party’s interests.
While negotiating can seem overwhelming, developing skills to negotiate effectively can be important for career (and personal) satisfaction. With some preparation and practice, you too can become an expert negotiator!
Dr. Bonsall
Dr. Stephany
Dr. Herzke
Dr. Bonsall is an associate professor in the department of medicine at Emory University School of Medicine and the chief of Emory Medicine Services at Grady Memorial Hospital, both in Atlanta. Dr Stephany is a med-peds hospitalist and the founder and president of A.I.M. Coaching & Consulting, where she works with teams and individuals in the healthcare space. Dr. Herzke is vice president of medical affairs and chief medical officer of the Johns Hopkins Hospital in Baltimore.
References
- Fisher R, Ury W. Getting to Yes: Negotiating agreement without giving in. 3rd ed. New York: Penguin Group; 2011.
- Bazerman MH. Negotiation: The Game Has Changed. Princeton: Princeton University Press; 2025.
- Walker S. Negotiate like a pro. Harvard Business Review website. https://hbr.org/2024/03/negotiate-like-a-pro. Published March-April 2024. Accessed April 24, 2025.