Negotiate Like a Business, Not an Employee

You asked for help. You got a no. Maybe it came with a long explanation about budgets and a promise to revisit it next quarter. Maybe you were told it isn't really that bad.

If you're an employed physician, you probably know this conversation by heart. And you probably walked out of it feeling like the problem was you. You asked wrong, or asked for too much, or should have just stayed quiet.

I want to offer you a different way to walk into that room.

You are a business. Act like one.

Imagine your career as a business, and the care you provide as services you contract to your employer. For some physicians that's literally the arrangement. For everyone else, it's a powerful frame, because it changes who is sitting at the table.

An employee asks permission. A business negotiates.

Health systems, for-profit and not-for-profit alike, run as businesses. They bring in revenue when care gets delivered, and care doesn't get delivered without you. That isn't ego. It's how the system works. Your skill, training and experience are what the whole operation depends on.

Most of us never learned to see it that way. We came out of training grateful to have a job, used to doing what we were asked, wanting above all to take good care of patients. That deference made sense in residency. It doesn't serve you at the negotiating table.

The boundary that comes first

Before you negotiate anything, there's a boundary to set, and it's around how you see yourself. You decide your needs are reasonable. You decide your value is real. Then you hold that, even when the person across the table pushes back.

Part of holding it is knowing your deal breakers ahead of time. Only you know your capacity and what matters most in your life and your work. If you can't find an arrangement that works for both sides, it may not be a good fit, and that's allowed. Not as a threat. As clarity. You have your own back.

What actually helps

Pick the right room. Staff meetings are usually where leadership talks at you, not where they're ready to listen. Ask for dedicated time to talk.

Get grounded first. If you walk in exhausted and armored up, you'll react, and so would anyone. Acknowledge your own feelings before the conversation, and remember the person across from you is a human with their own pressures. You don't have to agree with them to acknowledge them.

Find the overlap. Where do your needs and your employer's goals meet? Dr. Weili Gray, a recent guest on my podcast, asked for an in-person scribe right as her employer was about to ask her to see more patients. She'd done her homework on how faster documentation could help cover the cost. That's a win for both sides, and a much easier yes.

Borrow a strategy. Chris Voss's book Never Split the Difference is where a lot of physicians start. Much of it will feel familiar: empathy, mirroring, labeling emotions, letting the other person say no without ending the conversation. You use those skills with patients every day.

Reflect afterward. Notice where it went well and where it broke down. This is a skill, and it grows with practice.

One important note: if your workplace is truly unsafe or toxic, this isn't the approach. Bring in an advocate, whether that's an attorney, an ombudsperson, or another official resource who can protect you.

Whether you stay or go

If you're quietly wondering whether you should leave, all of this matters even more. If you stay, these skills help you get what you need. If you go and build something of your own, you'll be negotiating with other businesses all the time. Either way, you're not broken for wanting more. You're a highly skilled professional deciding what kind of deal you're willing to make.

If you have a specific conversation coming up and want to walk in clear and grounded, let's prepare for it together. Book The One, a single deep dive session focused on exactly that conversation: https://www.healthierforgood.com/offers/2Lo6ZeJL/checkout