Negotiation Pearls: Tips for the World of Value

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Many neurosurgeons are facing practice environments that are radically different from the ones they have known for years, or perhaps decades. Much of this is being driven in the name of medicine’s newest mantra: value. Too many neurosurgeons enter into these new situations expecting their intelligence and education, along with the flourishing practices they have developed, to be sufficient to insure a successful business outcome. Too often, this is far from the case.

 
Case Study
A mid-career neurosurgeon sought a new hospital-employed system after 20 years in a booming, large practice. The chosen hospital was part of a regional network with a small, but growing, number of employed physicians. While the neurosurgery department was in growth mode, this individual arranged a two-day visit independently rather than in response to a recruiter or advertisement.  The visit was a disaster due to:

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  • Inadequate preparation;
  • Failure to understand the true hierarchy of the administration;
  • Ignoring a number of “warning signs”; and 
  • Misunderstanding the key differences between private practice and hospital employment.

 

In simple terms, this neurosurgeon botched the basics of negotiation. To help ensure success in your future endeavors, take note of the following tips:

Negotiation 101

  • All life is a negotiation.
  • Negotiating is a learned art.
  • Practice does help.
  • There is little or no negotiation education for most physicians. 
  • Don’t sweat the failures – some pretty notable folks have botched critical negotiations, and there can be important silver linings to these failures.

 

There are three phases of negotiation: pre-bargaining, bargaining and closure. Almost all negotiation failures occur at the pre-bargaining phase. Along with this, it is essential to understand when the negotiation starts, as it is rarely when you enter the conference room or administrators office. Particularly as value in medicine becomes a prime driver, neurosurgeons must commit to becoming better negotiators. Take note of the following recommendations for enhancing your negotiation skills:

  • Read a book – see recommendations below.
  • Take a formal course – many are available online.
  • Take preparation seriously.
  • Allow sufficient time, even if it means blocking your schedule from patients and surgery.
  • Eliminate distractions – leave your cell phone with someone else.

 

Theory to Practice
In the current climate, neurosurgeons are increasingly facing the following challenges:

  • Increasing hospital employment, with resultant loss of influence;
  • Bait and switch in contract offerings;
  • “Value-based” changes as means of decreasing compensation; and
  • Downward spiral of reimbursement metrics.

 

While comprehensive discussion and understanding of each of these is beyond the scope of this article, here are some worthwhile tips that have proven effective in the following areas:

Increasing Hospital Employment

Neurosurgeons’ loss of influence
Tip: Get on the right committee

Contracts presented as “non-negotiable”
Tip: Contracts are always negotiable

Challenge determining with whom to negotiate
Tip: Human Resources (HR) ally will be invaluable

Bait and Switch with Contracts

Guarantee contract is great
Tip: Understand after-guarantee parameters

Contract terms not inviolate
Tip: Build a coalition to fight

Bonus parameters often unattainable
Tip: Be involved in the process. It can be your friend but will take an investment of time.

Wherever you are in your career, it is likely that the shift to value will impact your practice in a multitude of ways. Often, negotiations, both formal and informal, will significantly influence your job satisfaction as well as compensation. Take this seriously, and when needed, utilize available resources including data on compensation, RVUs and call coverage available through organizations such as the American Association of Neurological Surgeons (AANS), Council of State Neurosurgical Societies (CSNS), American Medical Group Association (AMGA), Medical Group Management Association (MGMA) and Neurosurgery Executives’ Resource Value & Education Society (NERVES). Professional consultant services may also prove worthwhile if the negotiations warrant particularly careful attention.

Informational Sources
Future of Neurosciences: Service Line Innovation Brief, 2005

The Advisory Board Company

The Physicians Guide to Comprehensive Negotiations. Stephen Babitsky and James J. Mangraviti.

Resnick, et al: Surgeon Contribution to Hospital Bottom Line Ann Surg 2005; 242: 530–539.

Spine Centers of Excellence

Disclosure
Deborah L. Benzil, MD, FAANS, is a founding partner of Benzil Zusman, LLC, Healthcare Strategy Consultants.

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