Title: Reasons Why Physicians Face Challenges in Negotiation—and Ways to Improve

Negotiation is a vital skill in life, yet numerous physicians find themselves ill-equipped and uneasy when engaging in these crucial discussions. In a recent episode of The Podcast by KevinMD, Dr. Jessie Mahoney—pediatrician and certified coach—delves into this issue, examining the factors that contribute to physicians’ difficulties with negotiation and presenting empowering tactics to enhance their confidence and effectiveness as negotiators.

The Core Issue: How Medical Education Diminishes Negotiation Skills

Dr. Mahoney highlights that a physician’s struggle with negotiation stems not from a lack of capability or intellect but from their training and socialization. In contrast to lawyers or business professionals who receive structured education in negotiation techniques, physicians often do not. Medical education prioritizes self-sacrifice, service, and humility. Characteristics like assertiveness and self-advocacy are commonly perceived as negative or even selfish—especially among women.

This cultural conditioning creates a mentality where negotiation is seen as confrontational or self-serving rather than cooperative or necessary. This discomfort is often exacerbated by perfectionism and catastrophic thinking. For instance, many physicians worry that requesting more could endanger their employment or reputation.

Significant Psychological Challenges Physicians Encounter:

– People-pleasing behavior: The pursuit of validation from patients, colleagues, and administrators frequently overshadows the advocacy for one’s own needs.
– Avoidance of conflict: The medical field often promotes harmony over confrontation. Negotiation is mistakenly viewed as aggressive rather than collaborative.
– Undervaluation of personal worth: Many physicians believe their role demands unconditional giving, which undermines their self-worth.
– Catastrophic thinking: There exists a widespread fear that failures in negotiation will result in dire consequences—such as being disliked, terminated, or ostracized.
– Perfectionism: Even successful negotiations can lead to discontent, with the constant refrain of “I could have improved my performance.”

Women in Medicine: A Greater Challenge

While both male and female physicians encounter negotiation obstacles, Mahoney emphasizes that women in medicine face additional challenges. Historically marginalized in a male-dominated field, many women learned to navigate by conforming rather than standing out. Self-advocacy was often negatively branded, further deterring assertiveness. Although progress has been made, persistent stereotypes and double standards remain.

Mindfulness as a Basis for Enhanced Negotiation

Dr. Mahoney presents mindfulness as a powerful method to improve negotiation approaches. She explains that the tone and energy brought into negotiations are just as crucial as the actual content. Physicians frequently approach negotiations laden with stress, urgency, or guilt. Altering that energy—through mindfulness practices like breathwork and taking pauses—promotes greater calmness, clarity, and strategic thinking.

Essential Mindfulness Techniques for Negotiation:

1. Pause and Breathe: Calm your physiology before reacting. A few deep breaths can enhance intentionality and reduce reactivity.
2. Deliberate Attention: Clearly define what you want and your reasons for it. Use research and self-reflection to refine your goals.
3. Patience: Avoid rushing the process. Resist the temptation to fill silence with words—you may accidentally undermine a good deal.
4. Non-Judgment: Separate emotions from the process. Negotiation is not about being liked—it’s about reaching equitable agreements.
5. Trust the Process: Have confidence in your value and believe that a favorable outcome can benefit all involved parties.

11 Practical Strategies to Enhance Negotiation Skills

In her article and podcast conversation, Dr. Mahoney details several actionable approaches:

1. Utilize breathwork to maintain composure and focus.
2. Clearly articulate your asks.
3. Conduct thorough research on salaries, schedules, workload expectations, etc.
4. Recognize and express your unique value.
5. Determine your minimum acceptable outcome and be ready to walk away if necessary.
6. Frame your request as a solution that serves both sides.
7. Foster patience and leverage silence strategically.
8. Avoid acting on impulse; don’t rush your responses.
9. Practice managing emotional reactions like resentment.
10. Redefine success—not as gaining everything, but as fostering a sustainable win-win situation.
11. Acknowledge your negotiation successes without guilt or self-doubt.

From Patient Care to Paychecks: Negotiation is Ubiquitous

Mahoney also stresses that physicians continually negotiate without realizing it—be it persuading a family to vaccinate or coordinating complex treatment with a care team. Viewing negotiation as a conversation rather than a conflict can enable physicians to recognize their inherent negotiation skills.

Real-Life Example: Negotiating Speaking Fees

In a personal anecdote, Mahoney discussed negotiating speaking engagements, often done via email. She highlighted the significance of understanding your worth, checking in with your instincts to prevent post-negotiation resentment, and allowing time before responding. In email negotiations, tone and timing are crucial. She encourages replacing urgency with thoughtful consideration—opting to reply the following day instead of immediately.

Concluding Thoughts: Re