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Key Takeaways

  • Physicians need to frame their requests to align with the benefits of the hospital, like improving patient satisfaction or reducing backlogs.
  • Physicians should prepare for common negotiation tactics employers use, such as creating fake urgency or stating a flat payment rate. Being prepared helps to counter these tactics effectively.
  • Physicians should plan exit strategies from the onset and understand their limitations. Key factors to consider include tail insurance and non-compete clauses.
  • For doctors in toxic environments to challenge perceived constraints and consider alternative paths such as relocation, telemedicine, or pharmaceuticals.
  • This is a solution for coverage in areas where a specialty is scarce. However, discrepancies in compensation between permanent and temporary staff may lead to higher attrition rates.
  • The removal of these clauses in the healthcare sector is advocated, as they disrupt the patient-doctor relationship and don’t protect any ‘trade secrets’ in this context.
  • Improving negotiation skills enhances communication, leading to better patient relationships and outcomes. Recognizing individual patient concerns is essential for effective care.

Executive Summary:

Hello everyone; welcome back to the NEGOTIATEx podcast. We are continuing our conversation with Dr. Linda Street. In Part A of this interview, she shared her transformative journey from discovering pay disparity in healthcare to becoming an advocate for equitable compensation. 

She also delved into the unique negotiation challenges faced by female and transitioning military physicians and the systemic barriers they encounter. Furthermore, she outlined strategies for confident and effective negotiation, emphasizing the importance of understanding one’s value and advocating for fair compensation.  

Today, Linda explores these topics with unparalleled intricacy, so make sure you read this summary until the end.

Aligning Physicians’ Requests with Hospital Interests for Mutual Benefit

Nolan resumes the conversation with Linda by asking her how she advises doctors to frame their negotiations in a way that benefits both the doctor and the hospital/clinic. In response, Dr. Street highlights the importance of preparation and making a convincing case for why a particular request, such as having a scribe, is valuable.

Additionally, Linda recommends that physicians should show how their requests can benefit the hospital, using an example of a doctor wanting a scribe to handle paperwork and charting. Instead of simply stating the desire for a scribe, she advises framing the request as a way to increase patient visits, reduce the backlog, and improve patient satisfaction. This, in turn, would likely improve the hospital’s reputation.

She also touches on the importance of Press Ganey scores, which are akin to Google reviews for doctors and are currently receiving significant attention. According to her, once doctors frame their requests within the context of these scores, they can show how their needs also align with the hospital’s interests.

Negotiating Through Employer Tactics: Guidance for Physicians to Navigate Contractual Challenges

Moving on, Nolan asks Linda about the common tactics that employers often use during contract negotiations and how she coaches physicians to navigate these challenging situations. The latter explains that every negotiation is unique, but there are common tactics that employers often use. 

One of the frequent ones is the statement, “This is just what we pay.” To handle this, she encourages physicians to anticipate obstacles in negotiations and prepare their responses ahead of time. This preparation allows them to respond from a more informed and calm perspective instead of reacting in the heat of the moment, which might lead to a defensive stance and potentially less beneficial outcomes.

She also mentions another common tactic: fake urgency. Employers might take a long time to draft a contract amendment but demand a quick response. Street warns that this is often a deliberate tactic to propel the employee into making a hasty decision without sufficient thought or legal advice.

In response to such urgency, Linda advises physicians to stress their desire for a sustainable relationship and the importance of turnover costs for the organization. The aim is to negotiate for more time to review the contract thoroughly. That said, she acknowledges that the response will largely depend on the physician’s alternative options.

Empowering Physicians through Contractual Awareness and Versatile Options

Subsequently, Aram asks Linda about negotiating exit strategies and dealing with toxic work environments. 

Linda acknowledges that many of her clients are indeed seeking to negotiate themselves out of challenging situations. She mentions two critical aspects: planning an exit strategy from the onset and understanding the extent of one’s limitations.

When joining a practice, Linda advises physicians to ensure their contracts have appropriate clauses for exiting, highlighting the importance of tail insurance and non-competes. Tail insurance, she explains, is a significant burden for physicians as it covers potential future lawsuits for care provided in the past and can be prohibitively expensive. Doctors may sometimes find themselves paying more to leave a job than they earned from it.

Non-compete clauses, on the other hand, restrict a doctor’s ability to practice in a particular area for a certain period after leaving a job, posing another significant challenge for those wishing to exit toxic environments. On that note, she shares a personal anecdote about how she felt forced to stay in a toxic job due to her non-compete clause. When she finally decided to leave, she practiced travel medicine while waiting for her non-compete period to lapse.

She encourages doctors already in toxic work environments to challenge their perceived constraints and explore their options. They could consider relocation, telemedicine, pharmaceuticals, or other avenues for a temporary period until they are free from any legal constraints imposed by their current contracts.

Overall, Street highlights the importance of preemptively considering an exit strategy when signing a contract and being open to exploring unconventional options when trapped in a less-than-ideal work situation.

Travel Medicine: A Double-Edged Sword in Addressing Healthcare Shortages and Discrepancies in Compensation

Next, Aram delves into the impact of travel medicine on hospital operations and compensation roles. He asks whether this is a sustainable or temporary solution for current healthcare shortages.

Linda notes that travel medicine has always been a vital solution for providing coverage in areas where a particular specialty is scarce. She further highlights that historically, travel medicine was used to fill gaps between hiring permanent staff or supplementing existing staff, especially in rural healthcare. However, the ongoing pandemic has seen a considerable increase in temporary roles to address the attrition in nursing and, to some extent, in doctor roles.

Dr. Street notes that this has caused discrepancies in compensation. Temporary staff can command higher pay due to the urgent need to fill vacancies. This has led to situations where permanent staff have chosen to quit their jobs.

She indicates this is not a sustainable practice, leading to higher attrition of permanent staff and hiring more expensive temporary staff. It’s a situation that healthcare systems will need to address urgently.

Debating Non-Compete Clauses: The Case for Protecting Patient-Physician Relationships and Community Health

After that, Nolan shifts the conversation towards the proposed FTC rule to ban non-compete clauses. Dr. Street responds by strongly advocating for removing non-compete clauses, which she believes serve no real purpose in healthcare. She argues these clauses were designed to protect trade secrets, something she feels is not applicable to her work as a physician. 

According to her, non-compete clauses act as punitive measures and ‘golden handcuffs,’ often harming communities by disrupting doctors’ and patients’ relationships. She argues that the trust between a doctor and a patient is crucial and takes time to build. 

If a doctor has to leave due to a non-compete clause, it forces patients, especially those with complex conditions, to start building that trust anew with another physician. Thus, it leads to delays and disruptions affecting patients and doctors.  

Enhanced Communication: A Keystone of Negotiation and Effective Patient Care

Aram expresses appreciation for Linda because of her negotiation skills. The latter mentions that improving her negotiation skills has essentially been about enhancing her communication abilities. It has helped transform her into a better physician, allowing her to connect with her patients on a deeper level. She highlights that acknowledging individual concerns, barriers, and obstacles is essential in providing more effective care.

Linda strongly believes that seeing patients as unique individuals rather helps foster better relationships and outcomes. When patients feel genuinely heard, they engage more in conversations and are more likely to trust the system. This approach is particularly beneficial when dealing with marginalized communities, who often face disparities in healthcare due to distrust in the system.

Linda, Aram, and Nolan discuss a lot more on this episode of the NEGOTIATEx Podcast. Write to us at team@negotiatex.com and share your thoughts on this very informational podcast episode.

Thank you for listening!


Nolan Martin : Hey everyone, thanks for joining us on the NEGOTIATEx podcast. We are continuing our conversation with Linda Street, the CEO of Simply StreetMD Negotiation Coaching. If you haven't already checked out part A of the show, be sure to do that first. Let's jump into the conversation with Linda.

NM : Linda, so you know, these are obviously going to be a little bit more difficult conversations because you may be asking for something that may not be the norm or the norm for that hospital. So, how do you advise them to kind of set this in the framework as, hey this is a win-win for the hospital, a win for me as the physician, you know, how do you frame it so that maybe you could get a little bit easier support from the hospital?

Persuasive Communication: Demonstrating Value And Gaining Support (01:25)

Linda Street : Yeah and I think that's where that preparation comes in because if you show up and you just say I'm valuable to you, I wanna scribe, okay, [laugh] like done. That's not really going to get you as far as if you've done the work to say, okay, I'm going to assume since this is outside of the norm that they don't see why this is valuable.

So, just go in with the assumption that you have to convince them. Kinda like when I go in to talk to a patient, like if they don't know why insulin is important for diabetes, they're not going to take it. They're like, you want me to give you, give myself a shot every day, like couple times a day? What are you doing? So you have to educate them like you have to say this is why this is important, this is what it will do for you.

And same thing that you already know how to do with your patients, you can do with your administration, like hey look, this is why this is important to me and this is why it's important to you. And spend some time ahead of time thinking about why it is so- the scribe example…

Say you're in a for-profit healthcare system because a lot of us are starting to work in those, even the non-for-profits, like it's all fake. Like most of the non-for-profit healthcare systems are kind of for-profit-ish. And so say you know that that's their goal and you know that the paperwork is soul sucking for you and you would like a scribe. So instead of saying I want a scribe, you could say look I recognize that it is valuable for you.

We have this three month backlog on getting in new patients for me to see as many patients as I can. I like seeing the patients but I'm spending a lot of time doing the charting which is necessary for billing and government regulations and all these other things. So I feel like if I had a scribe to do that for me during my patient encounters, I could probably see one or two more patients a day and I would be happier in my position and we'd be able to clear through that backlog a lot faster and make sure that those patients are happy and not leaving our system because they can get the care they need.

Now you've presented it in a way that these business people who you're interacting with can say, oh I want people to stay happy and stay in my system because if they're happy seeing you outpatient, then they're going to get their procedures done at our hospital. They're going to get their x-rays and labs and all these ancillary services that make hospitals money at our hospital. So I can see the value of you seeing one to two new patients a day. Also, the patients that you already have are going to be happier because nobody wants to have an illness and not be able to see their doctor for three months.

They want to see you while they're sick. And so if we can get in a couple more of those patients every day because somebody else is doing this paperwork piece, like that's valuable to the system, even if it's a net zero as far as your individual billing, you can present to them why it keeps them happy, it keeps them in the system. Hospitals are obsessed with all these Press Ganey scores, kinda like Google reviews for doctors. And I have all sorts of thoughts because all my negative ones have to do with like billing procedures that I have no control over because I work for a system.

But they are really, really paying attention to these things right now. It's a big focus for them. So patients who get seen faster are happier, look at that, we can improve our Press Ganey scores. So you just have to present it in the context of why it's helpful to them even though you're asking for it because it's helpful for you.

Aram Donigian : And Nolan, I'm glad you asked that as a follow on. What a great question and thanks for your answer there Linda. We've made a shift it feels like from that entry point negotiation for a brand new physician to now we're talking about as I've been on the job for some time obviously salary negotiations, these sorts of negotiations continue throughout a physician's career. Is the advice different for somebody who's starting off versus somebody who's been, they love their job, they love what they're doing, but as you said they're, they're recognizing I'm spending more of my time with paperwork than I am with patients.

My current schedule is just wearing me out. I want to continue to do this, I just can't maybe do this at the rate I am. I've got other interests as you were mentioning your own business or I'm asked to do extra things that, you know, I haven't really changed my compensation for. It sounds like with what you're saying because you've kind of let us there already, the advice changes a little bit because now I've been in the system for a while. I've learned and I'm going to use that as leverage in my next negotiation

Proactive Career Choices: Anticipating Challenges And Maximizing Success (05:32)

LS : A little bit. But I think the way our training is structured, we're training in clinical environments. So medical school is two years in a classroom and then two years out in the hospital seeing patients. And then residency is three to seven years later where you are actively taking care of patients. And so you see as a trainee how your attendings who are the doctors who are able to practice on their own, who are finished with training, you see how their lives look, you see what they're doing, what are the things that drive them crazy, you see their burnout, you see their success, you see a lot of that very hands-on.

So, I think while trainees may not feel it at such a visceral level of oh my god the charting is killing my soul, they're aware of it too. And so I think when you're negotiating on the front end, they may be less focused on those things but my job as somebody who's seven years out of training at this point, so I'm not that far in my career but I'm further than they are, is to say look, these are the things that I see as common themes for physicians.

How do you insulate yourself from those problems from the get-go? Because it's kinda like preventative care versus fixing disease. Like if you can set yourself up from success or for success, pardon me from the get-go that is so awesome compared to having to fix problems after they've occurred. It's like the ounce of prevention and a pound of cure. Like if I can bring to their awareness, these are really big concerns for practicing physicians. How can you get the things you think you want and the things you know you want based on where you're at now, but also insulate yourself from these things becoming problems later.

And I think most trainees have enough awareness of what their attendings are going through that they can see that value. So they may not come up with it on their wishlist kind of automatically, but once it's brought up to them they can see, oh yeah that would be valuable. For example, I just hired a partner not that long ago or I guess my organization hired a partner for me and I had to share, like this is why a four day work week is really important. And part of it was selfish because I want the precedent I've set to be honored. But part of it was like look, I have seen this with four day work weeks, I have seen this with five day work weeks for physicians. What are the barriers for you to a four day work week and salary comes up, right?

If I work less, I'm going to make less. Well in some models of being paid in healthcare, that's not always true. So if I can say hey, because you're less tired because what we do is hard, like if you're doing that four days a week, you can have the energy to do it effectively and efficiently. You may not make that different of a salary four days a week than five or whatever. So if I can present that to somebody new so that I can address their concerns and show them what options are available, then they can choose from a eyes wide open place and they get to pick what's best for them.

And I'm not saying everyone should work four days, but I really do kind of feel that way. But it allows them to see like these are ways I can insulate myself and no employer is ever going to be sad about you working more. So I always tell people who are going for their first job, see if you can advocate for a four day work week and if they want you to work five days later or if you decide I want to work more, then most people are not going to be sad about you giving more time to them.

NM : Thanks for sharing that Linda, I really appreciate it. Are there common games or tactics that potential employers, hospitals, ambulatory surgical centers and others utilizing contract negotiations and how do you coach physicians to manage these challenging methods?

Preparing for Negotiation Challenges: Navigating Common Barriers In Medicine (09:06)

LS : Yeah, so there are definitely some that I see come up a lot. Every system is a little bit different. Every single negotiation is a little bit different. But some of the common ones I see are this is just what we pay. I always prepare people to respond to that and I'm going to answer both questions kind of simultaneously. The way I tell people to look at this is you have obstacles. These are the things in between you and getting what you want. If you wait until those obstacles come up, you have to like sit there and stare at them and figure out a plan and you're in the middle of things, your adrenaline's pumping, your cortisol is high, like it's harder to do that versus why don't we just anticipate these because there are certain things we can anticipate are potential barriers and come up with a solution from a place that is less cortisol driven.

Because when you're in a high stress environment, your brain is automatically designed to protect yourself. And so your brain's going to go into these cortisol rich fight or flight kind of moments because it can't tell the difference between a negotiation with your boss and running from a tiger.

So your brain is in that like singular focus, keep you safe, save you from the tiger kind of place. You're probably not going to come up with the best creative solutions from that spot. So if you can ahead of time anticipate, okay, what are the barriers that might be presented to me? Okay, they're going to say this is what we pay for this job. Okay, how do I want to respond to that when it's not scary, there's no hormones involved, I have somebody to sound things off of, which is the me in the equation and we can come up with a solution ahead of time so that when this is said, because some of these obstacles are going to present, I know how I want to respond.

I have at least a kind of broad roadmap of how to engage, how to respond from a more collaborative creative place in a less responsive defensive place. So this is just how we pay number one. The second one that I see a lot of is fake urgency. So they've taken six weeks to come up with a contract amendment for you and they want it signed tomorrow by five [laugh] and you're like, I haven't talked to my lawyer, I haven't thought about this. And I think we're such rule followers in medicine, like we've been indoctrinated with all these rule following kind of qualities for our whole lives.

And I think most people are a little bit rule followers anyway, right? But except my seven year old, he doesn't like any other rules [laugh]. But we're indoctrinated to follow these rules. And so when they say you have to respond tomorrow by five, it feels like a very real thing and most of the time this urgency is completely artificial.

You’ll know these things like this is just created to make you make a split decision and not to be thoughtful about it. So I think, saying something along the lines of, you know, I understand that you want to get this wrapped up, that you wanna move forward and that it's important to do that in a timely fashion.

However, I'm really looking for a sustainable relationship because turnover is a big pressure point for hospital systems. Turnover is really expensive. It's hard to recruit people. We're in a major healthcare shortage so finding a new person is not necessarily simple and not cheap. So turnover is a really good kind of pressure point for them.

So it's like I want this to be a sustainable relationship. I want to stay in this role and I want it to be successful to be able to do that effectively. I need a little more time to think about it. Let's circle back on whatever date you choose and all of a sudden there's a new guideline and most of the time that urgency magically disappears. Like all of a sudden no one's going to die if you don't respond tomorrow by five. And I have had some systems that they're like, it's this or you're fired.

So, I have seen physicians in that like you will sign this amendment that we've created that you're at the mercy of or you will be fired. And how you respond to that depends a little bit on what your best alternative is. If you have a strong best alternative, like for me, that wouldn't fly, right? I'm like, I have all these other options I can do at any given point. If you are going to treat me that way, I am going to say, well I'm not responding without giving it thought.

And if that's the case, then let's draw up my termination agreement. That's not going to fit for everybody. Like that's my position. But if you really need that job, you may respond, you may say, you know, I really need this job, I'm going to respond by then. And you get your team together, you get your lawyer on board, you try to call everybody quickly to make sure everything lines up so you can respond in a way that's best for what you can do with that timeframe. But I think a lot of times they're bluffing.

NM : Yeah, absolutely. I like the first point really that you kind of brought up there Linda, and that was the, hey let's kind of war game this, let's go through what are some of the responses that you're going to get and how are you going to address them? And so I think that that was key.

AD : Oh well building off the same reaction, Nolan, which is, this fits very well with the importance of mindset and preparation, right? If I'm going to anticipate I can better respond and not respond in the moment, but have thought about this, how do I actually want to lead, how do I wanna get creative? And then even the fake urgency piece, knowing what my BATNA is, we know obviously as negotiators that's a critical tool of strength. And if I prepare my BATNA ahead of time, uh oh, then I feel more, you know, confident that I can drop, I can rely on it when I need to. If they're saying no, you're going to be fired. Okay, well I've thought and I've done some preparation, right?

So that's a benefit. You mentioned earlier the importance of getting these right, getting yourself into a good situation so you've avoided a bad situation later. I wanna talk a little bit about those bad situations. You know I mentioned, so my wife graduated from nursing school but began practicing local hospital last year. She loves the culture of the environment. We know that's not always the case. We know that medical professionals often find themselves or sometimes find themselves in bad or even toxic situations. Have you ever had a client kind of in that situation who wants to negotiate themselves out of their predicament and what's your advice for doing that? That seems a lot stickier and harder to do.

Navigating Exit Strategies: Protecting Your Options In Physician Contracts (15:12)

LS : I feel like that's half my negotiations [laugh] unfortunately. So yeah, I mean I think there are twofold facets to this. One is on the front end, the more you can kind of have an exit strategy built into your contract, the better off you are. So the big things that come into play for physicians trying to negotiate out of situations are tail insurance. So I have had doctors have to pay more than they actually earned in the job to get out of the job, which is mind blowing and insane. But I'm an obstetrician by background. Obstetric malpractice insurance is really, really, really expensive because if you are sued successfully for something, these are children who are going to live with things for forever.

So, they tend to be really expensive claims. And so to get out of a job you may have to write a hundred thousand dollars cheque to pay for what's called tail insurance, which is insurance for things that happened before in case you get sued later.

So insurance is a big golden handcuff for doctors and making sure you have the right kind of insurance on the front end in your contract can really help you to be able to have safety leaving if you need to. Non-competes are a huge one and there's all sorts of flurry about that. And this was one that got me, I stayed in a job that was very toxic for me for a solid year, maybe two years longer than I should have. And I was only there for three. And a lot of what drove me to stay was I had a non-compete.

I couldn't work and live in the area I lived in for at least a year if I left this job. And I had family reasons why I needed to stay in this community. So as a new grad I felt like my choice is to be a doctor and suck it up or to not be a doctor and how am I going to feed my family? How am I going to pay the bills? And so I stayed because those choices feel very like this is life or death. Like I can feed my family or I can just have all these student loans that don't pay themselves, ruin my credit score and live under a bridge. Like that was how my brain saw my two choices.

And so I think being willing to negotiate that on the front end so it's less catastrophic is great, but also being willing to challenge yourself. Like how much of a barrier is this? Is this non-compete really life or death? And for me, ultimately I decided no it wasn't. And I did travel medicine for a year while my non-compete waited it's time out because sometimes you can get away with pushing it but you're always vulnerable to them suing you for violating it. And I was leaving the job from a position that I was confident I would be the one they made an example of.

So for me, I had to come up with a plan for a year and I was like, you know, I can do travel medicine and travel medicine as we've heard a lot of over the COVID pandemic, especially from a nursing perspective, tends to pay more per day because it's, it's PRN work. It's something that's not reliable. You don't get benefits, you don't get all those things. So it has to be compensated better. So I could do that two weeks a month and take care of my family and it was not optimal. Like I didn't want to be away from my four and seven year old every other week, but it was survivable and what it bought me was the freedom to do a job that is better fitted for me, to do a job that I'm now home every night and I'm happy and engaged where I wasn't before.

And so I think being willing to challenge yourself on what your possibilities really are is important here. But protecting yourself on the front end from these non-competes and insurance problems in Snafus.

So to the doctor who's on the front end, we have to set ourselves up with an exit strategy to the doctor who's already in that environment. Really challenging just how limited your options are because the reality is you're somebody smart enough to have gotten through medical school and to take care of patients. You are also smart enough to find something you can do for whatever timeframe and you're smart enough even if you can't relocate because a lot of us can, like we can just get up and move and that's a loss for the community.

So, I would say from a global healthcare perspective, that's really dangerous from a non-compete standpoint, but it is a doable thing and for people who can't relocate, like there are other options. You could potentially do telemedicine, you could do pharma, you could do something else for a year or two years until you're not constrained by those legal parameters and you could decide what you wanna do when you're not.

AD : A lot there. I know Nolan was going to ask about non-compete, I'm going to just kind of step in and ask a different question here. As with everything you're mentioning, travel medicine obviously has become huge in terms of how travel providers match with folks that is based at that hospital. Does this create any discrepancies for hospital operations and within the medical field with kind of an apples to orange compensation roles and responsibilities dynamic? Is it a long-term solution or is it just a bandaid to get us through the shortages we have right now?

Compensation Discrepancies: Challenges And Consequences In Temporary Healthcare Roles (20:11)

LS : So yes and no to both of those. It's always been around, like it's always been a critical way to provide coverage in places where you may not have an abundance of people who do one role. So for me, I'm a highly sub-specialized person. There may be several places where the people who do what I do are by themselves, I'm by myself. Like I don't have a partner at the moment.

So if I want to have a vacation, God forbid as a human, then they may or may not need to bring someone in to cover my clinic. And so there are different roles in different systems that require different levels of coverage, but I think there will always be a need for some of the positions in some of the places, especially when you get out to more rural healthcare. Some of the roles I did were in like Montana or South Dakota where I was the only one who did what I did for hours and hours and hours.

And so when that person's out of town or for that person to have a sustainable lifestyle so they can continue practicing in that environment, they may need coverage here and there to be able to cover them.

Now, that's different and that's kind of historically what it was mostly for is to stop gaps in between having someone to fill the role permanently or to supplement someone who is permanently there. We've seen a lot lately, especially with nursing and this has gotten a lot of attention that the compensation for these fill the gap places because we've seen a lot of attrition from nursing because healthcare has been more difficult to work within in the last few years.

So it's happened more with nurses, but I think it's trickling down to doctors now. We're going to see that kind of later because the urgency is starting to change a little and that's when they're going to start pulling out I think a lot. But when there's an urgent need to fill, people are willing to pay more for that because the value of having that gap filled is high and they're not constrained by the same things for a travel person from a fair market value and kickback statute as they are with a permanent person.

So they can compensate more highly. And what that led to in the pandemic with nursing is if I'm a nurse working in the ICU and I'm familiar with the system so I'm probably doing more work because I'm not being slowed down by learning the computer keys, by knowing where the bathroom is, like basic things that you understand when you work somewhere for a long period of time. If I'm seeing that I'm making $50 an hour and this person just waltzes in from God knows where and they're making a hundred dollars an hour to do the same thing less, then that led to people quitting their jobs to fill those roles often in the same town.

So they'd just go to a different system across town or they'd come back to their same system as a traveler and make more money. And so that's where we got into trouble because there was such a discrepancy and the people who were permanent employees were not valued, they were not treated with the value they deserved. And so systems ran into problems where now you have a lot of attrition and a lot more people coming in at these higher cost roles, which is not sustainable. So that's, I think where it gets dicey.

AD : That'd be interesting to see how that's navigated.

NM : So Linda, as you mentioned, the FTC has proposed a rule to ban non-compete clauses. We know you feel passionately about how non-compete clauses impact not only physicians' earnings but also the medical field as a whole. You were talking about some of the strategies physicians might use to navigate this issue. Is there anything else that you'd like to add?

The Disruptive Effects Of Non-Compete Clauses In Healthcare Communities (23:31)

LS : Yeah, I mean I just think they need to go away. They're designed for trade secrets [laugh]. I can tell you as somebody who's been an employed physician, like I've never had trade secrets important enough to prevent me from working in town. And I mean some of the planning, like if they're looking to expand a service into a certain area, you may be involved in some of those conversations, but I promise you a year later, like it takes so long to execute things in healthcare a year later you having that knowledge is still problematic if it was to begin with.

So a non-compete does not erase that problem. It just is punitive like it's used very frequently in healthcare as a golden handcuff and this is my opinion, other people have different ones, most physicians have mine. But it is I think harmful from a sense of it disrupts communities. Think about the doctor you know, versus the doctor you've just met. Especially for people with complex medical conditions, having to start over with a new doctor. There's such a trust level built into the healthcare relationship, that's disrupted.

You have to start all over so everything takes longer for the doctor and for the patient. Like there's so much disruption at a person level when you have to start over, that it's, I just think really harmful to hold physicians to these.

AD : I've had doctors take my negotiation course. I often hear how they talk about these skills we've been discussing have applications and other aspects of medical care. Could you share from your own experiences how negotiations or the communication skills that you teach and share with others show up on a daily basis for physicians as they work with nurses across departments, hospital administration?

Leveraging Communication Skills For Better Patient Outcomes And Professional Advancement (25:23)

LS : Yeah, I mean I think the skillset you already have, this goes two ways, right? The skillset you already have makes you more able to negotiate effectively. Being able to more able-y negotiate helps you to have these conversations you're having in your daily life more effectively. Because healthcare is so built upon communication. If I don't communicate with a patient well I can't help them as well. Even something as simple as not taking medicine. So we'll use that as an example. It's a nice clean one. Say a patient's not taking their medicine, if you don't know why they're not taking their medicine, you can't help them. It could be side effects, it could be expense, it could be a social cultural barrier. It could be that they don't think they need it, like however they're coming to the conversation, however they're coming to it is where you have to meet them to be able to make a change.

I can't help you take your insulin by explaining how to give yourself insulin if the problem is not giving yourself the shot. But the problem is affording the medicine, like I can tell you all day long how to give yourself a shot and that doesn't change that you have to exchange money to have this drug. So you really have to be able to know what is important and where someone else is coming from to be an effective clinician.

And that's the same skillset you're using with your employer to navigate your negotiation. So I think they kind of feed off each other because they're conversations, it's a conversation between two parties or more sometimes, but mostly between two parties where you both have different needs, different kind of holistic ways you're coming to the conversation. And the more you can stand under that person's reality, the more you can meet them where they are, the better the conversation is going to be at getting whatever outcome you want. Now whether that be getting a patient to take insulin, whether that be getting my employer to pay me what I should be being paid, like it's the same skillset, it's just how you're using it. So I think it benefits both ways.

AD : Yeah, again, those conversations at the desk with the attending nurse or right.

LS : Yes, With the healthcare team.

AD : Yeah. And then I would think especially with patients when you're talking care plans, procedures, yeah, I mean, what's getting in the way of them doing what you're asking them or advising them to do, that's gotta be some of the more difficult negotiations that doctors have to navigate. I'm also curious, you know, doctors are often looking, whether it's to pharmaceuticals, companies or medical device developers for the latest and greatest to improve patient care and health and yet the doctors themselves obviously don't conduct the procurement for these items and sometimes the tension between managing costs and patient care can be really tough. Can you tell us anything about how that process works within the medical field and is there advice of what doctors can do to be more persuasive when talking to their purchasing agent?

From Value to Impact: Effective Communication Strategies For Healthcare Procurement (28:12)

LS : Yeah, so this is an area I don't spend a whole lot of time doing many navigations within. But I think that again, it goes back to why is this valuable and how does it meet our goals? So value can either be because it's cost effective or value can be because it saves lives. So I live in Georgia and Georgia has embarrassing maternal mortality statistics to say the least. I think we're usually 50 or 49 or something really tragic. And so one device we've tried to procure is this device that helps reduce the risk of postpartum hemorrhage or bleeding after a delivery, which is one of the leading causes to moms dying.

And so even if it's more expensive, when I can go to a CEO and say, look, this is a 27 year old's life that we're talking about and this $2,000 device may make the difference in that. And to be honest, if they don't wanna hear that argument, I don't wanna work there because to me that's a no-brainer. But they live in a world with budgets and so they may say, well are there other ways you can do this with what tools you have? And so then it's up to me to say, this is the data for the tools I have, this is the data for this device. Why is it worth your investment?

And so I think your job when you're trying to procure those things is to be really clear on why it's valuable. You can't assume someone else is going to see value in something you see value in. You sometimes have to take them there step by step from A to Z to say, look, this is exactly why this is valuable and this is the downstream impact. Do you want the PR nightmare of a mom dying at your hospital because her family's now on Facebook talking about how they died at your hospital and ‘da da da da da’.

And not that that's the most important piece to me. I'm like hello, it's her life. Like do we need to have a conversation beyond this? But I might need to point out to people who live in a spreadsheet world, like look, these are the downstream ramifications of this. This is going to lead to X, Y, and Z. These are possibilities that are also able to be mitigated by potentially having more tools.

And so I think that for a doctor it's really easy to say, but this is going to help someone and that's enough for us. That's a hard stop and it should be like, if you're not coming to medicine that way, please don't be practicing medicine. Don't take care of me. But you have to be able to translate that sometimes to the audience that you're communicating with. And so I think having that data, doing your homework ahead of time can make you a lot more effective.

NM : As a closing idea, how has building your own negotiation skills made you a better physician? And is there anything that you'd love to share with our listeners that we didn't ask you today?

Closing Statements: How Effective Communication Improves Healthcare Outcomes (30:54)

LS : Yeah, I mean I think that the more you build communication skills, which is how I see this, like I see negotiation is really just becoming a more effective communicator, becoming more effective at connecting with humans so that we can both hit objectives that are important to us. And I think that that skillset is always going to benefit you. Like connecting to my patients as individual people has become much easier when I've started looking at it not as, okay, you have this condition, this is the treatment for this, but rather you have this condition, this is the treatment for this, how are you coming to the table? What are your obstacles? What are your barriers? How do I wanna respond to those things? How can I re-sent this in a different way so that it's more effective to communicate what I know to be true? I think when you can come at these conversations from that place; A, you're going to connect with people better.

So, if I am treating my patient as a human with individual concerns, they're going to open up to me more. They're going to engage in that conversation more the vast majority of the time and they're going to leave the conversation feeling heard, which is huge, especially when you're dealing with marginalized identities and marginalized communities. Like a lot of the reason that there are disparities in healthcare is because those communities feel like they can't trust the system and for a lot of reasons they can't.

So those are valid concerns. I may not relate to that as a white woman all the time, but I am obligated as a physician whose goal is to care for this patient to at least engage in the possibility that their reality may be different than mine and I need to meet them where they're at and hear them. So I think that these techniques that help me to understand these business people, that I may not relate to their goals the same way because I'm like, let's just take care of the patient has been translatable to let me meet my patient where they're at better and be able to step aside from my own biases and my own lenses that I'm seeing this picture from enough to be able to help effectively. So I think that has been, that has been valuable enough that this journey was worth it regardless of any other valuable things that I've gotten from it.

NM : Awesome. Well thank you Linda for being on the podcast today. Really appreciate it. This is a podcast that is all about elevating your influence through purposeful and negotiations and you definitely helped us explain why it's so important and everything like that, even for medical professionals. So thank you very much. I'm going to turn it over to Aram for closing thoughts.

AD : Yeah, I feel like we just scratched the surface, Linda, so we'll have to have you back on. I think it's a fascinating topic looking at a specific group and I hope that for those who are listening who aren't physicians, you'll hear the broader application around things such as, you know, engaging with confidence, negotiating with great clarity, being able to communicate value and thinking how the broader application, shows up, whether it's in a salary or compensation negotiation or just in our day-to-day lives.

And I think Linda illustrated that beautifully. So Linda, thanks so much for taking the time to come on with us. Wish you the best and encourage folks to check out your podcast and go listen to you and get some of those tidbits of wisdom that you are sharing on a weekly basis. So thanks for doing that.

LS : Yes, thank you so much for having me. And for those of y'all that are listening that aren't in healthcare, everyone is a patient like you can use these same strategies to more effectively advocate for your healthcare.

AD : Great point.

NM : Well that is it for us on the NEGOTIATEx podcast. Thank you so much for listening. If you haven't already, please rate review and subscribe to the NEGOTIATEx podcast and we'll see you in the next episode.

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