The Physician's Comprehensive Guide to Negotiating

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The Physician's Comprehensive Guide to Negotiating 

The average physician will negotiate for millions of dollars over the next twenty years without receiving any training in negotiating skills. This book was written specifically for physicians like yourself to give you the negotiating skills that you need to get what you deserve. The book is straightforward, easy to read, and features over 200 examples which explain exactly what to do, and what not to do during a negotiation. It is guaranteed to save you money immediately.

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I purchased your book on negotiating after attending your course in October. I am the surgeon who can’t walk to the end of the street while I’m on call which is every other night. Your book paid for itself many times over before I was half way through it- and I’m just getting started. I had been laboring under the assumption that most people are as fair-minded as I would like to be. Sometimes we do need to have the obvious pointed out to us. The course and book have been eye- opening and life-changing. Tom Bryant, MD

Perfectly tailored to the negotiating needs of a physician. Michael McLaughlin, MD Parsippany, NJ

…offers a solid, comprehensive means to begin building negotiating skills…many excellent pearls offered. Emory Patrick, MD Shaker Heights, OH

invaluable…It is clear, concise, complete, and clearly written. Jan Feltowicz, MD Knoxville, TN

Terrific!!...a well organized and entertaining book packed with extremely valuable insights and pearls of wisdom specifically geared for physicians and their success. Jessica Scott, MD Raleigh, NC
I particularly like the specific examples and immediate analysis of the pros and cons of each example/scenario. Michele Curtis, MD Houston, TX

An excellent resource and so easy to read.
Lakshmi Chaudhuri, MD Yorktown, VA

Fantastic. This book should be in every physician’s library and it really is as essential to your practice as your stethoscope or scalpel. John W. Canady, MD Iowa City, IA

Reading this book will put physicians on an equal footing with the professional negotiators we come into contact [with] every day John Flaherty, MD Buffalo Grove, IL

…a well written, informative and even entertaining book. The examples in each chapter are right on target.
Bill Wassel, MD Toms River, NJ
You will learn:Chapter 1 The Physician Negotiator
Chapter 2 Negotiation Basics
Chapter 3 The Best Place to Negotiate
Chapter 4 Controlling and Obtaining Information
Chapter 5 The Best Time to Negotiate
Chapter 6 How to Gain Power in a Negotiation
Chapter 7 Preparing to Win
Chapter 8 Silence Is Golden
Chapter 9 How to Gain Valuable Concessions
Chapter 10 Using and Breaking Deadlock
Chapter 11 Using Controlled Emotions to Your Advantage
Chapter 12 Telephone Negotiations
Chapter 13 E-mail Negotiations
Chapter 14 Defeating Your Opponent’s Tactics
Chapter 15 Team Negotiating
Chapter 16 Negotiating for the Retention of an Attorney
Chapter 17 Negotiating Employment, Managed Care, and Other Formal Written Contracts
Chapter 18 Closing the Deal
Chapter 19 Negotiating an Employment Contract
Chapter 20 Negotiation of a Managed Care Agreement C
Chapter 21 Negotiating a Real Estate Lease for a Medical Practice
Chapter 22 Negotiating the Sale of a Medical Practice C
Chapter 23 Negotiating the Purchase of an Established Medical Practice
Chapter 24 The Biggest Mistakes Medical Organizations/Journals Make in Negotiating with Medical Publishers


Chapter 1  The Physician Negotiator

Executive Summary
How Much Are You Negotiating For?
More at Stake than Money
Why Physicians May Not Be Skilled Negotiators
Why Physicians Don’t Negotiate

Chapter 2  Negotiation Basics

Executive Summary
Negotiation Defined
Cooperative Negotiations: Long-Term Relationships
Be Assertive
Build Trust
Be on Time
Be Sensitive to Your Opponent’s Needs
Emphasize the Benefits of a Long-Term Relationship
How Much Is a Long-Term Relationship Worth?
Build Goodwill
Make a Phone Call or Send an E-Mail
Let People off the Hook
Competitive Negotiation: One-Shot Deals
Negotiation’s “Magic” Formula
The Beginning of a Negotiation
Ambush Negotiations

Chapter 3  The Best Place to Negotiate

Executive Summary
The Home Field Advantage
The Home Field Disadvantage
Deflecting Decisions
Preparation and Focus
Advantages of Visiting Negotiators
Kicking the Tires
Gathering Intelligence
Authors’ Recommendation

Chapter 4  Controlling and Obtaining Information

Executive Summary
Preemptive E-Mail
Bargaining against Yourself
Trickle-Down Loss
Your Own Authority
Asking Questions
General Questions
Specific Questions
What’s in It for Me?
Answering Questions
“That Is Proprietary"
Active Listening
Active Listening Techniques
Minimal Encouragement
Equivocal Statements and Verbal Leaks
Body Language
Needs, Interests, and Desires
Determine Your Opponent’s Needs
Faulty Assumption #1:  Everyone will act logically
Faulty Assumption #2:  Everyone we negotiate with will operate as we do

Chapter 5  The Best Time to Negotiate

Executive Summary
When to Negotiate
Patience and Pausing
Acceptance Time
Deadlines Make Things Happen
Negotiators Respond to and Strive to Meet Deadlines
The Power of Deadlines
Deadlines Play on Your Opponent’s Fears
Deadlines Help Reduce Your Opponent’s Options
The Pressure of Close Deadlines
The Efficacy of Objective Deadlines
The Extension of Deadlines
The Importance of Accelerated Deadlines

Chapter 6  How to Gain Power in a Negotiation

Executive Summary
Knowledge Is Power
Industry Standards
Industry Standard as a Starting Point
Legitimacy and Precedents
Coping with Uncertainty
Sole Source

Chapter 7  Preparing to Win

Executive Summary
Recognize When You Are Negotiating
Physicians Are Too Busy to Prepare
How to Prepare
Information Gathering
Assumption #1: Your Opponent Will Act as You Would
Assumption #2: Your Opponent Will Act Logically
Assumption #3: Your Opponent Will Do What Is in Her Best Interest

Chapter 8  Silence Is Golden

Executive Summary
Strategic Weapon
Method of Communication

Chapter 9  How to Gain Valuable Concessions

Executive Summary
Room to Negotiate
Recognizing Concessions
Size and Rate of Concessions
Information and Rate of Concessions
The Story of Concessions

Chapter 10  Using and Breaking Deadlock

Executive Summary
Appear Willing to Walk Away
Techniques to Break or Avoid Deadlock
Conciliatory Language
Adequate Room to Negotiate
Deadlines and Ultimatums
Eliminating the Possibility of Deadlock
Going Off the Record

Chapter 11  Using Controlled Emotions to Your Advantage

Executive Summary
Playing It Cool
Diffusing the Opponent
Controlling Your Anger
Personalize the Negotiation
Tapping into Fear or Anxiety

Chapter 12  Telephone Negotiations

Executive Summary
Concentrate and Focus
Initiate the Call
Listen for Auditory Feedback
Take Notes and Send Confirmation Letters

Chapter 13  E-mail Negotiations

Executive Summary
Advantages of E-mail Negotiations
Direct Access to Opponents
Specific (in writing
Encourages a Prompt Reply
Easy to Interrupt with Instant Messages
Easy to Send Multiple Requests
Ability to Utilize E-Mail 24/7
Quick and Easy “Back and Forth” without Phone Tag
Disadvantages of E-Mail Negotiations
No Buffer
Reply without Thinking
Easy to Get Caught in an Ambush Negotiation
Lack of Confidentiality
Demand Confidentiality
Change Mode of Negotiation

Chapter 14  Defeating Your Opponent’s Tactics

Tactic 1: Let’s Split the Difference
Tactic 2: Take It or Leave It
Tactic 3: The Estimate: Ballpark Price
Tactic 4: Lack of Candor
Tactic 5: Outrageous Opening Offer or Demand
Tactic 6: Belly Up
Tactic 7: Anchoring
Tactic 8: You Have Got to Do Better than That
Tactic 9: Pleading Poverty
Tactic 10: Limited Authority
Additional Tactics

Chapter 15  Team Negotiating

Executive Summary
Team Size and Composition
Controlling the Information Flow
Goal Setting
Taking Notes
Resolving Team Disagreements
Team Negotiation Tactics
Divide and Conquer
Weak Link

Chapter 16  Negotiating for the Retention of an Attorney

Executive Summary
Law Office Economics
Reasonable Attorney Fees
Determining Reasonable Fees
Legal Fee Arrangements
Contingency Fee
Fixed Fee
Hourly Fee
When to Hire an Attorney
How to Be a Good Client and Make It Pay Off
Selection of Counsel

Chapter 17  Negotiating Employment, Managed Care, and Other Formal Written Contracts

Executive Summary
Contract Law
Important Contractual Clauses
Choice of Forum Clause
Choice of Law Clause
Arbitration Clause
Indemnity Clauses
Limitation of Liability Clause
Covenants Not to Compete
Liquidated Damages Clause
Force Majeure
Non-Form Contracts
Negotiating Standard Form Contracts

Chapter 18  Closing the Deal

Executive Summary
Assumptive Close
Clear Choice
Power of Investment
Having a Deal
Outstanding Issues
Written Memoranda and Contracts
Living up to the Agreement
Saving Face
An Alternative Approach

Chapter 19  Negotiating an Employment Contract

Executive Summary
Consult with Counsel as Early as Possible in the Process
Make Sure That the Negotiated Contract Terms Are Well-Defined and That You Understand Them
Duration of Employment
Perform Due Diligence on Your Prospective Employer Before Negotiating 
Determine Specifically What Your Duties and Responsibilities Will Be       
Negotiate Fringe Benefits Before Salary
Obtain as Much Specificity as Possible Regarding Your Proposed Compensation    
Tie Your Bonus to Objective, Realistic, Obtainable Triggers
Physicians Should Negotiate Diligently to Protect Additional Income     
Negotiate Fair and Balanced Termination Provisions
Negotiate a Fair and Not Unduly Restrictive Covenant Not to Compete
Negotiate for Medical Malpractice Protection
Additional Resources

Chapter 20  Negotiation of a Managed Care Agreement

Introduction and Executive Summary
Have an Experienced Attorney Review the Agreement
Require a Verifiable Fee Schedule
Make Sure You Will Be Paid for Your Work
Make Sure You Know with Whom You Are Contracting
Protect Yourself Against the “Bad Apple"
Learn from Past Problems
Limiting the MCO’s Ability to Retroactively Reduce Previously Paid Claims
Limit the Plan’s Right to Offset Money Owed to the Practice
Maintain Your Leverage at Termination
Do Not Continue the Agreement while a Dispute Is Pending
Do Not Violate Anti-Trust Laws
Additional Resources

Chapter 21  Negotiating a Real Estate Lease for a Medical Practice

Introduction and Executive Summary
Be Prepared to Negotiate and Assemble Your Team
Obtain Confirmation that the Space Is Suitable
Make Certain that Your Lease and the Leases of Other Tenants in a Multi-Tenant Building Protect Your Specialty
Review the Rules and Regulations
Triple Net Can Mean More than Triple the Cost
Additional Rent Can Really Add Up
Reserve a Realistic Right to Audit
Take Steps to Protect Your Security Deposit
Consider Subleasing and Renewal Options
Be Sure the Lease Includes a Requirement that the Landlord Obtain a Non-Disturbance Agreement from All Existing and Future Lenders
Do Not Overlook Signage

Chapter 22  Negotiating the Sale of a Medical Practice

Introduction and Executive Summary
Retain Experienced Advisors Early in the Sale Process
Understand the Goals of Each Selling Physician
Use of a Confidentiality Agreement
Use of a Letter of Intent
Understand Due Diligence
Structure the Transaction to Take Advantage of Tax Laws
Payment of Purchase Price
Obtain Adequate Collateral
Addressing Other Post-Transaction Obligations
Understand the Restrictive Covenant
Limit Representations and Warranties
Limit Indemnification of the Sellers and Obtain Adequate Indemnification from the Purchasers
Determine Whether “Tail” Malpractice Insurance Is Necessary
Consider Including Dispute Resolution Procedures
ConsiderEstate Planning

Chapter 23  Negotiating the Purchase of an Established Medical Practice

Introduction and Executive Summary
What Are You Negotiating to Buy?
What Entity Will You Establish to Buy the Medical Practice?
What Items Do You Want to Negotiate to Buy?
Medical Charts
Medical Supplies
Furniture, Fixtures, and Equipment
How Do You Negotiate What the Medical Practice Is Worth?
How Will I Pay the Bills When the Practice Is Mine?
What Do I Need in Place for My Practice to Run from Day One?
How Do I Ensure the Selling Physician Stays Retired?
Non-Competition Provision
Non-Solicitation Clause
Employing the Retiring Physician
Am I Negotiating about the Right Practice Opportunity for Me?
What Should You Negotiate to Be in Writing?
Do I Need Help in My Negotiations to Purchase a Practice?

Chapter 24  The Biggest Mistakes Medical Organizations/Journals Make in Negotiating with Medical Publishers

Executive Summary
Not Retaining Ownership
Ill-Defined and Inadequate Royalties
Share of Profits
Royalty Based on Total Journal Revenue
Not Obtaining Guaranteed Royalties
Permitting Delayed Royalties
Signing Bonus Not Assured
Editorial Support Lacking
Advertising Revenue Not Maximized
Term of the Contract Not Considered
No Negotiating Alternatives
Not Obtaining Professional Assistance
Additional Negotiation Issues


By Steven Babitsky, Esq. and James J. Mangraviti, Jr., Esq ©2007 SEAK, Inc.  

babitsky-thumb.jpgSteven Babitsky, Esq. (, is the President and founder of SEAK, Inc. He serves as a negotiating consultant. He is the co-author of The Successful Physician Negotiator: How to Get What You Deserve  and How to Avoid Them and Never Lose Again: Become a Top Negotiator by Asking the Right Questions, 2012. He is the developer and trainer for SEAK’s Negotiating Skills for Physicians seminar. Steve is also the co-editor of the text The Biggest Legal Mistakes Physicians Make. He trains physicians and others on negotiation strategy and techniques and acts as a consultant to medical societies and journals in their negotiations with medical publishers, other organizations, and individuals. Steve has lectured nationally on negotiation strategies and techniques. He was a personal injury trial attorney for twenty years and is the former managing partner of the firm Kistin, Babitsky, Latimer & Beitman. He has trained thousands of physicians over the past 26 years. 

mangraviti-thumb.jpgJames J. Mangraviti, Jr., Esq. (, has trained thousands of physicians and expert witnesses across the United States and Canada. He currently serves as Vice President and General Counsel of SEAK, Inc. Mr. Mangraviti received his BA degree in mathematics summa cum laude from Boston College and his JD degree cum laude from Boston College Law School. He is the co-author of The Successful Physician Negotiator: How to Get What You Deserve and Never Lose Again: Become a Top Negotiator by Asking the Right Questions, 2012, the co-editor of The Biggest Legal Mistakes Physicians Make and How to Avoid Them, and serves as a trainer for SEAK’s Negotiating Skills for Physicians seminar.