Intended for healthcare professionals


The art of negotiating as a doctor

BMJ 2014; 349 doi: (Published 10 November 2014) Cite this as: BMJ 2014;349:g6662
  1. Beryl De Souza, honorary secretary, Medical Women’s Federation ,
  2. Andrew Barton, London regional coordinator, British Medical Association
  1. 1London, UK
  1. bds{at}


Beryl De Souza and Andrew Barton look at the importance to doctors’ work and careers of negotiation skills

We all need negotiation skills in our day to day lives. We negotiate with our family about how to spend holidays, we negotiate with contractors about when to come to the house for a delivery or repairs, and we negotiate in shops when making big purchases.

As doctors, we negotiate with patients when discussing treatment options and when agreeing our job plans and responsibilities. Each of these situations has a different level of risk and impact. Nonetheless, many of the skills of negotiation covered in industrial relations courses are transferable to other circumstances.

The importance of negotiation as a career skill for doctors is often not taught in medical school or in postgraduate training. But negotiation can be necessary in training—for example, to ensure a particular skill is learnt and practised. Negotiation is also important for academics and others when developing a job plan around dual commitments and deciding a workable and appropriately remunerated timetable.

The BMA provides extensive training on negotiation for its local negotiating committee representatives, and negotiation training is also available through BMJ Learning. Such training covers the concepts, knowledge, and skills needed to work in a team and negotiate terms and conditions in the workplace. Much of what is covered would be useful as part of a doctor’s role.

The classic example of where negotiation skills are needed is in job planning. This is where you might have to bargain hard to ensure you keep in your job plan what you believe will develop you as a doctor, such as an educational, college, or committee role that you find useful in your job. From the point of view of the staff of a trust or clinical commissioning group, they would want you to provide a service and there is a vital need for you to negotiate. There are two models that can be used in the job planning scenario: positional bargaining and principled negotiations.

Positional bargaining

Positional bargaining is the traditional model of negotiation, where each side takes a position, argues for it, and makes concessions to reach a compromise. When negotiators bargain over positions, they tend to lock themselves into those positions. Bargaining over positions creates incentives that stall settlement. The result is often an agreement that is less satisfactory to each side than it could have been.

Principled negotiations

Roger Fisher and William Ury1 have developed an alternative to positional bargaining, a method of negotiation explicitly designed to produce wise outcomes efficiently and amicably. This method, known as principled negotiation or negotiation on the merits, will often result in a much more acceptable result as a “win-win” for both sides to the negotiations.

Anticipating the other side’s case

Negotiation deals with conflict and with uncertainty, and being informed helps you to manage both. Good organisation increases your bargaining strength. A major step in preparing for negotiations entails assessing the bargaining situation and making a realistic judgment about your relative bargaining strength. Negotiation also involves dealing with detail and analysing precisely what you are going to negotiate about. There are two main considerations: one is the issue you are negotiating about, and the other is the person you are negotiating with.

Negotiation is about trying to reach agreement, and this means that you have to deal with the other side’s case. Anticipating the other side’s case is an important part of your preparation. When the actual negotiation is in progress you will be trying to get information from them about how they see the situation, what their interests are, what they want out of the negotiation, what concessions they may offer, and what other options they have.

Planning a strategy

Never negotiate without a clear idea about what your objectives are. To clarify your objectives ask two basic questions:

  • What is the most I can realistically hope to get?

  • What is the least I absolutely need to have?

In deciding the most you can achieve, you must set demanding but realistic objectives. In deciding the least you can have you must think about what options you would have if no agreement were reached. What will you do if there were no agreement? What is your best alternative to a negotiated agreement (BATNA)? The negotiating range is the distance between the most that you can achieve and the least that you will accept. The concept of a BATNA is psychologically and strategically important. A good negotiator will always have anticipated in advance what to do if no agreement is reached.

All negotiators work towards agreement. It is essential that both parties agree what they have agreed with each other before they leave the table, and that the agreement is recorded in an acceptable manner. This is the way to pre-empt subsequent confusion, disagreement, and hostility. If the summary of what it is that you believe has been agreed does cause conflict, then it is necessary to re-open negotiations until you can find an agreement. Failure to reach full agreement before you implement a deal is as disastrous as trying to implement a deal that has not been agreed at all.

Many skills of negotiation are transferable to other areas of our lives, and the box looks at some examples of using negotiation skills training in other aspects of doctors’ daily lives. If this article has whetted your appetite for discovering more about developing negotiation skills perhaps you should consider being a BMA representative on a local negotiating committee to learn more.

Using negotiation skills

Quality improvement

A lead clinician in a hospital who was implementing a new care pathway for patients would use a wide range of negotiation skills, including influencing skills, identifying areas of resistance, and planning a strategy to overcome any difficulties.

Team working

Negotiation skills can help individuals become more diplomatic and persuasive and improve team working relationships. Encouraging a more collaborative approach can also improve patient care.

Family life

Trying to arrange anything in some families can be exasperating, with everyone pulling in different directions, but negotiation skills can help with this. Planning skills can be used to create “win-win” situations and compromises can be reached by trading off different perspectives.

Job planning

Doctors sometimes find themselves having to cope with an unfair job plan or extra work being expected without any recognition. Sometimes a number of doctors in an area feel the same, and this can have a demoralising effect on work-life balance. Learning negotiation skills can give such doctors the confidence to create an action plan for their next job plan review, with the aim of incorporating all work into a new job plan and negotiating extra supporting professional activities (SPA) time for education.


  • Competing interests: We have read and understood the BMJ’s policy on declaration of interests and have no relevant interests to declare.