Why dentists must learn to negotiate

Oct. 1, 1999
Negotiating is the most critical business skill for dentists to learn in today`s managed health-care environment. The founder of Power Negotiating Institute explains why.

Negotiating is the most critical business skill for dentists to learn in today`s managed health-care environment. The founder of Power Negotiating Institute explains why.

Roger Dawson

Dentists have difficulty negotiating for many different reasons. I`d be willing to wager that very few dentists thought about negotiating skills when they were going through dental school. It simply wasn`t a part of what they had to learn to deliver quality dental care to their community.

But what a difference a few years can make to a profession! The dental profession is now part of the health-care industry ... an industry where hospital administrators have become corporate presidents who describe patients as customers and diseases as product lines!

It`s hard to imagine an industry that has gone through the convulsions that health care in the United States has suffered during the last 10 years. Now, negotiating skills have become a fundamental tool that dentists and other health-care professionals must have in order to survive and prosper.

Most dentists are remarkably intelligent, hard-working, and dedicated to constant self-improvement. Because of these characteristics, logic says it shouldn`t be hard for them to develop the negotiating skills that today`s health-care environment demands. Unfortunately, dentists possess other traits that make them remarkably ill-equipped to become good negotiators. They include:

1. Dentists feel that most negotiating tactics are unethical.

I`ve been teaching all-day and two-day advanced "Power Negotiating" seminars to the health-care community for 18 years now, and this attitude continues to astound me. Negotiating techniques that are perfectly acceptable to business people, such as vendors and third-party payers, seem unethical to most dentists.

For example, asking for more than you expect to get is a cornerstone principle of good negotiation. Henry Kissinger said, "Effectiveness at the bargaining table depends on your ability to overstate your initial demands."

However, asking for more than you expect to get seems deceptive to dentists. This is because dentists` training has taught them to be totally open and frank with their patients.

It`s important to have hidden agendas. To negotiate well, you can`t reveal everything that is of importance to you. You must often downplay the importance of key issues, so that the other side doesn`t seize upon your need as an exploitable weakness. Sometimes it`s necessary to do the reverse - to overemphasize the importance of an issue, so that you can trade it off for a real issue later. Dentists have a terrible time with this, because they have been taught to reveal everything to their patients and hold nothing back.

2. Dentists have been trained not to reveal emotions. A dentist can`t be looking at a patient`s X-ray and loudly exclaim, "My goodness, would you look at that!" Dentists need to be able to control their emotions. But, to be a good negotiator, you also need to be able to communicate emotions effectively. What emotions do you need to communicate?

* Surprise at the other side`s opening negotiating position

* Shock at their audacity in making such an outrageous proposal

* Anger that the other side is not willing to be more reasonable

* Outrage at what you feel is a breach of faith

Of course, all this must be done while you are completely in control of your own emotions. Warren Christopher, President Clinton`s first Secretary of State, made this point when he said, "It`s O.K. to get upset with the other side when you`re negotiating, as long as you are in control and doing it as a specific negotiating technique. It`s when you get upset and lose control that you always lose as a negotiator."

Reality vs. perceptions

A negotiator deals in perceptions, not reality. A negotiator knows that if the other side believes it to be true, it is true, as far as that negotiation is concerned.

In 1945, the Japanese surrendered to us because they believed that we had an arsenal of atomic bombs with which we could destroy their country. We didn`t! We didn`t have any atomic bombs at that time. We only built two bombs and we had used both of them. We didn`t have any more bombs, and it would have taken us at least 60 days to produce another one. But the Japanese didn`t know that. That perception was enough for them to surrender.

Dentists would call this deceptive, if not downright devious. But, it is all standard operating procedure for a negotiator. For example, the most important thing that you can do in a negotiation is to service the perception in the other person`s mind that you have options. The perception of options gives you power. I don`t advocate lying, of course, but if the other side believes that you have options if you can`t reach an agreement, you have power.

Dentists are trained to gather facts before determining solutions. This is the standard training method for scientists. It means strenuously avoiding making any kind of judgment before you have gathered all of the information. That`s an excellent model for treating patients, but it is a poor way to resolve conflict.

I teach the three-step method to resolving conflicts that is advocated world-wide by hostage negotiators. Those three steps are:

(1) After letting them vent, get the other side committed to a position and let them know where you stand.

(2) Gather all the information you can, such as: Who is this? Are they part of an organized group? Have they ever made this threat before? Have they ever followed through? What religion are they? Where is their family?

(3) Strive for a compromise with which both sides can live.

This method is counter to all the training that dentists receive. Dentists are taught to gather all the information first, and then look for solutions. It is difficult for me to get them to try to resolve problems by looking for solutions first, but it`s the best way to handle a crisis.

Dentists are conflict-adverse

A dentist`s drive is centered on wanting to make things better. The Hippocratic oath to do no harm dampens the desire to take risks. However, negotiation calls for a great deal of risk-taking. Power negotiators have mastered the art of managing risk. They do not think of loss as being unacceptable; instead, they consider whether the risk of loss is justified by the chance of success.

To a dentist, losing means death. A negotiator doesn`t like to lose either, but a negotiator knows that he cannot exclude losing from his options. The most powerful pressure point in a negotiator`s arsenal is the willingness to walk away from the negotiating table. Once a negotiator excludes the possibility of walking away, he has surrendered his strongest bargaining chip.

Dentists feel that it`s beneath them to do anything for money. The image of "Marcus Welby" is wonderful, but it`s not the way health care operates today. Profit consciousness is the key to survival in today`s competitive health-care environment.

Since Wall Street moved in on our health-care system in the 1980s, the profit motive has driven the health-care industry in the United States. The ability to run a dental group profitably has become the essential issue in the battle to provide quality dental care to our communities. Today`s health-care environment says that you must make a profit in order to survive.

Many participants at my seminars have confirmed the urgency of doing this. Dentists have told me, "Roger, we`re losing money for the first time in our history. I`ve had my practice for over 25 years and we`ve seldom had to worry about making a profit before. But last year, we got outnegotiated by an HMO. We`re losing money so fast that we don`t even know if we can keep the doors open!"

Dentists don`t feel `credentialed`

Dentists must not only be taught how to do something, they must also feel authorized or credentialed to do it. But there are no "Delineation of Privilege Forms" in the world of negotiating. That`s why it is so important that you learn not only how to negotiate, but also understand that you are authorized to use negotiating tactics.

Dental practitioners must master the negotiating skills necessary to survive and prosper in today`s health-care world. Learning the art of successful negotiation is as essential to their prosperity as keeping their clinical skills up-to-date on the newest procedures.

Negotiating tactics

Tactics which would be unethical in the medical world are accepted practice in the business world. These tactics include:

x Project emotions when you`re negotiating.

x Deal in perceptions and not just reality.

x Address solutions before gathering all the facts.

x Conflict is good.

x Loss is an acceptable risk that must be managed.

x Money has become an acceptable motive in today`s health-care environment.