Negotiation Strategies as a Pathway for Creating Equity within Organizations

**It’s official - we are published!**

I’m so excited to announce that we are published authors!

The Journal of Graduate Medicine has published our article Negotiation Strategies as a Pathway for Creating Equity in Medicine in the National Library of Medicine at the National Institute of Health (NIH). I was so excited to see my name listed in the author line with co-authors Onyeka Otugo (MD, MPH, MPA) and Vonzella Bryant (MD).

I first met Onyeka during our time at the Harvard Kennedy School when I was a Fellow at the Women and Public Policy Program running negotiation workshops. Several months later, during the peak of the COVID pandemic, Onyeka reached out to me to run negotiation workshops for the black women physicians in her fellowship called Lift and Elevate.

About Lift and Elevate

Lift and Elevate’s ultimate goal is to create a healthcare system where Black women can thrive as both patients and physicians.Their fellowship is a 6-month professional development program aimed at giving Black women the tools needed to advance and support their careers in medicine. Lift and Elevate’s vision for improved health outcomes for patients and increased physician representation for Black women begins by increasing representation of black women physicians pursuing academic and leadership positions

Black Women: A Neglected Group in Healthcare

Onyeka explained her motivation for starting this program: As a Black woman, I belong to a neglected group in healthcare. As a physician, I have been overlooked because I “did not look like a doctor.”

Postpartum rates for Black women are 3-4 times as those of white women. The breast cancer mortality rate is 40% higher for Black women despite a lower incidence.

Black women make up 2% of physicians and 2% of faculty. Retention and promotion of minority women, specifically Black women in senior leadership positions, is currently lacking. Black women are less likely to pursue or be promoted into these roles for many reasons such as lack of support, microaggressions, and lack of consideration for promotion.

Studies have shown that increasing physician diversity improves patient outcomes. Addressing the dearth of Black women physicians in leadership positions will improve health outcomes and prevent further morbidity and mortality of Black women in the United States.

“Isn’t it a conflict of interest to teach negotiation at an organization?”

*Our first virtual workshop with the Lift and Elevate fellows*

I get this question a lot because so many people strongly associate negotiation with salary. It makes sense that they would think that because there has been so much news coverage on the gender pay gap. They assume that a negotiation workshop would focus on salary negotiation with the employer who is sponsoring the event. But negotiation is about much more than salary.

“Negotiation” is defined as when two or more people are trying to come to an agreement.

Negotiation can be about allocation of resources, project deadlines, and resolving conflicts in the workplace. Research also shows that women who negotiate the non-salary aspects of their jobs tend to be happier at their workplace and stay longer - basically, it is in the best interest of the organization to provide negotiation training to retain women talent.

In the article, we give examples of how Black women can negotiate to get the resources to perform their jobs well. For instance, if a Black woman gets asked to fulfill more responsibilities, such as working on diversity committees, she can negotiate that arrangement, perhaps by asking for more time to fulfill committee responsibilities or moving other responsibilities off of her plate. This helps her do her job better and still meet the goals of the organization.

So rather than seeing employer-sponsored negotiation workshops as a conflict of interest, organizations can provide inclusive negotiation training (meaning negotiation training that specifically shows how to overcome gender and racial bias) to their members as a pathway for creating equity.

I was so excited to collaborate with Onyeka for an important cause. Read the full article below.

Negotiation Strategies as a Pathway for Creating Equity in Medicine

Onyekachi Otugo, MD, MPH, MPA, is Director of Research, Office of Inclusion, Diversity, Equity, and Social Justice (IDEaS), and Instructor, Brigham and Women’s Hospital, Harvard Medical School;

Joan Moon, MPP, MSE, is Negotiation Consultant & Trainer, Moon Negotiation, and Negotiation and Conflict Resolution Collaboratory Fellow, Harvard Kennedy School of Government; and

Vonzella Bryant, MD, is Assistant Professor of Emergency Medicine, Assistant Dean of Student Affairs, Boston Medical Center, Boston University School of Medicine, and Vice-President of Operations, New England Medical Association.

She was excited to start her first job after residency. She was told that her skillsets and her interests were highly marketable. However, when it came to her interviews, she received feedback that she was perceived as aggressive. As she went on in the process, she felt herself shrinking.

She felt powerless.

Once she started working, she was placed on multiple committees because she was one of the only Black women at her institution. She noticed that she was spending numerous hours daily on committee work and barely had enough time to focus on her clinical-related activities.

While at work, she was constantly questioned by her colleagues regarding the orders she would place. Despite introducing herself as a physician, her patients often complained that they were never seen by the doctor or mistook the male nurse or medical student as their physician.

She had twice as much responsibility without the compensation, protected time, or recognition as her male colleagues.

She didn’t feel valued.

These are common situations that women of color, especially Black women, encounter as attending physicians, fellows, residents, and even medical students. The frequency of these interactions can lead to higher burnout rates, poor workplace performance, and ultimately attrition from medicine. These daily occurrences contribute to the large disparities seen within the medical field.

There are known equity issues in medicine between women and men that are further compounded by race.

In medicine, there are few women and even fewer women of color in senior leadership positions. Even when women have similar leadership positions to men, they earn significantly less than their male counterparts.

In the United States, women physicians “make between 17% and 28% less than men at all career stages.” Women physicians who are racial and ethnic minorities in medicine face further pay disparities, earning between $0.69 to $0.77 for every dollar earned by their White male colleagues.

Furthermore, Black women at an institutional level face both gender and minority tax burdens.

They end up in institutions where they are expected to do work in diversity, equity, and inclusion (DEI) spaces with little administrative or financial support. Women are more likely to do work that benefits their institutions such as committee work; however, this work may be less valued at the time of promotion review. Ironically, Black women who lead DEI initiatives often begin to feel isolated or get pushed out of the organization if their views are not in line with the position of their organization.

A contributing factor to disparities in pay and leadership representation is the backlash that women, especially women of color, face when they attempt to advocate for themselves using conventional negotiation strategies. When they do negotiate and advocate for themselves, women of color, specifically Black women, are often afraid of pervasive stereotypes such as being labeled as aggressive or angry. This enhances negotiation challenges. The study Bargaining While Black: The Role of Race in Salary Negotiations demonstrated that when Black applicants negotiated, “job evaluators [were] less willing to make concessions,” which ultimately resulted in lower starting salaries for Black applicants. Faculty and trainees of color face these unique challenges, which are compounded by gender when negotiating.

Therefore, it is essential to transition away from “typical” negotiation tactics and toward strategies that take into consideration the role of bias.

It is also vital to understand that negotiations also occur in daily interactions, outside of traditional salary and contract negotiations, such as when talking to patients about their medical treatments, dealing with a difficult patient, or peer encounters. Although inexperience, gender, and institutional barriers are commonly cited reasons why individuals may feel inadequate when negotiating in these situations, the intersection of gender and race is critical here as well. Traditional negotiation frameworks usually do not take into consideration these intersections. For example, when women are taught and use gender-specific negotiation strategies, these can be perceived as “inherently adversarial in nature.” Therefore, it is important to inform and shift a person’s mindset in when, where, and by whom specific negotiation strategies can be best used.

Negotiation Training

Similar to fields such as law and business, offering negotiation curricula in medicine can address some of the unmet needs at the intersection of race, gender, and negotiation. Starting early in training, in medical school, is essential. Negotiation content can be incorporated into existing medical school courses as well as residency curricula. Examples include existing case studies, simulations, and DEI training sessions.

These interactive sessions must include the numerous informal scenarios in which negotiations occur, to practice strategies.

This is in addition to traditional leadership courses that emphasize salary and contract negotiations and often occur toward the end of residency and fellowship training. Instead, these sessions should emphasize a mindset shift that many situations are actually negotiable (Table). These teaching sessions can also address the power disparities that are frequently encountered throughout and after training.

Negotiation curricula should deemphasize hard positional bargaining and instead emphasize collaborative negotiation skills, such as win-win framing, which are proven to be more effective. The Table outlines key negotiation concepts for daily interactions. Interactive, required negotiation training integrated into current case conferences, simulations, and other curricula to highlight critical negotiation strategies, especially for Black women, will increase trainee success and potentially improve program goals in diversity and retention.

Incorporating negotiation strategies can empower these women to advocate more effectively for themselves as well as their patients.

Offering negotiation curricula is a critical step at the institutional level in creating a system where women of color feel valued and are operating on an equal playing field.

Other useful negotiation strategies include identifying the best alternative to a negotiated agreement (BATNA), either in the moment for daily interactions, or proactively, in planned negotiations. Thus, if the desired outcome is not attainable, there are backup options, rather than a “win-lose.” For example, if a patient refuses recommended treatment suggested by a Black woman physician, the BATNA may be a mutual agreement to return later to the discussion. If a residency program is unable to obtain administrative support for a resident who is leading DEI initiatives, a reduction in shift or clinic hours may be the BATNA.

The intentional sequencing strategy is also helpful in negotiation. This requires anticipating preference outcomes in a proactive way. An example of intentional sequencing would be an attending introducing a new resident or fellow throughout the day as doctor during interactions with staff and patients, rather than reacting during an encounter.

Peer Allyship in Negotiations

Allyship is essential for mitigating negotiation obstacles and creating an equitable work environment, instead of expecting trainees to handle difficult situations on their own. For established leaders, allyship may include sponsoring and supporting a Black woman for a new role or mentoring around career obstacles. However, negotiation allyship is not limited to those who are in positions of power.

Being an ally includes gentle gestures that can have profound effects.

If similarly trained in these daily negotiation strategies, a colleague can provide more informed support during a difficult patient encounter, such as when a patient does not acknowledge their Black woman physician as a doctor. A colleague can address the Black woman physician as doctor and clearly defer to her expertise, as she talks to the patient. Recognizing the opportunity and employing negotiating strategies immediately can foster an atmosphere that is committed to diversity.

Institutional Support During Negotiations

The institutional environment is critical to Black women successfully employing daily and high-stakes negotiation strategies. Institutions also must understand that negotiations can occur in frequently low-stakes as well as high-stakes encounters.

Institutions should approach negotiations not as a loss versus gain but instead an opportunity to highlight shared interests for the organization and the negotiator.

It is beneficial for institutions to be open to negotiator suggestions, such as using benchmarks employed by comparable institutions for the same role or duties. For example, when a Black woman is presented with an opportunity with increased responsibilities, such as DEI committee work, the institution should recognize and be open to the need for support. This could be through reducing clinical time, increasing administrative support, or funding advanced training. This approach is likely to increase success for the Black woman in a new role and for the institution in a more productive committee, with less participant turnover.

This approach requires institutions to explicitly consider prevalent stereotypes—the intersection of race and gender—and employ strategies to mitigate their effects, to reach mutual agreement. Institutions can further support trainee and faculty success by requiring and funding negotiation training that considers the effects of intersecting identities. Creating a supportive environment is essential for negotiations to be successful.

Conclusions

Daily and high-stakes negotiations pose unique challenges for Black women medical trainees and faculty, due to stereotypes surrounding their intersecting identities of race and gender. To effectively address these barriers, it is essential to adopt strategies that have been effective in other fields, such as business.

By integrating these strategies into existing medical school, residency, and fellowship educational experiences, we can cultivate a safe space for negotiations practice. These strategies include mindset shifts from perceiving negotiations not as win-lose but as win-win, recognizing negotiation in everyday interactions, using benchmarks in discussing the need for support or funding, including allyship in negotiations, considering best alternatives, and intentional sequencing. By implementing these measures, we can work toward creating a system that values and empowers Black women medical trainees, enabling them to thrive in their careers.

Thereby creating a system where she feels valued.

Read the full original article here.

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