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Pediatrician and certified coach Jessie Mahoney discusses her article, “Why physicians find negotiating challenging—and what they can do to negotiate better.” She explores why negotiation often feels stressful for physicians, linking it to medical training that emphasizes service, self-sacrifice, and conflict avoidance over self-advocacy, particularly impacting women. Drawing from her own experiences and coaching work, Jessie shares eleven actionable strategies designed to help physicians negotiate more effectively and mindfully. These tips include using breathwork to stay calm, clearly asking for what you want, conducting thorough research, understanding your value and bottom line (including the willingness to walk away), framing requests as mutual solutions, leveraging patience and silence, managing emotions like resentment, and celebrating successful outcomes without guilt. The conversation reframes negotiation not just as a business necessity but as a vital skill for physician well-being, energy protection, and building a sustainable career.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jessie Mahoney. She’s a pediatrician and certified coach. Today’s KevinMD article is “Why physicians find negotiating challenging and what they can do to negotiate better.” Jessie, welcome back to the show.

Jessie Mahoney: Thanks so much for having me.

Kevin Pho: All right. So, I think that negotiation is a critical topic when it comes to physicians. They don’t get a lot of training in that, and negotiation is part of pretty much what they do every day, both in the exam room and with their contracts and administration. So tell us what your article is about.

Jessie Mahoney: So I wrote this article primarily because my husband, who’s an attorney, didn’t understand why physicians have so much trouble negotiating and why we get in our heads about it and what the issues were. I do a lot of retreats for women physicians, and my husband would listen to them talk about all of the ways that we think about this and what the challenges are, and I thought, you know, there’s so much about how we were trained that makes negotiating hard. I know that my husband has taken negotiation classes as an attorney, and I’m like, these two don’t mesh.

And so the idea was sort of bringing together how we were trained to think as physicians and why that makes negotiating hard, and then just understanding some of the principles, which are really pretty basic. They’re not actually a lawyer thing at all; they’re just ways of thinking about things that are kind of the opposite of what we were taught in medicine because we were taught to serve, sacrifice, martyr, give, and that really—at least when I was trained—maybe didn’t even have a value, or if you focused on that value, that you somehow didn’t care about the profession.

I think that when we negotiate better, we actually care about the profession more and we’re able to care about our patients better. And as you mentioned in the intro, we actually negotiate all day every day; we just don’t realize it. You know, I, as a pediatrician, negotiate with families about vaccines all day every day, but I don’t think about it in those terms. And I think when we step out of the emotion of it and step out of the personalization of it, we’re much more effective at what we do. Because when families don’t want vaccines, for example, it’s not about us as a person; it’s really about some other deeper belief.

And so when you get into this idea of, OK, well this is a negotiation—and not in a—you know, when I even say the word still, even with all the work I’ve done in this, I get nervous. Like, oh, well I’m negotiating, and so it’s a winning or a losing. And instead, it’s really just a conversation and making sure that you are clear and non-emotional, honestly.

Kevin Pho: All right, so let’s talk about that first part. So why are physicians, in general, such poor negotiators?

Jessie Mahoney: Well, we were trained to be people-pleasers, OK? And have people like us at all costs. And so negotiating—people actually don’t like you when you negotiate, is what we tell ourselves in our head. And so really, we are there sort of overgiving and over-pleasing. And so when we can step out of it, it’s not really about whether people like us or not; it’s more of a concrete sort of process. And I think that we get really into the emotion of it.

I was also taught, really, we try to avoid conflict in medicine at all costs. And so negotiation, we see it as a conflict. It’s not really a conflict; it’s really finding a place of peace and finding something that’s OK for everybody. But I wasn’t really trained to think about it that way. It’s like if you negotiate, you want something and they want something, and so it becomes a sort of a conflict when it doesn’t have to be. Yeah. It’s really finding peace and understanding and a happy place in the middle.

I think also, you know, I was trained that a good doctor doesn’t advocate for themselves. A good doctor sacrifices and gives and is a martyr and a savior and a healer. And that has nothing to do with advocating for yourself. And so therefore, when we go to advocate for a salary or a position or something that we want, I was trained something that you want—like, you don’t advocate for that, that’s selfish. When actually, I think when we advocate and negotiate effectively, we actually can give so much more to the world because we have this sense of value of ourselves.

And then I really do believe that in medicine, we were kind of trained to undervalue ourselves and what we have to give because we’re there to give. So the inherent value, if you value yourself, it was seen, especially as a woman, like that’s cocky or that’s gloating, or you shouldn’t assume that you bring this tremendous value—even though physicians bring tremendous value, but that we definitely are taught to undervalue that.

And then I think the other piece that really gets in the way that we often discount is that we always catastrophize. And so it’s like, I don’t wanna put myself out there or if I negotiate, they’ll fire me. Or and we don’t like uncertainty. And one of the things I have learned in getting better at negotiating is that a lot of it is sitting and being patient and not responding and not being urgent and not saying something and sitting in that uncertainty. And that often in the uncertainty, things work out, but we tend to jump in and try to solve and fix right away. And so the catastrophizing and the uncertainty is really a challenge.

And the last one that I think it also plays in is so many of us are perfectionists. Yeah. And negotiation is not about perfection. You’re not gonna get what you want. The other person’s not necessarily gonna get what they want. It’s meeting in the middle, and that is uncomfortable for us. And so one of the things that my husband thinks is funny about physicians is that we do this whole negotiation, we get what we want, and then we’re still not happy. Because we want something better and more is better, and we want the perfect outcome even though we got what we asked for, because if we got what we asked for, our brain says, oh, I could have gotten more. And so this ability to be happy and satisfied and just decide that where you are is enough and what you’ve got is enough, but we tend to drop into the guilt or the shame that maybe I should have done it better or could have done it better. And so negotiation brings up all this sort of self-judgment as well.

Kevin Pho: So there’s a stereotype that women physicians don’t negotiate as strongly as their male counterparts. Is that stereotype true? As someone who coaches and does a lot of retreats with women physicians, what do you think about that stereotype?

Jessie Mahoney: I think we don’t negotiate as well, and I think much of it is that as women in medicine, we were trained to fit in and accommodate and not ask for special things, especially people in my generation who trained. It’s getting better over time. But if you are a woman who advocated—which is another really more comfortable way to say negotiated—but advocated for yourself, you were often seen negatively. And so for people who are people-pleasers, that’s really traumatic.

And I think—and this is again, stereotyping—but as women, we tend to stay out of conflict. We tend to not rock the boat. We tend to really want to please and make nice. And so it’s a further step and a further reach. And in a profession that has been really designed by men so far? It’s changing. My medical school class was the first class in my institution that was 50/50. And this was a while ago, but it’s changing, but it was really not built for women with families and other things; like the culture of medicine wasn’t.

So it’s actually much more uncomfortable to accommodate or to negotiate, especially for those in male-dominated professions, which there are still certainly many pockets of medicine where women are few and far between. But really it has more to do with we really wanna be liked, and we feel very threatened. You know, in medicine we’re actually taught, like, if your patients don’t like you, you get bad evaluations. Or if you advocate and you offend someone, we go into catastrophizing. We’re experts at that. And, you know, I coach men too, and they do also have trouble negotiating. But it’s not quite to the same degree because a lot of that is sort of ways that women were socialized.

Kevin Pho: OK. So we’ve talked about how physicians—because of the training and who they are and who self-selects to be a physician—in general are not as good negotiators, and women in particular, in contrast to men, are weaker negotiators. So let’s talk about the top points in terms of how we can be better negotiators as physicians. What would your strongest points be?

Jessie Mahoney: Well, from the coaching mindfulness perspective, I actually think that’s the most important point: it’s the sort of tone and energy you bring to a negotiation. So we bring stress, anxiety, wanting to change things, whereas if you can come to a negotiation calm and grounded and trusting and believing that it’s gonna work out OK, you are a much more effective negotiator. And so that’s really dropping into, I always say pause and breathe. Like, we don’t pause; we just jump right in. Even as we’re talking, right? Doctors don’t pause. I don’t pause very well. So remembering to pause and the breathing literally shifts your physiology so you are in a more steady state, which makes you much better able to be intentional and strategic and less reactive.

And then I also lean into sort of the philosophic points of mindfulness because I think they really help you: which is patience, and non-judgment. Negotiating is not personal and even not striving, like more is not better. There’s not a right or wrong way. And it’s really coming to it with presence and groundedness.

And another tenet of mindfulness I think is really helpful here is paying attention on purpose. So paying attention to the things you really want. So when I put sort of these tenets in the article, they all fit into that, right? It’s showing up intentionally, choosing how you wanna be, breathing, doing your research, taking your time to know your options, know what you bring to the table, and being realistic, staying grounded in what is and what information you can find out there, knowing your own worth and not undervaluing yourself. Also not overvaluing yourself. It’s really sort of, when you are calm and present in it, you can get that information and process it. Be more clear about asking for what you want.

I coach many fellows actually as part of my work, and when fellows are out interviewing for jobs, right? They’ve been training for years and years. And we have this thing in medicine that you’re lucky to get a job and you have to want them to want you. And you know, when you’ve been training, you have all these amazing skills, but we don’t come at it that way. And so it is really valuing yourself. You’re not lucky to get a job; they’re lucky to get you. And when you come with that different energy, it’s not that you’re, you know, gloating up here, but that you’re just real and honest and present and grounded. Physicians are super smart.

And then being patient and allowing silence is one of the things that we just struggle with immensely. And so when we are wanting to solve it, we often, as my husband says, negotiate against ourselves. Yeah, well this will be OK; this will be OK. And so recognizing that the pausing and the sitting in uncertainty—which can be for days or weeks when I work with people and, you know, maybe they’ve sort of countered back on a proposal—that sitting in the physician world is torture, right? And so I think just the idea to be patient and being OK to be uncomfortable and allowing the silence and the pause is 100 percent a practice. It’s one of the reasons why I think you really need to bring mindfulness both into the practice of medicine, but as a coach and sort of moving through strategically, it helps us sort of sustain our energy. Otherwise, we’re just wasting all this energy, anxious about the what-ifs and going into that catastrophizing.

The other thing that I think is kind of funny is that we often in medicine don’t know our bottom line. We don’t know when we’re gonna walk away. We don’t go in with a plan. And then if we do have our bottom line, we just tell them right away. Again, it’s this urgency to get it done and to get outta the discomfort. And so deciding in advance what’s your bottom line? What is the minimum amount of salary or what are the things that are non-negotiable for you? And being willing to walk away is a really important thing.

I think in medicine, we really worry about walking away. If I walk away from this, will I ever get another job? You could hear all this catastrophizing in there, or I will never get another job, or they won’t like me, or they’ll say something to somebody. And so knowing what it is and being willing to walk away, believing that there are other jobs, right? Our scarcity mindset gets in the way. There’s only one job and what if nobody else wants me? And so just sitting in that uncertainty is a key one.

And then looking for the places you can compromise, the things that are shared. I often talk about this in relationship coaching too: How are they just like you? What do you both want? How can you both win and—while this might sound negative—like both lose, right? If nobody’s ever happy, both people are never happy in a negotiation, and both people are never miserable in a successful negotiation. It’s just, you’re all OK. It never feels amazing.

I think the other thing is in doctoring, we have a lot of—and I’m laughing at myself here—but righteousness: it’s right and wrong. And it’s about our value. And so often in medicine, especially around salaries, it’s not about our value, it’s not about what we bring; it’s about something well beyond us. And so when we get out of that personalization, we’re much more effective and strategic, and then being OK with, as I mentioned earlier, like with what you get. Because I am someone who then is like, well, but maybe I could have done better, and so then I’m never satisfied. And when you always feel never satisfied, you then decide you’re a bad negotiator.

I think the last point would be actually—and this is probably the thing that gets in our way the most—is we think we’re not good negotiators. And I would say we actually are; we do negotiate with our patients about care all the time. We know these strategies. We just tell ourselves, I’ve never been to school to do this, I don’t know these things. And so, so much of it is in our own head, as opposed to the lack of training or skill.

Kevin Pho: Excellent tips all around. I especially like the one about the pause because, yeah, when you’re talking, for instance, about money, about salary, sometimes you have to just say that number and let that breathe because if you start talking so soon after that, like your husband said, you’re just negotiating against yourself. And I see that happen so many times, and sometimes pausing—that in itself is uncomfortable because even though what seems to be three, five, seven seconds, that seems like an awfully long time, and you have to fill that space. So I just wanna reemphasize, don’t feel the need and resist that urge to fill that silence with saying something. Because once you say something, you’re immediately negotiating against yourself.

Jessie Mahoney: Yeah, I would agree that the pause—in fact, in everything that we do—if physicians could pause more, we would be much healthier and be able to move forward with much less wasted energy and have a more sustainable career, whether it’s negotiating or practicing medicine.

Kevin Pho: Yep. So I want you to share a success story, and this story doesn’t have to be a contract negotiation. It could be something as simple as talking to a family or patient in the exam room. Give us a scenario, it could be real or hypothetical, where a physician uses some of the techniques that we talked about in order to engineer a successful outcome. What would that look like in practice?

Jessie Mahoney: Yeah. You know, I would say—and maybe I’ll just use one of my own examples—I do a lot of speaking now, and that is where I have to negotiate, and I still find it so uncomfortable. So for me, and most of that’s by email, so you’re not even talking. And I think that’s a really important point: we negotiate by email all the time.

And I think when that comes to pass is really, so in terms of maybe negotiating for speaking, a contract or something you really want to do. So many of us don’t wanna negotiate ’cause we know we really want to do it. And so clearly knowing your bottom line, like where will you not go or it’s not, you’re not able to do it. And I often use the idea: if you’ll feel resentful afterwards, if they say yes or you went and you did it, then that is your inner gut knowing that it’s out of alignment.

Yeah, but it really ties into getting at the trust and belief that you have value and what value do you bring, and sitting with that, not in a way that like, oh, I’m so amazing, but what, honestly, what value do I bring? I think writing down what value you bring, what feedback have you gotten, really grounding into your own, what you know to be true about yourself. And then believing that you have that worth and believing that you can negotiate. And I actually just like to say advocate because even the word negotiating brings up a little bit of anxiety for me.

And then I think sharing other things. So some of my most successful negotiations are just sort of putting things out there. Like, well, you know, they may come up with an amount, and you might say, well, you know, I have done it for this other organization and they paid me this often. That works the best. And in the past, I had been afraid to put that out there because it might be perceived in a certain way or what might they think of me. And so it’s really grounding into your own worth.

And I would say pausing and choosing that, as I said, tone and energy you bring to the email or to the conversation. I never respond right away. That’s my other thing is take a break, breathe, go for a walk, even respond tomorrow. I think we always think I gotta do this today. And many of us wanna get out of the discomfort; we wanna have it sent. And so that pausing is very strategic and believing in yourself. Remembering you’re not lucky. I just remember so many times I was told that I was lucky to get a job or lucky that they were interested. And what if it’s not luck? What if you have worked really hard to be able to do what you do, and you have a lot of skill and wisdom and experience to offer even in your first job in medicine?

Kevin Pho: We were talking to Jessie Mahoney. She’s a pediatrician and certified coach. Today’s KevinMD article is “Why physicians find negotiating challenging and what they can do to negotiate better.” Jessie, last thoughts, as always, some take-home messages you wanna leave with the KevinMD audience.

Jessie Mahoney: I think to remember that you aren’t a bad negotiator. That negotiating is more about presence and trust and pausing and breathing and slowing down. And that the story that we don’t know how to negotiate is actually the thing that gets in the way the most. And that really believing in yourself and believing in your own worth is how you can become a better negotiator without going to law school and without taking a class: deciding you’re good at it.

Kevin Pho: Jessie, as always, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Jessie Mahoney: My pleasure.