When do you walk away from a negotiation?

When is the best time to walk away from a negotiation?

The short answer is there are three reasons not to walk away versus ONE reason to leave.

Does this story sound familiar?

As a practicing gastroenterologist of almost 20 years, Dr. X found himself working harder and harder for the same pay with diminishing return on with work satisfaction.   Add to this his home life where he has a sick child and an estranged wife with whom he barely communicates.   The attitude at work where is a partner at a very busy private practice is to eat what you kill and work as hard as possible to maximize the profit for himself and his partners and maintain the reputation of his group.   Lately, group meetings have been strained since the payer mix has slowly deteriorated and to make up the difference more patients must be seen on a daily basis while trying to expand the market share in a very competitive urban city.  Costs have not been well-contained with mandates such as electronic medical records and preauthorizations require more capital and personal.

A Very bad day

Dr. X always feels as if he is on the edge of a cliff but there doesn’t seem to be any other way of practicing, and to his knowledge, his partners seem to be handling the situation without too much difficulty except for the occasional complaining at meetings.  Call can be brutal, but after his most recent call, he suddenly came face to face with a life-threatening condition requiring all his skill and attention to keep the patient alive.  After successfully treating the patient, he felt this why he had trained all these years and felt a sense of pride.   The next day he decides to round on his patient first in the ICU.  The patient had done well overnight and was conscious.   He introduced himself to the patient who then immediately asked “Are you the %^&&@-@#$%$# who did this to me?  Dr.  X  explained to the patient that he was dying and that without intervening he would have died.   The patient then spat in his face and  said: “you should have let me die.”

This is your brain on drugs

What do you think happened next?  What would you do?  Thinking about it I get a knot in my stomach and start to feel anxious…It is called the “witches brew, ” a nice cocktail of epinephrine and cortisol.   Under the influence of catecholamines and glucocorticoids, blood flow to the pre-frontal cortex nearly ceases, and long-term memory fades.   The best course of action would have been to walk away and regroup while calling security to make sure the patient doesn’t assault someone.  Maybe take a trip to the ED.   Well that not how this story ends.  Dr. X went straight to his office and resigned on the spot and walked away from his career and medicine.

Was this the right move?   I think it is a matter of opinion.   But what would have happened if Dr. X could take some time off to burn some steam and then get some help to process what happened and what has to lead up to this point in his career?   Maybe the outcome may have been different?  I don’t know.

If you walk away, you lose all your power

Getting More author, Stuart Diamond calls this having a “guarantee that things won’t go well.”  When you walk away, you lose all your power.   After further questioning, Dr. X wanted to have a better life-work balance to spend more time healing his relationship with his wife and child.  Here was an opportunity to explore options to reduce his workload and possibly go part-time.   How willing would the other partner be to taking an extra call or see extra patients?   Would the group be ready to bring on a new partner to reduce everyone’s workload?    Maybe the group would have refused?   Either way, it will never be known since there was no communication and no conversation.   Starting a new job after having walked away from his current position in a tiny medical community will be very difficult if not impossible.

Where does power come from?

Every negotiation comes with a balance of power of both sides.   Dr. X has tremendous power in his group. Every five years in practice shows commitment, and everyone knows what quality of products and services you provide.   Every five years serves as a benchmark for excellence since anyone could get derailed in the process.  Most employers reward the employee who goes the distance.   At my organization, we get the day off and are bused to a Mall for a reception and shopping day as a reward for sticking it out.  Every five years after that we get the same thing, but you have to get to 20 years first.   So the person who sticks it out has tremendous Power, and this should not be carelessly given away.

Sometimes things don’t go so well, and you have a bad day

Samsara is an ancient Sanskrit word meaning “wandering” and “world.”   Not to go into the eastern religious significance but it describes a human condition, a cycle of life.  We all have bad days and good days.  Every winter will always follow with spring, and daytime will follow night.  Cycles are a natural part of human existence.   The problem come when we think or perceive we have more bad days than good or focus on the present instead of the future.   Dr. X had a terrible day and probably had a secession of terrible days leading to his resignation.   I am sure there must have been some good days too to have lasted 20 years in one place.   Maybe the bad days were getting too much attention and threw off his balance.

What is the solution to a bad day? Get your mind right!

Although this will not be a prevalent opinion from the perspective of the stoic medical community, the easiest way to deal with what had happened to Dr. X is talking it over with a good friend, confidant, coach or therapist.   The more you can distill emotions and thoughts in your mind the easier it will be to manage them.   Michael Jordan, Jerry Rice, and Lebron James have much in common.  They are the absolute greatest of all time, have a tremendous work ethic, have failed as much as they have won but what makes them champions comes from somewhere else.   They all talk about an inside game, what happens in their minds when things don’t go well, and they all had the luxury and luck to have a professional psychological coach help them process it all.   How are you any different?    Are you so talented and intelligent that you can see your blind spots?   Are you not susceptible to the same cognitive biases as everyone else in the world?  When things get tough, the tough get some help!

Splash Financial

Communication is key

“Just keep swimming” made popular by Dory in a famous Disney movie resonates with both young and old alike because it reflects some universal wisdom.   Stopping and losing momentum, losing that kinetic energy comes at a great cost.   The absolute worst version of myself comes when I get in a disagreement with my wife, and during the skirmish when I can’t find a way to win, I shut down.   I stomp out and stay mad for hours and for what?   To be right?   I lose an entire day steaming over something trivial which seemed important at the time.   IF you look at couples who divorce versus who stay together even though they all have the same number of arguments, the divorced couples quit talking and often seek to win their respective arguments.   Win what?  Being right has its costs and loneliness is one of them.   Just keep communicating.


So let us say for argument sake Dr. X decided to approach his group after having worked out his issues.  He decides he would like transition out of his busy practice of 20 years to reduce his hours, shifts or call.  He chooses to cut everything by 25%.   His group consists of over ten docs so each would have to increase their workload by 2.5%  but would also increase their income by the same amount.   Now he has something concrete and will be able to make creative changes as the negotiations evolve.   He has plenty of power with seniority, and unlike many physicians who enter a negotiation, he knows what he wants and is willing to walk away as a last resort.   If the terms are challenging and the group is too large to keep all parties satisfied a 3rd party mediator can sometimes work wonders so long as that person is impartial to either side.

If all else fails? Don’t fall for a Sunk Cost Fallacy

The sunk cost fallacy may apply here if you consider you have spent 20 years of your life in a practice that doesn’t match up with your values and expectations.  Maybe Dr. X felt this way and had been considering quitting for some time but was waiting for the last straw to act. Perhaps the practice used a loss leader strategy to get him into the practice knowing that they had underlying problems that could only be unearthed after it was too late after making a partnership?    Either way, I had an excellent senior colleague of mine who had a very, very bad day and decide to leave our practice.   I feared that his bad day would ruin his ability to practice for life, but after speaking to him several years later he offered me this advice,

“Sometimes it isn’t the job, it’s the venue”

Now he has made multiple changes in his career and personal life and still practices medicine, only happier and on his terms.


During a negotiation, you must ask yourself, “what do I want?”  Walking away and shutting down communication can be a valid strategy but If could also backfire.   If you tally up the wins versus losses in negotiation strategies, then you want to maximize the gains. Regularly communicating will maximize the wins and reduces the losses by getting inside the mind of your opposition to empathize with their situation and maximize your chances of reaching an agreement.  IF all else fails, your mediation with a 3rd party has failed, and your BATNA is solid don’t give in to the Sunk Cost Fallacy and walk away.


4 thoughts on “When do you walk away from a negotiation?

  1. Wonderful analysis of a day we’ve all experienced. In the ED, we call it the F-U to thank you ratio (likelihood that your patients, after working hard on their behalf, are likely to use the former or the latter phrase). I agree that burnout can diminish your willingness to hold onto your negotiating power, but as you describe, that power is critical to getting what you need out of a group that knows, trusts and hopefully likes you.

    1. Is the F-U ratio similar to the tooth-tattoo ratio? I think for every word of discouragement we need 20 kind words. If this happens everyday then no wonder ED docs get “crispy” ? We don’t have to deal with this as much since they only get a few seconds of belligerence before they get a white milky nap. We, on the other hand, have to deal with the other side of the coin, Surgeons! Too bad I can’t give them the same cocktail. Ha-ha, JK, all surgeons are sweet as puppies…?
      Thanks for the insights, they are great! DOAT

  2. I sometimes walk away as a negotiation technique. It usually isn’t ideal, but sometimes it is needed to reset the discussion. If I have a solid BATNA, there isn’t really a big risk of losing.

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