September 13, 2021

Gender-based disparities in academic medicine are well-known.  Women earn less than men, even after controlling for rank, RVUs and grant funding, and the pipeline for talent leaks more as it gets to the top, with only 25% of full professors being female compared to 46% of assistant professors. While the etiology of these disparities is multifactorial, one of the potentially issues identified has been the fact that women often feel less comfortable with negotiation than their male counterparts. Training in negotiation may equip women with these skills, and thereby help reduce the gaps that exist.  But does such training actually work? Are there best practices? And how do we democratize such training for maximal benefit?

Several organizations, including the AAMC and several individual academic institutions, have developed negotiation workshops to teach these important skills. However, these mandate in-person training. Women who are not affiliated with academic institutions that offer such courses, or those who may not have the time nor funds to travel, may be disproportionately disadvantaged, magnifying the intersectionalities in disparities already seen. While there are books and online courses that can be taken, these lack the critical element of interaction to practice negotiating skills, and are blind to the particularities of negotiations within the medical context. Particularly given the COVID pandemic, the need to develop a virtual negotiations course for female faculty became evident.  Having taught negotiations workshops for the AAMC MidWIMS and Johns Hopkins Leadership Development Program for a number of years, and with the support of the Joan Giambalvo Fund for the Advancement of Women, I set out to create – and then study – the impact of a virtual negotiations course for female faculty/attending physicians and trainees. 

So what did we find? First off, there is a huge thirst for this type of course. While we only could accommodate 100 people per course, there were over 3,900 applicants within 48 hours of our posting the opportunity to participate in this beta test. And such opportunities attract a highly diverse cohort – 12% of our cohort were Black and 16% were Hispanic. Over 85% had never taken a negotiation course, and when they thought back to their last major negotiation, 67.6% stated it went “slightly well” or “not well at all.” Prior to the course, 66.7% were “not at all comfortable” or “not very comfortable” with initiating negotiation; by the end of the course, this figure dropped to 5.5% (p<0.001). Similarly, prior to the course, only 1% felt “pretty comfortable” or “extremely comfortable” with negotiation strategy, a figure that increased to 41.8% by the end of the course (p<0.001).  Only 17% claimed to be at least “somewhat comfortable” with post-settlement settlement prior to the course; after the course, this figure rose to 75.5% (p<0.001). 91.1% stated they found the course valuable and 92.9% felt their knowledge about negotiation increased. 80% and 18.2% stated they were “very likely” or “somewhat likely” to use some of the things they learned in this course in the future. 40.7% of respondents, when surveyed three months after taking the course, had in fact used what they had learned from the course. 57.7%, 41.7% and 32.0% of respondents at three months had negotiated for pay, promotion or job-related perks, respectively, after completing the course. These negotiations went “better than expected” in 26.6%, 30% and 37.5% of cases, respectively. Compared to their experience prior to taking the course, 28% felt their last negotiation after the course went “very well” or “extremely well” (28% versus 2.9%, p=0.002). 

Our course built in interactive cases for participants to negotiate, not only during the session but also over the course of a week. This allowed participants to practice more complex negotiations that may be more drawn out.  In addition, participants were encouraged to initiate negotiations with others outside the class, helping them overcome some of their fears of negotiation, particularly in situations with a perceived power differential. When we surveyed participants about the class composition, the majority strongly agreed that they liked the diversity of region, specialty and rank – all elements that are often missing in traditional in-person negotiation courses. 

The vast majority (94.6%) felt that courses like this should be available on an ongoing basis for faculty and trainees, 85.7% wished they would have taken it earlier, and 80.4% would recommend it to a friend or colleague. Based on their feedback, we enhanced the course even further, and now offer it on an ongoing basis at negotiation-101.square.site. Participants hailed the new course as “one of the best courses [they] have taken towards [their] professional development.”

So what have we learned? Negotiation training works – improving both objective and subjective outcomes. Best practice would encourage diversity of class participants and opportunities to practice. And a virtual platform may democratize the opportunity to obtain negotiation training. We are grateful to the Joan Giambalvo Award for funding this work. Perhaps through this effort, we can start to chip away at the gender-based gaps that exist in academic medicine in terms of pay, performance and perks.

Anees B. Chagpar, MD, MSc, MPH, MA, MBA, ELAM '10
Professor, Department of Surgery
Yale University School of Medicine