Knowledge of the business of orthopaedics, practice management, and basics of compensation and finance are critical elements to a successful negotiation process. Formulating and refining a personal list of priorities is essential. Determine areas of common ground and overlapping goals between your employer and you. Various stakeholders will be involved in your employment experience. These include your medical group or hospital system, possibly an associated academic department or medical school, your patients and their families, along with you and your family. As you identify substantial agreement about these priorities and related goals of the stakeholders and you, it becomes simpler to engage and to realize the common ground.

Building on this foundation, the next steps are to specify priorities for yourself, but to synthesize these as they affect value to these other parties. Your priorities should be thoughtful and well-defined. These priorities should also be further delineated into high and low priority levels. Once you have developed your plan, rethink it with respect to the anticipated response of your employer. Speculate about their priorities. To complete your preparation, have conversations with other employees (current or former), seek advice from other community stakeholders, and discuss options with your mentors and colleagues.

When negotiating a concept exists known as BATNA: the best alternative to negotiated agreement. It is advisable to determine your BATNA but not disclose it. Ponder what the BATNA of the other party will be. Your BATNA may be the point of ceasing to
negotiate and walking away without an acceptable agreement. Whatever it is, allocate time in preparation and planning for negotiation, so that if you get to your BATNA, you will at least feel confident that you have participated effectively.

Productive negotiations result in value creation. Conceptually, the image of a pie is often used, and we consider how the pie is to be divided. Fortunately, the reality is more complex and more favorable. Determining how to make pieces of the pie bigger and presenting your argument as such is imperative. This is much more constructive than arguing over a small and shrinking pie. Determining ways to share pieces of the pie (continuously or sequentially) may also be reasonable. In real terms, this may equate to value generation through your presence within the group or how the department will produce more revenue, or how you will enter new/untapped markets via a unique procedure or service or within a novel geographical area. Realizing your unique attributes in clinical skills, teaching experience, research potential, administrative experience, and/or business acumen is essential. Determine how you may be able to adjust your goals and priorities to be more aligned with the employer, yet to achieve a satisfying career position for yourself.