Saturday Morning Rounds September 19th, 2020 - How to become an "Antifragile" negotiator

Posted by BossB, MD on September 19, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

Antifragile by Nassim Nicholas Taleb

Ya know that feeling when you read a book and then you can't stop seeing its concepts literally everywhere you look? Like you've added a new lens through which to view the world?

Well, this is one of those books for us.

Matter of fact, this might be the single best non-fiction book we've ever read (and we read A LOT of 'em). We just finished it a couple weeks ago and can't wait to dive back in for our first re-read.

Why the effusive praise? Because in Antifragile, Taleb:
  • Presents a truly original and iconoclastic core idea - that the uncertainty, volatility, and stress which we often try to remove from modern systems are actually nature's way of improving things, and that the more we smooth out short-term volatility the more expose ourselves to huge long-term downside
  • Convincingly shows this concept at work in a wide variety of fields, from medicine to investing to politics and just about everywhere in-between
  • Provides real-world, tangible ways that you can apply the concept(s) to improve your own thinking and life

Reading this book helped to flatten out the emotional roller coaster that is living in 2020, and provided not only a real tangible sense of increased calm and equanimity in the face of all this uncertainty - it also provided us ideas on how to make that uncertainty work in our favor.

Taleb is a bit of a pugilist, so be forewarned that he does like to pick some fights, and that he doesn't spare the field of medicine their turn in the ring. That being said, if you read this book and expose yourself to the ideas therein, you'll come out of the experience with either:

  1. A new and improved worldview, or
  2. A much more solid grounding in your existing one 
Either way, it's entertaining and well written, so even if you disagree with what he presents you'll likely enjoy the experience of reading it. Cannot recommend highly enough.
Who we're following 

Taleb (@nntaleb) is also one of the most interesting, least predictable Tweeters we follow. We don't always agree with what he says but he never fails to make us think - definitely worth a follow if you're into that kinda thing.

BBMD tip of the week

The approach to negotiations that we teach in our curriculum is all about keeping things simple and limiting what you have to focus on. You're never going to get enough reps in to become better at all the negotiation skills than your MBA-wielding, business-person counterpart, so it's our job to make sure you can out-maneuver them on just a couple of the most important basics, where it really counts.

To do so, we always encourage our students to focus on maximizing 2 variables in a negotiation:

In his book, Taleb presents the idea of "Optionality" as one of the core strategies for creating antifragility, and it maps perfectly to the idea of maximizing your informational advantage and emotional resonance. In his own words:

"Options, any options, by allowing you more upside than downside, are vectors of antifragility.

If you 'have optionality,' you don’t have much need for what is commonly called intelligence, knowledge, insight, skills, and these complicated things that take place in our brain cells. For you don’t have to be right that often. All you need is the wisdom to not do unintelligent things to hurt yourself (some acts of omission) and recognize favorable outcomes when they occur. (The key is that your assessment doesn’t need to be made beforehand, only after the outcome.)

Option = asymmetry + rationality

The mechanism of optionlike trial and error (the fail-fast model), a.k.a. convex tinkering. Low-cost mistakes, with known maximum losses, and large potential payoff (unbounded). A central feature of positive Black Swans."

Seeking an informational advantage means that you know your counterpart's stance before you reveal yours, which gives you the option of orienting toward them in the most adaptive way possible. One of the best examples of this is finding out their pre-defined pay range for a job before telling them what you make today or are hoping to make.

Seeking emotional resonance also provides a great deal more options to you because it's a way of amassing more "chips to spend" interpersonally. If someone has goodwill toward you and is feeling positive "vibes," they're more likely to go along with what you present, more likely to make concessions to keep those good vibes flowing, and less likely to say or do something that would turn things sour.

These two factors, when combined, create a positive feedback loop that just works. After reading Antifragile, we now understand more deeply why it works, which means that we can get even better at the skills and their application.

Quote we're contemplating


“Fight for the things that you care about. But do it in a way that will lead others to join you.”

“You can disagree without being disagreeable.”

“So often in life, things that you regard as an impediment turn out to be great, good fortune.”

“Feminism … I think the simplest explanation, and one that captures the idea, is a song that Marlo Thomas sang, 'Free to be You and Me.' Free to be, if you were a girl—doctor, lawyer, Indian chief. Anything you want to be. And if you’re a boy, and you like teaching, you like nursing, you would like to have a doll, that’s OK too. That notion that we should each be free to develop our own talents, whatever they may be, and not be held back by artificial barriers—manmade barriers, certainly not heaven sent.”

“Another often-asked question when I speak in public: “Do you have some good advice you might share with us?” Yes, I do. It comes from my savvy mother-in-law, advice she gave me on my wedding day. “In every good marriage,” she counseled, “it helps sometimes to be a little deaf.” I have followed that advice assiduously, and not only at home through fifty-six years of a marital partnership nonpareil. I have employed it as well in every workplace, including the Supreme Court of the United States. When a thoughtless or unkind word is spoken, best tune out. Reacting in anger or annoyance will not advance one’s ability to persuade.”

- The Hon. Ruth Bader Ginsberg (1933-2020)

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PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds August 29, 2020 - In defense of the psychologically rich life, and how to use negative emotions in a negotiation

Posted by BossB, MD on August 29, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

In this article, recently published in The Scientific American (which is currently celebrating its 175 year anniversary!), the author offers an incredibly compelling new framework:
"What does it mean to live a good life? ... In the field of psychology, two main conceptualizations of the good life have predominated: A happy life... and a meaningful life. But what if these aren’t the only options?

In recent years, a long-neglected version of the good life has been receiving greater research attention: the psychologically rich life. The psychologically rich life is full of complex mental engagement, a wide range of intense and deep emotions, and diverse, novel, surprising and interesting experiences. Sometimes the experiences are pleasant, sometimes they are meaningful, and sometimes they are neither pleasant nor meaningful. However, they are rarely boring or monotonous.

Recent research on psychological richness has found that it is related to, but partially distinct from, both happy and meaningful lives. Psychological richness is much more strongly correlated with curiosity, openness to experience and experiencing both positive and negative emotions more intensely."

The article is pretty short and well worth a full read - and in our "tip of the week" we'll provide some ideas for how you might apply the concept. 

Who we're following 

The author of this week's article, Scott Barry Kaufman (@sbkaufman) is one of the clearest modern thinkers on the topics of well-being, meaning, creativity, and really just the human mind in general.

He is a prolific researcher and writer, as well as an engaged and interesting Tweeter. You'd be hard-pressed to find any other source that provides more novel, scientifically-backed insights about the human condition -  definitely worth a follow.

BBMD tip of the week

We talk a lot around here about "emotional resonance," - a sense of emotional connection and alignment, of "vibing" with someone. And the reason we talk about it so often is that if you focus on maximizing this variable, especially during a negotiation, everything else just tends to fall in place a lot easier.

But a common misconception is that emotional resonance needs to be centered around positive emotions. That's simply not the case. Emotional resonance is about feeling a sense of connection with and goodwill toward your counterpart, period, regardless of the emotional valence that's being experienced. 

And that's where the alignment with this concept of the psychologically rich life  comes into play. The psychologically rich life focuses on heightening and fully experiencing ALL emotions - a kind of increasing of emotional resonance with oneself, in a way. And we know from research on negativity bias that human beings are far more (~5-10x) reactive to negative stimuli than to positive stimuli.

So how exactly does this relate to negotiations?

Well, almost any "ask" we would make in a negotiation comes from a gap between our counterpart's offer and what we want, and gaps have tension (negative emotional energy).

So, once you get into emotional sync with your counterpart, you use that tension by taking them temporarily into the negative emotional state that you experience when you are faced with said "gap" - a great way to frame your negotiation ask.

This all sounds kind of theoretical in writing, so here's an example from our curriculum of a role-play that our students do to learn how to use the combination of negative emotions AND emotional resonance together to their advantage:

In the example above, we're coaching our students to explicitly and directly bring up one of the most emotionally charged topics possible in a negotiation - the gender pay gap.

The motions are as follows:

  • Double down on emotional resonance and give them a positive vision of themselves to live up to: "draws me to this practice... everyone here has a high level of integrity"
  • Highlight the tension and shift them into your negative emotional frame: "bit surprised and, honestly, disappointed"
  • Avoid defensiveness but maintain tension: "Now I’m sure it’s not intentional or malicious, but this is an impossible pill for me as a woman to swallow. I’d be lying to you if I didn’t tell you that stings.”
  • Sit in silence and watch them jump through hoops you never would have thought possible to relieve said tension and get back into a positive emotional state w/you

Quote we're contemplating

"Then a woman said, Speak to us of Joy and Sorrow.
And he answered:
Your joy is your sorrow unmasked.
And the selfsame well from which your laughter rises was oftentimes filled with your tears.
And how else can it be?
The deeper that sorrow carves into your being, the more joy you can contain.
Is not the cup that holds your wine the very cup that was burned in the potter’s oven?
And is not the lute that soothes your spirit, the very wood that was hollowed with knives?
When you are joyous, look deep into your heart and you shall find it is only that which has given you sorrow that is giving you joy.
When you are sorrowful look again in your heart, and you shall see that in truth you are weeping for that which has been your delight.

Some of you say, “Joy is greater than sorrow,” and others say, “Nay, sorrow is the greater.”
But I say unto you, they are inseparable.
Together they come, and when one sits alone with you at your board, remember that the other is asleep upon your bed."

- Kahlil Gibran

PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds August 22, 2020 - What drywall can teach us about negotiations

Posted by BossB, MD on August 22, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

Have you ever found that some of the best "ah-ha moments" you have in your work come from concepts and experiences that you encounter completely   outside of your field?
Well, we had one of those this week.
Some context - we've been renovating our basement for a few months now, and luckily we have family visiting right now who are experienced in such things to help guide the final steps of that process.
We're currently on the "putting up drywall" step. IYKYK.
Now the last thing that Carlton built here was a fence - also at the guidance of expert family members - and that was a project that required a lot of precision. A "measure twice cut once" kinda deal.
For this project, the first step was to take measurements for the drywall where it was to be installed. Simple enough.
Next, it was time to outline & cut the first chunk - Carlton went upstairs to do so. Nobody could do anything without this step completed, so as more and more minutes ticked by without said piece of drywall appearing, our expert helpers decided to check in. Upon doing so, they found an explosion of straight edges, levels, and pen marks - but no cuts. That's when one of them said:
"Drywall isn't carpentry - it doesn't have to be perfect, just get it close and we'll spackle it from there."
The essence of the message is this: precision is great, but it is rarely an end in and of itself. Make sure you only take it as far as it actually serves you.
More on how to apply this concept to negotiations in our "tip of the week." 

Who we're following 

Speaking of concepts that originate outside of one's field but provide some of the most valuable frameworks for improving one's work, Yuval Noah Harari (@harari_yuval) is an author that should definitely be on both your radar and your bookshelf.

His most well-known work, "Sapiens: A Brief History of Humankind" is required reading for anyone who wants to better understand who we are and why we do what we do. He's now turned his lens to the present and the future, with his latest titles being "Homo Deus: A Brief History of Tomorrow" and "21 Lessons for the 21st Century."

His Twitter feed is a great place to stay abreast of books that are worth reading, concepts to help us understand the world (especially what's happening geopolitically), and a rich, thoughtful, informative perspective on LGBTQ issues & topics.

BBMD tip of the week

Now, back to the limits of precision.
We've said many times before that any "ask" should embody what we call   the "2 Rs" - it should be reasonable and it should be relational.
A reasonable ask is exactly that - an ask that   has a reason. And almost any ask that has a good reason is going to be precise - meaning it won't be a round number.
Think "I'm asking for a $25,670 raise" as opposed to "I'd like a $25,000 raise."
This approach invites curiosity from your counterpart and activates their sense of fairness. It's much harder to deny something that has a well-reasoned logic behind it and is attached to real-world variables (avg pay for your specialty in your region, the money you generate for your employer, etc etc etc) than it is to deny a round, imprecise number.
But the point of this approach isn't to get a specific number   in return  from your counterpart, and if that's what you expect to happen, you'll be disappointed and frustrated almost every time. When we make a precise ask, what we're really trying to do is:
  • Anchor high
  • Get more information from our counterpart

So a typical response to the kind of precise ask outlined above might be "well, the most we can do is $20,000."

And if you're too focused on precision you'll miss the fact that you just got a HUGE WIN. You maxed out their range, and you now know all of the cards they have to play. But instead of celebrating in that moment, we've seen people get upset and recklessly spend relational capital/goodwill by arguing that their counterpart's offer is imprecise, and therefore unreasonable.

Precision has its limits, and is rarely an end in and of itself. Drywall isn't carpentry. If you're close enough to where you want to be, we promise that figurative "spackle" can handle the rest. And we're always happy to hop on a free 30min intro call to help you brainstorm what your specific version of "spackle" might be.

Quote we're contemplating
"I was taught that if you're going to study something, you must understand it deeply and be familiar with primary sources. But if you write a history of the whole world, you can't do this. That's the trade-off." - Yuval Noah Harari
PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds August 15, 2020 - Why emotional intelligence is important, and how to develop more of it

Posted by BossB, MD on August 15, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

"A Loyola Medicine study demonstrates that an educational curriculum for physicians in training improves their emotional intelligence, which may help protect against burnout.

Before and after completing this educational intervention, doctors took a test measuring their emotional intelligence. There were significant increases in their scores for overall emotional intelligence, stress management and overall wellness."

One of the most helpful skills in any interpersonal engagement, and especially in any negotiation, is emotional intelligence.
When most people hear the term emotional intelligence, they think of someone who has a great ability to understand and empathize with the emotions of others, but that's only half the story. 
The most essential component of emotional intelligence is the ability to recognize and modulate  one's own emotions.
And according to this paper, it seems that emotional intelligence will do more than help you to achieve external outcomes, it will also improve your internal experience as well!
More on that below in our "tip of the week."

Who we're following 

MS4s are becoming physicians in a time of incredible volatility & uncertainty, & the match/interview process going virtual only adds to that burden.

So, this week on Twitter, we've reached out to and followed a bunch of program directors and #WomenInMedicine leaders to ask their help in answering a quick (<5min) survey that we built to help ease that burden and provide some clarity. 

If you are a program director, please take a few moments to answer, and if you know a program director, please consider forwarding the survey on to them!

BBMD tip of the week

Want to increase your EQ but aren't sure where to start? The single greatest intervention we have for this is also the simplest.
"Labeling," or naming, an emotion as you're experiencing it is a highly impactful way to (a) create some space between yourself and whatever emotion it is you might be experiencing, and then (b) decide whether and how that emotion might serve you in your situation, rather than being hostage to it.
One of the best ways to start this practice is by  expanding your emotional vocabulary, but don't wait till you have the perfect word to try labeling! A close approximation is far better than nothing.
Quote we're contemplating
 " When dealing with people, remember you are not dealing with creatures of logic, but with creatures of emotion." -Dale Carnegie
PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds August 8, 2020 - The most important variable in a negotiation

Posted by BossB, MD on August 8, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

We've had a number of conversations this past week about what we like to call the "pay:time" ratio.

It's a simple and essential fact that almost all of us are trading our time for money at work. Most people just focus on total pay, but once we shift our paradigm to focus on the pay:time ratio as the most important variable in a negotiation, we gain the ability to think clearly and creatively about how to achieve the outcome we want.

Given the importance and ubiquity of this topic, we're going to repost an article from our archives that covers it in greater detail:

Women Did Everything Right. Then Work Got ‘Greedy.’ - How America’s Obsession with Long Hours Has Widened the Gender Gap

This article, written by Clair Cain Miller from the New York Times, presents a compelling narrative about what drives the typically large pay gaps within white-collar couples. A few trends that have been increasing for decades now have come to a head, creating an environment that often limits women's earning potential - namely:

  • Work - Particularly compensation for working long hours
    • "Being willing to work 50 percent more doesn’t mean you make 50 percent more, you make like 100 percent more.. The trade-off between time and money is not linear."
    • "Four decades ago, people who worked at least 50 hours a week were paid 15 percent less, on an hourly basis, than those who worked traditional full-time schedules. By 2000, though, the wage penalty for overwork became a premium. Today, people who work 50 hours or more earn up to 8 percent more an hour than similar people working 35 to 49 hours"
  •  Coupling
  • Parenting
    • "Highly educated women are more likely to have children than they recently were. Eighty percent of women in their early 40s with doctorates or professional degrees are mothers, up from 65 percent two decades ago"
    • "Being a parent, particularly a mother, has become more intensive. Working mothers today spend as much time with their children as stay-at-home mothers did in the 1970s. The number of hours that college-educated parents spend with their children has doubled since the early 1980s"
  • The bottom line (with a little good news mixed in!)
    • "There’s no gender gap in the financial rewards for working extra long hours. For the most part, women who work extreme hours get paid as much as men who do. But far fewer women do it, particularly mothers. Twenty percent of fathers now work at least 50 hours a week, and just 6 percent of mothers do... There has always been a pay gap between mothers and fathers, but it would be 15 percent smaller today if the financial returns to long hours hadn’t increased"

Here at BBMD, we talk often about the tension between (a) the fact that these problems are systemic in nature, and (b) the reality that we can't afford to wait for the system to change itself. For the "systems-based" side of things, the author offers some solutions that would be great to see raised in a legislative session or a board meeting: 

  • "Certain changes would lighten parents’ demands at home, like universal public preschool, longer school days, free afterschool care and shorter school breaks. But the ultimate solution, researchers say, is not to make it possible for mothers to work crazy hours, too. It’s to reorganize work so that nobody has to. The most effective way to do that, Ms. Goldin’s research has found, is for employers to give workers more predictable hours and flexibility on where and when work gets done."

  • "Conventional wisdom... is that this is impossible — certain people are too valuable and need to be available to clients anytime. But some professions have successfully challenged that notion. Obstetricians, for instance, used to be on call when patients went into labor. Now it’s much more common for them to work eight-hour shifts in a hospital — and many more women do the job."

For the "can't afford to wait" side of things, see our tip of the week ;)

Who we're following 

One of our favorite Tweeps, Dr. Kimberly Manning, MD (@gradydoctor), is crossing a couple of big milestones next month and could use your help celebrating!

BBMD tip of the week

If you're reading this, you're almost certainly a physician. And if you're a physician, you're almost certainly employed in a model that trades your time for money.

People tend to think that because they're not paid an hourly wage, that because they have some mix of "fixed" salary and/or variable (RVU, bonus, etc) compensation, they have flexibility. But really, that just obfuscates the fact that there's a hard cap on your pay, and it's directly related to 3 variables:

  1. How much "doctoring" you can fit into every minute (increases with efficiency, support staff, etc)
  2. How many minutes per year you can spend "doctoring" (the focus of the article we shared this week)
  3. How much money you get paid per minute of "doctoring"

However, most of our clients come into the "negotiations" phase of our curriculum thinking that we'll be focusing most of our energies on how to maximize their total income - e.g. how to go from $100,000 per year to $125,000 per year.

In reality, the more important number to focus on (and maximize) is #3 - your pay:time ratio.

And that's great news! Because institutions often have a lot more flexibility to offer time (and time-saving resources) than they do money. While getting "pay" as high as possible certainly helps the equation, getting "time" as low as possible is oft-neglected and offers far more viable routes to success.

Here are a few examples of variables you can negotiate (or tweak in your own life) to maximize your pay:time ratio:

  • Paid time off
  • Parental leave
  • Commute time (this one gets you on both ends - it's essentially uncompensated work time, AND increasing your commute is the most reliable way to tank your quality of life/happiness)
    • One way to get your employer to help with this is a moving/relocation stipend - instead of thinking of that money as money saved on costs you would have incurred anyway, consider rolling it into a home that gets you closer to work
  • Productivity-based compensation (higher $ per RVU generated, lower RVU thresholds to achieving bonus, etc)
  • Call shifts/night shifts/schedule in general
  • Support staff (esp. a scribe and/or a mid-level)
  • Admin/research time
  • Dedicated office space (if that would help you work more efficiently)

There are even some more unconventional ideas that you can propose which (a) the private sector already offers so there's precedent + social pressure and (b) might actually be lower-cost to your employer and higher-impact to you, such as:

  • Childcare (onsite, subsidized, etc)
  • Laundry service
  • Free meals
  • Pumping room for nursing mothers
  • Legal aid from their counsel if you've got any issues with your previous employer
    • This is actually a situation we see often that can really add up quickly if you deal with it yourself - just remember that these institutions often have retainers with law firms or employ internal counsel, meaning a much lower cost to them for the same result
At the end of the day, the real goal for most of our clients is to operate at the top of your license and to get paid at the top of what's possible for doing so. Once you realize that time is often a more malleable variable in that equation than money, it provides a lot of creative solutions to achieve what you want.
Quote we're contemplating

All this talk about the cost of family planning and pay:time ratios can make it very difficult for a physician with children to avoid calculating the monetary loss from every game or recital or field trip they attend. And that can be a dangerous thinking trap to fall into, because humans are powerfully loss-averse by nature. So while we can't afford to ignore these economic realities, we should also strive to keep them in perspective and remember what it's all in service of. Antoine de Saint-Exupéry says it best in The Little Prince (chapter 21 - if you don't know the book read the whole chapter, it's beautiful):

"It is the time you have wasted for your rose that makes your rose so important."


PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds August 1, 2020 - President Obama's eulogoy for Rep. John Lewis, and what it can teach you about influencing others

Posted by BossB, MD on August 1, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

President Obama's eulogy for Rep. John Lewis

The speech is ~40min, but well worth the listen regardless of which side of the aisle you inhabit. Plus, President Obama is just about the only speaker that you can listen to at 1.5x without missing anything.

More on that, and a few other things you can glean from this speech to make yourself more effective at influencing others, in our "tip of the week" below.

Who we're following 

They say it takes a village to raise a child

They also say that writing is an act of creation, a "labor of love"

So if what "they say" is true, does that make President Obama's former speechwriter, Jon Favreau (@jonfavs) an OB/midwife/doula?

We're not sure, but we do know that his Twitter feed delivers (see what we did there??) a consistently interesting and thoughtful perspective.

BBMD tip of the week

There's a lot that can be learned from President Obama's speech, but we're going to highlight 3 skills today that he modeled especially well.


We made a joke about how you can listen to Obama at 1.5x and still absorb everything, and we're not the only ones - SNL, every comedy news show, and every White House Correspondent's Dinner act during his administration made a lot of much better jokes about his speaking cadence over the years.

It's unique and sometimes funny, yes, but it also works. And it's something we practice A LOT with out clients.

See, it's often the case that when we slow down our speech or let a silence hang for a beat, we feel awkward. We worry we might seem like we don't know what we're talking about. We worry like might seem weak or unsure of ourselves.

Most of us are incredibly uncomfortable with silence - especially silence while discussing an already-uncomfortable topic - which happens often during business conversations.

So we talk fast, we use vocalized pauses ("um, like, ya know"), and we hamstring ourselves by undercutting the strength of whatever we said before the silence with a bunch of qualifiers to make others feel more comfortable.

Not any more.

We offer a reframe - silence is not a sign that you're weak or don't know what to say, it's a sign that you're thoughtful and worth listening to. It's a sign that your word means something, that you're a serious person, and that you respect your counterpart's time and attention, and expect the same in return.

Once you can think of a silence like that, you can use those pauses to command a conversation the way a conductor commands an orchestra. You can hang in the balance and take a moment to be intentional with what you want to say next. And you can be pleasantly surprised by what your counterpart will concede just in order to break the silence that's made them uncomfortable, but that you can sit with.

As always, practice makes perfect.

Write out a script for some kind of business conversation - any kind will do, but the more uncomfortable or potentially confrontational the better - and then practice it in a mirror. Time your first attempt as you would usually speak it, then try as hard as you can on your second go-round to take at least 150-200% that amount of time to say the same words. You'll blow yourself away with how much more expressive you can be and how much more worthy of being taken seriously you'll sound.

Be Other-Centered

We talk about this concept a lot, and for good reason. 

It's no secret that President Obama is a Democrat, and the Democratic party is well-known to be more secular and specifically to advocate more strongly for the separation of church and state than Republicans. This is an important core value in the Democratic party. However, here are a few pull quotes from Obama's speech:

"James wrote to the believers..."

"Like John the Baptist preparing the way, like those Old Testament prophets speaking truth to kings..."

"As The Lord instructed Paul..."

Obama probably wouldn't have said those things if he was giving a speech in most other contexts - he almost certainly would have actively avoided them if he was speaking in front of, say, the ACLU.

But during this speech, he was in a church. So, he made an active attempt to be other-centered. Obama read the room and spoke to his audience.

And so should you.

To provide a more applicable example, we just had a call yesterday with a client who's been passed up for consideration to become a partner in her private orthopedic practice after two years of employment with them. Their bullshit excuse is that COVID has made money tight - really, they probably just wanna profit off her efforts for another year.

So, how can you speak to your audience and be other-centered in such a situation? Well, Orthopedics is a male-dominated field well-known for being the "jocks of medicine," so we asked if that was true of her counterparts and she said yes. 

This lead to us building a strategy together that hinged on an analogy - we named it the "put me in coach" approach. 

We'll spare you the details of the analogy other than to say that the idea is for her to frame this to them as the feeling of being passed up for varsity your junior year but not knowing why.

Such an analogy works because it:

  • Connects  to a context that's meaningful to her counterpart
  • Humanizes her by highlighting the pain and unfairness she's feeling in a way they can empathize with
  • Humanizes them as coaches who have to make a tough call, thus avoiding the shame/blame/defensiveness game just enough to make space for a productive conversation

Never pass up an opportunity to maximize connection with your audience.

Reject Zero-Sum Frames

One of our favorite quotes from the speech was:

"We don't have to choose between protest and politics - it's not an either-or situation, it's a both-and situation"

So many conversations hit a stalemate because someone frames things as zero-sum, as win-lose. That's an "either-or" construction, and it's almost always a logical fallacy and a trap (often an unintentional one - just a reflection of that person's fear/scarcity/deficit mindset).

This often takes the form of "squabbling" over how big of a "slice of the pie" each party gets.

Instead, we always always always want to focus on growing the whole pie for everyone. That's a "both-and" mindset - it's also the reality of any productive business relationship, a great way to get on the same side of the table/on the same team as your counterpart, and the best quickest most effective shortcut to maximizing your outcome in a negotiation.

Quote we're contemplating
"We are hard-pressed on every side, but not crushed
Perplexed, but not in despair
Persecuted, but not abandoned
Struck down, but not destroyed"
- 2 Corinthians 4:8-9 (also, President Obama)
PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds July 25, 2020 - How medicine became the stealth family-friendly profession, and how to make it moreso by negotiating better parental leave; also, #MedBikini

Posted by BossB, MD on July 25, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

How Medicine Became the Stealth Family-Friendly Profession by Claire Cain Miller in the NYT Upshot.

This article captures the current-state of work-life integration for women physicians better than any other we've read - and we've read a lot.

The title, we'll admit, is deceptively cheery when compared with the reality that many women physicians face today. However, the author does a good job of balancing her celebration of the wins that have been tallied to-date with her coverage of the structural imbalances that still need to be addressed.

Overall, it's a pretty short read that's densely packed with good information - we highly recommend you scan it fully for yourself. Some of the main themes touched upon are:

  • The importance of flexible, predictable hours for shrinking gender pay gaps (this applies to all professions, not just medicine)
  • The transition from small private practice to large group practice or hospital employment as the driving force for this change, a "happy consequence" of which being more flexible arrangements for women physicians
    • There are a lot of downsides to this as well, which are not addressed in this article and which make many of the more lucrative work arrangements in medicine more punishing toward women than they are toward men even if their family planning decisions are the same. The biggest example of this is in how a lack of equitable parental leave policies financially punishes women physicians and hurts families by forcing male physicians to go back to work sooner than would usually be optimal after the birth of a child - we will cover this more thoroughly in our "Tip of the week"
  • Women & work hours
    • "Female doctors are paid 67 percent of what men are, but much of the gap is because they work less. After considering their hours, their specialty and the years they’ve been doctors, the gap shrinks to 82 percent"
    • "There’s a downside when women cluster in certain specialties: In general, when a field becomes female-dominated, its pay and prestige drops"
    • "One possibility — which could help alleviate this problem — is that more men will also choose less time-intensive specialties and ask for predictable hours. There’s evidence that’s happening. This year, 80 percent of male medical school graduates said work-life balance had a strong or moderate influence on their choice of specialty (up from 70 percent a decade ago, when the question was first asked)"

Who we're following 

Less of a who, and more of a what, this week - and that what is the trending #MedBikini controversy

Long story short, the Journal of Vascular Surgery published a "study" in which 3 male researchers created fake social media accounts, searched the Vascular Society's database to find member physicians on social media, and then shamed physicians they deemed to be "unprofessional" for wearing a bikini or holding a beer in their personal social media profiles.

Same bullshit, different day.

Med Twitter recently discovered the article, and the outpouring of rage + swimwear photos that has become #MedBikini has successfully gotten the journal to retract the article and publish a formal apology. Good on y'all for showing that being a doctor and being a human aren't mutually exclusive.

That being said, we have a responsibility as your de facto career consultants to point out that a lot of organizations do informal social media reviews like this without publishing them, and while we look forward to the day when such social media posts don't disproportionately punish women, that day has not yet come. We're not gonna preach to you about what's professional or unprofessional or make any specific recommendations, but we will encourage you to (a) intentionally draw that line for yourself and (b) generally err on the side of caution.

BBMD tip of the week

Parental leave, the gender gap, race and intersectionality, politics - all of these topics share a common theme: they're very charged.

What do we mean when we say a topic is charged?

  • Opinions about charged topics are often strong and entrenched
  • Emotions about charged topics often run high
  • Discourse on charged topics tends to quickly escalate or quickly shut down

But more importantly, what do we DO when a topic is charged?

The first question we should ask ourselves is whether it's worth the fight in the first place. If you (a) can't change the outcome and (b) aren't likely to change an opinion, yelling into an echo chamber or at an unreceptive counterpart is only likely to make things worse.

However, there are many topics - parental leave being one of the most important among them - that we can't afford to ignore.

So how do we wade into this dangerous territory in a way that's productive? The key is to:

  • Avoid defensiveness at all costs - in both yourself and your counterpart
  • Humanize, humanize, humanize - again, both yourself and your counterpart

Defensiveness is the single most counterproductive emotion in any exchange, and becoming sensitive to it in both yourself and others is a communication superpower.

Humanizing your counterpart and yourself is like putting guardrails on the conversation that keep it on the road and headed in a productive direction. It increases empathy and puts everyone's focus on solving the problem at hand rather than "winning" a fight against an opponent.

What can you tactically do to avoid defensiveness and increase humanization (I think we made that word up)? Ask yourself a simple question:

  • "How could a well-intended and intelligent person come to that conclusion?"

We talk a lot in our curriculum about how important it is to assume best intent - it provides the clearest path forward and maximizes the emotional resonance of your interactions.

In this case we also add the assumption of intelligence because it helps us to more effectively see things from our counterpart's perspective and to understand their priorities. Doing so greatly increases our chances of actually changing their position.

In the specific area of parental leave and career perceptions, one great way to do this would be to actually have an open conversation with the decision-maker(s) at your institution about the topic. Transparent conversations about charged topics can be incredibly effective if you follow this outline:

  • Start on the Right Foot - It's key to start the conversation with something like "I know that you are dedicated to creating an equitable workplace and that the studies I'm about to show you don't reflect the kind of institution you want to run." We call this tactic "preemptively saving face" for your counterpart - it avoids defensiveness and gives them an occasion to rise to; a positive vision of themselves to live up to.
  • Express Your Concern - Proceed to lay out your argument in clear terms, preferably with data to back it up. Share the article above, print out a study about the gender gap, tell an anecdote about what happened to a friend. Then make it personal by again reiterating that "I know this institution would never intentionally do something like that, but I'm still concerned about becoming one of those statistics."
  • Create Space for Them - After you drop a line like the one above, STOP TALKING. Let them squirm in silence for a few seconds. You'll be amazed at the kinds of commitments people will make to avoid a little interpersonal discomfort. And even if they don't commit to fixing the problem in that moment, you'll gain an informational advantage over your counterpart if you outline the problem in clear terms but then let them start to talk about solutions. There's usually very little to lose and a lot to gain by "not going first" in a negotiation.

The above method might not solve the gender gap overnight, but we've seen it change entire institutions' policies more quickly than any legislative action ever dreamed.

As an example, one of our clients works for a very large, well-known academic institution on the east coast. With our help, she negotiated an increase from 6wks of unpaid to 12wks of paid maternity leave. A year later she called to let us know that the mere existence of her contract had catalyzed an institution-wide policy change to match everyone's parental leave offer to hers - not just on the medical side of things but throughout the whole university!

Change comes most often from inside an organization itself, and you can be the most powerful force to make it happen for both yourself and others.

Quote we're contemplating
 "When you learn to see the world as it is, and not as you want it to be, everything changes." - Shane Parrish


PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds July 18, 2020 - How to help MS4s during COVID & talking about money during your interview

Posted by BossB, MD on July 18, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

As we mentioned last week, a lot of our time and attention right now is being directed toward helping MS4s with the residency interview and match process - particularly helping them to know how they should adjust their approach in light of COVID-19.

To do so, we've created a quick (<5min) survey for program directors that will help to provide some clarity around:

  • What changes programs are making in their process because of COVID-19
  • What's staying the same
  • How med students should adjust their approach this year

If you're a program director, PLEASE take this survey. If you know a program director, PLEASE forward this to them.

Every medical student we've spoken to feels incredibly uncertain and "in the dark" about what to expect this year. If we can get enough responses to this survey to actually provide some clarity, it will make a huge difference.

Obviously, we will make whatever results we receive from this available to anyone who wants to see them, free of charge. We will also scrub the responses of any identifiable information so as to protect the privacy of respondents and their programs.

Who we're following 

One of our favorite Tweeps, Dr. Kemi Doll, MD MS (@KemiDoll) JUST GOT PUBLISHED IN THE NEJM 🙌👏🎉

What's more, the paper - "Structural Solutions for the Rarest of the Rare — Underrepresented-Minority Faculty in Medical Subspecialties":

  • Got desk rejected twice before being accepted
  • Strikes a perfect balance between telling a powerful story and providing concrete recommendations for action
  • Was written & accepted in December before this issue got a lot of the attention it currently has

Dr. Doll has been on a helluva roll lately, and if you're not following her yet, you should be.

BBMD tip of the week

We had a call with a client this week who is about to interview for partner in her private practice. She's been employed by them over the last 2 years, and during that period she has:
  • Built her practice up from nothing with very little support
  • Made them 2x more money than they paid her
If your jaw is not currently on the floor from reading that last point, it should be.
One of the biggest red flags we highlight in   our curriculum  is if a private practice won't show you their books. This creates an incredibly lopsided power dynamic, takes away your ability to build a profitable practice, and most importantly hides from you the essential knowledge of whether they're running a solvent business.
And if you're in academics or are hospital-employed and thinking this doesn't apply to you, think again.
You don't need to self-teach an MBA curriculum overnight, but you should always understand the basics of how your employer makes money, how you'll fit into that equation, and what you can do to ensure that you're getting a piece of any profit you generate. Here are a few tips on how to do so:
  • Private Practice - During the interview and well before you even consider an offer, ask to "see the books" and have their accountant + business manager walk you through everything thoroughly (esp % of revenue that goes to overhead and how overhead is distributed)
  • Hospital/Academic - During the interview and well before you even consider an offer, ask "how does this institution make money?" - spend time with the administrators to fully understand where funding comes from and how you as an individual physician will engage with that system
  • Ask, "if I generate a profit for the institution, where does that money go?" - there should be some financial incentive for you to do so and this is often a place where you can negotiate some huge pay increases for yourself because it's a no-risk situation for the institution (they're already in the green) 
Quote we're contemplating
“Money is the opposite of the weather. Nobody talks about it, but everybody does something about it.” – Rebecca Johnson


PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds July 11, 2020 - Residency interviews in the age of COVID

Posted by BossB, MD on July 11, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

In speaking with a number of MS4s recently to get input on our forthcoming Residency Interview Guide, we've heard one common message loud & clear:

2020 is a year of terrifying uncertainty

The med students we've spoken with:

  • Have no idea what impacts COVID will have on the interview & match process
  • Feel abandoned by a lot of the institutions they would usually look to for clarity
  • Worry that virtual interviews and lack of clinical rotations will just exacerbate any disadvantage an applicant might already have (or perceive themselves to have)

Which gave us an idea. We - not BBMD alone but this whole community writ large - can help fill the gap for them. And the way to do so? Get the info directly from the source - ie program directors!

So here's the plan. We're gonna create and distribute a short survey for program directors about what's changing this year, what's staying the same, and how med students should adjust their strategies. Then we're gonna distribute the results to med students for free.

In order to do so, it would be great to have a couple of 1:1 conversations with program directors beforehand so that we can make sure we're asking the right questions.

So if you know any program directors who'd be willing to chat with us for 15min this week to help shape the survey, please forward this email to them or put us in touch some other way. Thanks!!

Who we're following 

We're huge fans around here of what you might call "pluck"

Pluck /plək/ (Noun): Determination, persistence, spiritedness, courage, resilience, adaptability

Taking your problems head-on instead of waiting for someone else to come solve them shows a lot of pluck

And this week we were impressed with the pluck that one osteopathic med student demonstrated on Twitter in response to the scarcity of clinical rotation opportunities:

In this Tweet, Melissa Few (@MelissaFew) - an aspiring family physician - showed more than just pluck; she also demonstrated humor, humility, and a good bit of creativity to boot. This kind of well-designed, personalized, virtual "hand-raise" is an idea that a lot of other med students could benefit from, and it's definitely earned her a follow from us. Best of luck Melissa!

BBMD tip of the week

All these conversations with MS4s recently has reminded us of a core truth about the world in general and interviews + negotiations specifically that's easy to forget.

It's lonely at the top

Most of the MS4s we've talked to speak about program directors as if they're some all-powerful, gatekeeping Gods whose wrath makes them all but unapproachable.

And while those who seem to have the "power" in an exchange - whether because of a leadership position or an informational advantage or scarcity or social/political capital or any number of other reasons - are certainly in a privileged position and are often gatekeepers, they're also human. Which means:

  • They have fears and goals, just like you
  • They likely have someone in a position of power above them, just like you
  • They have informational gaps and uncertainty, just like you
  • They want to be empathized with and have positive interaction, just like you

They're powerful yes, but more times than not they actually want you to approach them - if you have something of value to offer.

In terms of their goals, people decisions are the most important decisions the majority of institutional leaders make. Hiring a great person can literally be everything to a program, and hiring the wrong person can be a catastrophe. Yet women will only apply for a job if they meet 100% of the requirements, while men will do so if they only meet 60%. Kanye West is running for president for God's sake. If you're a good fit for a role, you're doing them a favor by letting them know.

In terms of their fears, public-facing risks like a lawsuit or bad press are what keep institutional leaders up at night. So empathize with that, express how you can help minimize that risk for them, and all of a sudden you'll be a name rather than a number.

It's all about humanizing - humanize your counterpart and the organization they serve, and they in turn will humanize you (you can also humanize yourself in many ways, one of which is employing humor like in the Tweet we highlighted this week).

Do that, and in the minds of these leaders you'll go from:

"Potentially sufficient candidate 642"



We teach more specifics about this in the "Finishing School" portion of our curriculum:

Quote we're contemplating
 "Loneliness is the penalty of leadership" - Ernest Shackleton


PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds June 27, 2020 - Where to focus your attention when there's so much coming at you (just say "NOP")

Posted by BossB, MD on June 27, 2020

First, a quick request

We're currently creating a resource to guide med students through the residency discernment and interview process, and we could really use your input to ensure that it's as helpful for them as possible. We only have a few quick questions:

  • What did you do that worked really well?
  • What do you wish you'd known or done that you didn't?
  • We design our solutions around the people who will use them - do you know any MS4s or early-stage residents that we should interview 1:1?
  • What else we should ask that we haven't?

If you'd prefer to take this as a survey instead of just responding to the email, you can do so here. Thanks!!

What we're reading

If you're anything like us, you're consuming a lot more news than you usually do.

And if you're consuming more news than usual lately, you're probably also noticing that the pace and emotional pitch of the news have gone up exponentially.

This creates a tension.

On the one hand, it's important to stay informed of what's happening - especially during times like these when EVERYTHING IS HAPPENING and it is all truly important and the stakes are high and there's real work to be done.

On the other hand, simply keeping up with the news has inadvertently plugged us into a 24hr cortisol drip - it's an exhausting effort that's been shown to cause increases in anxiety, depression, helplessness, stress, and pretty much everything else you don't want.

So we've got a devil's brew of high stakes, real-world consequences, infinite information to sort and process, rapid pace, and volatile emotions. 

You know what else shares those qualities? Negotiations. And luckily for us, the strategy for both is the same.

It's all about deciding where to direct your attention BEFORE you're in the mix.

Our "tip of the week"  will address that question when it comes to business conversations, but when it comes to your informational diet, the process is the same:

  • Narrow - Choose just 1 trusted general information/news source
  • Organize - Every input by a simple yes/no question: "is it actionable?"
    • If so, proceed the next step
    • If not, resolve to skim it quickly and move on
  • Perform or Plan
    • Perform - If it is actionable and takes <2min, just do it right then and there (for the news, this might mean sharing the article, signing a petition, etc)
    • If it is actionable but takes >2min, immediately plan a time for it on your calendar so that you'll (a) avoid it rattling around your mental to-do list, (b) avoid having it fall through the cracks, and (c) realize in the process that it's probably not as essential as you might have thought

We like shortcuts and acronyms around here, and this handy little one is easy to remember by thinking "just say NOP (Narrow, Organize, Perform or Plan)."

Which is the polar opposite of its close homonym and the default operating system of most this newsletters' readers, "just say Knope"

Who we're following 

If you're ready to narrow down your new sources, it can be difficult nowadays to find one that's high in data and low in opinion or spin. Our current favorite is Quartz (@qz), specifically the Quartz Daily Brief. The daily newsletter shines in our opinion because it is:

  • More impartial and data-driven than anything we've seen
  • More globally focused than most sources
  • Easily digestible in just a minute or two each morning

Their daily email generally opens with headlines from around the world, progresses on to curated summaries of that day's best thought/interest/opinion pieces (with links if you wanna dive deeper), and then ends with something fun or interactive. We love it - and they didn't even pay us to say that - so if you're currently looking for a news "home," we definitely recommend you check them out.

BBMD tip of the week

We've learned how to "just say NOP" to too many news sources, but how do we do so to the deluge of information and emotion that can so easily overwhelm us during a negotiation?

We're glad you asked.

  • Narrow - Your focus down to just your counterpart
    • We call this being "other-centered," and it's the place from whence all good comes in a negotiation because your counterpart is (a) the most important source of information in that moment and (b) the person you most need to influence in that moment to maximize your outcome
  • Organize - Every piece of information for its effect on 2 things:
    • Informational Advantage - Can this help you to gain a piece of pertinent information about your counterpart that your counterpart doesn't yet know about you (ie what they're willing to pay vs what you're willing to accept - you want to know their number first)?
    • Emotional Resonance - Can this help you increase the feeling of "vibing" with each other (ie can you use this piece of information to create a sense of promise, excitement, and mutual goodwill)?
  • Perform or Plan - Whether to dive down each rabbit hole as it presents itself
    • There are a lot of distracting thoughts that come up in consciousness during a negotiation, and most of us just dive into them immediately because we don't know better - so next time, take a moment to pause and actually decide whether something is worth exploring and will add value to the conversation; if not, just write it down so you can get it out of your head, note it as something to maybe come back to, and then return to step one by re-narrowing your focus back on your counterpart
Quote we're contemplating

“What is your heart worth?
What about your time?
What holds your heart, holds your attention.
What holds your attention, holds your time.
What holds your time, holds your life."

- Eric Overby

PS - If you were forwarded this email and enjoyed it, subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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