The Discussion

Negotiating fees as a locum

Locum optometrist, Rebecca Rushton, and learning and development consultant, Trevor Bibic, discuss how locums can up their negotiation game in a post-lockdown world

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Getty/Kubkoo
Decreased availability of work and downward pressure on rates are just two of the issues that locums have faced in recent months. Fees have the potential to vary wildly, depending on location and practice cash flow. Added to this is a new conversation around supply of personal protective equipment (PPE), and the safety of practices that locums are walking into.

The good news is that, as a self-employed locum, the answers to these challenges are within your control - if you've got the negotiation skills at hand.

Communicating your value

Negotiation means generating the maximum that you can offer, and getting the maximum in return. This is different to a compromise, which tends to be the least that we're willing to accept. When negotiating you need to be aware of the value your skills hold. If you don't, it's going to be harder to get the rates you deserve.

Rebecca Rushton believes that there’s a taboo that needs to be broken when it comes to discussing pay. She says: “In this country, it's not the done thing to discuss earnings with colleagues and it can be very difficult to know your monetary value.

“I've definitely undervalued myself in the past and it's frustrating to find out that you're getting paid significantly less than the optom in the next room.”

There is light at the end of the tunnel, though: “I think, as you get more established, both yourself and the clients learn your true value,” Ms Rushton says.

Trevor Bibic thinks that if you believe the fee you’re asking for is fair, it will “come across in your communication. You should be so clear on the value and benefits that you bring that you're shocked by a low offer, and feel confident and ready to counter that offer.”

He recommends building up the “library of benefits that you bring to organisations as you go. Don't stop with the handful you might pick up today - keep going.

“When you're in the practice and you’re in situations that you don't feel are appropriate or fair, because you have a very strong sense of the value that you bring, you’ll feel valuable enough to say ‘no, this is not fair or appropriate.’ When you're able to communicate that value, if somebody does want to take advantage of you it's going to make it much easier for you to look for alternatives.”

Identifying practice need

When negotiating, people tend to stop after stating the advantages they’ll bring. To move the conversation on, you need to ask yourself: “Why does this person actually care about that? What are the real benefits?” Make sure you’re not just describing the advantages, but instead are thinking in terms of what they allow the practice owner to do.

Mr Bibic uses the example of being an independent prescriber, meaning “I can treat patients without referring to the hospital, and this makes things more convenient.”

He adds: “Where things are more convenient for patients, where you have that additional skill in your practice, you're going to encourage more people to come. That increases your competitive advantage. Now it's going to be harder for me, as the practice owner, to bargain you down, because you'll bring me some significant benefits and you’ve thought about what my needs are.”

Ms Rushton agrees: “This year I've decided to state my interest in anterior eye,” she says. “If a client focuses on refractive surgery, contact lenses or dry eyes then I know that I'm the optometrist for them.

“If you do specialise, put it in your profile on LinkedIn or the AOP Locum Register so clients know that you're the best for the job.”



Negotiating with agencies

When dealing with an agency, Mr Bibic advises that you remember that “You're solving a problem. If you could earn that agency exceptional amounts of money, they will do whatever it takes to use you as opposed to somebody else. Be aware of what you need and what you want, because you might need to ask for those things.”

Agencies want the same thing you do: the highest possible rate. Make sure they understand what differentiates you from other locums, and why you should be the first person they call. If they can charge more because there's something special that you bring, they will respond to that. Emphasise how much value you can add to their clients.



How to prepare

So, how do you prepare to have a negotiation with a practice owner? The first thing is to have a good sense of what you think is fair, and of what you're aiming for.

Mr Bibic says: “Often when we declare what those things are, it has a psychological effect on us. When we give ourselves these targets, we're more likely to meet them.

“Be aware of what the going rate is; don't ask for unreasonable things.”

It’s also important to identify the things that are most important to you, and how you can make accommodations as easy as possible. At the moment, this might be a guaranteed stock of PPE provided by the practice.

Mr Bibic points out that this could also be a pain point for them, and that the more you can help them with that challenge, the easier it is going to be for them to justify your rate: “So for example, if they are uncertain about how to handle PPE with locums, and you say, ‘well, I've got some great ideas for this, and I'd be happy to discuss them further with you…’

“That sense that you're working with them on a solution is going to mean that it's easier for you to explain why you're worth more money, and easier for them to accept that they're going to pay a bit more for somebody who's engaged and proactive.”

Ms Rushton agrees that, at the moment “money isn't everything. Sometimes negotiating testing times, or someone to do pre-testing, might be more important.”

She adds: “It's important for me to know testing times, what I'm expected to do (fields, scans etc), what equipment is provided and what equipment I'm expected to bring along. I'm also interested to know if the practice specialises in anything, maybe contact lenses or dry eyes. That way I can be aware of extra products and services that may be available in that practice.”

Focus on the most you can give and the most you can get for yourself, rather than how quickly you can reach a financial agreement

Trevor Bibic


You should also think about how long you want to spend on the negotiation. Rather than thinking of it as a quick five-minute call, put time aside and set your ground rules. Ask the practice owner how much time they’ll have to talk on a certain day at a certain time, and change it if it’s not going to be long enough. Let them know that there is specific information you need.

What if, despite all this, you suspect you might have to have to walk away with no agreement? Ahead of your discussion, think about what you're going to do as an alternative. This is a powerful preparation tool.

Ms Rushton isn’t afraid of standing her ground: “I accept that rates may be a bit lower as volume is lower, and I'm totally ok with that,” she says. “I'm not, however, ok with rates being kept low when business is steady again, and I'm concerned that practices may 'forget' that rates need to rise along with the number of patients we are seeing.”

She adds: “I try to give and get as much information as possible to ensure a good fit between me and the practice. I'm also not afraid to decline work that I think might not be a good fit.”



Managing expectations

Mr Bibic says: “Try and understand the whys of the practices that you're working with. What are the challenges they're facing, and why? Is there something going on that you should know about? Try and really understand what's going on with them; what problems they're working on.

“Generate a range of options for mutual gain: spend time identifying different ways you could solve that problem. Don't just jump in with the first idea that you have, but ask them for advice: how would this work; what about this idea? Get their input, because usually you'll find the answer, and it's not always the first thing you think of.”

Ms Rushton echoes this: “It's important to find out what you can offer the practice. Why do they need a locum? Is there anything in particular they are looking for? Is there anything extra you can bring which perhaps nobody else does?”

There's not an infinite supply of you. If you're expensive for good reason be prepared to share that reason, but certainly don't apologise for it.

Trevor Bibic


Mr Bibic continues: “Establishing what they need will allow you to move into the phase of the negotiation where you set out your own requirements. This will lead you into discussing whether you’re happy to trade those things.

“There is a give and take here. If they want you to do something, they need to give you something in return. It's not all money.”

Supplies of PPE and how a practice approaches safety are also important aspects to consider at this stage.

Before you propose something, it’s useful to test the waters. A useful phrase that sounds natural is simply: “how does that sound?” With this you're going to get immediate feedback on whether what you're proposing is connecting or not.

When you’re done, make sure you follow up in writing to confirm all the details.

Renegotiating contracts

Reviewing contracts with existing clients might seem awkward, but it’s vital that you treat your relationship as an evolving process. Otherwise, you risk missing out on vital aspects of your work.

Practice owners have already bought into you if you’ve worked with them before, so are going to be reluctant to let you go if it means they’ll then need to find alternative cover. There can be a lot of value for both sides in having the discussion, and it can make your working relationship and the service you offer stronger. It's important to ask open questions and address any changes that you might need.

I think this is the time to prove how invaluable you are as a member of staff, and to remember that everybody is trying to get used to a difficult and ever-changing landscape

Rebecca Rushton


As you've already been in the practice, you've got the inside track on its circumstances. If you want to renegotiate, circumstances have likely changed. Maybe the job is harder than expected. It's very reasonable to point this out, and ask how things could be adjusted in terms of your contract, pay, and so on. Be clear about what's changed in order to justify the discussion.

Ms Rushton is confident about the future: “I think this is the time to prove how invaluable you are as a member of staff, and to remember that everybody is trying to get used to a difficult and ever-changing landscape so we all need to be flexible,” she says. “This is equally true for employees, locums and business owners. Now is a great time to develop strong relationships, and I hope that a lot of good can come from this difficult time. Ultimately, know your value and always be the best version of yourself.”

She adds: “I think there is a backlog of patients waiting to be seen, so clinics ought to be full for the next few months. It's an interesting time as I think that practices will be able to cherry pick those locums who offer the best value - and I don't necessarily mean those who charge the least.”


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