You were never taught to ask. Not really.
Medicine trained you to be prepared, competent, and grateful for the opportunity. It didn’t train you to walk into a room and say: I want more.
And so for most of us, negotiation feels like a performance we never rehearsed for.
Something that requires a script, a strategy, a podcast on repeat. I would have Kwame Christian on a podcast loop for a week before the big meeting.
But I’ve been thinking about the negotiations that catch you off guard. The ones that weren’t scheduled. The moment at the store, the hotel, the conversation with your boss that just… goes there.
Are you ready for those? Because those are the ones that tell you what you actually believe about whether your needs belong in the conversation.
Today we’re talking about negotiation in all the different ways, not just the formal ones, but all of them.
And by the end of this episode, I want you to have a simple framework you can start practicing today, in the small moments, so that when the big ones come, you’re ready.
Why Women Physicians Struggle to Negotiate—and What It’s Actually Costing Them
We have been conditioned — by training, by culture, by the specific way medicine socializes women — to believe that the answer will be no before we even ask the question.
And so we negotiate in our heads. We run the simulation, we predict the outcome, and we never say a word out loud.
The cost of that is invisible and enormous. It’s the admin time you never got. The title that never reflected your actual scope. The ownership stake that stayed implied and never got put in writing. The raise you knew you deserved but convinced yourself wasn’t possible right now.
This is not a character flaw. It is a conditioned response. And conditioned responses can be unconditioned. The skill of asking is exactly that — a skill.
You build it the same way you built every other clinical skill.
You practice it until the butterflies get quieter. They don’t disappear. But you stop waiting for them to.
Real Stories: How Women Physician Leaders Are Practicing the Ask
I want to tell you about a friend of mine. She had been taking on more and more at her organization — responsibilities well beyond her job description, leadership that nobody formally recognized or compensated.
She was good at it, so they kept handing her more. And she kept saying yes, quietly absorbing the load.
When we started chatting, I asked her: what would you actually want, if you could ask for anything?
We brainstormed.
- Job titles that reflected the scope of what she was doing.
- Compensation that matched the responsibility she’d been handed.
- Admin time to actually do the job well.
She’d never let herself want those things out loud before.
So she did the work. She met with the CFO to understand what reasonable compensation looked like and why. She built the case. She got clear. And then she sat down with her bosses and asked — for the title, the compensation, and the admin time.
She asked for all three, and she was ready to be happy with one.
She got all three.
She told me afterward: had she not done that work, had she not pushed through the butterflies and made the request, she’d still be sitting in her resentment.
That’s what not asking costs. Not just the thing you didn’t get. The slow accumulation of resentment that comes from swallowing your needs over and over.
And on the flip side, I had a client who negotiated everything — creatively, persistently, trying every angle she could think of to make her current role work.
She heard a lot of no’s. But what those no’s taught her was the shape of her organization: what it could give and what it couldn’t.
She didn’t take the no’s personally. She took them as information. And she eventually changed practices — and asked for everything she wanted.
A no is not a rejection. It is a data point.
The ASK Framework: A Simple Tool for Women Physician Leaders Who Are Learning to Ask
Here’s the framework I use with clients. Three letters: A-S-K.
A is for Anchor in curiosity.
Before you make your request, ask questions. Understand the landscape. What are the constraints? What does the other person care about? What’s possible here that you might not know about yet? Curiosity is not a weakness, it’s strategy. It also buys you time and gives you information that makes your ask sharper.
S is for State what you want.
Clearly and directly. Without apologizing for it. Not “I was wondering if maybe at some point we could look at…” Say the thing. “I’d like protected admin time for this project.” “I’d like to revisit my compensation.” One sentence. Specific. No hedge.
K is for Keep exploring until you find the overlap.
Not every ask ends in yes. But the conversation doesn’t have to end at no either. Where is there room to move? What can be modified, delayed, or offered differently? And if there’s genuinely no overlap to find — that’s information too. It tells you what this organization is and isn’t willing to give. That’s worth knowing.
Now here’s where I want to challenge you. You are not going to master this framework in the high-stakes meeting.
You’re going to build it in the small moments first.
Let me tell you a few examples so you can start to see how you can build this muscle in your life.
My husband asked his department for a standing desk and a curved monitor. They said yes. His partner — shocked at his sweet setup — asked how he’d managed it. His answer was two words: Just ask. She asked. She got the same setup.
I found beautiful greenery on sale after Christmas. The kind that’s usually outside my budget. One package was missing a piece. I asked for a bigger discount anyway. I walked out of that store with more greenery than I had room for and a deal I was genuinely proud of.
These are not high stakes. They are the practice needed to make the high-stakes asks feel possible.
I want you to choose three things to negotiate this quarter. One financial — a raise, a reimbursement, coaching covered by your department. One structural — admin time, a title, a schedule change, expedited shipping, a better table at the restaurant. One personal — something just for you, low stakes, just to feel what it feels like to ask.
Start there. Your confidence comes after the ask. Not before.
The Next Step for Women Physician Leaders Ready to Lead with Clarity
Here’s the one thing I want you to take from today:
Your job is not to predict the answer. Your job is to ask the question.
Every tiny negotiation you practice teaches your brain that your needs belong in the conversation. And they do. They always have.
If you’re ready to work on this — on the asks you’ve been putting off, the resentment you’ve been quietly carrying, the clarity that makes the hard conversations possible — I’d love to chat.
Apply to work with me at womenmdleaders.com/work-with-stephanie. That’s where we do this work together.
And if you’re not there yet, start small. Pick one thing this week. One real ask. Out loud. See what happens.
Thanks for listening and thanks for leading with heart.