You Paid $18k With No Alternative
How a collab fee gets priced off fear instead of the job, and the one box to fill before the check.
- BOX 1 · WHAT THEY MUST DO
- sign · reachable · review charts · QA
- BOX 2 · NEXT-BEST LEGAL OPTION
- physician B · 800 / mo
- BOX 3 · WALK-AWAY
- 1,000 / mo
- BOX 4 · THE OFFER
- 1,500 / mo
- 500 × 12
- 6,000 / YR FOR FEAR
Composite. Your state board’s current rule is the source. Not legal advice.
BATNA
NegotiationYour power in any deal is your best alternative to it, not your need for it.
Every deal has a number nobody says out loud. It is what happens to you if there is no deal. That number has a name: your best alternative. It is the floor under the whole conversation, and it is set before anyone speaks.
Composite. The quote was $1,500 a month. So I went and got a second one. Same job, different name, $800 a month. Now $1,500 is not a price any more. It is a price with a gap in it, and I can see the gap.
That gap is $500 a month. Over a year it is $6,000. Nothing was bought with it.
Here is the uncomfortable part. You cannot negotiate past a weak alternative. Technique moves a price a little. A real second option moves it a lot. The other side can feel the difference between someone who wants a deal and someone who merely prefers one. They feel it in the first minute.
So the work is not in the meeting. The work is before it. Finding the second name. Pricing the do-it-yourself version. Learning what the job actually costs. That is the highest-value hour in the whole negotiation, and it happens in a room the other side is not in.
When the alternative is blank, price stops attaching to the job and attaches to fear. You stop paying what the work is worth. You start paying what it costs to make the worry stop. That is the $6,000.
Go deeper: three things a school would add
- An alternative must be real enough to take: a name, a price and a start date. "I could probably find someone else" is a hope, and it prices like one.
- Reservation price is where the deal stops beating your alternative. Calculate it alone, in advance, in writing — the mid-conversation version is always more generous to the other side.
- Your counterparty has an alternative too, usually weaker than their manner suggests. Ask what happens to them if this does not close.
Work the case
Two decisions. Choose before you read the reasoning. The wrong answer is the one worth understanding.
You have one quote and no second option. You spend the week before the meeting preparing your negotiation technique.
Choose one — the reasoning opens after you commit.
A supplier quotes $1,500 a month. You find one other supplier at $900 who cannot start for two months.
Choose one — the reasoning opens after you commit.
Box 1 is what the state actually makes this person do, from the board of nursing page, not the group thread.
Composite: sign, be reachable, review charts, a QA meeting.
Some states it's four things. Some states it's zero, because the state doesn't require the signature at all, and some of those still want a transition period first.
Check the map today, not the map from school.
Box 2 is the whole negotiation: someone else, legal, at a number. Composite: physician B at $800 a month.
Who else would sign? At what price? Until this box has a name and a number, you're negotiating against yourself.
Box 3 falls out of box 2: the walk-away, the most you'll pay before you take physician B.
Box 2 plus the hassle of switching: $1,000.
It comes from the alternative. It doesn't come from what others pay.
Box 4 is the offer: $1,500. What they asked. What you paid. Five hundred a month above your walk-away. $6,000 a year.
Not for the job. For the blank box.
Schools call box 2 the BATNA, the best alternative to a negotiated agreement. The whole negotiation is box 2. Everything else is theater.
You started from "what do others pay," and that's an anchor: somebody else's fear became your price.
The order is boxes 1, 2, 3, and the offer last.
You did it in the other order. Everyone does. That's why $1,500 is "the going rate."
What's $6,000? Divide it by the 59 you keep on a follow-up: about a hundred visits. Eighty-five hours of work at fifty minutes each.
Five weeks of visits at twenty a week. You worked five weeks this year for a blank box. And the physician did nothing wrong.
He named a number and you said yes. The number was never the problem. Box 2 was empty.
The question, as it actually gets asked
Composite questions — blended from the operator rooms, never one person's words.Read these for the method, not the answer. The next question you have will not be on this list — the point is that the concept above answers it anyway.
Which concept this really isReasonable isn't a market fact you can look up in a thread, it's whatever your alternative makes it. With no named second option, the fee is priced off fear.
How you work it outGet one real alternative with a name, a price and a start date before you negotiate. Published marketplace floors sit far below what most first agreements pay; a quote at two to three times the floor is common and is almost always the price of having no alternative in hand.
The mental model that makes it hardTreating the fee as the price of a statutory duty. It's the price of your uncertainty, and it moves the moment a second name exists.
The Monday rule, what do you actually run this week?
The whole negotiation is box 2. Write the alternative before you write the check.
Connected lessons
- the-split The $6,000 is divided by that page’s 59 — a hundred follow-ups for a blank box.
- four-gates The collab agreement sits beside gate 2 on the critical path — it gates the cash door.
This is one of eleven lessons, free to read. One arrives by email each week, on composite numbers you can check.