In February 2022, I got a message that the dean wanted me to call him. My heart trembled as I dialed his number. He answered pleasantly as he always did. “Well, Vidhya,” he said, “I would like to offer you the CMO position.” I nearly collapsed. “Of course!” I exclaimed. “I can’t thank you enough!” He went on to say that the overwhelming majority of those who interviewed me had glowing comments and that my exemplary track record as a leader at our institution and at the regional and national levels would serve me well in the role. He asked me to remain quiet until he had an opportunity to talk to the other two candidates, although I was permitted to tell my family.
I called my mother, who rejoiced when I told her the news. She put my father on the phone, and he congratulated me and told me how proud he was of me. I then ran to my husband, Big Eric, and threw my arms around him. He told me he knew I would get it and that I would do great things in the role. I then asked my boys, Eric Shiva and Ethan, to come sit with me, and by the looks on their faces, it was clear they knew. They both congratulated me, and then Ethan, who had spent so much time coaching me, said with a grin, “I knew you would get it.”
Once the dean spoke to the other two candidates, everything happened quickly. I signed my contract within a few days, having already looked at the average salary for a CMO at the national level and knowing that the salary was the same as my predecessor’s. I did request a dedicated space in one of the major clinical hubs for our core healthcare team, which the dean granted.
A colleague asked me, “Shouldn’t you use this as an opportunity to negotiate heavily for your salary?” My response was that I had prepared. I knew my predecessor’s salary, had done a review of salaries online, and felt comfortable with what I was offered, as it was fair. My interests were in bridging the great chasm between Central and the departments; hence, my negotiating for space in the form of a dedicated room in the heart of the clinic, as opposed to more money.
I had attended negotiation seminars and even held a few sessions at local and regional meetings. Two books that were particularly useful were Ask For It: How Women Can Use the Power of Negotiation to Get to What They Really Want(1), by Linda Babcock and Sara Laschever, and Getting to Yes(2), by Roger Fischer and William Ury. Babcock and Laschever found that women, in particular, are less likely to ask to be assigned to high-value accounts, ask to join powerful committees, or approach leadership to take their careers to the next level.
Further, women who consistently negotiate their salary increases earn at least $1 million more during their careers than women who don’t.(3) According to Ury and Fischer, a successful negotiation improves relationships, fulfills the interests of both parties, and is fair and long-lasting.
Also, the end does not justify the means; how you get to “yes” matters. I learned that it is important to separate people from the problem by understanding the other party’s perspective, active listening, and refraining from blame or attack. Focusing on interests rather than positions is also key.(2)
My favorite anecdote that illustrates the power of interests over positions is that of two chefs fighting over an orange. When the chefs focused on their positions (“I want the orange”), each walked away with half an orange. However, when they focused on their interests (one chef needed the juice of the orange while the other just needed the rind), they walked away with a win-win.(2) Finally, using objective data as your foundation and inventing options for mutual gain are imperative to a successful negotiation.
Something I found especially interesting was the role emotions play in negotiation. Roger Fisher and Daniel Shapiro’s Beyond Reason: Using Emotions as You Negotiate(4) was another gem in my negotiation treasure chest. Recognition of the five core concerns: appreciation, affiliation, autonomy, status, and role, which evoke myriad emotions, and treating them appropriately is crucial. Appreciation — Are my thoughts and feelings valued? Affiliation — Am I treated as a colleague instead of as an adversary? Autonomy — Is my freedom to decide what matters respected? Status — Is my relative standing to others given recognition? Role — Do I define my role and find it fulfilling?(4)
Why is it that women struggle so much in negotiation? Is it that we are just bad at it? Is it just that we have less experience than our male colleagues? Are we socially conditioned not to negotiate? My Harvard Kennedy School teacher, Hannah Riley Bowles, published an article on this topic with Linda Babcock entitled, “How Can Women Escape the Compensation Negotiation Dilemma? Relational Accounts Are One Answer.”(5) Bowles and Babcock discuss how gendered pay expectations, where pay expectations are higher for men because men typically earn more than women, are only part of the explanation for gender differences in starting salaries.
Women pay a heavy price for negotiation because by simply asking for more, they violate social norms and expectations. In fact, evaluators viewed women who negotiated for more pay as “less nice and more demanding” than women who didn’t and were thus less inclined to work with them.(6) It is the social backlash that makes many women reluctant to negotiate; even if they negotiate a higher wage, they may reduce their chances of long-term earnings by upsetting colleagues who may otherwise have helped them advance their careers.(7)
In their study, Bowles and Babcock found that women who negotiate can mitigate social backlash by communicating a concern for organizational relationships. They underscore the importance of establishing a foundation of evidence-based understanding of social and gender contexts in negotiation training for women and end with a powerful statement: “Every woman who reduces the gender gap in pay and authority reforms the social structures that keep women in their place.”(5)
What I heard over and over again from negotiation pundits like Babcock, Laschever, Bowles, Ury, and Fischer was that it takes practice, practice, practice. To overcome social backlash, women should do their homework, focus on objective data, and practice with trusted colleagues before entering a negotiation. Negotiation expands beyond salary; flexible hours, vacation time, space, start date, and so much more are on the table. Again, it all goes back to interests and relationships.
After the dean made the announcement, I was overcome by the kindness of search committee members and colleagues who took the time to congratulate me and send me words of encouragement and support. It meant the world to me to have so many people believe in me. I talked to my department chair, who was genuinely excited for me and told me that we would always be a team. I was grateful for his support and guidance throughout the process.
I called my mentor who had first breathed life into the concept of me as CMO; they were over the moon with excitement, stating, “The universe whispered this to me, and look at you now, Miss CMO!” I reached out personally to each member of my core team, which included the COO, CMIO, and the directors of quality improvement, patient safety and risk management, population health, and clinical informatics. They were gracious in wishing me the best, and each expressed their excitement to work closely with me.
Excerpted from The Leadership Learning Curve: A Woman Physician’s Journey as a Chief Medical Officer by Vidhya Prakash, MD, FACP, FIDSA, FAMWA (American Association for Physician Leadership, 2026).
References
Babcock L, Laschever S. Ask For It: How Women Can Use the Power of Negotiation to Get What They Really Want. New York, NY: Bantam Dell; 2008.
Fisher R, Ury W. Getting to Yes: Negotiating Agreement Without Giving In. 2nd ed. New York, NY: Penguin Putnam; 2006.
Pinkley RL, Northcraft GB. Get Paid What You’re Worth. New York, NY: St. Martin’s Press; 2000.
Fisher R, Shapiro D. Beyond Reason: Using Emotions as You Negotiate. New York, NY: Viking; 2005.
Bowles HR, Babcock L. How can women escape the compensation negotiation dilemma? Relational accounts are one answer. Psychol Women Q. 2013;37:80–96. https://doi.org/10.1177/0361684312455524 .
Bowles HR, Babcock L, Lai L. Social incentives for gender differences in the propensity to initiate negotiations: Sometimes it does hurt to ask. Organ Behav Hum Decis Process. 2007;103:84–103. https://doi.org/10.1016/j.obhdp.2006.09.001 .
Amanatullah ET, Morris MW. Negotiating gender roles: Gender differences in assertive negotiating are mediated by women’s fear of backlash and attenuated when negotiating on behalf of others. J Pers Soc Psychol. 2010;98:256–267. https://doi.org/10.1037/a0017094 .