🇺🇸 English

In Puerto Rico's healthcare landscape, saying "no" can feel risky. As PA-Cs/Asociados Médicos building our profession on the island, we often find ourselves negotiating our scope, our value, and our place in a complex system. William Ury, the legendary negotiation, offers us a lifeline in The Power of the Positive No. Ury's insight is deceptively simple: a Positive No is not rejection, it is assertion. It is saying "no" to one thing so you can say "yes" to something more important. For us in Puerto Rico, this framework is immediately relevant. We are navigating negotiations with stakeholders who may misunderstand our role, working within federal and local systems that constrain our autonomy, and advocating for resources in an environment of scarcity. The temptation is to say "yes" to everything to overextend, to accommodate, to avoid conflict. Ury warns that this path leads to resentment, burnout, and ultimately, diminished impact.

First, the power of the Positive No begins with your "Yes!" Before you can decline anything, you must be crystal clear about what you are saying yes to. For AAMPR members, this is our "why": quality healthcare access for the people of Puerto Rico, workforce stability, and professional legitimacy. When we say no to scope limitations that harm patients, to working conditions that compromise care, or to partnerships that diminish our profession, we are simultaneously saying yes to our core mission. Ury teaches us to lead with this affirmative purpose: "I am saying no to this because I am saying yes to serving our patients and strengthening healthcare on the island."

Second, the Positive No requires a respectful "No." This is where many of us struggle. In Puerto Rico's close-knit professional community, we worry that standing firm will isolate us. Ury's method addresses this by embedding the no within a conversation about shared interests. We can say no to physicians, medicos asistentes, or administrators while affirming our mutual
commitment to patient outcomes. We can decline certain demands while offering alternatives that serve everyone's needs. The respectful "no" acknowledges the relationship and preserves it, even strengthens it, through honesty.

Third, the Positive No ends with "Yes?" which is an invitation to find another way. This is crucial for our advocacy. When we face legislative barriers or institutional resistance, ending with "yes?" opens the door to creative solutions. It signals: I am not your opponent; I am your partner in solving this. In Puerto Rico, where coalition-building across professions and political lines is essential, this final "yes?" transforms potential conflicts into collaborative problem-
solving.

So let me ask you: Where in your professional life do you most need the power of a Positive No? Is it in setting boundaries around your scope, in negotiating fair working conditions, or in advocating for our profession's recognition? What would change if you could say no with confidence—and still get to yes?

🇵🇷 Resumen en Español

El libro The Power of a Positive No plantea que decir “no” no es rechazar, sino afirmar lo que realmente importa. En el sistema de salud de Puerto Rico, donde los PA-Cs/Asociados Médicos negocian constantemente su rol y autonomía, este enfoque es especialmente relevante. Decir “sí” a todo para evitar conflictos puede llevar al agotamiento y a una menor efectividad.

El “No Positivo” comienza con un “¡Sí!” claro: nuestro propósito, como mejorar el acceso a la salud y fortalecer la profesión. Decir “no” a limitaciones o condiciones inadecuadas es, en realidad, decir “sí” a esa misión.

Luego, implica un “No” respetuoso que establece límites sin dañar relaciones, reconociendo intereses compartidos y abriendo espacio a alternativas.

Finalmente, culmina con un “¿Sí?”, una invitación a colaborar y encontrar soluciones en conjunto.

En esencia, el “No Positivo” permite mantener límites firmes mientras se preservan relaciones y se avanza hacia resultados constructivos.

Déjame preguntarte: ¿En qué área de tu vida profesional necesitas más el poder de un “No Positivo”? ¿Es al establecer límites en tu alcance de práctica, al negociar condiciones laborales justas, o al abogar por el reconocimiento de nuestra profesión? ¿Qué cambiaría si pudieras decir “no” con confianza—y aun así llegar al “sí”?