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Mark. Don't go at it alone! Before sitting down to negotiate this, make sure that the agenda includes discussion of the escalation policy's inclusion of medical consultants etc coming in when some of these queued up cases are theirs or look as if they could be theirs to the triage nurse. Then negotiate a rate for all specialty consultants together. Does the list agree that even sitting down to negotiate a rate seems to indicate that one accepts one SHOULD be called and from then on it's just a matter of a gradual downwards adjustment of how much of a queue one requires...