Career resources content posted on NEJM CareerCenter is produced by freelance health care writers as an advertising service of NEJM Group, a division of the Massachusetts Medical Society and should not be construed as coming from, or representing the views of, the New England Journal of Medicine, NEJM Group, or the Massachusetts Medical Society
Physicians should proceed from the premise that their questions are expected — and, ideally, welcomed
The pandemic has had far-reaching effects in many areas of physician practice — namely added stress, job-security concerns, and emotional and psychological challenges for physicians at the front lines of care. This sustained disruption in the practice environment has also prompted many physicians to take a deep look into what matters most to them. That, in turn, has impelled some to reevaluate — even reorder — their priorities for the jobs they’re in or the new opportunities they’re considering.
While a good cultural fit and practice support structure have always been important, those two considerations, along with work-life balance, have begun to eclipse compensation on the wish-list scale, recruiters are reporting. “Of course, what constitutes a good fit is personal and individual for each physician, and what’s important for residents coming out might differ from priorities for career physicians. But what we’re seeing, since the pandemic, is that physicians are placing a higher priority on work-life balance and family concerns in opportunities they’re considering than they might have before,” said Emerson Moses, MBA, regional director for Clinical Talent Acquisition in Optum Health’s Northeast, North Central, and Tri-State regions. “Many physicians are deciding, based on what they’ve experienced and witnessed in the past 18 months, that it’s very important to live near family.”
Physicians who are seeking a first or subsequent practice opportunity should have more than a vague idea of what they desire in setting, culture, and practice support, before they start actively interviewing, according to Kelley Hekowczyk, director of Physician Recruitment and Credentialing for UCHealth Medical Group in Loveland, Colorado. “Employers assume that if you reach out, you know what you’re looking for in the culture and what you want your practice to look like. Ideally, you’ll have a pretty good idea of that when you come to the recruitment process, so that you can match up the qualities you’re looking for,” said Ms. Hekowczyk.
Recruiters can be essential in both helping physicians focus their preliminary, “pre-interview” questions around factors that help reveal the culture of an organization — and in answering those queries early in the process, Ms. Hekowczyk reminds physicians. “The list of information that we as recruiters try to provide candidates is constantly evolving, but we do provide details on things like schedules, coverage, call backup, and mentoring. However, assessing the family [flexibility] issue can be a tough one,” she said, that’s best addressed in site interviews and open discussions with prospective colleagues.
Do ask all the questions on your mind
Even though it’s hard to assess culture and physician support from afar — especially when onsite interviews and those all-important dinners with prospective colleagues haven’t been possible — there are ways to get a sense of the practice environment, Ms. Hekowczyk maintained. She urges job-seeking physicians to review the organization’s website thoroughly for evidence of cultural characteristics and then set one-on-one conversations with prospective physician partners. This can help physicians determine, she said, “whether the practice environment is one that they’ll likely thrive in.” In her organization, Ms. Hekowczyk noted, there’s a strong emphasis on ensuring that candidates have ample opportunities to ask questions of their prospective colleagues — and all questions are fair game if they’re important to the physician.
One of those culture questions has taken on new importance of late, Ms. Moses reports, and it’s one that she thinks young physicians should ensure they ask: What is your strategy around physician well-being? “To some extent, it’s a generational thing. Seasoned physicians may be willing to work themselves to the bone to make good money, but that’s not core to this newer generation — the Generation Y and millennial physicians,” she said. “They’re hard workers, but they’re also committed to having work-life balance.”
Ms. Moses cautions that if an employing entity’s interviewers appear reluctant to answer the “physician well-being” question, or if the question is received negatively, that might be a sign that the organization isn’t focused on physician well-being. “Don’t be afraid to ask all your important questions about culture — those questions are very important to finding a good fit,” she said.
Lynne Peterson, president of the Association for Advancing Physician and Provider Recruitment and a 30-year veteran of physician recruiting, believes that cultural fit is too important a consideration for it to be short-changed in the job-search process. “Physicians really need to look at both practice and organizational culture,” said Ms. Peterson, senior director and ambassador of Provider Recruitment and Retention for Bluestone Physician Services in Stillwater, Minnesota. “At the practice level, that culture encompasses things like whether you like and trust prospective colleagues, and if you can be assured that they’ll take care of your patients when you’re not around.”
Organizational culture is important for a different reason, Ms. Peterson explained. “You want to make sure that the organization truly supports the practice, that when executives talk to physicians, the physicians’ voices are truly heard.” Further, she said, physicians should try to find out, from prospective colleagues, whether “what the C-suite people say about doctors is borne out by physicians.”
Assessing collegial environment and practice support
For invasive cardiologist Eks Wye Pollock IV, MD, at UCHealth in Fort Collins, Colorado, assurance of a culture of collegiality and having a good team were key considerations, along with a family-supportive environment, as he began looking for his first practice position. “That question was answered for me at each interview,” he said of his experience at UCHealth, his first choice because of the university’s standing and the practice’s proximity to his extended family. “It was clear that the practice was collegial, and that the organization valued physician lifestyle and non-work time,” he said. “I’ve since learned that other people I trained with aren’t necessarily finding that in their jobs.”
The team support in place became evident soon after Dr. Pollock started his job in 2019. Just a few months into the position, there was a death in his family. He emailed his colleagues, worried about getting his duties and patients covered while he was away. “Almost immediately, I received several emails from my team, and it was clear that everything would be taken care of,” he said. “I was told when I joined that ‘we’re all here to help each other,’ and I certainly experienced that.”
Mary Ebbets, MS, a senior physician and Advanced Practice Provider (AAP) Recruiter at Cooley Dickinson Hospital, in Springfield, Massachusetts, echoes what Ms. Peterson says about teasing out the culture through pointed questions. But Ms. Ebbets also advises physicians leaving residency to ask about the overall practice-support environment, which can be key to ensuring both a good fit and longevity in the position. Some new residency graduates are reluctant to do that for fear that they’ll be seen as self-serving or demanding, recruiters report, but that’s generally not the case. Ms. Ebbets suggested the following as good starting questions for gauging practice support:
- Will I have “mentor-type” access to senior physician colleagues?
- What kind of nursing and administrative support will I have in my daily practice life — is there a dedicated medical assistant and do we have APP support?
- What is the group’s or hospital’s policy regarding schedule flexibility for addressing family-life needs or requests?
“Remember that interviewing is like dating, so physicians should vet the organization just as much as the organization vets them — which means that physicians should ask all of the above questions,” Ms. Ebbets said. “The only types of questions that cause my organization pause are questions or requests around patient volumes that are below the industry standard — such as physicians saying that they only want to see 10 patients a day.”
Ms. Ebbets added that perhaps the most important question physicians should ask in assessing culture is: Why is this position available? If it’s a “replacement” position, she said, physicians should be prepared to ask why the previous physician left and should expect a candid answer. If it’s a new position based on growth, Ms. Ebbets added, the organization should be able and willing to supply market data to support the addition of another physician.
In posing key questions, be candid but cordial
In terms of how to phrase probing questions, Tom Farrington, MS, Director of Physician and Provider Services for Franciscan Physician Network in suburban Chicago and Indiana, offers some observations and guidance. First, he says, physicians should know that questions about work-life balance are common — and expected — these days. Likewise for detailed questions about training support and orientation, and the administrative support available. “I also believe that physicians want to know that demands on them to do burdensome administrative tasks are going to be minimal,” he said.
Mr. Farrington suggests posing such questions in a diplomatic manner. “Questions phrased as ‘help me understand the practice schedule, how call works, and the frequency of calls during coverage’ are all fair questions that provide physicians information without them making overt demands,” he said. On the other side of the spectrum, if physicians are asked to describe their ideal practice setting, they should supply a thoughtful, candid response. “That question is surely an opening for physicians,” he said, to talk openly and honestly about what’s important to them.
When internist Luis Gerald Lora Garcia, MD, was seeking his first post-residency practice position, he had specific needs and he made those known early in his search process. First, because he is on a J-1 Visa, he wanted to ensure that any practice he joined would be amenable and prepared to process his immigration. He also wanted to be close to a big city and to ensure that there would be some schedule flexibility and support from colleagues who were seeking a structure that enabled time for family and lifestyle pursuits.
In the end, Dr. Garcia found both at Franciscan Health’s Valparaiso, Indiana, primary care clinic, the Franciscan Physician Network Health Center. He practices four 10-hour days, and he has enjoyed his proximity to Chicago and his ability to travel around the region and explore — activities he didn’t have time for in residency. He admits that he has also found both a supportive culture and a collegial environment, and the ability to pursue his preferred clinical interests of cardiovascular-disease reduction and diabetes management. “It has worked out well so far, and I’m glad I was able to find an opportunity that meets my needs,” he said.
When physicians do ask about what the clinical and administrative support they’ll receive, they should expect detailed answers, according to Tammy Hager, MBA, Executive Director of Physician Recruitment and Privileging for Surgical Affiliates Management Group, Inc., in Sacramento, California. “When you’re asking about staffing, you really should expect and be given some numbers behind that,” she said, not just blanket statements suggesting that support will be adequate.
On the topic of collegiality, physicians should ask questions in a manner that calls for somewhat specific answers. Ms. Hager suggests inquiring about outside-work activities that physicians engage in, such as group dinners, boating excursions, or family get-togethers, for example.
For physicians who are trying to figure out whether they’ll be a good fit within the existing group, it’s not out of order to ask questions that will give the candidate a sense of the physician partners’ diversity, backgrounds, and families. “If ethnic diversity is important to you, you might ask the recruiter where the other physicians live and where their children go to school. I think it’s possible to do that without coming across as racially biased,” she said. She notes that the Association of American Medical Colleges (AAMC) maintains and publishes data on race, ethnicity, and gender patterns in US medical education and the practice patterns of the physician workforce in its Diversity in Medicine: Facts and Figures reports.
Finally, all interviewees agreed that while assessing culture and practice support are hugely important, physicians should ensure that the organization they’re considering joining has the financial viability to keep them gainfully employed for the long term. That’s become especially important in the wake of the pandemic’s initial impact on health care organizations of all sizes. “More experienced physicians ask about things like whether there’s a planned merger or acquisition that might affect their job, and whether there was an issue with layoffs or furloughs during the pandemic,” Ms. Hekowczyk said. “But the younger ones don’t tend to ask questions about the organization’s financial position, but they should.”
Ms. Moses urges physicians to do some research on the financial and market position — hospitals and health systems compile and publish data on their operating ratios, revenues, and cash reserves, for example — of any organization they’re evaluating. Ideally, candidates will conduct their research before the interviews begin. Annual reports and other public published data are a good start, and local media coverage on market factors and financial problems can be telling, she said. “When you’re doing this research, Google can be your friend, but physicians also shouldn’t be afraid to ask questions about how the organization is positioned financially,” she said, especially if it’s a private practice.