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
Self-assessment, up-front research, and ample time for interactions are key
By Bonnie Darves, a Seattle-based freelance health care writer
Practicing medicine in an organization that has established a strong, positive culture can make all the difference in terms of physician satisfaction, studies and surveys have found, just as a toxic culture can create a miserable experience for all practice staff. In fact, a negative or unsupportive culture is consistently among the leading reasons physicians cite when they leave a job.
So, how can job-seeking physicians, particularly residents and fellows eyeing a first job, ensure that they’re not heading into a bad situation when they explore practice opportunities? It’s not always easy to spot a “problem practice,” but by doing some advance research and asking the right questions, physicians might be able to avoid this pitfall. This is not to suggest that undesirable culture is rampant among practices and physician organizations, but rather that young physicians generally aren’t proactive enough about looking into a practice’s culture before accepting opportunities, according to recruiters.
One of the first steps physicians should take when looking for a good cultural fit is to identify what’s important — or possibly even nonnegotiable — in the practice’s cultural environment. Ideally, this self-assessment should occur before starting the job search. Patrice Streicher, senior operations manager for Vista Staffing Solutions, recommends that physicians create a list of “absolute must-haves” and “would be nice to have” to guide their discussions with recruiters and, later, with the prospective employers’ hiring team. These categories, Ms. Streicher said, can be very helpful overall in evaluating practice opportunities and gauging potential cultural fit.
Ms. Streicher also stresses the importance of physicians being honest with themselves (and recruiters) about what they’ll need to practice successfully in any cultural environment. “Physicians should be realistic about their abilities, their competency level, and their confidence in their own autonomy. These answers will inform the degree of collegial support they’ll need in a new position,” she said.
Physicians who have identified their preferred practice location should start their culture research even before they start scheduling site interviews, advises Louis Caligiuri, director of physician services for North Shore Medical Center, in Peabody, Massachusetts. “It’s important to connect with other physicians in the area — physicians in your field in several practices and people you trained with, in addition prospective colleagues, if possible — to get a sense of the cultural environment in area practices,” Mr. Caligiuri said. “Those connections can be very meaningful and informative.”
Self-assessment key in determining cultural fit
In the early stages of a job search, physicians should also tap their recruiter’s expertise and experience to help identify a potentially positive match. And that means vetting the recruiter to determine how well she or he knows the opportunities under consideration, according to Michelle Baker, a recruitment director for Merritt Hawkins & Associates. “Once candidates do that, they should let the recruiter know their specific needs and concerns about cultural fit, and what their priorities are for themselves and their families,” she said.
A well-informed recruiter should be able to provide ready answers to the following: Why there’s an opening, when the other physicians joined the practice, and what the physician turnover rate is. Candidates should also ask about physician satisfaction scores and for a view of the “day or week in the life” of prospective physician colleagues (or the physicians who left). The responses to such questions are often good indicators of the organization’s culture, Ms. Baker said.
Brigitta Glick, founder and chief executive officer of the staffing firm Provenir Healthcare in San Antonio, Texas, advises physicians to get into the nitty-gritty with the recruiter about the working environment, which is often predictive of both culture and physician-satisfaction levels. “Physicians should ask about the makeup of the team and the logistics of the working environment,” she said. For example, physicians should find out if they would essentially be working “on an island” or with dedicated, accessible staff in close proximity. “You want to know if you’ll be essentially in a pod or on your own, and whether you’d be working with your own support staff rather than ‘borrowed’ extenders,” she said.
Ms. Baker reminds candidates that the organization’s scheduling practices and financial priorities might also be helpful cultural barometers. For example, if there’s a focus on schedule flexibility, structured hours, and minimal call, the opportunity will “fall on the quality-of-life end of the [culture] spectrum,” she said. Conversely, an opportunity that entails aggressive production goals and a more intensive schedule “reflects a more entrepreneurially, financially driven culture,” Ms. Baker said.
Finally, the recruiter can also play a vital “messenger” role in assessing cultural fit in the early job-search stages, according to Katie Cole, president of Harlequin Recruiting in Denver. “The recruiter can ask the uncomfortable questions of the prospective employer, and that won’t be held against the candidate personally,” said Ms. Cole, whose firm focuses on surgeon recruitment. “If there’s a specific aspect of culture that the physician wants to avoid, the recruiter can determine the related situation before an engagement or scheduling a site visit.”
Ms. Streicher adds a further recommendation regarding the tough questions: Don’t relegate such important discussions to informal electronic exchanges. “I advise against written discussions over email or via text messages,” she said. “Sensitive disclosure about cultural aspects or practice preferences should take place during a telephone conversation with a professional recruiter.” Such formal discussions, she added, also help the physician evaluate the recruiter’s credibility, working knowledge, and communication professionalism.
All recruiters interviewed for this article concurred that physicians tend to avoid asking the sensitive questions or delving into the organization’s culture, before they agree to site visits. The sources also agreed that relatively few young physicians, in their experience, ask very direct questions in the site-interview setting, about matters that would be key in ensuring a good cultural and professional fit.
“As for practice culture, for most physicians, a compatible atmosphere is understandably going to be based on their individual style, preferences, and value systems,” Ms. Streicher said, “so they should be very clear about what they’re seeking in those regards.”
When onsite, ask focused questions
Physicians who’ve done their due diligence before agreeing to a site interview should still be prepared to revisit the important questions with the interviewing team. The tone, tenor, and completeness of that interviewers’ responses will either validate what the candidate has already discovered or, possibly, raise new questions or concerns.
The best place to start, recruiters advise, is by focusing on the cultural “must haves” and potential concerns. For example, the surgeon who seeks adequate support staff in a collegial environment in which colleagues are available to pitch in as needed when call gets unmanageable should articulate that in a direct question. She might ask, Would I have dedicated clinical support staff, and if not, how is staffing arranged to ensure I have the support I need?
Likewise, the internist who wants to ensure that he’ll be able to attend his son’s Thursday afternoon soccer games regularly, as feasible, will have to pose a question whose response will indicate how family-friendly the culture is. An example might be the following: How does the practice accommodate physicians who want to schedule time away for family activities during the work week?
When assessing culture, expect answers to challenging questions
“The two things physicians should keep in mind are that no questions about culture are ‘off limits’ and that good practices really want physicians to ask the challenging questions,” Ms. Glick said, because that’s an indication of how seriously they’re considering the opportunity. “Physicians should be prepared to show up as they are and be very clear about what they’re seeking and what they hope to avoid.” She offers the following as examples of questions whose responses provide insight into the practice culture:
- How are decisions made in the practice, and how are physicians involved in that process?
- What causes conflict here, and when that happens, how is conflict resolved?
- Who has the power to get things done in the practice?
- What do you celebrate here — and how do you celebrate?
- How does the organization support professional growth?
Ms. Glick said that even tangential questions, such as how much physician PTO (personal time off) is left on the table at the end of the year, can provide a good sense of culture and expectations, and how well the practice is structured to permit the promised time off.
The point, Ms. Baker said, is that candidates have to raise the issues that are important to them, from not only a professional standpoint but also a personal one. For example, she thinks it’s appropriate to ask questions about topics such as gender diversity and neutrality, and whether internal medical graduates are accepted by colleagues and patients. “Physicians should also ask about practice or hospital leaders — do they value physician input or is it our way or the highway?” she said.
When inquiring about the reason for the job opening and physician turnover, physicians should ask detailed questions and expect honest, detailed answers, Mr. Caligiuri said. “If the interviewers say that they don’t know the [turnover] data or aren’t candid about why there’s an opening, that’s not a good sign,” he said.
Don’t skimp on social time with potential colleagues
In preparing for the onsite interview, physicians should request time outside of the interview to meet with prospective colleagues, ideally outside the workday and the practice setting, Mr. Caliguiri suggests. “It’s best to schedule a dinner or lunch meeting offsite, when physicians won’t be running off to see the next patient,” he said.
Job-seeking physicians often don’t set aside enough time for such interactions, as important as those encounters are, according to Ms. Glick. “In my experience, residents and fellows often do themselves a big disservice by trying to cut the visit short,” Ms. Glick said, or by trying to fit in too many site interviews in a short period of time.
“You really need two days to get a good feel for a practice,” she said. “It’s not beneficial to try to fit in eight site visits in a few months; do your research and due diligence to narrow the list, and then pursue three or four opportunities.”
Ms. Glick and Ms. Caligiuri both recommend that candidates request a few hours to shadow a prospective colleague, to observe a typical workday and to thoroughly assess the level of physician support and the cultural environment. If a practice is reluctant to allow for offsite social opportunities or a shadowing experience, that might indicate problems or issues that the practice is trying to hide.
“It’s a red flag if the practice doesn’t facilitate those interactions or if the head of the practice doesn’t make the time to meet with the candidate,” Mr. Caligiuri said. He also stressed the importance of candidates visiting all practice locations where they might work. In his organization, candidates are encouraged to come back for a second visit if the initial schedule doesn’t accommodate requested social and worksite activities.
“The social setting may provide the best opportunity to gauge whether you fit culturally,” Ms. Baker pointed out. Such opportunities enable candidates to find out whether the potential partners share your sense of humor, your values, or even your attitude toward raising children, she added. “That social gathering can tell you a lot about the ‘feel’ of the practice,” she said, “that you might not get during the interview.”
Mr. Caligiuri adds another important reminder for job-searching physicians: practices are also looking for a good match, and the social gathering gives prospective colleagues an opportunity to gauge whether the candidate will fit in. “It gives them a chance to ascertain the candidate’s suitability — and that’s obviously important for everyone involved,” he said.
Although being well informed and proactive and asking the important questions can go a long way toward finding a good cultural fit, at a certain point the candidate also needs to just trust his or her instincts, Ms. Streicher said, because those are telling, too. “If you have concerns that there is a misalignment of your beliefs with the core values or practice culture with an opportunity, I suggest keep looking,” she said, “because the right practice culture match is out there.”