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October 8, 2010

Annul your job choice

Annul your job choiceLike most physicians fresh out of residency, Karen Wicksmith, MD*, an internist, was excited about her first job. She had her eye on a position in a primary care clinic in the South owned by a not-for-profit hospital, a clinic that would soon be housed in a new, multimillion-dollar facility. After being wined and dined, Wicksmith netted a nice offer complete with a tidy benefits package that included a 401(k). She was happy and hopeful. "I was going to get paid to make a difference."

But within six months, things changed. The practice was sold to a for-profit corporation, and Wicksmith discovered that there was an urgent need to expand a practice that apparently had not been profitable. The new administration was counting on Wicksmith and her two colleagues, also new hires recently out of residency training, to do the entire job alone. "I was completely unaware of the business side of running a practice and making it profitable," says Wicksmith. "I had suspected that you just hang out your shingle and people will just walk in the door." Wicksmith found herself leaving her baby in daycare only to spend workdays sitting around with her colleagues figuring out how to get patients.

"It was then that the blinders were taken off, and I really saw things in a different light," she says. Questions came to mind that she had never considered when interviewing.
The for-profit practice model was the polar opposite of the non-profit model she had signed on for. Within a year, it became clear to Wicksmith that she and her colleagues were going to have to bring in enough money to cover overhead costs, which were substantial on the new facility. Yet, there was no marketing program or other support to help them spread the word and build a patient base sufficient to establish a viable practice.

The three newcomers tried to stick it out, even attempting to lure some subspecialists into leasing part of the available space, but it quickly became apparent that,at this point in their careers, the young physicians were illequipped for business building. Wicksmith finally had to admit: "This is not going to work."

An early departure wasn’t what Wicksmith had in mind when she had signed her three-year contract, and she was concerned about the financial and professional implications, but she knew she had to leave. After 18 months on the job, she secured another position and resigned; her two colleagues did the same.

You realized your job isn’t the right fit. Now what?

Discovering early on that you chose the wrong job can rattle the most stalwart physician, but there are many reasons a job may turn out to be a regrettable choice. Taking a hard, honest look at the issues, obtaining appropriate support, and learning from the experience can prove invaluable to moving on unscathed and making a better choice
the next time.

Leaving a position while it is still relatively new is actually not so uncommon. According to Brian McCartie, the vice president of business development at Cejka Search Inc., physician turnover is highest within the first three years of employment. Although in 2009 the turnover rate for the first 12 months of employment was 5 percent, the rate jumped to 8 percent in the second year and peaked at 11 percent between the second and third years of employment. The lower turnover rate in the first year of employment suggests people tend to make an effort to stay in a position for that period of time, perhaps due to investments of time and money made by both employer and employee. The overall physician turnover rate in 2009 was 5.9 percent, which was slightly lower than in 2008. According to McCartie, the decline reflects changes in the economic climate.

Turnover is defined as all reasons for leaving a practice (voluntary, retirement, termination, etc.). The 2009 survey was co-sponsored by Cejka and the American Group
Medical Association. The 73 respondent administrators manage groups that collectively employ 12,452 physicians. The data showed no significant variations in turnover rates between group size, geographic region or type of practice ownership.

Anyone, even a seasoned physician, can make a poor job choice. Experienced physicians who are excellent clinicians are sometimes courted for management positions, says organizational psychologist Billie Blair, Ph.D., the president and CEO of Change Strategies Inc. According to Blair, popular wisdom is that if you are a great physician, then you will be wonderful in management. "That often is absolutely not the case," she says. Management is an entirely different field. Though coaching or additional training
to develop managerial skills can help, the fit may still prove to be uncomfortable.

Physicians who are still relatively new to their careers may be more vulnerable to falling into a position that ultimately feels wrong. "Folks new in their careers are often tempted by great offers," says Blair. However, they do not always have the experience to  determine all that a position means.

Wicksmith found that to be the case with her first job. "I did not know what questions to ask." When you’re 20 something years old and have been in school and protected, you don’t have a lot of experience.

Hiring incorrectly takes a toll on everyone

It is important for employers to understand that hiring the wrong person can be costly for all parties. Sometimes a position turns out to be nothing like it was described during the interview process. "The best way to avoid this is truth in hiring," says Blair. Employers should make sure candidates spend a lot of time interviewing and talking with people to gain the most complete picture possible of the organization and a thorough understanding of the position. "The very worst thing that one can do in these situations is to try to portray the position as something it is not," Blair says.

Annul your job choiceHowever, even after an extensive interview process during which the physician candidate asks all the right questions, there are certain aspects of any practice or organization that can only be discovered on the job. "Unless you have a personal relationship with a mentor who is in that practice setting, you are really going out with blinders on," says Wicksmith. When you’re interviewing, it’s impossible to know what’s really going on behind those walls. "When you enter into a practice setting…there’s already a culture there," Wicksmith says.

There are values that trickle down from the top, and it will be very difficult if you’re not clear about those values or if they are in conflict with your own. There is no amount of money that can compensate for those kinds of fundamental differences.

Emily Strohmeyer, MD*, a surgical subspecialist on the West Coast**, knew what it felt like to work in a fulfilling position. She had enjoyed such an experience following her residency when she served for two years as an associate in a small, private practice. However, she left that practice to pursue additional training. After completing her fellowship, she accepted another position as an associate in a practice owned by a single physician. On the first day of the new job, unexpected circumstances gave Strohmeyer the chance to learn more about who her boss really was, and she got the distinct feeling she had made the wrong job choice.

One of the physician’s established patients arrived in the clinic in emergent need of additional surgery. Strohmeyer was surprised by her boss’s reaction. "She expected me to handle it. I kept thinking, ’Why wouldn’t you want to take care of this problem? You operated on this patient.’ "

Strohmeyer had anticipated a much more collegial response from her new boss, such as suggesting they manage the emergency together, particularly since she had not yet
been oriented to the operating room. In the end, the practice owner stepped up, albeit indignantly, and performed the necessary surgery on the patient.

Strohmeyer remembers that first day as being a big red flag. "I just kind of knew that it wasn’t a good situation," she says, but being so new, she felt compelled to stay on. She met with referring physicians, participated in educational programs, and became involved in community activities to try to build the practice. As she learned more about the practice she had joined, she discovered that several associates had come and gone before her. Meanwhile, the lack of support she felt on her first day became a theme and after six months, Strohmeyer secured another position and resigned.

Is it more than just the job?

How to know when it’s time to go

Often, there are good reasons for trying to hang on to an unhappy job at least for a while. Blair advises people who have been in a job that has felt wrong for six months or so to try and stay on for another six months if at all possible, "but in that period, I wouldn’t just stick it out, I would do some serious work on what seems to be wrong."

She suggests finding a mentor, a former professor, or a counselor - someone outside the employment setting to use as a sounding board and guide. "I would not recommend someone on site," Blair says, as word can travel quickly within organizations, and confidentiality is not always respected. Communicate with that mentor to help you work out the issues, Blair says. "It could be that there are very easy fixes to many of the issues."

If you feel you are in the wrong job but you like the organization and its location, sticking it out for a while might provide enough time for a creative solution, such as proposing an entirely new position. Francine Gaillour, MD, the executive director of the Physicians Coaching Institute Inc., based in Bellevue, Wash., has helped some physicians create new roles for themselves.

"You must be very clear about what it is you want, and then you must identify all of the stakeholders and specify how the new position will benefit each of them," says Gaillour, who works with clients to help them make and present an argument. She helps clients consider the individual personalities of the decision-makers and the various ways in which people process information. According to Gaillour, physicians benefit by learning to craft a more cogent proposal, even if the individual position ultimately
is not approved.

Aaron Spokane, Ph.D., a psychologist and a professor of education and psychology at Lehigh University in Bethlehem, Penn., also sees value in thinking it through before moving on to another position. When people are experiencing occupational stress and are unhappy in their jobs, their options often seem to constrict, and they decide
the best way to fix it is to leave. Spokane says, "I think it’s wrong to take another job before you figure out what is wrong with the one you’re in now because you’re likely to make the same mistake again."

At least theoretically, doctors should be well-equipped to handle an objective evaluation of their job situation, according to Spokane. "Physicians are very good at diagnosing and assessing issues. They have the proper tools to look at their own situations," says Spokane, who says there are different ways to look at job dissatisfaction. "One is to conclude that there is something wrong with the job itself. Another is to conclude that there is something wrong with me, and the third thing is to conclude that there is a combination of things going on, some of which might be fixed and get better."

Some individuals benefit from working with a career counselor, says Spokane, who has written extensively on career issues. There are certainly good assessment and career development tools that can help determine job stressors and how one’s own behaviors that might be affecting work experiences. However, his strongest recommendation for those struggling with career matters is to talk with someone about what you want in a career. It sounds surprisingly simple, but often people do not actually sit down and talk
about their careers with anyone - even spouses. "If you don’t verbalize it externally, it’s hard to think it through yourself," says Spokane. Verbally acknowledging the problem and talking about what you would like to improve can help. Spokane refers to this process as "rehearsal of your aspirations."

"Once you articulate that and it’s out in the open, it’s easier to clarify the issues and to arrive at a solution. When people suffer quietly and don’t talk to anybody, they often conclude, ’This is awful, I’ve got to get out of here.’ I think that it may be a natural thing for physicians to do because they are so self-reliant," says Spokane.

However, Spokane says, "If you look at all the factors and you conclude that leaving is the right thing, then you trust your judgment and you go."

Blair agrees. If a job situation becomes dangerous or disastrous, "I would get out now."

Make a gracious exit

It may be a great relief to head toward the door to escape an uncomfortable job, but making a smooth exit can sometimes prove challenging.

Strohmeyer intended to keep her departure entirely professional, so she was careful to honor the terms of her contract, including giving appropriate notice. She also took care to inform the surgery scheduler to book no new surgical patients within the month prior to her last day since she would not be available to provide follow- up care. When her boss learned that Strohmeyer would not be performing surgeries a month prior to leaving, she moved Strohmeyer’s last day up by two weeks and had the office manager break the news. In addition, her boss refused to honor the contract that provided for both parties to split the cost of Strohmeyer’s tail insurance. The practice owner explained her actions by saying, "I’ve already spent enough on you."

Rather than press the issue, Strohmeyer paid the entire insurance premium. Though the events surrounding her departure proved costly, they only confirmed for Strohmeyer that leaving was the right thing to do.

When Wicksmith and her two colleagues found new positions, they were only about halfway into their three-year contracts. A major concern for Wicksmith was whether she would be required to return part of her sign-on bonus. After several negotiation meetings, which were heated at times, the new administration agreed to let all three physicians out of their contracts.

Looking for a new opportunity

Getting out of the wrong job does not guarantee the next job is going to be perfect. Wicksmith’s next position was in an internal medicine practice with a patient load that was "bursting at the seams" and offered future potential partnership. Once she was on board, however, she discovered the future was not quite as bright as it first appeared. "I

was once again naive," Wicksmith says. Over the next couple of years, she became aware of certain signs of fiscal irresponsibility and the management style was much like a dictatorship. After two years, as Wicksmith was about to go on maternity leave, the personal life of the owner began to fall apart. The practice soon followed suit. Though she was planning to return to work after maternity leave, there was nothing to return to. In 2008, she established her own practice focused on allopathic medicine, integrating nutritional and lifestyle medicine and emphasizing healthy living. At this point, her practice is nearly full.

When Strohmeyer accepted her next job, she was hopeful. "It was a job that I thought would eventually lead to partnership," she says. However, the position turned out to be
even worse than her prior experience. Despite having a contract, the owner’s management style included changing rules and policies on a whim. After three years, Strohmeyer decided to do something different and struck out on her own. For the past two and a half years, she has since been working as an independent contractor. She currently works for two healthcare facilities and is paid based on the fees she collects. She pays for her own health and malpractice insurance and enjoys the freedom of operating as her own boss.

Wicksmith looks back on those early jobs without regret. "I learned a lot through those experiences. I learned business savvy." She adds mastering different leadership and
negotiating styles, an introduction to business practices, and a better awareness of the way she wanted to practice medicine as some of the lessons learned along the road. "I also learned about my own character faults and I grew personally and spiritually," she says. "I’ve had a multitude of experiences that prepared me to go and hang out my shingle."

Leaving an uncomfortable position relatively soon after taking it is certainly not career suicide. A career is never over because of such an event, says Blair. "There are actually no bad decisions. There are decisions that might be less well advised," she says, but a bad experience is often the greatest learning experience for a career. "One can always take from an experience that didn’t work out as one had planned and make it a true benefit," says Blair.

Susan Sarver is a registered nurse and a Chicago-based freelance writer. Her articles and essays have appeared in a variety of anthologies and national publications.



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