Penelope Hsu, M.D., walked into the job with high hopes. "I didn’t notice how toxic the workplace was at the interview," she says. "I was nervous, I was worried about getting the job, and I wasn’t paying attention." In hindsight, she says the clues were there. "I was on a unit and heard the phone ring. It kept ringing - no one answered it."
A short time in, Hsu realized that she wasn’t in the kind of workplace culture she wanted. She had just come from working in the ER for six years, where she’d experienced a completely different culture: "There, everybody was focused on the same goal. We were motivated, we collaborated, we pulled for each other." Her new job, however, soon showed a workplace that was inefficient and non-communicative. "No one talked with anyone," she says. Three or four months into the job, Hsu realized the position she had taken was not going to work out. Six to seven months in, she was looking for a new opportunity.
Stacy Smith-Foley, M.D., loved her first job. She was in a radiology group that practiced at the top of its game, and its philosophy of putting patients first was morally and ethically aligned with her values. She stayed 10 years and only left when the practice was destroyed by a fire.
Finding a first job where you’ll be happy to stay a while isn’t easy. A recent survey by an Atlanta-based recruiting company found that half of the 500 physicians the company surveyed left their first job after five years. More than half of those stayed on the job only one or two years.
Jonathan Pagan, M.D., left his first job after a year. "It was a tough decision," he says. "But if you’ve made the wrong decision the first time, admit it. The longer you stay, the harder it will be to leave."
Not to mention that, the longer you stay in a culture that doesn’t fit your goals or values, the greater your chances are for burnout and medical errors. A 2018 study by the New York University School of Medicine and another 2018 study by the Stanford University School of Medicine suggest that workplace culture can play a more important role in reducing physician burnout and medical errors than improving safety protocols or using checklists.
"Workplace culture is huge when considering a job," says Gretchen Nolte, team lead for physician and advanced provider recruitment for Indiana University Health. "But each person’s right fit is going to be different. You have to follow your instincts."
So how do you determine what the right workplace culture is for you?
Consider these five steps.
You won’t be able to recognize the right practice fit until you first determine what you want in a workplace.
"As new physicians, we are told where to be," says Pagan. "Fit doesn’t play into it. We’re at the whim of match algorithms. We’re programmed to take what we get."
"As a new attending looking for a job, we think we are lucky enough to be given a job," says Hsu. "But the best part about being an attending is that you finally become in control of your destiny, to a degree. That provides the freedom to ask yourself what is it that I want, does this job fit me, is this job good enough for me rather than the other way around."
Hsu suggests before starting a job search, decide what your values are, what’s important to you, and what your ideal job would look like. What kind of environment do you want to work in? "If you know the answers," Hsu says, "it will inform the kinds of questions you ask at the interview."
"Ask yourself what your typical day should look like," says Smith-Foley. "What would your worst day look like? Know what you value before you look for a job."
Physicians seeking their first jobs often prioritize the wrong things, like salary or location, says Pagan. "Of course, salary is a pre-requisite. You need to know you’ll make enough money to take care of yourself and your family. And location can be important. But if you want to be happy on the job, you need to prioritize what a comfortable environment would be for you."
For Pagan, it was important to work in a place where he felt he could make a contribution and a difference in people’s lives. He wanted to work where other people shared those values.
Don’t forget to also discuss your goals, values and priorities with your family. Consider their input. "My wife has had to sacrifice a lot along the way, so I prioritize her views more than my own," says Pagan.
"I had a lot of conversations with my spouse before making our move," says Smith-Foley. "We made a pros and cons list and finally decided that the opportunity I was given was one that we couldn’t say no to."
Michelle Roland, M.D., has moved around a lot in her career, including jobs in Tanzania and Botswana before returning to her home state of California. With each move, Roland says she first received "100% input from my family."
"The first thing you can do, if you’re interested in a job, is to research the company’s website," says Nolte. "Go to the ’About Us’ section and look for the kind of buzz words that reflect what you’re looking for." If teamwork, compassion, patient-centric care and leadership are among the values you’re looking for, see if they are listed in this section.
"If you can speak to someone with firsthand knowledge of the employer, that’s even better," says Nolte.
"If you have a network, use it," says Hsu. She had learned some red flags about the poor fit from an old co-worker, but by then the information came too late to help. "My suggestion is to reach out to your network while you are still researching," Hsu advises.
Roland did her primary research online, "but I spoke with my colleagues for a reality check. I wanted to know what the place was really like and if they thought I would be happy with the work."
Brendan Kolber, national sales director with MGMA, says you can often find those with firsthand knowledge of a facility by networking at the local medical association. "Members will give you the inside scoop and let you know about the pros and cons of the place. What you don’t want to get hung up on is reading patient reviews on a website," he says.
Pagan read local publications to learn more about the organization with which he was interviewing and was pleased to see articles about the growth and expansion of the facility. "That’s usually a pretty good indicator of the employer’s financial health as well as its leadership position in the community," he says.
Smith-Foley also checks a facility’s financial health online to understand its business health. "Is it in the black or in the red? If it’s in the red, how has it changed, or how is it changing, to turn things around?"
The site visit will reveal much about a workplace culture if you take the time to notice everything - like Hsu’s experience with the ringing telephone that went unanswered.
"Look around you," says Nolte. "How happy do the employees look? Do they look like they want to be there?" And when you meet team members, Nolte adds, pay attention to their demeanor. Are they professional, respectful, open?
"Spend as much time at the workplace as you can," says Pagan. "Two days is best, because you will learn more on your second day there. You’ll have more candid conversations with the people who work there."
"You might even ask if you can shadow one of their physicians for a day," Hsu says. That way, you’ll see for yourself how things work and how communication is handled. "But," she adds, "You should strive to meet as many people as you can, including other team members. Talk to them about why they work there. Are they happy? What do they like about the job? What’s the worst part?"
Smith-Foley also suggests paying attention to how things are done while on the site visit. For example, notice if handwritten records are still a feature of an organization that might become a time-consuming task likely to be an impediment to your work/life balance.
There are other red flags to watch for, says Andrew Walker, national director of business development-organizational membership with MGMA. "Make sure you receive a detailed agenda prior to an on-site visit," he says. Is the agenda a "mixed bag" - including visits with both physicians and non-physicians? That’s a good sign. "It should be a grab bag of people, a wide array, because you’ll get a more truthful picture of the workplace."
"If you witness a conversation that is disrespectful, or it’s unfriendly or uncomfortable in some way, ask about it," says Nolte. "If there is not a good answer, the workplace may not be a great place to work."
"Watch for a lack of transparency," says Pagan. "If you can’t meet with everyone, like the CEO, or with any of the support staff, that’s a red flag. You should be able to talk with anyone, about anything. If the only questions that are being answered are business questions, then you have the right to be worried."
"How much time did they spend with you? How engaged were they when they were with you? That will tell you a lot about a place and the people who work there," says Walker.
Here again, says Nolte, trust your instincts. "Consider the entire process," she says. "If you go through the process, and if something doesn’t feel right, then that position is probably not the right fit for you."
Communication and transparency are key during the interview. You should receive open, honest answers to every question you ask, says Nolte.
You should be prepared to ask lots of good questions, says Kolber. Of course, you are going to ask the inevitable: How much will I be paid and for what? "You need clarity on that," says Kolber. "Changes in the marketplace and new pay structures have placed increased pressures and stress on physicians. Attaining all the facts you can upfront will allow you to make an informed decision about your job opportunity."
Those stresses, as already discussed, can lead to burnout, along with uneven call distribution. "You’ll want to ask about that as well," Walker adds. But he suggests going even further with your questions. "Ask employers what steps they’ve taken to provide physician health and wellness opportunities. That’s going to show you how they value physicians at their workplace and their well-being."
You should have a good idea after your research, your site visit and the interview whether the workplace is going to be the right cultural fit for you, but don’t forget to check out the area to make sure it’ll be a good fit as well.
"Does the community meet your needs and the needs of your family?" asks Nolte. Most workplaces will connect you with a local realtor who can take you on a tour of the area and show you places where you might want to live, she says.
"My wife and I went on school tours as well," says Pagan.
"We wanted to live in a small, tight-knit community," says Roland, but it was also important to her to connect with people who are like-minded. She found that in the small California town where she’s living now - but it took research and some searching.
Just as you did when you initially sat down to determine your values and the kind of workplace you wanted to be a part of, now is the time to sit down and assess your experience.
"Were you treated with respect while you were there?" asks Kolber. "How were you received? Did you feel welcomed, or was there a sense that something didn’t feel right? Spending time to evaluate your feelings, both good and bad, about the environment, staff and fellow physicians is an exercise I encourage."
"How was your family treated?" Walker adds. If you still have questions or hesitations, now is the time to ask why. "Use your instincts to uncover and ask more questions."
After his site visit, Pagan spoke with colleagues, mentors and those familiar with the practice patterns at the facility before he accepted the offer.
"Set up a vision of your ideal life for you and your family. What would it be like?" asks Hsu. After the interview and the site visit, compare your vision to the job that’s open. Is it the job - and life - you want it to be?
"Ask yourself, does it match what I want?" If it doesn’t, keep looking. "It’s easy, when you’re first starting out, to have a feeling of desperation." But accepting a job offer out of that feeling is no way to start your career.
"If you’re not sure about the job, be honest," says Smith-Foley. "Make a second visit. Advocate for yourself and what you want."
But what happens if you take the job, and, like Hsu, soon realize that this is not the workplace for you?
"It’s a situational problem," says Nolte. "If you’ve uprooted your whole life by moving there, give it some time. Talk to your direct supervisor about any issues that are troubling you - the sooner the better."
"In some cases, you can help shape the culture of the place, in terms of communication or patient care," Pagan says. "But give yourself a time limit to affect the change. You don’t have to stay there."
…Unless, of course, you have slipped on a pair of what Walker calls "golden handcuffs." "If you’ve earned a signing bonus when you took the job, you’re on the hook for that money if you leave," he says. Just be aware of that when you enter into negotiations. "Be aware of what you can do if you want to exit a three-year contract in the first year," says Kolber. "The new workplace might help you repay the signing bonus if they really want you."
If you do decide to leave shortly after accepting a job offer, use it as a learning tool, says Kolber. "Ask yourself what worked, what didn’t so you know what to look for at your next workplace."
"Stay open to opportunities, and remain flexible," suggests Roland. "Don’t worry if your first job doesn’t last forever. In fact, that can be a really good thing."
Furthermore, says Hsu, "It’s unrealistic to think your first job will last forever. Priorities change, especially with families. Your own values and priorities may change. If you can’t incorporate those changes into the job you have, it’s time to leave."
"All you can do," says Pagan, "is to make the best decision you can at the time, and work hard while you’re there. If it doesn’t work out, it’s not your fault."
But by following the tips provided here, chances are you will find the perfect job fit for you - even on your first try.
Karen Edwards is a frequent contributor to PracticeLink Magazine.