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Two dimensions in which physician expectations were out of line with the reality of the job.
In the course of my work helping practices become more efficient and profitable, I do a fair bit of physician recruiting. I frequently write about job-seeking for physicians, too, and when I begin my research for a new piece on physician career planning, one thing always stands out: It’s not hard—not at all!—to get physicians talking about how much they’ve regretted some of their career choices.
Physicians tell me they want to help their younger colleagues avoid the same pain. Often, their regrets boil down to a mismatch of expectations versus reality. This is pain that could have been avoided with better information.
In a field where candidates have already been through some of the toughest intellectual screens around just to get their M.D. or D.O. credential, “better” talent isn’t mainly about who ranks higher on objective measures. It’s about who matches up best with your organization.
Your ideal candidate isn’t just someone with impeccable credentials, it’s someone who will stay with your organization, help shape its future, enhance its reputation, and earn back the costs of their recruitment many times over. A physician with an outstanding C.V. who leaves your practice as soon as they can—and who is unhappy for most of the time they were with you—represents a huge cost, both in actual dollars spent and in the missed opportunity to bring on someone more compatible.
Yet even though the mismatches are costly, practices and integrated systems don’t always do enough to make sure the fit is good. Perhaps they believe that this is up to the physician candidate to decide. The employer, however, bears much of the cost, and is in a better position to ensure the candidate has the information needed to make a smart decision.
Here are two dimensions for which physicians often tell me their expectations were out of line with the reality of the jobs they accepted:
Some practices spend little time describing their culture when hiring, perhaps because they don’t appreciate how important it is. Culture can also be difficult to define. If you haven’t thought about yours (i.e., you haven’t thought about what the experience of working in your practice is like, compared with others), it’s useful to give it some thought.
For example, if your practice values productivity highly, own that it is a place where people who want to earn more by working harder will earn more. Like-minded physicians will be delighted to know that you support their financial focus! Aim to attract those sorts of people, instead of hoping a physician whose attitude differs will eventually come around.
Similarly, if your practice prizes collaboration, mentoring, etc., make that clear from the start. You want physicians who wish to be more independent to disqualify themselves.
There are many of these kinds of cultural dimensions that are not inherently good or bad but will be good or bad to a candidate if they don’t match that candidate’s work style and preferences.
Sometimes, culture is not discussed in recruiting because either the need to hire is urgent or the recruiter is aware of some toxicity and unable to do anything about it. In either case, concealing what it’s really like to work in your practice in order to fill a job quickly can be penny wise and pound foolish. And if the reason for being less transparent is fear that the environment in your organization will scare candidates away, remember that this type of truth usually comes out. It’s easy for unhappy employees to share their experiences online with the entire world anonymously. Once that happens, your recruiting costs will increase. It also can be much harder to reverse a negative online reputation once established. Though obviously difficult, it’s best to address underlying issues first, rather than hoping new employees won’t notice what you already know is a problem.
Another source of job dissatisfaction physicians frequently cite is opaqueness of compensation plans. Some doctors even describe their experiences as “bait and switch,” especially when their compensation plans are based on productivity metrics the physicians didn’t understand or that rely on factors physicians don’t believe they control.
This problem often starts with a recruiter who doesn’t understand enough about productivity calculations to answer candidates’ specific questions. Terms like “RVU” and “net collections” that are relatively straightforward once you understand their meaning can be intimidating when you don’t.
Preparing either the recruiter or the hiring managers to explain compensation plans in detail can go a long way to minimize these misunderstandings. Young physicians, especially, may be reluctant to admit that they don’t fully understand how they will be paid. Be proactive and avoid a potential problem by preparing detailed information.
In addition, plan for and make clear the support you will give to the physician to help them meet volume goals when they do their part. Will you be willing, for example, to add clinical staff support if the physician demonstrates they’ll be more productive? How will you market the new physician? Will he or she start work with patients already assigned, or do you expect new physicians to market themselves (and will they have guidance if so)? What kinds of reports and metrics will the physician have to monitor their own production?
It’s also worth noting that some physicians shy away from jobs with productivity plans altogether, even when they can earn more, if they don’t understand how the plan works. Being clearer about compensation helps you attract more candidates who might work out well in your practice and gives you a much better chance of retaining physicians you eventually hire.
Laurie Morgan, MBA is a partner and senior consultant for Capko & Morgan. Her consulting focuses on practice management effectiveness and practice profitability. She is the author of the book People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice business as well as the Management Rx series of e-books, and blogs at capko.com/blog.