It’s a horse, not a zebra
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.
You have to be there
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.
However, 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 kind 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.