How to discover a practice’s true culture

These examples of different practice cultures show how varied—and important—the heart of a workplace can be.

By Therese Karsten | Job Doctor | Winter 2020

 

By this point in your training, you have worked in enough environments to spot signs of a toxic culture. Unfortunately, there isn’t a universal checklist for how to identify a healthy practice culture. But seeing how culture plays out in both clinical and personal decisions at a variety of organizations like in the examples following can help you identify cultures where you are most likely to thrive and grow.

Emotional vs. financial connections

How important to you is a strong emotional connection with your colleagues? Consider these two approaches, and see where you’re most comfortable.

Practice A is a thriving group where physicians talk to each other throughout the day, often stopping to ask a question or get a colleague’s thoughts. Everybody eats together several days a week. The whole practice gets together with their families a few times a year, and mandatory physician meetings are lively breakfast events with everyone participating in the debate over proposed changes. Everyone from front desk to the last remaining original partner describes the practice as a “work family.”

Practice B is just as successful. They also earn above market, have a very good reputation and great patient satisfaction scores, but the practice culture is very different. Physicians interact primarily with staff and advanced practice providers (APPs) they personally interviewed and selected for their own “pod.” They like and respect colleague physicians, but don’t interact much beyond “how was your weekend?” at the Keurig machine. They describe their group as a successful medical business, talking about ancillary revenue sources and good strategic decisions.

Shared cultural driver

When interviewing with smaller groups, look for common denominators that drive culture. It may be something obvious, like Group C, founded by physicians coming out of Air Force medicine.

The founding partners loved the camaraderie they experienced in squadron life and essentially replicated the elements they believed contributed to a great culture in the Air Force. It works wonderfully for them and has stood the test of time, but adjustment to this culture hasn’t been smooth for all. Spouses of candidates travel with the physician for the first interview and are often surprised to realize that the other spouses are not selling the group, but rather interviewing them for fit. Selected candidates and their spouses get fully indoctrinated from the day they say “yes.” The spouse group ensures that the new family has everything they need: babysitters on move-in day, the website for the best pediatric dentist, the behind-the-scenes scoop on each school. None of the physicians recruited over more than 10 years has left or failed to be offered partnership. The practice chose well, and the physician families “opted in” to a culture that fits them.

When religion comes into play

Interviewers are not supposed to ask you questions about your faith because asking is a slippery slope. But you, as the candidate, can initiate discussions. I personally think you should, because faith shapes so many aspects of leadership decisions, and that power is amplified when all of the partners are voting on practice issues based on shared values. Take this example into account.

Practice D is led by physicians who are evangelical Christians. They interviewed a candidate who had listed Christian Medical Dental Association membership on her CV. Clinically, the new practice was a great fit. Practice meetings opened with a prayer. Partners’ vacation travel consisted primarily of mission trips, and they expected her to use most of her PTO days the same way.

Then, a pregnant patient was referred by a Catholic OB/GYN practice. Her partners warned that she was not to mention pregnancy termination as an option with the patient. The new hire, however, believed that she had a responsibility to discuss all options so that the patient could make an informed decision. The partners operated differently. Not only did life begin at conception, they reminded, but also…the lucrative and exclusive referral relationship from the OB/GYN practice would be at risk if this patient reported termination was discussed as an option. The physician started her job search.

Group E consciously made religious diversity a new pillar of their practice culture. The group was founded by Jewish physicians from the Northeast. The community wasn’t quite large enough to arrange call sharing, so one of them was on call for every High Holy Day. The next new hire was Christian, and she happily introduced herself as “the only triple-boarded intensivist educated and trained at top 10 institutions ever hired entirely because I’m a Shiksa (non-Jewish female) who will work on Jewish High Holy Days.” The intro always got a laugh (because it obviously wasn’t true). Religious humor became their “thing.” No one was surprised when subsequent hires were from Hindu and Muslim backgrounds, respectively. The themes common to all of their faiths—caring for the most vulnerable, kindness, loyalty and respect for human life—bound them together as a group.

Politics play a role

Not surprising that politics has surfaced as a divisive issue in physician cultures, just as it does at family reunions and neighborhood block parties across the country. If you are interviewing with a small practice, this should come up if either you or the practice is strongly in one camp or the other. (Indifferent or dispassionately independent physicians need not focus too much.)

If you have a collection of MAGA or LGTBQ Pride stickers on your bumper, the first glimmer of your deeply held convictions should not come as a surprise to the practice on the first day you park your car in the physician parking lot.

Be relentless in your asking

Questions, questions and follow-up questions are your best tools to uncover practice culture. There is no universal template for “good” practice culture, but asking a lot of questions about what makes the practice tick will help you know if a practice you are considering has a culture in which you can thrive and grow.

Therese Karsten, MBA, FASPR, is division director of physician recruitment for HCA Healthcare’s Continental Division.

 

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