We Go to the Altar Together

Last month, I wrote about onboarding and the important responsibility that everyone associated with a hospitalist program has to ensure that each new provider quickly comes to believe he or she made a terrific choice to join the group. Upon reflection, it seems important to address the other side of this equation. I’m talking about the responsibilities that each candidate has when deciding whether to apply for a job, to interview, and to accept or reject a group’s offer.

The relationship between a hospitalist and the group he or she is part of is a lot like a marriage. Both parties go to the altar together, and the relationship is most likely to be successful when both enter it with their eyes open, having done their due diligence, and with an intention to align their interests and support each other. Here are some things every hospitalist should be thinking about as they assess potential job opportunities.

  1. Be Clear About Your Own Needs, Goals, and Priorities. Before you embark on the job-hunting process, take time to do some careful introspection. My partner John Nelson is fond of saying that one of the key reasons many doctors choose to become hospitalists is that they prefer to “date” their practice rather than “marry” it. Which do you want? Are you willing to accept both the benefits and the costs of your preference? What are your short- and long-term career goals? In what part of the country do you want to live, and are you looking for an urban, suburban, or small town environment? Is it important to be in a teaching setting? Are there specific pieces of work, such as ICU care or procedures, that you want to either pursue or avoid? What personal considerations, such as the needs of your spouse or kids, might limit your options? What structural aspects of the job are most important to you? Schedule? Daily workload? Compensation? I encourage you to think through these and other similar questions so that you are clear in your own mind about your personal job selection criteria. This will enable you to honestly articulate these things to others and to assess potential job opportunities in light of them.
  1. Do Your Homework. Just like the organization you are considering joining has a responsibility to learn as much as it can about you, you have a duty to do some digging to learn as much as you can about the hospitalist group and the hospital(s) it practices in. Don’t just sit back and expect to be spoon-fed what you need to know. The tendency of the folks you interview with will be to put the best face on things, and they may not always give you the full scoop. Look carefully at the hospital’s website, both to learn about the hospital and to see what it says – if anything – about the hospitalist practice. Check out the hospital’s performance on Medicare’s Hospital Compare site and read anything you can find on the Internet about it. Plumb your professional networks to see if anyone knows anyone who knows something about the hospitalist practice. If you’re working with a recruiter, ask the recruiter hard questions about things like the group’s turnover and vacancy rates. How much locums use is there? What’s the group’s morale and culture? What do exit interviews say about why people leave the group?
  1. Accept Your Share of the Responsibility. No marriage will work well unless both parties are fully committed to making it work. While the hospital and hospitalist group should be attending to fundamentals like adequate staffing, well-designed work, and building a healthy, supportive culture, the ultimate responsibility for your own job satisfaction and morale lies entirely with you. You need to meet your new hospitalist program at least halfway. This means being prepared to compromise some, to give others the benefit of the doubt, and to support your new group even when things don’t always go the way you think they should. Even if you don’t plan to be part of the group for the rest of your career, you shoulder much of the responsibility for making the relationship work for as long as you are in it.

Long ago, a dear mentor told me, “Leslie, be led by your objectives, not by your opportunities.” I have found this advice incredibly helpful as I have navigated my career. Sure, a fabulous opportunity may come out of nowhere that you feel like you just can’t pass up. But it’s easy to be seduced by the shiny brass ring. Before you decide, you should think carefully about whether that opportunity is likely to take you down a path that is different from where you want to end up. Sometimes pursuing such opportunities will work out fine anyway – I never really planned to get into the world of hospital medicine but am immensely thankful for the unforeseen circumstances that threw John and me together and started me down my current path. But I did have some core objectives that I wasn’t willing to compromise: the ability to be my own boss, to roll up my sleeves and do the work myself rather than just overseeing others, and to contribute in a meaningful way to making hospitals better, safer, more satisfying places for patients and the people who care for them. If I had chosen a path that ignored these core objectives, I would have been much less professionally satisfied and effective. The same will be true for you.

Good luck in your search. May you find a happy marriage that represents the best possible fit for both you and the practice you join.

Leslie Flores

Leslie Flores is a founding partner at Nelson Flores Hospital Medicine Consultants, a consulting practice that has specialized in helping clients enhance the effectiveness and value of hospital medicine programs as well as those in other hospital-focused practice specialties since 2004. Ms. Flores began her career as a hospital executive, after receiving a BS degree in biological sciences at the University of California at Irvine and a Master’s in healthcare administration from the University of Minnesota. In addition to her leadership experience in hospital operations, business development, managed care and physician relations, she has provided consulting, training and leadership coaching services for hospitals, physician groups, and other healthcare organizations. Ms. Flores is an active speaker and writer on hospitalist practice management topics and serves on SHM’s Practice Analysis and Annual Meeting Committees. She serves as an informal advisor to SHM on practice management-related issues and helps to coordinate SHM’s bi-annual State of Hospital Medicine Survey.

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