Avoiding the Wrong Fit: A Physician’s Guide to Evaluating Culture

Career Resources articles posted on NEJM CareerCenter are produced by freelance health care writers as an advertising service of the publishing division of the Massachusetts Medical Society and should not be construed as coming from the New England Journal of Medicine, nor do they represent the views of the New England Journal of Medicine or the Massachusetts Medical Society.

March 2012

By Thomas Crawford, MBA, FACHE, Faculty, Department of Urology, College of Medicine Adjunct Faculty, Department of Health Services Research, Management and Policy College of Public and Health Professions at the University of Florida. Along with Cilia Zayas, MHA Student Department of Health Services Research, Management and Policy College of Public Health and Health Professions at the University of Florida.

Poor cultural fit is the leading cause of voluntary physician turnover (Cejka Search, 2009, “Key Findings”). Consequently, understanding the cultural questions to ask a potential employer becomes paramount to ensure that unwanted personal and professional disruptions associated with changing employment settings are avoided. For the purposes of this article, and based on discussions with numerous physicians of all specialties, culture is defined as the accepted behaviors, expectations, and outcomes that influence a given work environment.

Why is it difficult to assess the culture of a department, practice, or organization during the interview process? Because first and second interviews generally don’t last more than a combined total of four days, and you are left with a limited window of opportunity to evaluate the work culture. That said, it is essential that you know which questions to ask — and each question is important.

Cultural Assessment Questions
The following questions were designed to ensure you are equipped with an armamentarium of workplace cultural assessment tools to size up a potential employer.

How frequently is physician satisfaction measured?
Physician satisfaction metrics provide department, practice, and hospital leadership with an opportunity to understand what is working well and what is detracting from the work environment and what is dissatisfying to members of their medical staff. It provides decision-makers with a snapshot of aggregated physician satisfaction — with their employer, with other medical staff, and with each other. Physician satisfaction should be measured at least biennially, and if it is not measured, you need to ask how you will provide feedback on practice elements you find dissatisfying (e.g., at medical staff meetings). If physician satisfaction is measured, ask to see the results; survey findings may illuminate potential issues before you accept an offer. Additionally, ask if any negative trends were captured in the survey and how the organization plans to address them. If an organization fails to work on identified problems, it may be indicative of an environment characterized by low physician morale, and you run the risk of working in a practice setting with high physician turnover — turnover that someday might include you. 

How frequently is overall employee satisfaction measured?

Employee satisfaction, which should be measured annually, is imperative because the results influence the safety and efficacy of the care you are accountable for, and more than likely your quality of life. Unseasoned or insufficient staff can dramatically increase the number of interruptions during office hours, after-hours calls, and the quality of the care you deliver (e.g., decubitus ulcer, patient falls, and failure to rescue). Additionally, measuring employee satisfaction provides leadership with an opportunity to understand employees’ perception of their treatment as equitable and if they have the tools and equipment necessary to perform their job requirements. Staff turnover will dramatically impact your care environment, because industry-specific knowledge is acquired through training and experience, and practice-specific knowledge — mainly physician preferences — can only be acquired through provider-specific exposure.
How frequently is patient satisfaction measured?
High patient satisfaction is the hallmark of a successful team-based care environment and should be reported at least quarterly. No other metric will provide you with a clearer picture of the perceived successes and failures of a team than patient satisfaction. 

Why, if applicable, did your predecessor leave?
To ensure you are not walking into a less-than-desirable employment situation, you should inquire if it is possible to speak to your predecessor. However, be cautious to capture facts versus opinions, and never accept a single-sided version of the story.

What is the financial health of the department, practice, or hospital?
Nothing changes a culture faster than poor financial performance. A financially challenged practice setting can affect your pay, your work schedule, and the resources made available to you. Ask questions that pertain to the entity’s profitability for the current and previous fiscal years. If financial performance is poor, ask about the strength of the balance sheet. Since a balance sheet offers a snapshot in time of an organization’s assets, liabilities, and equities, it will shed light on whether or not your prospective employer has the cash and cash equivalents required to weather an unpredicted financial storm.

What keeps you up at night?
Though you may not want to lead with this question, when asked at the right time, it will provide you with personal insight into the pressing challenges faced by your potential leaders and peers. Furthermore, it is a strategically open-ended question designed to stimulate a dialogue on the pertinent issues within your future work environment. 

Potential employers will assess if you are the right fit through the interview process and by performing their due diligence by verifying your references prior to extending you an employment offer. Offer yourself the same opportunity. Don’t be apprehensive to ask questions about the culture you will be working in. There are no good surprises in health care, and finding out that you’re the wrong fit after you begin a new position will be an unpleasant disruption that could have been avoided for both you and the employer.

Cejka Searchwww.cejkasearch.com/Physician-Retention-Survey/2006RetentionSurvey/default.htm.


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