How to keep your job in a tight market

Maybe you can't make yourself indispensable, but there's plenty you can do to ensure that colleagues and staff like having you around.

By Gil L. Solomon, MD

No longer are primary care doctors guaranteed a great job. In California and other places where managed care is the norm, practices are downsizing and even going out of business. When you land a position, you can't assume it's yours for life, or until something better comes along. You have to work hard to keep it.

How do I know? I've seen the process from both sides—serving on a task force charged with eliminating nine full-time doctor positions, and as an employed physician who was given 30 days' notice when my group ran into financial problems. Let me share these lessons with you:

A medical group is not a meritocracy. You may be more up to date, see more patients, and stay later than any other physician in your office. But seniority and longstanding relationships may carry greater weight than ability and effort.

For instance, I teach with a well-qualified, clinically competent, hardworking family physician who was fired from a large, closed-panel HMO at the end of her first year. Why? Other members of her department weren't "comfortable" with her. In retrospect, she wonders whether the termination would have happened if she had gone to lunch with the other doctors and gotten to know them better.

Bear in mind, too, that looks count. Perhaps, during med school, your idea of fancy dress was a pair of black jeans and scrubs. Now it's time for a business wardrobe. Your colleagues and patients don't expect Beau Brummell, but I've found that unprofessional attire will be noticed.

Be a team player. From the start, do more than the minimum. Say your group asks you to join its utilization review committee. "I'd be glad to help. What time should I be there?" you should respond. By stepping forward, you'll build valuable relationships with physicians who you might not get to know during your regular workday.

As a bonus, the committee's chair is probably on the group's board of directors—a body that will decide your salary, workload, and tenure. If someday the directors have to trim staff and their choice is to fire either you or a colleague, you'll want them to have formed a positive opinion of you.

What if you aren't sure you can handle the extra work? Say something like, "I'd love to, but I'm already on the staffing committee. I don't know if I can give both my best effort. What's involved exactly?" This response buys you time, so you can mull over your decision. It also shows that you're taking all your assignments seriously.

And what if you're sure you can't satisfy a request? Give a positive and honest response. "I'd be glad to switch on-call days," you might say. "But unfortunately I'll be in Scottsdale then."

Productivity counts. Most groups keep track of the number of patients a physician sees, and many groups peg salary to the statistics. Carefully look at your stats to make certain you're within the norm. If you're an outlier, you may have to modify your practice style.

Not all groups are sophisticated enough to take treatment complexity into account. A physician I once worked with saw a small number of patients because many of the people she treated had time-consuming problems, such as fibromyalgia and depression. In my view, her extra time with patients actually saved the group money under capitation. Without her, these patients likely would have heavily utilized specialty care, diagnostic testing, and the ER. Unfortunately, others in our group didn't see it that way. The physician's status suffered because of her low numbers. Eventually, she resigned.

I'm not suggesting you refuse to see patients who require large chunks of time. But you might consider scheduling a second visit rather than try to take care of numerous problems at once. In any case, the most important thing is to understand how your group views productivity, and act accordingly.

Choose your battles. For sure, you won't always agree with the group's other physicians. But be cautious in expressing contrary views. The doctor you tell off because he constantly dumps patients on you in the late afternoon may play golf every week with the medical director and some of the board members. Being right does you no good if you're never given the chance to tell your side of the story.

Compliments cost nothing. Apply them liberally. As a physician, you're used to presenting a patient to an attending, only to be criticized for the obscure fact that you left out. Doctors thrive on such abuse. But your staff doesn't. Thank them at the end of each day for their efforts. Praise them for tactfully handling a difficult patient. Tell them you appreciate the way they juggled three tasks and at the same time kept you on schedule.

As you sow appreciation, so you may reap it. The administrative staff—which is responsible for creating call schedules and prioritizing vacation requests—can have a major effect on your life. Friendly, courteous behavior toward staff members will pay off later. It might, for example, change the response to your request to meet with the medical director. Instead of "He's booked for the next three weeks," you'll get "I'll try to squeeze you in."

Communicate clearly and own up to mistakes. Physicians get in the habit of giving verbal orders to hospital nurses, then expecting the orders to be followed. But your office medical assistant isn't the same as an RN in an ICU. For your staff, write everything down to avoid mistakes. If you forget to request a test, acknowledge that it's your fault. No screaming, "I'm sure I told you to order it!"

A medical group is like a small town: awash in gossip. Your proclivities are sure to be spread far and wide. If you refuse to see patients after 4:30 in the afternoon or you spend a lot of time talking on the phone with your stockbroker, the group's medical director—along with everyone else—soon will know. You can't stop the staff from gossiping, of course. But you need to make sure what they say is positive.

By the same token, your staff is a good source of information. You just have to give them the opportunity to communicate. On occasion, take your staff to lunch. You'll learn more at a single such outing than during a half-dozen board meetings.

Remember, however, that you're their boss, not their best friend. If they want to spill the beans, you'd do well to listen. But keep your negative opinions about colleagues and staff members to yourself.

Beware of gossiping physicians, too. A person who eagerly gives you the dirt on others is likely to dump on you, as well.

The author, a family physician in Glendale, CA, is a Contributing Editor to Medical Economics.

 

Gil Solomon. How to keep your job in a tight market. Medical Economics 2002;3:104.