Employed? What your boss wants from you.

from Medical Economics, January 18, 2008
by Gail Garfinkel Weiss

For physicians, being in someone else's employ has its advantages—most prominently, the chance to practice medicine without the headaches of partnership. On the downside, you're not your own boss. Someone else is, and to be a standout employee, you need to know how practice leaders define and measure success.

Even in the busiest practices, conscientious leaders take the time to indicate what they're looking for in terms of productivity, call schedules, practice building, creating a referral network, and collegiality. A couple of examples: "In addition to having a good fund of medical knowledge, we want staff doctors to be warm and friendly, realize that they're part of a team, be flexible regarding call coverage and the need to pinch hit for sick colleagues, and maintain good relations with other local physicians," says pediatrician Richard Lander, managing partner of the four-doctor Essex-Morris Pediatric Group in Livingston, NJ.

Houston gastroenterologist Gary Glober, who conducts workshops in communication and leadership skills, puts it succinctly: ''Employers are looking for results. They want associate physicians to be efficient, effective, and sensitive, and to get on with it."

Practice leaders who don't spell out what they require from physician employees are probably looking for the same qualities as Lander and Glober. However, leaders' interpretations of how those traits apply in daily practice life may differ. So you'd be wise to request "What do you want me to do?" and "How am I doing?" and talk with them to clarify practice-specific expectations and determine if you're meeting them. Here's advice on how to do that, as well as more on what makes a boss decide that a physician employee is a "keeper."

Getting it right from the beginning
If you're fortunate, you'll know something going in about how to succeed in your job—either through a clear job description or a statement of performance expectations. During employment interviews with the 90-doctor Colorado Springs Health Partners, for instance, doctors are told what the practice is looking for regarding call coverage, work hours, patient relations, and what it will take in terms of work RVUs or patient visits for them to realize the financial compensation they want, says Jeffrey B. Milburn, CSHP's senior vice president.

When he interviews prospective employees, ophthalmologist Frank J. Weinstock of Canton, OH, looks for buy-in to the practice's philosophy—"high-quality medicine, no unnecessary surgery or procedures, and a desire to enjoy life and the family." From an employer standpoint, Weinstock continues, "honesty and lack of greed are essential. We discuss what we seek in terms of time in the office, production, high-quality patient care, and willingness to handle emergencies."

Once a doctor signs on, succeeding becomes a dual responsibility, according to Martin H. Osinski, president of American Medical Consultants in Miami, a healthcare consulting firm specializing in physician recruiting. "Some physicians come out of training and go into practice believing that all they have to do is show up. It doesn't work that way," says Osinski, who's president-elect of the National Association of Physician Recruiters.

"Someone entering a practice has to be willing to reach out to an eclectic group of customers, starting with patients but also including third-party payers, referring physicians, the hospital, the practice's other physicians, and support staff," Osinski adds. "You want to be the person who comes to mind when a nurse's friend asks her to recommend a physician."

At Colorado Springs Health Partners, those points are hammered home during the orientation period. "We tell recruits how they'll be evaluated when we consider them for partnership," says pediatrician Steven Reich, the practice's medical director. That evaluation looks at whether the doctor has adapted to the group's culture and met departmental productivity and financial benchmarks (the latter are based on data from the Medical Group Management Association and the American Medical Group Association). "We also look for evidence of good 'citizenship,' " Reich adds, such as attending interdepartmental meetings and CME programs and participating in committees.

The building blocks of a job well done
Once you've gotten your foot in the door, continued employment with a medical group is usually based on your ability to develop your practice; your rapport with patients, staff, and other physicians; and your willingness to go the extra mile.

Practice building.
"Incoming physicians have to recognize that turning a profit is a never-ending process," says Osinski. The practice should invest some money in newspaper ads introducing new doctors, and physicians in turn should make themselves available for community events and join hospital committees to develop contacts and widen their patient base. Being active in the local, regional, or national medical community helps, too. "Physicians need to recognize that they're marketing themselves whenever they're out in public," Osinski notes. "Whether they're in church or the grocery store, or the hospital, people are sizing them up and considering whether they'd seek that doctor's services, if necessary. You want to stand out as someone who cares."

Patient relations.
Colorado Springs Health Partners does annual patient satisfaction surveys, and as Steven Reich points out, "It's clear from the responses which doctors are providing a higher level of customer service." Occasional complaints from patients don't compromise a physician's employment status, Reich notes, but he'll think twice about retaining a physician whose patient complaint level is higher than average for that department.

Support staff.
Jeff Milburn is impressed with doctors who introduce themselves and make an effort to get to know and develop good working relationships with clinical and nonclinical staff. "If there's a lot of staff turnover attributable to one physician, we'll try to determine if there's something about that doctor's management style that's driving staff away," says Milburn.

Physician colleagues.
Medical group directors want the other physicians in the group to be happy working with— and referring patients to—new hires. They also want physicians to he available to cover for and consult with each other as needed.

Work ethic.
While some practice honchos ache for the days when employed physicians uncomplainingly put in 80- hour workweeks, most understand that today's younger physicians are less inclined than their predecessors to make medicine their whole life. As Steven Reich jokingly notes, "It's more difficult today to hire physicians and expect to be able to work them to death." Nonetheless, taking on extra work and showing initiative are time-honored means of impressing the boss, says Richard Lander. For instance, if you notice that missed appointments aren't tracked, suggest a means of doing so, or tell the practice head about a form that will improve documentation.

One caveat: While most bosses respect initiative, few respond well to mavericks. Run your ideas past the practice head or relevant committee, and then abide by their decision. "If I reject an associate's suggestion, I'll explain why, but I want the associate to respect my decision," says Lander. "It's still my practice."

How to elicit feedback from employers
CSHP's Steven Reich takes new physician hires to lunch two months into their employment to assess their level of satisfaction and comfort with the practice. Not all managing partners or medical directors are as accessible, however, which means it's up to you to elicit feedback—early and often.

Questions that can simply be answered Yes or No often inhibit feedback. Instead, ask specific, open-ended questions, such as: How is my charting? What comments has the group gotten from my patients? What are your thoughts about my practice-building?

Dale E. Fuller, a radiation oncologist in Dallas, suggests that when you're interviewing for a job, if the prospective employer doesn't give you a job description, ask about his expectations, performance benchmarks, and evaluation policies. "Essentially, you're creating your own job description," Fuller says. "Once the conversation is concluded, write a memo to the employer setting forth your understanding of the particulars and invite the boss to amend it accordingly. The ensuing document is, in effect, your job description."

After starting a job, physicians are often reluctant to bring concerns to light that might result in their being viewed as complainers or malcontents. But if these issues aren't addressed, it will affect your long-term satisfaction; plus, the problem is likely to continue.

If your practice doesn't have a formal evaluation process, ask to be evaluated after your first 90 days on the job, and again when you reach the six-month mark. Issues regarding quality of care, patient satisfaction, productivity, utilization of group services, and ability to interact in a positive manner with physicians and staff can compromise employed physicians' standing in group practices. It's important to know how you're faring on all those fronts.

Performance expectations and job descriptions, helpful as they are, only go so far, Fuller points out. "Just as understandings are merely a road map to a successful relationship, a job description for a professional shouldn't be construed as a set of boundaries outside of which the professional has no responsibility," he notes. "An 'it's not my job' mentality has no place in a medical practice. Physicians always have to be ready to do what needs to be done where patients are concerned. The gamut of performance expectations is a useful means of defining and gauging performance and can result in performance improvements, but there's no substitute for resourcefulness, effort, and self-awareness. To paraphrase the Cheshire Cat in Alice in Wonderland, if you don't care where you're going, any road will get you there."

Bringing a lifetime of learning to the job
When ED physician John C. Johnson, regional director of the 140-doctor Unity Physician Group in Valparaiso, IN, is asked what he wants from employed physicians, he starts with his "simple" response: "Everything they should have learned in kindergarten." His "more complicated" response encompasses other practice members, patients, work ethic, and practice policy:

• Provide outstanding patient service as well as sound clinical care, in that order.
• Work well with ancillary personnel in your department and with other physicians.
• Show up on time for patient care.
• Complete all of your medical records at the time of patient contact. If something slips through the cracks (a nurse has a chart squirreled away or you forget), complete the documentation as soon as you find out it's delinquent.
• Be willing to help out when the office gets overwhelmed or a staff member is late, sick, at the hospital, or needs an emergency leave.
• Respect everyone's right to have an opinion.
• Stay within the guidelines, policies, procedures, and laws of the group. If you feel that you have a better way to accomplish a task, ask the group to decide on a change. Don't ask staff to do things differently just for you.
• If you're getting ready to leave the office as another physician comes in, try to see all your patients without having to hand them off to the incoming doctor. "Handoffs" can lead to disasters for the patient.
• Enjoy your work and the people you do it with. If you don't, we need to talk.