Wait a minute. Isn’t there an ongoing national shortage of hospitalists? Don’t most hospital medicine groups have trouble recruiting enough providers? You wouldn’t think hospitalists would be at much risk for being laid off. But believe it or not, it does happen.
Management companies lose contracts. Hospitals get acquired or lose a big book of business. Some administrator decides NP/PAs are more cost-effective than doctors. And – if our work with hospitalist groups around the country is any indicator – large integrated delivery systems are increasingly expecting top-quartile productivity from their physicians across all specialties, which means more work with fewer resources. I worked with a hospitalist program recently that has laid off several NP/PAs in an effort to improve productivity and financial performance; they haven’t yet laid off any doctors, but it could still happen.
While it’s still rare, I expect that hospitalists will become more vulnerable to layoffs in the future. Over the past decade, hospitalist programs have moved beyond being “nice-to-have” strategic plays and have become part of overall hospital “must-have” core staffing. But just like nurses and other core clinical staff, being necessary won’t protect us from being downsized when the entity that employs us becomes financially distressed or market-challenged. And all the current uncertainty over ACA repeal and tax reform is causing hospitals to tighten their belts at an unprecedented rate.
Getting laid off is traumatic. I can vouch for this from personal experience. Early in my career as a hospital administrator, I was the junior VP at a community hospital in southern California, responsible among other things for managed care contracting. At my urging the hospital terminated a contract with a major HMO that accounted for about 16% of its total business, rather than accept the unreasonably low rates the payer was offering. Little did I know that my own job would be one of the 200+ that vanished when my hospital lost that business!
In the aftermath, I second-guessed myself over and over: “If only I hadn’t . . .” It affected not only my finances and job prospects, but also my self-esteem and my confidence in my own judgment in ways I couldn’t have anticipated before experiencing it for myself. And even though I landed on my feet professionally and snagged a decent job at a different hospital within a few months, it took years for my confidence and self-esteem to catch up. I don’t want that to happen to you. Here are a few things you can do today to make sure you aren’t taken by surprise.
- First, know how your employer is doing financially – and in the marketplace. Don’t assume you’ll get plenty of notice if things start to go south. Read about your employer in the relevant media. Volunteer to participate in some committee or activity where you can be exposed to organizational leaders and the strategic decision-making process. Talk with other physician leaders who are “in the know.” Make sure there’s clear and open communication between you (or your group) and key stakeholders such as the hospital CMO.
- Second, know how you’re doing financially, and make sure you have enough savings set aside to cover your living costs for at least six months in the event you lose your income source. Fortunately, most hospitalists have employment agreements that have a reasonable notice period built in; but don’t count on that being enough.
- Make sure your CV is up to date. When you need it quickly is the worst time to have to update it.
- We like to say that hospitalist groups should never stop recruiting even when they are fully staffed; the same principle holds true for you. Never stop keeping your eyes open for professional options and considering where your next job might be, even though you’re perfectly satisfied where you are right now.
If the unthinkable happens and you do get laid off, here are some suggestions for successfully weathering the experience, some of which are courtesy of this great Harvard Business Review article.
- Find someone you trust to be a sounding-board for you. You will need to talk about this traumatic thing that has happened to you, and you’ll need someone who can help you look at it objectively. Your spouse or other close loved one may not be best for this role, since very often they may also be emotional – angry, resentful, bitter, or fearful – on your behalf. Best if it’s a trusted friend or professional mentor. If you don’t have someone like that in your life, ask your employer to provide you with some counseling or outplacement support as part of your severance package.
- Develop a simple, to-the-point explanation for being out of work that you can share with others. It should be a truthful, but positive message – one that doesn’t bash your former employer. You don’t come out looking good when you play the blame game and bad-mouth others. More importantly, if you get stuck in victim-talk, it will affect your own morale and ability to move forward. Believe me; I know whereof I speak.
- Take some time to regroup. If you’ve planned for this possibility, you shouldn’t need to immediately launch into job-search mode with laser-like focus. Go do something fun or interesting that you’ve always wanted to do but never had the time for. By far, the most important thing you can do for yourself during this time is to pay attention to your own physical and emotional well-being.
- Once you’ve taken some time for yourself, be diligent launching into job-search mode. Sustaining the energy and effort required of a job search isn’t easy. In 2007, my husband got laid off because his company closed its LA office. It was right before a trip to Italy we had been planning for months, and I said, “Don’t think about looking for a new job until we get back from Italy.” Somehow, he never got around to looking very hard, and eventually “I’m between jobs” morphed into “I’m retired.”
I know this isn’t a fun topic for any of us to think about. But it’s part of life in the workforce. My goal is to help people position themselves to have sustainable, rewarding careers in hospital medicine, and my hope is that these thoughts will help you be better prepared in the event the unthinkable happens to you.
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.