As our specialty of hospital medicine continues its exponential expansion, so does the number of established programs to choose from. Without exaggeration, the job market in most areas of the country is pretty hot right now—and all of us know this from the avalanche of offers and job advertisements out there.
Speaking as someone who has worked in several different hospitals and interviewed in dozens of programs across the country, I’ve probably seen the best and the worst of them. Fortunately for me, I’ve mostly had the pleasure of working in the better places—with great leaders and strong support for the specialty. But I’d also be lying if I said I hadn’t seen some fairly terrible places too, and certainly interviewed in some that struck me as toxic almost as soon as I walked through the door. I therefore feel I’m in a position to offer a little bit of advice to all those colleagues out there who may be considering their next job move.
Before I do that however, I’d like to base what I’m about to say on a theory called thin-slicing. For those of you unfamiliar, it’s a theory in psychology that says you can use the shortest of time periods and snapshots to gain profound insights into any given situation. It can equally apply to a person or an institution. For example, fascinating studies have been done looking into people’s facial smiles in photos and their life outcomes, which I’d encourage anyone to read about. Another example is the advice that rather than interview someone for a job and ask a series of questions about their organizational skills and competency, just take a picture of their bedroom. How they keep their room will tell you more about them than sitting and asking them questions for 30 minutes. An intriguing phenomenon, and a strong school of thought in psychology believes it to be valid.
So having said that, I would like to apply the thin-slicing theory to any hospital medicine program (and please feel free to use this as a checklist during your next interview):
- Pre-interview day. Has the hospital sent you a well organized and detailed itinerary with people to meet at set times, or does everything seem very random and haphazard (red flag number 1)?
- During the interview, is a physician from the group leading you around (ideally the Chief) or is it some random non-clinical administrator (red flag number 2)? Along the same note, does the program appear to be run by physicians or non-clinicians?
- When you are being shown around, observe carefully how the program Chief interacts with his or her colleagues. Is it collegial and friendly, or is it somewhat awkward (red flag number 3)?
- If you have lunch with the group, is the atmosphere a jovial one or is it slightly uncomfortable (red flag number 4)? Watch carefully whether the head of the group is also present (which they should be) and be sure to ask all the usual questions about turnover, specialist support and a typical workday. Make sure you get the answers directly from members of the group. Can you talk directly to the member(s) of the group that are leaving and gauge their thoughts? I’m going to throw in a curve ball here, but also look carefully at the hospital cafeteria. Is it well run with enough staff, or does it seem poorly maintained with inadequate staffing? In my experience, a hospital with a badly run cafeteria says a whole lot about the entire organization.
- Insist on taking a trip to the hospitalist office. The size and appearance of the office will tell you a bucket load about how much the organization values hospital medicine. Is it spacious, clean and nice appearing, or does your local RMV office appear more modern (red flag number 5)?
- After the interview, does the place seem in a hurry to hire you and evasive of certain specific questions you have (red flag number 6)?
- If you are permitted to do so, sitting in on a monthly meeting of the group is also a very worthwhile thing to do. Again, is it led by the head of the group or a non-clinician? Does there seem to be a tense or strained atmosphere within the group (red flag number 7)? Even if you’ve already signed the contract, consider doing this before your official start date.
My own experiences over the years have ranged from being left waiting for over an hour in a busy Miami physician’s office prior to my interview (no itinerary given to me that day), and being told by one hospital Chief in Connecticut that he only had a few minutes to sit down with me and that the whole group was too busy to talk with me or give me a tour of the hospital, but that I could walk round myself!
Like most of healthcare, hospital medicine is of course facing its fair share of changes and challenges. As someone who loves the specialty, I know how choosing the right group makes all the difference. Due to the uniquely grueling nature of a typical busy day in our field, choosing the wrong one can truly break you. Take your time to consider your next job carefully and be careful and wise before you sign on that dotted line.