20 September 2009

A good primer

The Unstable Business of Emergency Medicine - Interview Questions for New Grads of Residency
While in the midst of the job-hunting process, I uncovered a file I created for myself when I finished residency. It had a list of Interview Questions to ask a potential employer. Many of the questions were very good, however, now having had a chance to look at the questions through the eyes of experience, I discovered that much more information should be given so the new graduate can truly understand what they can expect from their first job.
From Dr Brenner. Good stuff to think about if you are looking for a job, especially your first job out of residency.

Interestingly, I was recently interviewing a candidate who seemed to have a pretty strong opinion that he wanted to work for a small "democratic" group as opposed to a large corporate group (i.e. the multi-hospital contract management groups). 

So, I asked him, what do you mean when you say "democratic"?  He really didn't know, though he ad-libbed a decent interview reply.  But it was clear that he'd never really thought about it, or defined to himself what a democratic group is.  Rather, he'd been indoctrinated by his faculty that big groups=bad and small groups=democratic.

This is not an uncommon attitude among ER docs, especially new ones, and it's not without validity -- some mega-groups were/are notorious for abusing/ripping off their docs.   But truth be told, I've seen more abuse from small groups which purport to be "democratic" but in fact are quite dictatorial.  And in fairness, there are a few mega-groups which actually are quite democratic.

So what is a democratic group?

There are two key qualities that make a group democratic, in my opinion.  One is that it should be democratic in governance: There should be equal ability for all physicians to have a voice in the management and direction of the practice.  All physicians should be partners (perhaps after a reasonable "tryout" period), and all should have access to leadership roles (at least as often as they turn over).  The decision-making process should be inclusive and transparent.

The other necessary quality for "democracy" is that the group should be egalitarian in its operations.  Compensation and bonuses should be fair; perhaps driven by a predetermined formula, agreed on and understood by all.  New physicians should be paid fairly and not exploited.  Buy-ins for new partners, if required, should reflect the value of the group's assets and not simply an opportunity to enrich the existing partners.   Scheduling should be fair, with all partners working comparable ratios of weekend, evening and night shifts.  Vacations and holidays should also be fairly allocated. Seniority should not be excessively rewarded.

In my experience, the large groups occasionally fit this description more than independent practices.  Their size requires standardization of practices, especially financial.  On the other hand, the small scale of a small group allows the concentration of power in the hands of a small few, who are able to skim profits off of new docs without even appearing to do so. 

The point here is that size should not be used as a proxy for whether a group is one that you want to work for.  Ask the questions Dr Brenner outlines and do not be shy about it.  I respect candidates who clearly have prepared themselves and understand what to look for in a practice.  More to the point, if a potential employer doesn't want you to be asking questions, or won't answer questions satisfactorily, that's probably a really good sign that you don't want to work there.

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