As discussed in previous blogs, I work with young physicians coming out of fellowship/residency and taking their first jobs. Sometimes they work with hospitals but, more often than not, they go to medical practices across the country.
Once a contract is signed, I rarely hear from the physician until it’s time for partnership. However, recently I worked with a nice physician (“Dr. Green”), who moved his family across the country to Florida in order to join a busy solo physician eager to expand his practice.
Last week Dr. Green called to inform me he had been terminated on the six-month anniversary of his start date. What went wrong? Dr. Green was not sure. His employer had not provided any formal reason when he provided notice of termination without cause. I peppered my client with questions: Were patients happy with you? Were you busy? Did you have clinical issues? Dr. Green reported that everything was going well, patients liked him very much and there had been no complications with any procedures or services he provided. The practice remained busy and Dr. Green’s collections were good.
In pressing Dr. Green further, he revealed that his employer had seemed annoyed when Dr. Green asked questions or sought guidance and had mumbled to him “you need to go back to training” when he issued the notice of termination. Dr. Green was understandably upset by this comment — his clinical skills were good so to what was his employer referring? Efforts to seek clarification on the reason for termination went unanswered and the employer further refused to provide a letter Dr. Green could present to new groups in his job search.
Dr. Green and I were both angry and frustrated with his employer. Had he forgotten what it was like to be a new physician starting his first job? Did he not realize his actions could permanently impact the life and career of this young physician?
Luckily, Dr. Green negotiated a deal with a specialty group in the same city who both knew and spoke with his employer. The group was able to determine that the reason for Dr. Green’s termination was simply the employer’s dislike of working with a new physician who asked questions and looked to him for guidance. He provided no other reason for the termination. To their credit, the new group was appalled by the employer’s response, since the group has mentored young physicians effectively through the years and understands the process involved.
With any new physician, there will always be a period of transition. As good as a physician’s clinical skills may be, there is more to being a good physician than how well one performs a procedure or interprets a test. Young doctors need to be mentored by more senior physicians, whether it’s answering questions on how to interact with patients when sharing bad news, how to market the employer to referral sources, or even how to interact with particular physicians and medical staff. New physicians are not only young clinicians, they are also young people, and regular feedback on professional and personal choices and openness to answering questions are what a physician out of training needs, whether or not the mentor process is “formal.” An employer who is unwilling to make herself available, does a disservice to that new physician just starting out in their life and career.
Employment agreements rarely outline the process of review and guidance for new physicians and instead focus on tail policies, restrictive covenants, and grounds for termination. In Dr. Green’s new contract we focused on those provisions, but we also insisted on additional language that assured Dr. Green would receive feedback on his performance. His new employer is sensitive of Dr. Green’s concerns and his job is going well although, understandably, Dr. Green is a shy about seeking counsel from his colleagues.
Being a mentor is a role a physician plays every day. Attitudes towards patients, compliance, and professionalism are all cues absorbed by young, impressionable doctors. To have the best healthcare providers (however that’s measured), we need to make sure physicians do a good job in their role as mentors, whether it’s a function they take on willingly or not.
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