My Medical White Whale: Finding a Hospital Where Doctors Love to Work and Would Recommend to Colleagues
I am a physician and retired from clinical practice. My happiest times were very early in my employed career and then my last six years doing Direct Primary Care. I thoroughly discussed the former in my book The Hospital Guide to Physician Retention: Why Creating A Physician-Friendly Environment Is Critical For Your Organization’s Success. It was a place where the physician community was close-knit in a medium-sized town in Maine. We knew each other. We were friends. We went to events together, and we even hung out in the Physician’s Lounge together. The administrators listened to us and valued us as physicians. We were so content there that we ended up recruiting 8 other family doctors we knew from residency. Then things changed.
Unfortunately, it’s been a long time since I saw a cohesive physician community. I remember almost taking a job for a large family physician-owned group at one point, but the feeling wasn’t there. There were four doctors in our office and none of us talked to each other. We maybe nodded when we saw one another. Or not. This contrasted with when I worked in Maine with three great friends where we did lunch and 3 PM coffee every day. Things were different.
Direct Primary Care solved almost all of my problems with practicing medicine. I didn’t deal with insurance companies, accounts receivables, coding, and administrators. I was my own boss with nothing between my patients and me. DPC, however, can be a solitary sport and I didn’t have the colleagues with me to commiserate or laugh with. Nonetheless, it was a great move.
I have written three books to help out other potential DPC doctors and I feel good about what I have done for the movement. That being said, I have always felt bad about leaving my peers who were employed by others, that being hospitals and other big organizations. They were burning out hard and many were quitting or even hurting themselves in different ways. This is why I wrote my book on Physician Retention.
Recently, I was on a “This Just In” radio show where the interviewer, Justin Barnes, asked me to talk about the good hospitals I came across in my research. I couldn’t answer immediately. Why? Well, for one, I had done my research for the book for over ten years. When I first put out surveys to doctors, there were only a few docs who told me of great hospitals to work for. What people don’t know is that CEOs and hospital administrators change very quickly in today’s landscape. I didn’t really feel comfortable giving names of places that may no longer have great environments. So, I decided to try again. That’s where this adventure began.
It is NOT easy to find enough doctors to discover the WHITE WHALE OF MEDICINE. You need connections. Luckily, through my blog of 20 years and my connections on social media, I have some but that is still definitely a limiting factor. There are many more. I couldn’t trust the awards given out to hospitals as “Great Places to Work.” The number of docs, who respond to give those awards, are few and far between. They usually use indicators that mean nothing if you, as a doctor who works there, want to recommend the place to other colleagues. For example, HCA in North Carolina is ranked number 7 in that state, but a recent article showed a massive exodus of physicians from that system. What does that tell you?
How about the physician turnover rate? I have seen that average to be about 2%, but again, that means nothing. The hospitals give those numbers out themselves and they lie. One system I worked for, an urgent care chain, claimed they had this same average, and yet I saw one local clinic go through eighty doctors in a year. Eighty!
The only legitimate number, in my opinion, would be the eNPS® score, which asks the question, “On a scale of zero to ten, how likely is it that you would recommend this hospital to a colleague to come work here?” We can talk about why that is the perfect survey, but it would be too lengthy for a discussion here. I would recommend you go to this link to learn more.
This leads me to my adventure on the high seas of social media. The only place I could ask doctors about a great hospital environment was LinkedIn, Twitter, and Facebook. Here was the question I posed just to get some leads:
Does anyone know of a great hospital system to work for? A place where you are valued by the administrators? Where the pay is good, Doctor’s Day is celebrated, and they still have a Doctor’s Lounge? A place where there is a solid physician community and doctors don’t want to leave? I am researching this topic to find the best places to work for physicians. I don’t care about the phony awards that some hospitals receive. I want to know what the doctors, who are actually working there, think.
This question went out to all the physician groups that are on FB. That was a total of 32235 members. Before I give you the results, let me fess up about why what I did is not an official study due to the confounding variables. For one, 32K docs is a small fraction of the 900K docs out there. Many of the 32K were also in the same groups I questioned, so there were duplications. Also, doctors are poor responders to any question posed to them. My question itself leads to a bias in the answers. Lastly of the “good responses”, a few were offered by medical directors. I have found that those docs are biased. I have seen that over and over again in my career. Were those directors who answered biased? I have no idea.
So, here are the results. Only 17 hospitals or hospital systems were mentioned to me as great places to work. This does not count the responses such as Xanadu, Utopia, Fantasy Island, Valhalla, and Twilight Zone. Those places are not real, but I think those doctors know that.
I have decided NOT to list the names of these places. Why? For the same reason that I mentioned above. To me, only the eNPS® score is valid. An N of 1 probably means very little. It is a starting point, though, and my future goal is to investigate these places more thoroughly and hopefully get them to allow me to give their doctors an eNPS® survey. What I will offer you are some of the comments I received. Here they are:
- I feel respected, I am able to accomplish much, and there is a strong community.
- They value independent physicians, your opinion matters, and they do have a Physician’s Lounge.
- I honestly think my employer does a good job. We have a Doctor’s Lounge and everything.
- I don’t have a NP or PA and new patients are seen by a MD/DO.
- The pay is competitive. They took my feedback and actually are calling it Doctor’s Day instead of Provider’s Days and this year recognized doctors’ accomplishments. There is a doctor’s lounge with free food though limited variety.
- They were still hiring doctors even when COVID hit and others were being let go. They continue to hire doctors. The CEO did awesome revamping financials several prior to COVID so was able to do this. Still saw raise even after COVID.
- We are small but we do have a small room for docs only and cafeteria food is free for docs. Almost every doc who has left in my 10-year career retired. There are issues but administration really does listen to us and the CMO has always been an MD/DO.
- Not only do they have a Doctor’s Lounge, but they have a private chef Monday to Friday who makes meals for the physicians. If you don’t like what they have in the lounge buffet or the private chef, physicians get free food in the hospital cafeteria which is beyond excellent. The nurses gladly assume whatever role is necessary, including unit clerk.
- They use “Planetree” for their guiding principles and Administration really “walks the walk” and “talks the talk” when it comes to following Planetree’s philosophy. I think the other “secret sauce” is that they are not part of a huge conglomerate oligopoly hospital system.
- The culture is very supportive. Granted I never worked there as faculty but have many friends who do or did in the past. Compared to all my peers who worked in different institutions they expressed that they were overall happier and less at loggerheads with the administration.
- We got spoiled on Doctor’s Day with breakfast and lunch. Plus, cookie cake was brought to the office. And the office manager and staff got us gifts. Good pay. Good benefits. Happy group of folks.
Let me sum this up. The best places had these traits:
- The doctors felt valued by the administration.
- The doctors were treated differently than non-doctors and the administrators knew this mattered.
- They celebrated Doctor’s Day.
- They had a Doctor’s Lounge.
- The doctors felt the administrators listened to them and acted on those opinions.
- There was a cohesive physician community.
- The pay was competitive.
- Free food matters.
- They responded well during the COVID pandemic.
- The doctors who worked there seemed happy.
- The little things mattered: gifts, benefits, not being called a provider, etc.
- Small hospitals seem to do better.
Did I find my medical white whale? Not yet. Remember, there are 6000 hospitals out there. It seems like some of them are doing things right. I didn’t mention all those doctors who responded to me by wanting to know the answer so they can go there and work. What does that tell you? When hospitals do the right things, they don’t have to worry as much about recruitment because doctors will want to stay there.
I was pleasantly surprised by these answers. Why? I had put all this in my book. It’s all there in writing. It’s the same thing over and over again. Doctors are human and are consistent in their needs. The game plan is available. All these hospitals need to do is follow it.
“Sorry, but physicians who crave free meals, gifts, and other pats on the head from administrators have profound neediness and approval issues that need to be addressed outside of their professional lives.”–Stewart
What an absolutely shallow take about colleagues. When I see that list, I see docs who just want to be appreciated and supported by their employers. What they are asking for is not much IMO. It is normal to desire acknowledgement of one’s hard work every once in a while, docs are human. Why a colleague would perceive that desire as a psychological flaw says more about him/her than the docs who responded to those questions. And it so typical of the toxicity of medicine. A doc asks to be respected and appreciated and is perceived as being obnoxious, arrogant and/or needy. It’s all so f***ed up.
When I was a resident, we had a resident’s lounge. Our call room was outside the hospital and up a hill. So we would eat, commiserate, sleep, study or just hang out in the lounge. My residency class was a close bunch, fostered by a supportive chair, PD, department secretary, attendings and nurses. We thrived. My hospital also had a physician lounge which I would use when I rotated on other services and I witnessed the same that “arf” describes so well in the commentary above. The influence of senior physicians, be they retired or not, cannot be understated. I was in awe of these docs who were walking textbooks. When physician lounges were allowed to be “invaded” by non-physicians and other staff or altogether removed, that very important connection/interaction was lost. The docs who never experienced it will never know.
Honestly, I don’t disagree with anything you’ve said.
Historically, “respect and appreciation” have been earned and have come to us from our peers, our co-workers, and our patients. My point is that when we begin to seek that kind of feedback from pimply-faced administrators armed with on-line MBAs – well, something has gone really wrong with a once noble profession.
Sorry, but physicians who crave free meals, gifts, and other pats on the head from administrators have profound neediness and approval issues that need to be addressed outside of their professional lives.
That wasn’t the point. No one said that but you go ahead with your moral superiority.
Those perks had a purpose. The Doctor’s Lounge. You could talk about matters going on in the hospital more informally, out of earshot of the patients. The hospital kept food there, as the doctors might be working through lunch or dinner with an emergency or difficult surgery. Also in the doc’s lounge, at one time, you would see the senior docs coming in just to be around medicine. My town, grew up and then practiced there, had old Victorians, the physicians bought many of them at one time. They had separate servant entrances and a carriage house that turned into an in-house office with parking. The town taxed the hell out of them as residential, better as business, and were once white elephants. It was good the docs used them as otherwise they would likely have been torn down in the ’60’s and ’70’s.
The old docs continued to see a few patients in their office that way, walked to the hospital. Others worked the free clinics that hospitals used to run. They were delighted to have a medical student (me). The back stories of hospital idiosyncracies, why a hospital does some funny thing, from some incident long ago. Plus great stories of their days as medics with Flying Tigers behind Japanese lines.
Of course, long gone.
Love this!
Well, you don’t want my hospita as an example. The doctors at my hosptal unionized a few years ago.
Do you know how much you have to piss off a doctor to convince that doc to join a union?
Another important value for the physicians lounge.
A few of the doctors liked their poker games. A thousand or so might come and go, but they weren’t gambling what they couldn’t afford to lose. A few local businessmen in the game. Food, booze, cigars, guys. Game is scheduled when they’re all off duty.
Nobody knows who dropped the dime to the police. Suspicion is ex-wife of one of the players. I was dating a local reporter, who covered the story. Call to police described a Tony Soprano mob operation fleecing people, drugs, etc. Police raided the place, and were not happy to see they had busted several local doctors and businessmen with whiskey and cigars. They really thought they had a Mob bust.
But, by law, the money on table was forfeit to the State (or cop’s pockets, who knows). Paid some fine, got some minor admonishment from the Board. Nowadays the Board would likely put the guy in some wellness program for fifty grand out of his pocket.
But to the point, you need the doctor’s lounge so you could be there the next morning when the doc walked in for lunch, to a standing-room-only physician lounge, to hear him describe the event, what it was like to Assume The Position, and spend an evening as a guest of the City.
I suppose that conversation was not something the hospital patients should hear, though I must say, it was a small town, so everyone knew and really didn’t care. Doctor in question continued to be my mother’s doctor until his retirement. He was a superb doctor who liked his card games, and I was more than happy to see him care for my mother. Back when doctors were allowed to have human idiosyncracies.
I remember those days also – they were good.
But what’s being talked about here, to my understanding, is being employed/owned by hospitals. And, no matter how much free food they toss at you, being a physician and being a pawn of the admins is a terrible, no-win situation.
The White Whale
Starbuck: To be enraged with a dumb brute that acted out of blind instinct is blasphemous.
Captain Ahab: Speak not to me of blasphemy, man; I’d strike the sun if it insulted me. Look ye, Starbuck, all visible objects are but as pasteboard masks. Some inscrutable yet reasoning thing puts forth the molding of their features. The white whale tasks me; he heaps me. Yet he is but a mask. ‘Tis the thing behind the mask I chiefly hate; the malignant thing that has plagued mankind since time began; the thing that maws and mutilates our race, not killing us outright but letting us live on, with half a heart and half a lung.
When it comes to Moby Dick, the hospital administrators stick to Chapter 95.
Had you stepped on board the Pequod at a certain juncture of this post-mortemizing of the whale; and had you strolled forward nigh the windlass, pretty sure am I that you would have scanned with no small curiosity a very strange, enigmatical object, which you would have seen there, lying along lengthwise in the lee scuppers. Not the wondrous cistern in the whale’s huge head; not the prodigy of his unhinged lower jaw; not the miracle of his symmetrical tail; none of these would so surprise you, as half a glimpse of that unaccountable cone,- longer than a Kentuckian is tall, nigh a foot in diameter at the base, and jet-black as Yojo, the ebony idol of Queequeg. And an idol, indeed, it is; or rather, in old times, its likeness was. Such an idol as that found in the secret groves of Queen Maachah in Judea; and for worshipping which, King Asa, her son, did depose her, and destroyed the idol, and burnt it for an abomination at the brook Kedron, as darkly set forth in the 15th chapter of the First Book of Kings.
Look at the sailor, called the mincer, who now comes along, and assisted by two allies, heavily backs the grandissimus, as the mariners call it, and with bowed shoulders, staggers off with it as if he were a grenadier carrying a dead comrade from the field. Extending it upon the forecastle deck, he now proceeds cylindrically to remove its dark pelt, as an African hunter the pelt of a boa. This done he turns the pelt inside out, like a pantaloon leg; gives it a good stretching, so as almost to double its diameter; and at last hangs it, well spread, in the rigging, to dry. Ere long, it is taken down; when removing some three feet of it, towards the pointed extremity, and then cutting two slits for arm-holes at the other end, he lengthwise slips himself bodily into it. The mincer now stands before you invested in the full canonicals of his calling. Immemorial to all his order, this investiture alone will adequately protect him, while employed in the peculiar functions of his office.
That office consists in mincing the horse-pieces of blubber for the pots; an operation which is conducted at a curious wooden horse, planted endwise against the bulwarks, and with a capacious tub beneath it, into which the minced pieces drop, fast as the sheets from a rapt orator’s desk. Arrayed in decent black; occupying a conspicuous pulpit; intent on bible leaves; what a candidate for an archbishopric, what a lad for a Pope were this mincer!
Bible leaves! Bible leaves! This is the invariable cry from the mates to the mincer. It enjoins him to be careful, and cut his work into as thin slices as possible, inasmuch as by so doing the business of boiling out the oil is much accelerated, and its quantity considerably increased, besides perhaps improving it in quality.
I left one employed position at a for-profit hospital for another position, this time at one of the largest not-for-profit health care organizations in the US, a year and a half ago. I was acquainted with my new employer from having worked in the “mother ship” hospital as a medical student, and then as a sub-specialty fellow over 20 years ago. What a difference 20-30 years makes. Over half of the Hospitalist staff has left over the past year. The hospital has been unsuccessful in recruiting anyone to join me. I’m taking 15+ days of call a month for an ER that is in the top 5 for patient volume in the state, in a community that is maybe the fastest growing in the US. No block time in the OR. No basic instrument trays or regular staff for OR cases in my specialty. An almost unusable EMR system (actually two systems that don’t communicate with each other). But the worst? Having the CMO schedule an important meeting about ER call, but doing so when those of us who take call can not attend the meeting. So much for the importance of physician input.
I don’t have any answers but maybe others do and then we can show them to the rest of the country.