With the long-term trend showing ever more physicians choosing employment over private practice ownership, there are questions about how to make it work. At the top of the list is how to satisfy one’s personal professional mission, but there are many others, including those about compensation, lifestyle, autonomy, as well as how to not just survive but actually thrive.
An episode of the “AMA STEPS Forward® Podcast” includes strategies for how to be employed “well” by optimizing your professional satisfaction.
“Once one is part of an organization, they are expected to be aligned with whatever goals, whatever values, that organization has,” said Mark H. Greenawald, MD, a family physician in Roanoke, Virginia, who has been employed since he started residency in the 1980s. Dr. Greenwald co-wrote an article, “How to Be Employed ‘Well': Optimizing Your Professional Satisfaction,” in a 2022 issue of Family Practice Magazine.
For starters, leadership structures will likely be more complex than one would find in a physician private practice.
There's also the idea of citizenship, or being “part of a structure or a community that will have certain expectations and standards that may be different even than the expectations and standards that I've been taught as part of my professional upbringing,” Dr. Greenawald said.
Then there’s the notion of how value is calculated, “which may be different than the value that I see in terms of my independent interaction with a patient,” he said.
And there’s the emphasis on improvement. If, for example, an organization is part of an accountable care organization, there may be metrics that come from outside the organization, and “having alignment around those for financial reasons, as well as patient care reasons, becomes a little bit different,” he said.
The AMA Transitioning to Practice series has guidance and resources on deciding where to practice, negotiating an employment contract, managing work-life balance, and other essential tips about starting in practice.
Dive deeper:
- What I wish I knew in residency about being an employed physician
- In transition to practice, know these 8 steps for evaluating jobs
- When seeking new physician job opportunities, follow this advice
Don’t stand on the sidelines
The crux of the problem is that physicians—despite their values and training and experience—have often been sidelined in the employed physician model.
“We physicians have, in some ways, stepped outside of the conversation and given up some of our influence,” Dr. Greenawald said, noting that doctors’ answer to this has often been to leave their organizations. Another option is to lean into the conversation.
When one joins an organization, it is vital to understand “what is expected and what is valued, making sure that in some ways that aligns with our values,” Dr. Greenawald said, adding that “there are going to be some things that we may say, ‘Oh, that's maybe not as important to me, but I understand why from an organizational perspective, that would be important.’”
The main thing is making sure your personal and professional values are not being violated.
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Focus on these 4 areas
Dr. Greenawald said physicians who have found satisfaction in employment have focused on the following domains.
Employment and onboarding. “From the very start, even before one signs the contract, they really understand what the expectations are so they don't show up on day one and are immediately disappointed,” he said.
Becoming active. He recommended “taking an active approach to one's practice and saying, ‘Just because I'm employed doesn't mean that I'm going to sit back.’” Dr. Greenawald suggested pointing out—from the start—that you want to help build a culture that is in line with the values and goals of the organization.
Optimizing your income. At the heart of this is knowing what you want and need in the way of financial well-being. “So really understanding things like contract structure, benefits and what optimization would look like,” he said.
Having meaning in your work. “How can I measure that I'm actually providing good care?” he said, adding that this goes well beyond having a “kind feeling that I'm providing good care and I'm enthusiastic about it.” The more important part is identifying “some objective measures that I can use and the organization may think are important.”
Health care leaders will benefit from consulting the AMA STEPS Forward playbook, “Wellness-Centered Leadership: Cultivating a Culture of Wellness Within Your Organization.” A culture of wellness is one that emphasizes values, behaviors, and attitudes that promote self-care, compassion and professional growth.
For residents transitioning to practice or those already in practice who are considering a midcareer switch, a separate AMA STEPS Forward toolkit, “What to Look for in Your First or Next Practice: Evaluate the Practice Environment to Match Your Priorities,” will help you identify available practice settings and understand how they may impact your experience, clarify your priorities, and tailor your search for a fulfilling career in a positive and supportive environment.
