With new research published in JAMA Surgery showing that faculty surgeons are more likely to get promoted if they change institutions, residents looking for their first job after the end of training may want to keep a potential employer’s career-development opportunities in mind.
“Many health care systems grow by recruiting from the outside, so the competition from within is much greater as they are taking steps to expand their footprint,” said Brooke M. Buckley, MD, MBA, vice president of medical affairs for Henry Ford Health in Detroit, and an alternate delegate for the AMA House of Delegates.
Henry Ford Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Dr. Buckley said the link between career development and turnover—even outside of academia—is clear, and it’s key for physicians to find an employer that takes the long view of your professional relationship with them.
“If you sense you're not going anywhere, you're more likely to be looking,” she said. “Henry Ford Health is an organization that very much celebrates and grows their own. We have a culture that prioritizes building a strong foundation and growing with us, rather than looking for someone from the outside to help us grow.”
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Moving around may aid promotion
The JAMA Surgery study shows that, after adjusting for other factors, an assistant professor was 33.7% more likely to be promoted if they changed institutions, and an associate professor was 58.1% more likely to be promoted.
“Amid the growing national surgeon shortage and reductions in federal funding, minimizing faculty turnover is critical to maintaining institutional stability and ensuring the continued fulfillment of clinical and academic missions,” say the authors of the study, “Implications of Changing Institutions for Promotion in Academic Surgery,” Isabelle M.C. Tan; Haley Harris; Yuqing Qiu, MS; Julianna Brouwer, MPH; Heather Yeo, MD, MHS, MS, and Julie Ann Sosa, MD.
Researchers tracked those who entered full-time faculty appointments in surgery between 2000 and 2010 using the deidentified data of 6,321 surgical faculty members from 136 academic institutions.
The study found that 67% of assistant professors and 71.1% of associate professors who changed institutions at least once in the study period were promoted within 10 years, compared with 60.3% of assistant professors and 56.6% of associate professors who were promoted without changing institutions.
The negatives of switching institutions
The study’s findings resonate with the experiences of Dr. Buckley, who, prior to arriving at Henry Ford Health, often had to move for new positions and career advancement.
“The place where you train often doesn't give you room to grow. Whoever you are when you arrive is often how you're typecast for the remainder of your career there,” she said, reflecting on the typical career frustrations that physicians have. “In the experiences of my colleagues, it's very common to have an outsider chosen over you for a promotion.”
It’s not a benign requirement, though, Dr. Buckley said.
“There's a real toll on physician families and communities when you're constantly expected to move to advance your career,” she said, adding that physicians often ask themselves: “I could get this promotion elsewhere, but then I would have to move my family, so should I make that transition or not?”
In addition to turnover being hard on physicians, “it can be very, very disruptive” to health care organizations and the patients they serve, she said.
“From the system side, many budgets are siloed, so the funding may come from a different pocket,” she said. “Looking across all the disciplines is an opportunity to assess the full, system-wide cost of outside recruiting, rather than viewing the impact only at the department level. External hires may bring visibility, but those benefits need to be weighed against recruiting fees, ramp-up time and potential cultural disruption."
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Leaders who take the long view
As a physician leader, Dr. Buckley said the work of an organization nurturing a physician’s career starts in training, when residents are just starting to think about what their life may look after the transition to practice. She said retention of residents and fellows is key, a process that involves getting to know their motivations.
“In terms of career development, it's important that we take the time—both when people are in training and throughout their careers—to understand their short-term goals. Are they about financial gain? Academic titles? Stability and family? Caregiving for aging parents? What is driving you? Because if you're in a complete mismatch, at some point, the cards get called, and life takes you in a different direction,” she said.
Leadership is a pillar of the AMA’s Joy in Medicine Health® System Recognition Program, which empowers health systems to reduce burnout and build well-being so that physicians and their patients can thrive.
Having been with Henry Ford Health for five years, Dr. Buckley said that she’s finding the value of long-term connection.
“I feel like I belong somewhere. I have a faith community and a school community, and I have people who look out for me and people at the grocery store I recognize,” she said. “There's so much intangible value. It's not in my awards, it's not in my title; it's in the stability and accountability of a community. And I would love for us collectively to think more about the value of being part of a community in addition to bringing in grant dollars or having an elevated title.”
