Hospitalists are in high demand. Given the physician shortage, new and experienced hospitalists alike are in a unique position to hold out for opportunities that deliver strong leadership, better work-life balance, and a cohesive team.

While compensation and location are often primary drivers in deciding where to practice, you should weigh an organization's culture just as heavily as it could have the greatest impact on your long-term career satisfaction and success.

The key to finding the perfect fit is a thorough vetting of every opportunity, and the best time to do that is during the interview process. Knowing what qualities to look for and questions to ask can help you separate programs that deliver the greatest satisfaction from inflexible, ineffectual programs that will leave you frustrated and unhappy.

Here are four critical factors to consider, along with what questions to ask:

1. Medical Director Leadership

Perhaps no other person has more influence on the hospital's culture than the medical director. As such, you want to look for a director who exudes a positive attitude and demonstrates a commitment to the hospital's well-being. Some tell-tale signs include:

  • Approaches challenges as opportunities for improvement rather than insurmountable barriers;
  • Is involved in hospital committees;
  • Has sophisticated leadership and decision-making skills;
  • Gives and seeks feedback from clinical and non-clinical staff;
  • Has strong relationship with the administration to ensure hospital medicine service has voice in implementing meaningful change.

Questions to ask the medical director:

  1. What challenges does the current program have and how are you addressing them?
  2. What is an example of a challenge the program faced in the past? What was the solution
  3. On what hospital committees do you sit?

2. Administrative Facility Leadership

The medical director's influence is considerable, but it's only part of what makes for a career-sustaining culture. Hospital administration also contributes to the positive atmosphere

Administrative leaders have an obligation to safeguard the financial sustainability of the organization. But if that obligation comes across as a money-first attitude, it could leave you feeling as if you're simply a commodity -- a cog in the wheel.

You want to look for an administration that balances its financial responsibilities with an emphasis on quality of care, where you're viewed as a vital member of the medical staff, and where the leadership comes to you for solutions rather than dictating them from above.

Questions to ask hospital administration:

  1. How does administrative facility leadership support the hospital medicine program?
  2. What is the nature of your working relationship with administrative facility leadership?
  3. Has a solution been implemented or process improved in which the hospitalist’s perspective was instrumental?

3. Scheduling Practices

Work schedules are another piece of the job satisfaction pie. The current industry standard for hospitalists is “7 on, 7 off," but having a week-long vacation every other week may not be in your best interest. A better, increasingly widespread alternative is the “5 on, 5 off” model.

In the “7 on, 7 off” model, the “switch day” typically falls on Tuesday, stressing the nursing and ancillary staff, concentrating the burden of communication, and disrupting continuity of care. Staggering the start dates of the team’s hospitalists -- which the "5 on, 5 off" model facilitates -- translates into smoother transitions for nurses, happier physicians, and fewer disorienting changes for patients.

Another scheduling issue regards patient volume. You want to work for a program that has an established “surge planning” process with a dedicated scheduler to handle the call tree while the physicians and nurses tend to patients. An experienced scheduler, one who develops a relationship with you, can make all the difference during a volume surge.

The best schedulers and managers will make you aware of expectations when it comes to surge planning to limit unexpected disruptions in your personal time.

Questions to ask about scheduling:

  1. What shift-length model does the program adhere to? Why is that a good fit for this program?
  2. How are service team transitions handled from a physician perspective?
  3. What processes and tools do you leverage to optimize provider communication during service team transitions?
  4. How is volume fluctuation support handled?
  5. Is there a staff member or other available resource dedicated to making calls and obtaining support for the physicians on shift when daily or seasonal fluctuations occur?
  6. Do you currently leverage or plan to leverage telemedicine?
  7. How do you handle night coverage?

4. Team Dynamic

One more factor to look for (and this one is extremely important) are organizations that invest in building a crew of local, committed team members. It goes without saying that positive team dynamics create a better work environment for all concerned. You want a culture where communication lines are open, feedback is welcomed, and team members are willing to support each other when the need arises.

Questions to ask regarding team dynamics:

  1. Is the hospital consistently staffed by locum tenens docs filling shifts or by local physicians invested in the success of the program?
  2. What is the average tenure of staff members or doctors on the team?
  3. How do APPs fit within the staffing model?
  4. How is team morale?
  5. Could you describe the culture within the hospitalist service team?

Conclusion

The sky-rocketing demand for hospitalists puts you in the driver’s seat. Your ability to assess the stability, success, and aptitude for improvement and innovation your prospective employer offers hinges on knowing what to look for and the questions to ask.

If you ask the questions outlined above, you’ll set yourself up to enjoy a placement that delivers real satisfaction, a healthy work-life balance, and a genuine sense of fulfillment.