A viewpoint published in JAMA Internal Medicine provided guidance for front-line physicians evaluating prospective clinical roles, highlighting the importance of assessing organizational governance, reward systems, and culture when choosing a new employer.
Daniel M. Blumenthal, MD, MBA, and Mike Jellinek, MD, from Massachusetts General Hospital and Harvard Medical School, argue that while clinicians often focus on work responsibilities, work-life balance, salary, reputation, and location, they may not adequately investigate other crucial aspects of prospective jobs and employers.
The article arrives amid a US clinician burnout and job dissatisfaction crisis, with rising rates of clinician turnover and retirement posing threats to clinician health and clinical quality, as noted in a referenced study by Murthy VH in the New England Journal of Medicine (2022).
The authors emphasized three key organizational characteristics for evaluation:
- Governance: The viewpoint highlights differences between for-profit and nonprofit entities:
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- For-profit entities: Governing bodies have fiduciary responsibilities to both the clinical mission and financial benefit of owners, including physician partners or investors.
- Nonprofit entities: Trustees' primary fiduciary responsibility is to fulfill and sustain the organization's mission, whether charitable, community-based, religious, or otherwise.
The extent of clinician involvement in governance varies across organizations.
- Reward Systems: The viewpoint discusses both monetary and non-monetary compensation elements:
Monetary compensation included:
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- Salary.
- Bonuses: Tied to individual clinical productivity, group performance goals, value-based care arrangements, quality or training incentives, and/or "citizenship" rewards.
- Benefits.
- Ownership opportunities.
Non-monetary rewards encompass professional development opportunities, schedule flexibility, and work autonomy.
The authors note different specialties may have varying compensation structures. They cite the 2023 MedAxiom Cardiovascular Provider Compensation & Production Survey, that finds in cardiology, total compensation and compensation per work unit were higher in integrated delivery systems than in private practice.
- Culture: The viewpoint emphasizes understanding how a clinician's values and professional mission align with those of a prospective employer. Key cultural aspects to consider include:
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- Support for seeing desired patient populations.
- Diversity and equity environment.
- Tolerance for clinicians' unionization efforts.
- Organizational plans that could impact values, specialty, or work environment.
The authors distinguish between relationship-oriented and transactional organizational cultures, noting most organizations possessed features of both archetypes.
The viewpoint references a 2013 RAND study on factors affecting physician professional satisfaction, indicating the longstanding nature of these concerns. It also cites a 2023 JAMA study about changes in hospital adverse events and patient outcomes associated with private equity acquisition, emphasizing the relevance of understanding organizational structures.
The authors provide a specific definition of organizational culture from the Encyclopedia Britannica (2014) as, "beliefs, assumptions, values, norms, artifacts, symbols, actions, and language patterns shared by all members of an organization."
This guidance comes at a time when the US healthcare workforce faces significant challenges in clinician satisfaction and retention. The authors' recommendations provide a framework for physicians to make more informed decisions about their career paths.
Conflict of interest disclosures can be found in the report.
