Meet Me Halfway

They don’t teach it in medical school. You don’t learn it as a resident. Throughout the recruiting process, chances are you’re oblivious to it. And perhaps it only dawns on you several weeks or months after joining a new practice.

What is “it”? Having well-defined expectations for your role as a new physician - expectations that complement those of your older, more established colleagues.  

More flexibility

Many experts agree that the number one point of disparity between physicians is that younger doctors want more flexible practice schedules compared to their “old school” partners. Physicians who have been practicing for 15 years or longer were assimilated in a different era, in which they lived and breathed their medical practices and “gave up their lives for medicine,” says Nelson Tilden, a New York-based medical consultant and trainer and founder of Medical Search Institute. Careers often played out at the expense of families, quality of life, and personal time. To that, younger doctors say “no way.”

“It’s burn-out,” says Terrence Steyer, a family physician who has been in practice for three years. “We’ve seen what’s happened to the older doctors.”

And that’s precisely what he and others want to avoid, Steyer explains. This is a new age of physicians who want a more balanced lifestyle and are foregoing incentive-based pay for a salaried employee option.

Michael B. Teiger, a pulmonary medicine physician in Hartford, Conn., who has been practicing for 20 years, says the trend of new physicians who prefer employee status to growing a practice themselves is rubbing older physicians the wrong way - and will significantly alter the way medicine is practiced.

But it’s not just about incoming doctors getting the flexible schedules they want. The other mammoth issues are the lack of collegiality and support, and the absence of professional mentoring.

“Many newer doctors feel ignored, and there is poor orientation,” Tilden explains.

Statistics show that the inability of the generations to compromise results in low retention for newer physicians, who may change jobs up to four times in their career, particularly in their first few years of practice. More importantly, the potential for continued turnover translates into a potentially chaotic practice where, ultimately, patient care suffers. Thus, the question is, how do both sides reconcile philosophies and needs to make for a more cohesive, efficient, and patient-centered practice environment?

Business of communication

In a nutshell, it’s all about communication, says Ray Thomas, president of National Health Partners Inc., a physician-recruiting firm in Deerfield Beach, Fla. But the lack of business training, and sometimes naivete, mean that new doctors need to be proactive in learning how to negotiate their wants and needs. Thomas’s firm is one of few recruiting agencies that offers such training.

“We’ll do business [communication] training during the last week of residency, for example, and go into the medical schools,” he says. “They eat it up. Medical school just doesn’t prepare them.”

Most recruiters don’t go near the medical schools, though. That means physicians-to-be who are going through the recruitment process need to ask for guidance. But Thomas suggests an even more aggressive approach.

“I think a great idea is to get the universities to add [business training] as a CME course, which then would allow funding,” Thomas explains. “Then you would see a firm such as mine and others actually create a comprehensive program to present it to as many academic programs as possible.”

For that to happen, however, medical students would have to lobby their academic institutions. It’s a great first step, and something that would help future physicians. But what do new doctors do when they’re in the thick of recruitment - or already in practice - and feeling dissatisfied?

Speak up - softly

Steyer says new doctors should start by creating an environment in which older physicians can recognize their commitment.

“A lot of times, the doctors who have been around longer see the younger ones as not as committed,” he says.

That’s not the case, he insists. Like many new physicians, Steyer cites the tug of quality family time as a primary reason for valuing flexibility. And he’s been able to achieve a relatively balanced schedule through open communication and compromise. It can be as simple as initiating discussions about other ways to be involved in the practice, such as working with a local high school sports team or attending health fairs.

“I’ve been lucky,” says Steyer. “My experience has been a positive one, but I have many colleagues who have been disappointed in their situations.”

Younger doctors must take the initiative, he says. But tread lightly. Tilden believes that, in most cases, being too aggressive with your demands will get you a quick trip to the nearest exit. He prefers a slower approach to working deals with practice partners, starting with a good understanding behind the philosophies of older physicians.

Longer-practicing physicians, especially those who started before the era of managed care, tend to be highly patient-centered.

“You develop a dedication to patients,” which transcends most other concerns, says Teiger.

It’s best to first put something else on the table other than economic and time demands, he cautions.

Be a mentor

Mentoring is another way to talk, compare philosophies, and understand expectations, says Tilden, though it is typically not a priority among older physicians.

“Most group practices don’t recognize the need,” says Tilden.

That’s too bad, he adds, because mentoring can have a dramatic impact on the success of a practice as well as the careers of its members.

Steyer has seen the benefits of mentoring first-hand; it occurs at his practice on a daily basis and has been a very helpful experience.

“[Older doctors] are generally open to new ideas and want to hear them,” he says.

On the flip side, he adds, older doctors show newer ones that patients are the key to thriving practices and that spending a little extra time with them is beneficial for everyone involved.

Sounds like the beginning of a beautiful friendship.

Daphne Swancutt can be reached at editor@physicianspractice.com.

This article originally appeared in the May/June 2001 issue of Physicians Practice.