Short stints on the CVs of physician executives are common. Use this checklist to help determine whether making a move would be beneficial.
Comedian Henny Youngman was best known for his one-liner, "Take my wife, please!" But the origin of his classic line is often misinterpreted. In the mid-1930s, Youngman took his wife to a show and asked the usher to escort her to a seat. His request, however, was taken as a joke, and Youngman used the line countless times thereafter.
I've changed jobs more than 10 times since completing my residency in 1984 - about one every three years on average. I know I am not alone in job-hopping.
Most people will change jobs four to seven times during their lives, and research conducted on physician executives has shown similar outcomes.1 Simply substitute " job" for "wife" and you've got the modern-day version of Youngman's one-liner.
Physician executives initiate job changes for many reasons. Some reasons are related to work and benefits while others are personal and related to lifestyle. In addition, nearly half of all physician executives can expect to be fired from their jobs, according to a survey published in 2000.2 As long as you are not a compulsive job-hopper, there is no stigma in changing jobs. Short stints on the CVs of physician executives are common.
Assuming you're not in a position where you are being forced into changing jobs and are thinking about doing this voluntarily, there are some things that are useful to consider. Reflecting on my experience, and in conversations I've had with other physicians, it seems most of us devise a mental checklist before leaving one job for another.
Here are some helpful questions to ask yourself.
How happy am I?
Overall job dissatisfaction is the No. 1 reason people leave one job for another. There are many determinants of job satisfaction in physicians. Some are industry specific and others are position specific.
Common factors appear to be autonomy, prestige, financial incentives, resource availability and control over medical decisions and the doctor-patient relationship. In general, the higher degree to which restrictions or requirements limit a physicians' scope of activity and interaction, the more negative the correlation with job satisfaction.3
If your job brings you no satisfaction, then it's probably time to move on and find one that really fulfills you. This is also the time to talk confidentially with family, friends and colleagues (probably not co-workers or your boss just yet) and begin networking for a new job.
Am I bored out of my mind?
Boredom is perhaps the No. 2 reason physicians leave their jobs. After about three years, you've learned most of what you're going to know about how to do your job. Boredom may manifest in different ways: restlessness, indifference to your responsibilities, even burnout.
These feelings usually signal you have maximized your learning opportunities with your employer, you have no interest in learning anything more in your position or you no longer feel challenged, and you need to search for a more stimulating job.
If you're not diggin' it, stop doing it!
Is this a dead-end job?
Dead-end jobs create inertia and limit earnings. However, I can think of two reasons why a physician would work for a company that offers no opportunity for career growth and advancement.
One is that some physicians are content to function in middle management. They have no desire to climb the corporate ladder, work in the C-suite, or aspire to become physician leaders, and there's nothing wrong with that.
The second reason applies to physicians who are close to retiring and simply biding their time. But they must remain productive and should not appear "retired on the job"4 as they approach the finish line.
Do I need to make more money?
Salary alone is seldom a good reason to change jobs, although it is a pressing concern for physicians who have large debt and living expenses.
If your pay is insufficient, make sure the salary you negotiate in your next job is on par with earnings reported by other physicians in your position.
In the long run, extremely high compensation packages make physician executives vulnerable to job loss.
The Physician Leadership Compensation Survey, conducted every two years by Cejka Search, is a very good reference for determining a reasonable salary. But remember, there's probably not enough money in the world to satisfy you if your next job doesn't truly suit you.
Is this a good time to make a change?
In 1980, I saw a sign in a Realtor's office that read: "Now Is the Time to Buy a House." I wish the same were true of changing jobs. Unlike real estate, which appreciates over time, life has ups and downs. It is best to avoid initiating job searches when significant events in your life have just occurred or are about to occur - for example, the death of a family member, marital separation or divorce, or a major personal injury or illness - because changing jobs is stressful.
Of course, if you are offered a job that requires an immediate decision, timing becomes moot. We may not be able to always control circumstances, but at least we can be aware of which factors have the most impact.
Am I running from or moving toward?
It's not uncommon for physicians to leave jobs because they object to the way things are being done or the quality of the services being delivered. But beyond that, there must be a positive charge, something you want to do or accomplish that can't be attained where you are now.
If you're running away from a bad situation, chances are you will trip on your shoelaces unless you are being pulled by a vision of the future, a vision based on reality and not wishful thinking.
And when you land that new job, make sure you avoid what human resource experts consider the "seven deadly sins" of new hires: ignoring the culture, arrogance, hiding out, not clarifying expectations, refusing to admit mistakes, rocking the boat, and not asking for feedback.
Is it me or my boss?
In medical school, we learned there is no such thing as a poor historian, only a poor history-taker. But as individuals working in health systems and corporations, it is perfectly natural for us to question the competency of our boss (historian).
People often view new jobs as a way to get away from bad bosses - bosses who block career advancement, micromanage direct reports, fail to provide performance feedback and exhibit personality afflictions.
Although these are all understandable reasons for leaving a job, there is no guarantee things will be better in a new job.
The Who's classic song, Won't Get Fooled Again, cautions us: "Meet the new boss/Same as the old boss." The worst thing for you would be to end up with a job with the same responsibilities in a new organization with another bad boss.
Is it me or management?
Unhappy workers tend to point the finger at everyone but themselves. It is essential to evaluate whether discontentment with your job stems from you or management.
If the latter, some telltale signs may be:
- One person is doing the job of two or more.
- Professionals are performing clerical work.
- The organization is constantly changing goals, decisions and direction.
- Leadership rejects well-done work, damaging the morale and esteem of those who performed it.
- Promotions are given to inexperienced workers, alienating staff and driving away good employees.
- Rigid hierarchies are in place preventing teamwork and cooperation.
- There are so many levels of management that decisions take forever, so called analysis-paralysis.
Is this job a best fit for me?
Employment changes frequently occur when employees believe their job is no longer a good fit with their skills and strengths. Initially the fit seems good, but over time, as organizational needs change and job responsibilities shift, you may find yourself in a completely different role than when you were hired.
Also, some organizations require employees to gain exposure in different functional areas after they are hired, potentially compromising the fit. Most jobs, especially those for physician executives, are dynamic rather than static, and therefore a good fit cannot always be maintained.
When the gap widens to where you feel out of your comfort zone, and neither you nor management can make concessions in your job duties, it may be time for a change.
Am I acting up or acting out?
Acting up refers to conscious and deliberate misbehaving commonly seen in impaired and disruptive physicians. In contrast, acting out stems from unconscious (repressed) memories and wishes.
Acting out is a manifestation of an emotional conflict that cannot be consciously recognized. Physicians who change jobs repeatedly, say, every two or three years, may be acting out any number of unconscious fantasies.5
Intense introspection or professional help, such as an executive coach or even a skilled therapist, may be a good idea for physicians who need to explore and resolve complex psychological issues.
Am I appreciated where I am?
If your boss or colleagues are stingy with compliments, and you perform quality work that goes unnoticed, you should certainly question why you want to stay. Nothing can be worse for morale than feeling unappreciated or taken for granted.
If your achievements are undervalued, it could be that your goals are not aligned with the organization's objectives. Stop wasting time and move on to something where your skills and accomplishments will be recognized and rewarded.
Does size matter?
Size does count, but bigger is not necessarily better. I once left the seventh largest pharmaceutical company for one ranked 37th. I felt the smaller company was able to adapt more quickly, provide me greater independence in making decisions, and offer greater opportunity for advancement.
Large companies can be impersonal and difficult to affect. On the other hand, they have more resources and tend to have established best practices for getting things done.
Consider these differences, because what you can expect from a company is sometimes dictated by whether it is large or small.
Am I being too impulsive?
A good friend was miserable at work. His boss was a tyrant. Yet he clung to his job and became clinically depressed before he resigned. Why did he wait so long to leave?
We all have different breaking points, but we should not beat ourselves up over exiting a job, or make ourselves mentally or physically sick.
Consider whether what's bothering you is an occasional itch or a worsening rash. Occasional itches are those little prods that are insignificant, like an irritating co-worker. A rash is intense and spreading, like the whole company is bothering you. It won't go away and clamors for resolution.
Resigning is your salvation. This checklist is not exhaustive. There could be many reasons why you would want to change jobs, e.g., a more desirable location, less travel, and getting away from a failing company or one that is restructuring.
You should evaluate reason(s) against criteria important to you. Use this checklist and consider other factors to determine whether it is advisable to change. Would you benefit overall by this move?
For me, the "best" job is one in which my values and interests are being satisfied most effectively, one that I feel passionate about. I thoroughly researched the "do's and don'ts" of job transitions and wrote this article in the midst of changing jobs. Still, my decision to leave my employer was largely a gut decision.
As the saying goes, your head holds gold, but your heart holds diamonds.
Even if you have a clear reason for moving on, don't jump at the first job that comes your way. A good job search will reveal more than one opportunity, and you should weigh the pros and cons of each you encounter. Try to find out as much as you can about potential positions and the people you would be working with. You don't want to change one set of problems for another.
Caution is important when deciding your future. On the other hand, don't let fear hold you back. Larry Buhl, a freelance writer for Yahoo HotJobs and other publications, claims that changing jobs is one of the most invigorating things you can do: "It's like experiencing youth all over again, except with the wisdom of whatever age you are now."
- Kindig DA, Dunham NC, Chun LM. “Career Paths of Physician Executives.” Health Care Manage Rev 1991;16(4):11-19.
- Kirz HL. “Congratulations ... you're fired!” Physician Executive 2000;26(4):19-25.
- Gothe H, Koster AD, Storz P, Nolting HD, Haussler B. “Job Satisfaction Among Doctors: A Review of International Literature.” Dtsch Arztebl 2007;104(20): A 1394-1399.
- Oetjen RM, Oetjen, DM. “Retire Already! Managing Physicians Who No Longer Want to Work, But Have to.” J Med Pract Manage 2010;26(1):49-52.
- Lazarus A. “Acting up or acting out.” Med Econ 2011;88(1):28, 30, 35.
Arthur Lazarus, MD, MBA, CPE, FAAPL, is medical director for Cigna Group Insurance, adjunct professor of psychiatry at Temple University and an editorial board member for the American Association for Physician Leadership. He wrote this article in 2012, when he was senior director/global medical affair for Shire Pharmaceuticals.