Are You in a "Best Place to Work"?

Jeff Brown, MD

There were very few health care companies on Fortune Magazine's Best Places to Work list. This is unfortunate since patients can sense if your office is an unhappy place.

Health care is 17% of the economy and growing, yet only 9% of the best places to workare in our field.

Fortune

magazine published its annual 100 "Best Places to Work" issue, this year on February 6. There are several interesting aspects to this idea, but the one that jumped off the page was that only nine (large) health care companies were listed. It is ironic since health care is totally, on paper at least, devoted to service and not product oriented, so one would think we ought to have a larger presence on this list compared to other sectors of the economy.

Scale is an important issue here because many, if a diminishing number, of doctors practice in a small office. So there is an apple versus oranges comparison issue to the large medical groups listed. But people/employees have the same needs and issues everywhere, so, if anything, small offices should have an easier time identifying and implementing worker-friendly policies and atmospheres. And maybe they do better; I've never seen a study on that subject.

Fortune

And you could legitimately raise some questions about the methodologies used to identify the alleged best versus the rest. But some common threads run through 's brief explanations, and there is some grist for our mill here.

How many doctors' offices have you visited beside your own? Can't you pick up a vibe when you walk in, when you look around, when you talk to the receptionist and the medical assistant? How many times have you heard a patient or a colleague say "I like Dr. X well enough, but the obvious tension and unhappiness in his office caused me to look elsewhere?”

And that kind of thing doesn't just affect the bottom line. It is becoming increasingly obvious from studies, if not intuition, that patient compliance and therefore outcomes are affected if patients sense that your office is not a happy place. Some of that training and hard work you've put in may be wasted because patients are human and respond to messages other than scientifically oriented ones.

Fortune

Let me list some of 's hallmarks of a "best place to work" and see if this matches your experience: "Pride," "...generous with employees," “Support staff are not ignored, but meet regularly (with their bosses),” “...we're all in this together..," "Big on recognition..," "...develop and celebrate employees, ending with awards...(and) bonuses," etc.

Medical practice has been blessed with a long tradition of selfless service and a worthy mission that is a built-in morale sustainer. But there has also been a long tradition of patronization, entitlement and often advantage-taking of support staff by physicians, which can provide a steady trickle of morale erosion undermining some practices.

How many of us under the daily pressures we face take our staffs for granted? Or are so disorganized that we create gratuitous stress? Examples abound that we can all summon up.

On the other hand, many of us "get it" and go the extra mile for our employees. We, they and our patients know the difference. One happy, if extreme, example is a friend of mine who closes his office once a year for a week and sends his staff of three off to Europe or on a cruise. And that kind of attitude rarely stops there, so you might imagine he has had the same staff for many years. OK, I'll stipulate that he is procedure-based and has the income to support this sort of largesse, but you get the idea.

It is hard to overestimate the impact of a (really) happy, loyal staff. It is easier to measure the disruptive impact of replacing a doc than staff, so let me cite a study from Kaiser Colorado a few years back. When a doctor leaves a group, for whatever reason, you could expect the disruption, delay and interview/travel costs of finding a suitable replacement. What was surprising and revealing in this study, was that ER visits from the "abandoned" patient population soared, in spite of other available doctors, costing Kaiser some $250,000-plus in unanticipated bills.

Years ago I hired a terrific assistant right out of school and she did so well that two years later she decided to go on and get her RN. And a certain number of patients moved on as well, citing her loss. It was a sobering lesson about the value of an effective team. It's not always just about the doctor.

Turnover always has unsettling effects upon the staff, regardless of positive policies. That's why I always had my staff interview new candidates as well. You may have skill and experience, but there has to be a match in style and affect. And turnover is inevitable in a field that has traditionally relied upon young women. They can be terrific, but they have families, spouses get transferred and it's a fact of life to be dealt with.

Many doctor's offices and hospitals are happy, well-organized places that you can feel good about working in and visiting; where the staff is appreciated in a formal way and a support structure underscores the fact.

But in medicine it all starts with you: attitude and policies. Would you really like to work with and/or for you/your organization? If the answer is "well, maybe not," it is costing you money, better patient outcomes and a happier work environment. Think about it.

What comes of thinking about the value of a happy workplace is that the most successful organizations realize the vital importance of employee morale on retention and on effectiveness. And the most successful and effective doctors take time and make the effort to secure this important facet of employment and practicing medicine.