It has been reported that up to 70 percent of emergency physicians leave their first job within two years. It’s in no one’s interest to hire physicians they won’t retain.

The questions for “What I Wish I Knew…” come
from Sarah Hoper, MD, and Jordan Celeste, MD.
Dr. Hoper recently joined the staff at Vanderbilt
University in Nashville, Tennessee. She is the legislative advisor for the Emergency Medicine Residents’ Association (EMRA). Dr. Celeste is EMRA president, is a fourth-year resident at Brown University in
Providence, Rhode Island, and will be heading to Florida this summer to begin practice.

A bad fit isn’t usually a reflection on the physician but the result of misaligned expectations and a lack of open communication during the interview process. Convincing someone to hire you or convincing someone to take a job based on inaccurate or incomplete information is a common mistake. Before signing, you should feel comfortable asking the difficult questions to make certain the position is right for you. Here are the 10 questions you should ask to make certain you aren’t a square peg signing a contract for a round hole.

Convincing someone to hire you or convincing someone to take a job based on inaccurate or incomplete information is a common mistake.

1. How many physicians have left in the past two years and why?

A revolving door may be a red flag you need to explore.

2. How can I develop professionally?

Any position you hold should help you develop professionally. Your director should be interested in your development as a person and as an emergency physician.

3. How long will you [the medical director] be staying in your position?

Most people identify with their boss and choose a position based on that relationship. If you are signing on to work with that person, make certain they’ll be the person for whom you’ll actually be working.

4. Is everyone paid the same?

You may or may not be interested in the nuts and bolts of how the compensation system works; however, you want it to be fair.

5. How is the relationship with the nurses, and how experienced are they?

Experienced nurses are a critical component of a well-run ED. Excessive turnover may result in less-experienced nurses working in the ED.

6. How many nurses have left in the past two years?

A revolving door on the nursing side may also be an indication of trouble.

7. Will I have an orientation? Will I be paid for any portion of the orientation?

A structured orientation is key for a successful start. It’s optimal to have a well-defined orientation process, and it’s a plus if when you start seeing patients, you are compensated for your time even during orientation shifts.

8. What performance expectations do you have?

Every medical director will have performance expectations. You need to know what they are before you accept the job. If you can meet or exceed them, great! If not, think twice about signing on the dotted line.

9. Are there plans for the hospital to change ownership?

Although hospital restructuring can be positive, it may also signal more change, including who staffs the ED.

10. Do you think the CEO will be staying in the position?

Much like hospital ownership, when a new CEO is hired, you can expect that policy change will follow. This can also result in a change in ED staffing models and partners.

Dr. Klauer is director of the Center for Emergency Medical Education (CEME) and chief medical officer for Emergency Medicine Physicians, Canton, Ohio; on the board of directors for Physicians Specialty Limited Risk Retention Group; assistant clinical professor at Michigan State University College of Osteopathic Medicine; and medical editor in chief of ACEP Now.