Think of a potential new employer as a tough diagnosis. If you don’t feel comfortable, what do you do? You keep digging and analyzing until you have an answer.

Alas, job searches don’t get that kind of scrutiny. “When I work with doctors, I will say most of them do not really do any kind of research about their employer,” said Ericka L. Adler, JD.

Adler is a practice group manager, Health Care, at Roetzel & Andress in Chicago, and part of her job is advising physicians on contracts and employment issues. The first rule going in should be: An enticing job posting and a fancy employment contract rarely tell the full story. Practice culture, call schedules, vacation coverage, noncompete clauses, productivity expectations — these things and more may not come up in interviews, and all have a significant impact on your work and well-being.

Medscape Medical News spoke with physicians who did their research and, in the process, discovered critical information that changed how they viewed an opportunity.

‘If You Smell Smoke…’

Several years ago, Cooper Stone, DO, psychiatrist in Philadelphia, was looking for an inpatient position when he found an opportunity at a local hospital that seemed promising. It was close to his home, which meant he wouldn’t have to move or deal with a long commute.

But Stone began to have concerns after asking more detailed questions about how the unit operated. The first red flag was learning that he would be one of only two clinicians working on the inpatient unit. If one went on vacation or left the position, the remaining clinician would be responsible for seeing all the patients without additional support or compensation, potentially indefinitely. Stone also learned that he would be required to round on the unit every other weekend and share frequent overnight calls.

“Usually positions like this make up for the substandard working conditions with generous compensation; however, this was not the case either,” he said. “More importantly, while compensation is important, taking care of one’s own health, avoiding burnout, and being in an environment that is conducive for providing high-quality care mattered more for me.”

Stone was told he wouldn’t be allowed to speak with current employees as part of his vetting process. That raised even more concerns. “When you smell smoke, there’s probably a fire, even if they tell you otherwise,” he said. “If people enjoy working somewhere and there is nothing to hide, it shouldn’t take convincing; you should be able to see it with your own two eyes.”

One of Adler’s first pieces of advice: Find out why a position exists in the first place. “If somebody left, do they have a lot of people leaving? Are they expanding? What is the reason? Why is there a job available?”

‘Where the Truth Comes Out’

A few years ago, Raymond Douglas, MD, PhD, oculoplastic surgeon and professor at Cedars-Sinai in Los Angeles, was considering an offer from a large organization. The offer, he said, was good and initially didn’t raise any suspicions. But then the recruiter mentioned that the organization was expanding its team “again,” which caught Douglas’s attention. “Why again? And what happened to the last round of hires?”

Before signing, Douglas decided to track down physicians who had previously worked for the company, beyond relying solely on references provided by the employer. Through his own professional network, he was able to find four. Two were physicians he knew from school, and mutual colleagues connected him with the other two.

“Everyone mentioned the same thing,” he said. “They were ordered to shorten consult times from 30 minutes to 15 so they could get more patients. That was the reason I declined the offer.”

Douglas now recommends that physicians look beyond a practice’s reputation and dig into its turnover. While you can learn helpful information by consulting the references selected by a potential employer, Douglas is now adamant about also seeking out physicians who have left within the past 2-3 years to get a full picture of the practice. He suggests asking former physicians why they left, whether they would return under the same terms, and what changed about their day-to-day work that wasn’t disclosed in the offer letter. “That last one is where the truth usually comes out,” he said.

His experience also taught him to look closely at productivity expectations. This could mean asking about the work Relative Value Unit or bonus structure and working backward to determine what those targets could mean for the number of patients a physician may need to see and how much time they may realistically be able to spend with each one.

‘The Hiring Process Itself is a Data Point’

Psychiatrist and clinical director Sarah Boss, MD, who is based in Mallorca, Spain, was in advanced discussions with a well-regarded private psychiatric facility early in her career when she decided to take a closer look at the offer. On paper, she said, the opportunity looked attractive. The practice had an established reputation, structured programming, and competitive compensation. But like Douglas, Boss spoke with physicians who had left the organization. She found “Dr X and Dr Y.”

“Both independently described the same pattern: clinical decisions being overridden by administrative priorities, concerns being quietly penalized rather than welcomed, and a significant gap between the patient care model presented during recruitment and what was actually resourced day to day,” she said.

She took this information back to her prospective employer to dig deeper. “When I raised this directly in my final meeting — asking specifically about turnover and what the institution was doing to address it — the shift in tone was immediate,” she said. “The question was reframed as difficult, every departure was attributed to personal circumstances, and there was no genuine reflection on whether something systemic needed examining. That confirmed everything Dr X and Dr Y had told me.”

The response prompted Boss to withdraw before signing. It also taught her to not only pay attention to the answers a potential employer gives but also to how it responds to uncomfortable questions. “The hiring process is itself a data point,” she said. “How an institution responds to a hard question from a candidate is exactly how it will respond when you raise concerns from the inside.”

Other recruitment behaviors Boss now watches for include vague answers about clinical autonomy, pressure to sign before having adequate time to review the contract, and broad mission statements rather than specific examples of workplace culture.

“Had I Asked for it in Writing…’

Christina Herald, OD, medical optometrist and practice owner in Massachusetts, learned early in her career that vague employment terms can be a warning sign. After accepting a position that required her to work across multiple locations, she was told she would split her time among four offices. She didn’t think to establish exactly how that time would be divided.

“In reality, I spent the vast majority of my time at the one location that other clinicians didn’t want to cover,” she said. “Had I asked for that breakdown in writing, I would have had a much clearer picture of what the job actually looked like.”

The experience changed what Herald now looks for before accepting a position. She recommends nailing down specifics about where you will work and how often, rather than accepting a general promise about rotating among locations. Compensation arrangements, she said, deserve the same scrutiny. Physicians should understand exactly how they’ll be paid, how their productivity will be measured, whether partnership opportunities exist, and whether the contract includes restrictions such as a noncompete.

One red flag Herald now watches for is an employer making assurances that it won’t put in the contract. She encountered this while considering working 1 or 2 days a month for another practice. Because she would only be working there occasionally, she asked the practice to remove a clause that could restrict where she worked after leaving. The practice refused but offered to send her an email saying it had no intention of enforcing the restriction.

“If an employer isn’t willing to put their verbal promises into the written contract, that’s a warning sign,” she said. “In my experience, if you’re not on the same page before you’ve even started working together, it’s often a preview of what’s to come.”

‘Now is the Time to Ask Questions’

Since some red flags don’t come up during an interview, Adler recommends doing some outside research into a prospective employer. This includes looking for lawsuits, news coverage, and potential financial concerns. “You could do a general search. Are there lawsuits against them? Are they financially solvent? Are they in the news?” she said.

Finding something concerning doesn’t necessarily mean physicians should rule out an employer. Public records, says Adler, can lack context, and a lawsuit alone doesn’t establish that an employer did anything wrong. She suggests using what you uncover to guide additional questions for the employer, then gauging the situation after you’ve given them a chance to explain.

Working with a healthcare attorney can also help physicians further vet employers. “I think it’s a good idea to bring in a lawyer from the start, and the lawyer should be reviewing the contract,” says Adler. “And I think there’s plenty of things in most contracts that a doctor will not pick up on their own, will not know the right questions to ask, or the changes to seek.” 

When vetting a practice, Adler also recommends asking whether it is financially healthy, whether becoming an owner is a possibility, and whether the owners are considering selling the practice.

Physicians may also want to ask whether previous employee departures involved peer-review investigations or disciplinary proceedings. One such situation may not necessarily indicate a problem, but a pattern is cause for concern.

Ultimately, Adler says, physicians shouldn’t be afraid to press a prospective employer for answers about anything they uncover. “I always tell my doctors, Now is the time to ask questions,” she said. “You don’t ask after you get the job. You ask now. You may not like the answers, but it’s better to find out.”

The experts cited in this article reported having no relevant disclosures.