This is going to be a long post, but it needs to be written. It has to do with a developing leader being told to speak up – but not speak up >too< much. It has to do with a seasoned physician being presented with a terrible choice: remain true to herself or become someone else’s definition of success.
And it has to do with trusting that one’s core values and self are really … perfectly reasonable and adequate, after all.
First of all, folks, let me set up this situation.
#1) Recruiting physicians to a rural area is the hardest recruit in all of medicine. When we see a quality applicant, everyone knows that this applicant is looking at several other locations, all equally in need of good help. Other locations do not have the constraints that my group does; we cannot throw a boatload of money at a candidate because of the way the larger organization is structured (our constraints involve maintaining Medicare designation, nonprofit status, etc.) What that means is this organization, unlike others who are also recruiting as hard as they can, is required to offer industry standard rates for things like salaries. We have to be careful with extra incentives like financial bonuses or created directorships to help the employment package. That’s cool, though. In the end, we doctors who want to be here for the right reasons. Just understand that candidates are not beating down any doors -- anywhere, given supply/demand in the market these days. And especially not FP/Ob (family docs who do obstetrics). They’re like the Sasquatch or the last of the white rhinos.
#2) I have been fortunate to do some work toward an advanced leadership degree over the past few years. One of the key components of that degree involved recruiting/retention studies. Not to toot my own horn, but that background uniquely positions me to provide best practices in the realm of recruiting.
#3) The group of physicians I work with comprises an eclectic bunch. Every last person is dedicated and nice. But God help us, we have our quirks. (This must be typical in rural areas. Every place I’ve worked, there are quirky characters in each group.) In meetings, we are outspoken and also support and respect each other.
There’s your background.
So, our medical group, like every other group across the country, is challenged to get enough physicians. True enough.
We successfully recruited a candidate early last year, and he is a nice person who will be joining us in 2019. (I should have AARP membership by then…) Then we had three additional interviews. One candidate decided to do a complete 180 and went with Indian Health Services (IHS) approximately 10+ hours from here. Totally different practice setting than here, and you know what? It’s A-Okay for folks to use their interviews to figure out what they are looking for in a practice/community. I’d rather they figure it out ahead of time than sign on and change their mind after starting practice.
Second candidate’s husband refused to move to our town and insisted that she move to his family’s town, even though the opportunity was more beneficial for her here. Hey, it’s a joint decision, I get it. Seemed rather draconian, but each couple has to find their own way.
Third candidate, we had a vey nice interview though she was a little quiet but that’s okay. She ended up going with a local rural health center (RHC). In light of the funding uncertainty of RHC’s, I question the decision from a fiscal stability POV, but she feels this is a more missional job. (May I posit herein that anyone going into rural primary care is mission-minded, but that’s merely one poor, overworked doc’s opinion.)
Se we had another interview scheduled for last month. Great candidate on paper and sounded great on my phone screen. Right attitude, right skill set, etc.. Everyone was jazzed about the site visit. We also knew he was looking at a minimum of six other places, some with the ability to provide a more juicy benefits package than we could.
A few days before the candidate’s visit, our physician leader sat down with me to “chat.” When I asked her why I didn’t have the typical hour to do a hospital/clinic tour with the candidate, but only 30 minutes this time, that’s when she said it: “Because you’re too intense. At least, that’s what a previous candidate said. So I’ve been told to ask you to be … less. Maybe talk less or don’t be as assertive.”
“Less?” I said, perplexed. Parenthetically, this physician leader is the highest energy person I have ever seen in my life and does not stop talking to breathe. My “manic-meter” goes off every time I’m around her. Pot, meet kettle. But okay. People can have opinions.
“We want you to be you,” she clarified. “But you know, just less … you.”
Honest to shit, it took me a full 15 seconds before I could respond. First instinct was to rebut this woman with her own reflection.
But that’s when it hit me. As much as her statement hurt? Yeah, I had pulled the same dick move on her 1 year ago prior to that 3rd candidate’s interview. Because this leader had not stopped talking for 20 minutes during the 2nd candidate’s interview. At that time, a few days before the 3rd candidate visited, I asked her to “tone it down”, which is pretty much the same thing as “be less.”
What we said to each other are both forms of “sit down and shut up”, which happens at a surprisingly high rate with women in leadership. There’s an unconscious bias or downward pressure that gets worse the higher up a woman dares to go. Let me give you an example:
Let’s say you describe Dr. A as
#2) a patient advocate
If you presume Dr. A is a man, then your response (based on sociological data from numerous studies) is more often positive. If you presume Dr. A is a woman, then the response is markedly more negative.
But the negative interpretation is magnified when it’s a woman telling another woman to “sit down and shut up”.
Worst of all? I should have known better a year ago. Now look, I cannot speak to anyone else’s personal/business ethics. But I can tell you that I disappointed myself a year ago by violating my personal ethics when I told this female leader to ‘tone it down’. Even worse -- I DIDN’T REALIZE IT at the time. Even worse? Another leader was present when I said it, and that woman said nothing, too.
It’s not like the world is tough enough without women freakin’ picking apart each other’s personalities and laying subtle blame for a bad outcome as a result of those personalities.
So I spent about three days stewing on what she had said and what I had said as well. The wrongness of the whole thing irritated me. The shame of being told to “sit down and shut up,” combined with the fact that I was equally as guilty? That really hurt.
Questions rolled through my head. Would I be successful only if I became “less” of a person? What did her assessment mean about my complete self? “Sit down and shut up” sends a hell of a horrible message.
A few days before the candidate’s visit, I had emailed him – tentatively and second-guessing every word – to welcome him and his wife to the community and offer an informal tour and coffee. Just wanted to be hospitable. But suddenly I was paralyzed: Was it too much? Too forward? Too pushy? Too … me?
Then the candidate wrote back that they would love to meet up. I wrestled with what to do and how to act. Should I be “less” – and if we were successful with me being “less,” what did that mean? Should I be “me” – and if we did not succeed with me being “myself,” what did that mean? It was damned if I do/damned if I don’t.
As hubs and I left our house to pick up the candidate and his wife at a local hotel, I still didn’t know what to do or how to act. Shame made me sweat. Uncertainty was paralyzing. It was an awful feeling and an even more awful decision to make.
We pulled up in the parking lot of the hotel and entered the lobby. A pleasant couple arrived a few minutes later, and that’s when it happened.
A switch flipped in my head.
My inner voice said (paraphrasing), “Fuck it all and fuck those people who told you to be quiet.” That inner voice was shocking and sounded a little like Tyra Banks and Amy Schumer combined.
And from there on out, we (the candidate, his wife, hubs, and me) had a lovely afternoon where I removed those “sit down and shut up” shackles and was – warts and all – myself. It seemed like we had a great time.
The next day, during the hospital tour, this candidate had many more questions for a hospital administrator and our tour was delayed. The tour ended up taking 1 hour, and it was an enjoyable hour. Know why? Because I was myself, showing the passion for what I do, vision for the future, and encouragement of someone like-minded to join me.
This candidate, bless his heart, mentioned in several group settings throughout that day how much he enjoyed the time my husband and I had spent with him and his wife. The expression on the physician leader’s face, the practice manager’s face, and the recruiter’s face told the tale: total surprise. Like, how could this be possible?
The typical evening candidate dinner was our practice’s usual raucous experience. Our physician leader was at least a solid drink into the dinner and honest to God, not coming up for air with the talking. But this time, I had a different perspective. In the filter of my own standards of social situational awareness, of course it’s reasonable to take a break and let the guest speak. But now I understand that my saying something to my colleague would do more damage than good. Support of who my colleague is and sending the message that she is perfectly fine as is – that was much more important.
At the end of a pleasant evening, I went home with hubs. We were happy that we had put our community and practice’s best foot forward. We felt that we had done the best job possible without being fake. The next day, I wrote a brief note, following up a few items from the visit and thanking the candidate for taking a look at our practice.
Two days later, I received an email in return. This candidate and his wife had a wonderful time, and he commented on how “real” everyone was, and how refreshing that was to see. He returned several weeks later for a second visit, whereupon hubs and I joined him and his wife again for even more time together to talk further about the practice and community.
With this second visit, there was no hesitation. I was me: big laugh, big personality, patient-centered intensity – all of it, right out there for the world to see.
My friends, as of this morning, this candidate signed the contract to join our practice.
Author, daydreamer, and practitioner of trying very hard to duct tape folks together and help when I can.