Group Culture

18 July 2010
Posted in Pearls in Ophthalmology

By Tom Harbin, MD, MBA

When I began my MBA studies, the faculty assigned a very dry book on the culture of organizations and made us read it before classes began.   We all groaned whenever the book was mentioned in our organizational behavior course.   But there was good reason in taking up the study of culture, and I appreciate the importance of culture more every year.   Group culture rules everything.  As one doctor said later, “Culture trumps strategy every time.”  

Culture refers to the unwritten rules by which a group operates, including “the way we do things,” the expectations of staff about behavior, how patients, vendors, and employees are treated, as well as the ethics and how strictly the rules are followed.  Culture determines all of these and more. 

If you learned very conservative indications for testing or operating and join a group with much looser ones, over time you will more closely mimic the group you joined.  It will happen insidiously and almost without your realizing it.  If the group’s norms are aberrant, you will either leave or become like your group.   If you stay, you will become aberrant.  You will not change the group by your different behavior.   On the other hand, if your group is conservative and you are too loose, either you will change or the group will ask you to leave.   The group will not change.

The April 2, 2007 issue of American Medical News[1] quoted a study performed by the Cejka Search group and the American Medical Group Association to determine why physicians left a group practice.   Fifty-one percent of the time, the most common reason was poor cultural fit with the practice.  This confirms the importance of culture as you evaluate a practice.

If you connect with the group’s culture, you and the group will be happier, and your adjustment will be easier.   So how do you find out about group or even a solo practice’s culture?   Ask and observe.   Spend time with the group.   Watch how the staff treats patients – in most instances, their treatment of patients mimics the doctors’.   Talk to referring doctors and hospital administrators; look and be aware of what you want to know.   Can you see yourself fitting in?  Would you want your family treated this way?  Is this how you learned to behave or want to behave?   Listen carefully to the doctors and staff during your interviews.   What do they demand of you?   What are their goals for you?   How do they refer to patients and colleagues in the community – respectful, scornful, loving, or calculating?

Be aware of the importance of culture.   Ask the doctors to describe their culture, although many will have no idea of what you’re asking.  Try to schedule some free time in the office just looking and listening, if that’s practical.  Observations on such occasions can help reveal culture and true personalities.  Ask and look.  You cannot do enough of this type of diligence.

When the interviews have concluded, you should know whether you like and respect the group and its culture, what your duties and travel requirements will be, and how much of your specialty you will be allowed to practice.   You should be happy and comfortable with all these factors.

About the Author:

Dr. Tom Harbin received his MD from Cornell Medical and trained in ophthalmology at the Wilmer Institute of Johns Hopkins. He has been practicing ophthalmology with a specialty in glaucoma for over thirty years and is a Clinical Professor Emeritus at Emory University. Dr. Harbin resides with his wife in Atlanta, GA. Waking Up Blind: Lawsuits Over Eye Surgery was his first book. His second book is The Student Doctor Network What Every Doctor Should Know… But Was Never Taught in Medical School, will be published in August 2010.