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In today’s complex healthcare system, organizations and hospitals are structured with many complex layers of personnel, both clinical and nonclinical. Demonstrating your value as well as your hospitalist group’s value in these systems is highly intertwined with visibility in your organization. With the constant supply of residents entering hospital medicine, there is a steady stream of talented individuals looking for job opportunities. For this reason, the newly hired or veteran hospitalist must ensure their employer sees them as valuable assets to their hospitalist group [1]. Regardless of your assessment of your value to your hospital or healthcare system, you are dispensable if key stakeholders do not recognize your value [2]. Demonstrating your value should occur at multiple levels including direct supervisors and key stakeholders with institutional influence. The 13 questions posed in this chapter will prompt you to consider ways to assess yourself and strategies to demonstrate your value in a meaningful, effective manner.

Who Are You?

As we discussed in the “Knowing Yourself and Your Style” chapter, self-assessment is a critical part of becoming a successful hospitalist. Once you understand your inherent characteristics such as personality, communication and emotional intelligence, it is time make an honest assessment of your abilities. Are you well-suited to be an effective hospitalist clinician, educator, or administrator [3]? In order to explore this question, a “SWOT” analysis on you and your career path can be used [4] (Fig. 16.1).

Fig. 16.1
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SWOT analysis. Adapted from http://www.businessnewsdaily.com/4245-swot-analysis.html

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This well-known model uses a basic two-by-two table to perform a self-analysis. You should fill in the top two quadrants with lists that describe your strengths and weaknesses and bottom two boxes with opportunities and threats. Strengths are the positive attributes that you bring to the table. Some examples may include a cheerful disposition, a can-do attitude, significant previous experience as a hospitalist, or procedural skills. In contrast, weaknesses are the internal negative attributes that may detract from your performance . You may have insight into these attributes or can glean it from previous evaluations. You still have the ability to exert some control over these attributes. On a personal level, they may include being easily frustrated, being confrontational, and not being a good team player. Weaknesses may also include subpar career skills, like performing poorly on certification exams, or even lacking a good support network.

Opportunities are external factors out of your control that can be used to your advantage. Opportunities may include a move toward an EMR at your institution where your IT skills can now be leveraged, an opening on an important committee, or increased patient volumes leading to expansion of your group. Threats are external factors that have the potential to impact your career path negatively. Often, these require development of a protective plan to prevent potential damage to your career plans. Examples include organizational restructuring where your hospital merges with a larger hospital system, reduced patient volumes as a result of the new regulatory landscape, or new physician requirements at your organization.

Performing a SWOT analysis provides you with a structure to consider opportunities to demonstrate value and gain visibility . It can help you to understand and affirm your present position and gain a better understanding of the skills and attributes that you should highlight or avoid advertising. The SWOT analysis also helps to generate specific actionable steps that you can take to demonstrate value and gain visibility. For instance, you may decide to improve your skill set or add a new skill that is advantageous to your career growth, focus on minimizing your weaknesses, pursue new opportunities or develop a protective plan against threats. With meaningful insights gained from your SWOT analysis, you can move on to other aspects of gaining visibility and demonstrating value .

What Sparks Your Interest in Your Daily Practice?

Identifying personal strengths is not always easy. Considering your passions and what makes you happy in your daily work life may serve as a starting point to identify your strengths [5]. Does providing care to patients make you the most happy? If so, your strength likely lies in being a good clinician. Do you get most excited about teaching house staff? If so, that is probably because you are a gifted educator. If you are a hospitalist leader, perhaps you find passion in negotiating better salaries and compensation packages for your hospitalists or mentoring more junior faculty through difficult transitions. These are the attributes you will emphasize on a larger scale as you take steps toward gaining visibility in your organization. A curriculum vitae cannot convey your passions, enthusiasm for being a hospitalist or hospitalist leader, or the entirety of your personal strengths, so you must be keenly aware of them and be prepared to showcase them to stake holders [6].

Are You Keeping Track of Your Performance and the Praise/Feedback You Have Received?

Tracking your formal and informal evaluations offers an opportunity to gather more objective data on your performance as well as insight into how your organization may perceive you. Formally tracking of the praise you receive may become important for leverage when seeking out high profile projects to increase your visibility . Tactfully reminding your supervisor, possibly during semiannual performance evaluations, about the positive feedback you have received from involvement in committees will help identify you as a strong candidate to join or chair another committee. This, in turn, leads to more face time with senior hospital leadership [7].

In order to advance your reputation, you must first understand how you are perceived in your organization. It is important to seek out feedback on how others perceive you, as positive impressions are easily discussed but negative opinions are infrequently shared. As we discussed in the Common Career Pitfalls chapter, you are always on stage. Each word and action you say and do leaves an impression on those around you [8]. Reviewing comments or evaluations that have been made about you, formally or informally, is one way to get a sense of how you are perceived. Eliciting feedback from your colleagues and supervisors may be awkward and possibly intimidating at first, but may be essential to your career development [9]. It is also important to try to elicit some feedback in real time [9]. Ask the nurses immediately after a patient flow meeting whether you incorporated the input of nonphysicians adequately. Ask the CMO at a utilization review meeting whether you presented the data well. Ask your chairman after a difficult meeting on negotiating administrative time for your hospitalists whether you should have approached things differently.

Eliciting feedback demonstrates maturity and makes those approached feel as though their opinions are meaningful. Receiving feedback that you are perceived negatively offers a valuable opportunity to either change behavior or explore why that perception exists. While this process may seem arduous at first, being conscious of the way you are perceived will help you ensure that all your interactions with fellow hospitalists, ancillary staff, and supervisors are viewed positively.

Who Do You Know and Who Knows You?

The process of self-promotion starts with developing good relationships across your organization, including with patients, colleagues, nursing and ancillary staff, supervisors, and senior leadership. Developing similar relationships with other health professionals outside your organization, like through a local hospitalist chapter, is equally important [5]. In addition to your work ethic, your likeability and development of strong relationships will greatly increase your consideration by others for leadership roles, high profile projects, or other desirable opportunities [1]. According to Joel Garfinkle [9], a top leadership coach in the United States, “Visibility is not about who you know—it’s about who knows you.”

If people are impressed by you and your skills they will naturally want to advocate for you. If that is not the case, then you will need to seek out at least three people who will willingly serve as advocates to champion you, promote your success, and work to improve the perception others have of you. These individuals can be your direct boss, nurse managers, or even fellow hospitalists with whom you have a favorable relationship [9]. You may need to work toward developing a strong relationship with these potential advocates before approaching them. You will also need to become comfortable in sharing your achievements and wins with those advocates [5].

Who Are the Stakeholders Who Have Direct Influence Over Your Career Growth?

As a hospitalist, you interact with many individuals who may influence your career growth and development. It is imperative to identify the key stake holders in your organization and the influence they can have on your career. Most hospitalists are aware of the influence their hospitalist director has on scheduling and other aspects that can impact review of their performance . However, it is equally important to know who makes decisions regarding promotion and salary of your hospitalist group or team. Is it your Departmental Chair, the CMO of your hospital, the CEO of your regional medical system? Knowledge of this provides you with an opportunity to target advertisement of your strengths and successful performance . Implicit in this, is an opportunity to prepare for a good first impression so that you are perceived in a positive way in your hospital or health care system [9]. You may discover that the CMO of your larger hospital system meets regularly with your hospital’s CMO to review performance metrics and hospitalist productivity. A chance meeting in an elevator, hallway, or at a committee meeting may present a good opportunity to make a lasting impression of your “hard and soft skills” [2]. Hard skills are the technical or clinical skills you need to perform your job well while soft skills are the interpersonal skills like team spirit, enthusiasm and likeability.

Do You Have a Mentor or Sponsor Within the Organization Who Is Your Advocate and Will Promote Your Talent to Key Stakeholders ?

Identifying the right mentor is a very important step toward strategically building the right relationship to demonstrate your value and gain visibility [2]. The right mentor can share wisdom, guide you on which committees to join and which pitfalls to avoid. They can also be ideal advocates for you and promote your talent to others. Studies examining mentorship, productivity, and promotion among academic hospitalists have shown that hospitalists without mentors are negatively impacted by having a lower rate of scholarly activities. However, academic hospitalists associated mentorship programs with promotion, job satisfaction, publications, and grant funding [10].

Finding a mentor does not have to be an arduous task depending on where you work. Some hospitalist programs have formal mentorship programs that pair you with a mentor while others do not. Remember that if you have impressed others already and built good relationships within and outside of your hierarchy structure, it will be less difficult to find a willing mentor. Mentors do not have to originate from your specific department or hospitalist leadership structure. You may have a good relationship with a senior surgeon who worked on an initiative with you or a senior hospitalist at another institution with whom you collaborated on a project for an annual meeting. These individuals are also important to consider for mentorship. Mentoring others, in turn, can be very rewarding and may also help you gain visibility if that is valuable to your organization.

Who Is Aware of Your Career Aspirations?

Being vocal is an invaluable skill in gaining visibility . How will anyone know of your career aspirations if you do not vocalize them? Though some of your talents will speak for themselves, it is important for you to inform all the necessary stakeholders of your career goals [3]. In doing so, stakeholders have an opportunity to identify high visibility opportunities that are in alignment with your career goals. In addition, your hospitalist director will need to know your career goals in order to pair you with an appropriate mentor. While sharing your career aspirations with others, share qualities about yourself that you believe make you well-suited for that position. Promoting aspects of clinical or administrative work at which you excel can be done tactfully and not in a boastful or narcissistic manner [11].

What Is Considered Valuable to Your Stakeholders ?

Knowing the qualities and abilities that are important to leadership when looking to approach someone for opportunities, is critical [2]. It will help you in career planning to take an insightful look into your skills and to start to work on the areas in which you have deficiencies. Every institution is different and the setting in which you practice hospital medicine may dictate factors that lead to promotion. Hospitalists in academic medical centers may have their promotion criteria weighted toward grants, peer reviewed publications, clinical research, and scholarly achievements. In the nonacademic setting, RVUs, patient volume, and involvement in key committees that affect the hospital’s financial bottom-line may be considered valuable. It is important to note that in addition to these “hard skills,” which are technical abilities or skills specifically related to your clinical duties, your softer skills are just as valuable for the stakeholders to notice you. Good communication skills, positive attitude, and good organizational skills may be equally valuable to your physician leaders [2]. A hospitalist who is very efficient and can manage a large patient volume might lose value to stakeholders if he/she has poor interpersonal interactions with other service lines and staff. Likewise, if top hospital leaders are looking for motivated and passionate individuals, they may seek out those individuals who do not necessarily display the best clinical acumen but have the passion to motivate others and lead [6].

Are You Aware of Others’ Expectations of You?

It is important for you to know what is expected of you so that you can meet and, at times, exceed those expectations [5]. Your hospitalist program may have their pillars of success clearly stated in your contract, especially if incentive bonuses are tied to performance . If your institution is not transparent in your contract about expectations, you will need to seek them out. You may need to arrange meetings with leadership in order to do this. You should inquire about the performance benchmarks by which you will be evaluated [12]. These may include quality measures (e.g., core measures, CMS benchmarks, patient safety indictors), efficiency indicators (e.g., length of stay, discharge time), patient satisfaction scores, or financial goals achievable by generating revenue and reducing cost. Likewise, if you are a hospitalist leader it is imperative that you are clear on senior management or hospital leadership expectations of your group. Demonstrating a positive return on investment in your group is of paramount importance. Meeting with hospital leaders to understand what performance benchmarks are valuable to them, will help streamline your data collection. Define which metrics will be used to judge your group. These may include aggregate measures for length of stay, readmissions at 7 and 30 days, Press Ganey scores for patient satisfaction and national external quality and safety benchmarks [12]. Learn efficient and reliable methods to acquire and analyze data and present it in a way that concretely demonstrates the value of your hospitalist group to senior leadership. Without understanding what is expected of you or your hospitalist group, you cannot create strategies to effectively achieve or exceed expectations.

How Can You Develop and Redefine Quality Relationships?

Developing quality relationships and redefining those that are dysfunctional are important processes to advance your career. This may be difficult and time-consuming but can be accomplished through in-built trust and establishing credibility with individuals one at a time [13]. You will have to examine current relationships that exist within your network and determine if they are productive. If not, consider what can be done to ensure they are positive influences on your daily activities and career goals [5]. If unable to redefine those relationships, it is best to seek out more advantageous ones. Avoid aligning yourself with colleagues who do not aim to advance the goals of your hospitalist group, are not invested in growing in the organization, or are looking to leave [14].

Work to build cross-generational relationships within your organization [2]. Strategic relationship building entails building relationships with other generations as those individuals may share skills and wisdom that can greatly advance your career. For instance, more seasoned physicians may impart wisdom on ways to successfully navigate the promotion structure while younger physicians may share knowledge on ways to leverage social media to expand your professional network.

How Can You Increase Visibility ?

Identifying tangible ways to increase visibility does not have to be difficult. Volunteering for new projects and initiatives is an easy way to accomplish this. As a hospitalist with a busy schedule, volunteering to do additional work is not always appealing. However, seeking out projects even when you are not asked may reap many benefits [7]. First, volunteering demonstrates initiative, one of the personal qualities that are important when considering an individual for promotion. Inform the key stakeholders in your career, including your direct boss, that you are interested and available to join committees or be the physician lead on projects. While initial opportunities may be on less desirable committees or initiatives, demonstrating a commitment to the hospitalist group or organization will lead to recognition and consideration for more desirable endeavors. Generally speaking, projects that affect the hospital’s financial bottom-line or reportable quality metrics will be of high value to the C-suite (hospital’s executive leadership team) and lead to positions of high visibility . If you are seen as a solution-driven hospitalist with initiative, it will open the door for more opportunities [3]. Even projects that may not appear to be high visibility may still provide an opportunity to network with other colleagues that are involved in more high-impact initiatives. Be sure that those in your circle of influence are aware of your efforts and accomplishments. Take advantage of opportunities outside of your department if they provide an opportunity to network, build productive relationships, and impart new skill sets as they can make you a better hospitalist and enhance your professional portfolio [7]. For example, volunteer to be a physician liaison between social work and case management. This may lead to a better understanding of the barriers to reduce length of stay and timely, safe discharge. This knowledge may become vital on future hospital initiatives.

Look for opportunities that arise when there is a vacant senior level position. If your hospitalist leader position is vacant, volunteer to adopt aspects of that position that may be within your expertise until a replacement is hired [1]. If you are a hospitalist leader and the CMO position is vacant, suggest to the CEO or other hospital leadership that you can assume some of the responsibilities within your scope.

Finally, advertise your accomplishments. This can be done by informing key stakeholders of your successes. Consider advertising your successes in organizational newsletters or hospital-based communications.

How Can You Demonstrate Value ?

Demonstrating value at advanced level sometimes requires you to become an expert in a high-value area. This may require additional education or training but can reap big dividends. Choose a focus that interests you and will make you essential to the success of your organization; your new skill set will be self-promoting [2]. For instance, physicians with advanced skills in informatics are invaluable for organizations looking to roll out new EMR systems. Also consider the advantages of investing in a new degree such as an Masters in Business Administration (MBA), Masters in Public Health (MPH) or Masters in Medical Management (MMM).

Have You Considered the Impact of Making Others Look Good?

When you promote the accomplishment of others, they find ways to promote your accomplishments in turn. This is true for your boss as well. Praising your hospitalist leader, departmental chair or CMO is effective for many reasons. It instills trust and loyalty. Your boss will praise you whenever they can. They will volunteer you for more opportunities and projects because they know you will be loyal to them and will not usurp them when you go in their stead, as the hospitalist representative. In addition, if your hospitalist leader gets promoted, they will most likely want to staff their new team with individuals who will continue to make them look good [2]. As a hospitalist leader, giving your fellow hospitalists the tools they need to excel will reflect positively on you. By mentoring them, paying attention to their career goals and trying to steer them in the right direction, the accomplishment of your team will show your strong leadership and motivational skills. Publicly recognizing others will show that you value collaboration and those with whom you work will respect you for your ability to acknowledge the efforts of others [3].

There are many ways to gain visibility and demonstrate value . However, doing so takes concerted effort and planning. Ultimately, though, your efforts will result in a highly satisfying and productive career.