In January 2020, ACP Member Read Pierce, MD, was in the early stages of interviewing to be chief of hospital medicine at the University of Texas at Austin's Dell Medical School. As talks progressed, Dr. Pierce anticipated lining up an on-site visit and, if that went well, taking another trip with his family to find a house and look into schools for his two young children.
Then everything shut down in response to the first wave of COVID-19. Dr. Pierce, who lived in Denver at the time, ended up landing the job and relocating to Austin last summer—but the process was nothing like what he had expected.
“After the first-round interview, everything moved online. I had eight to 10 calls and virtual interviews,” he said. “And the whole process toward the end was different because we couldn't take a family trip before I accepted. It was much more of a leap of faith to move compared with other job processes I've been through.”
Other hospitalists report similar experiences navigating the job market during a pandemic. As in so many areas of life, the move to virtual has had both positive and negative effects, many have found. For example, travel costs are eliminated and scheduling interviews is easier; however, it's significantly harder to get a feel for new work and living situations.
“For initial interviews, virtual formats provide most of the value of what employers would get in person and it's easier to schedule more calls with a wider group of people,” said John R. Nelson, MD, partner in Nelson Flores Hospital Medicine Consultants, in Bellevue, Wash. “However, for the candidate, it's nowhere near as valuable as spending a day or two in the community. You might learn about the program just as effectively, but it's harder to know what it might be like to live somewhere.”
Back in the beginning
In the early days of the pandemic, most hospitals eliminated elective procedures in order to set aside more beds for COVID-19 patients, resulting in substantial short-term revenue losses that triggered pay cuts and hiring freezes in many areas of the country, noted Michael Belkin, JD, divisional vice president at Dallas-based physician search firm Merritt Hawkins.
As a result, overall physician recruitment dropped significantly during the first quarter of 2020, he said. While the job market for hospitalists has gradually improved, he added, it has not returned to levels of previous years. Meanwhile, demand is up for pulmonary and critical care specialists, who are needed on the front lines of COVID-19 care.
Those first few months triggered anxiety among hospitalists seeking jobs, noted Valerie Vaughn, MD, FACP, who recently moved from a hospitalist position at the University of Michigan in Ann Arbor to a new role as assistant professor of medicine and director of hospital medicine research at University of Utah Health in Salt Lake City.
“At the end of April, when COVID numbers were very bad, I was in talks with two potential employers when I started hearing about hiring freezes that made me nervous about whether offers could be rescinded,” she said. “One day I came home from a 12 hour-shift, printed off the new contract from the University of Utah, and sent it back before anyone could change their mind.”
The pandemic has also influenced how younger physicians approach their first job search, noted Stephanie Conner, MD, FACP, assistant professor of medicine at the University of California, San Francisco (UCSF), who leads recruiting efforts for clinical hospitalists there.
At UCSF, there has been markedly lower interest in specialized clinical positions for hospitalists (eg, comanagement of cardiology patients), along with an uptick in applications for general internal medicine and subspecialty fellowship openings.
“Applying for a fellowship is a lot less expensive now because candidates don't have to spend thousands of dollars flying all over the country for interviews,” she said. “Physicians just out of residency also seem more likely than in the past to choose roles they're most comfortable in—general inpatient medicine versus subspecialty.”
Uncertainty around the pandemic also caused reluctance among some to move far from family and familiar surroundings, said Dr. Nelson, who recalled several physicians who backed out of verbal commitments or letters of intent during the first wave of COVID-19.
“Physicians felt insecure about moving, including selling a house in an uncertain financial market and incurring costs around relocation,” he said. “During the spring and summer, many were hesitant to make decisions or take on the risk of trying something new.”
Interviewing goes online
Candidates and recruiters alike cited several advantages of virtual interviewing. Besides the time and money saved by not traveling, it allows for a more relaxed process and makes it much easier to schedule meetings with a wider group of people.
“As a candidate, the ability to meet more people more easily at different times was very helpful,” said Dr. Pierce. “I've had multiple job interviews in the past where there were people I really wanted to meet who just weren't available that day or there were too many people to try to meet on a one-day site visit.”
With the virtual format, he was able to schedule calls with key administrative and clinical potential colleagues over the course of a couple of weeks. “That put me in a position to ask more thoughtful questions,” said Dr. Pierce. Conversely, “during on-site visits, we tend to be so focused on just getting through the next interview that there isn't much time to reflect on new information or perspectives.”
Similarly, Dr. Vaughn found it much easier to schedule calls with people across potential employers. She advised others to take advantage of the opportunity to set up as many conversations as possible before making a decision on a new job.
“My advice is to interview broadly and think of it as a great way to network,” she added. “My job at Utah grew out of connections I made during a previous job search, and now is a much easier time to make those connections without the burden of travel.”
When talking with potential coworkers about a new workplace, make sure to ask pandemic-related questions, she said. For example, ask them what the work climate is like during inpatient surges or whether staff has been asked to work extra hours without pay.
“A pandemic is a good time to see how employers treat their employees during the worst of times,” she said. “You want a place that continues to look out for the wellness and safety of their employees.”
However, the hospitalists said they never felt completely comfortable with making a big move—both professionally and personally—based on virtual interviews alone.
“With virtual interviews, you miss out on that casual interpersonal contact, off-the-record conversations, and walking around the area that you get during in-person visits,” said Dr. Vaughn. “Money and benefits are important, but most people choose a job based on whether they like the people and work environment, and it's harder to know that with a virtual visit.”
Transitions and onboarding
Pandemic-related issues also affect the transition from one job to another. For example, Dr. Vaughn accepted her current job at the University of Utah in April but negotiated a start date of Oct. 1 in order to continue helping with the COVID-19 response in Michigan while numbers were rising.
When her house sold faster than expected, she ended up moving to Utah, where her then-fiancé was already living, before her start date. She spent the next several months alternating between working remotely on research and traveling back to Michigan for clinical shifts.
The pandemic adds a layer of complexity to starting a job in a new state, said Heather Hofmann, MD, FACP, who last summer moved from the University of California, Irvine, to Cleveland to start a position as a staff hospitalist at the Cleveland Clinic. Many once-routine tasks, such as applying for a new driver's license or stopping by the human resources office, had to be handled online.
In prepandemic times, hospitalists might have spent their first day on the job touring the hospital, meeting staff, and perhaps going out to lunch or dinner with new colleagues. Not anymore.
“A few things had to be done in person, such as picking up my ID badge and parking pass, and getting oriented to the medical floor where I would be working,” said Dr. Hofmann. “But meetings that normally would take place with a group were now virtual, or people were called in one at a time with everyone wearing personal protective equipment.”
During his first three days at UT Austin, Dr. Pierce said he spent a total of about 10 minutes interacting with colleagues in person—a strange experience compared to the past. “I had to get a key and an ID. Aside from that, everything was remote.”
As the new head of hospital medicine, he initially worried about how the switch to virtual would affect his ability to build relationships and trust with his new team.
“I was much more cognizant of how I was connecting with people virtually in order to build the relationships I would need when we were in the hospital together, especially during pandemic surges,” he said. “In the past, a lot of work got done between meetings, as we walked to the next meeting, or we saw each other in the hallway. That space doesn't really exist virtually. Many of us are still grappling with how to handle this in our work and leadership.”
COVID-19 cast an eerie quiet over the administrative wings of hospitals, said Dr. Vaughn. At the same time, clinical staff were often exhausted and not as available to help orient a new colleague.
“Staff who don't have to come in are working remotely, so the administrative offices are usually empty,” she said. “Meanwhile, the patient care floors can be crazy. People are always willing to talk, but they're also a bit burned out.”
Despite the complications involved with starting a new job during a pandemic, some hospitalists said they've benefited in unexpected ways. For example, Dr. Vaughn's clinical service during surges in Michigan has informed her research in Utah. Much of her current research focuses on how to improve COVID-19-related care in the hospital and after discharge.
In some ways, this crisis is an optimal time to consider a new job, said Dr. Pierce.
“The degree of creativity around a job, what it includes, and what you might want to get good at are a little more open during a crisis because so many assumptions are being upended or reexamined,” he said. “Hospitalists entering new jobs can choose to lean into some of the leadership and clinical opportunities that have come with COVID-19.”