From medicine to business: why cultural fit matters

My first two years of medical school were mostly in the classroom. Although we spent half a day a week learning to interact with patients, none of that can really prepare you for 3rd year – which is your 1st real year in medicineYou spend your days, evenings and weekends in a hospital, and you start to understand what it means to be a doctor.

I had a lot of memorable “firsts” year. I delivered my first baby. I closed my first incision. I did my first (and last) thoracentesis on a patient with cancer so she could breathe more easily.

I can still remember how my first 24-hour call shift started. It was just myself and a staff physician who I had never met before. I told her I was a brand new trainee and I had never been “on call” before.

She replied: “So what? It’s not like I’m going to go easy on you.”

That’s one way to start the next 12 hours with someone.

That first year of clinical medicine really is “sink or swim”. Fortunately, most medical students figure out how to swim.

Once you can swim, you turn your attention to the bigger picture – figuring out what type of doctor you want to be, and giving yourself the best shot at getting into your preferred residency program.

With so much medical knowledge acquired in that first clinical year, you would think that one’s medical acumen would be the primary factor in getting into your residency program.

It wasn’t obvious to me at the time, but the counterintuitive truth is that one’s medical acumen is rarely the deciding factor in choosing candidates.

Fitting in

I first experienced this in my last rotation of my 3rd year of medical school: Plastic Surgery. Although I had no desire to be a plastic surgeon, doing a few surgery rotations was mandatory, and I heard plastic surgery rotations were a great opportunity to practice suturing and for learning to do it well.

Although I worked with several staff physicians, I spent a lot of time with a certain plastic surgery resident who was in her last year of training. When my rotation finished, she said to me:

“Josh, you are the best medical student I’ve ever worked with. You should seriously consider applying to Plastic Surgery. You would fit in very well here.”

I laughed at her comment, because I was not considering applying to any surgery program, let alone plastic surgery. I figured she was just being nice.

That is, until a month later, when I got a text from a classmate. He was applying to plastic surgery, and had just started an elective rotation at that same hospital. His text read:

“Hey Josh, that plastic surgery resident told me you were the best medical student she’s worked with. What did you do to impress her so much?”

I guess that resident meant what she said.

It caught me by surprise because I didn’t remember doing anything special. In fact, one of the nice things about doing a rotation in a specialty you’re not applying to is that you can focus on doing a good job, and you don’t care about impressing people.

So I reflected on that rotation and I began to remember:

  • We got along really well and had lots of laughs.
  • She mentioned she would get annoyed by overly keen students who would try too hard to impress her. She liked that I was easy going.
  • I did whatever I could to help the team move faster, save time, and go home earlier. Even if it was a menial task, I did it before anyone asked. And I never complained.
  • A little example that had a big impact: I memorized how she documented her notes, and I did them exactly the way she liked, so she could focus on more important tasks. She noticed.

In summary: I made myself easy to get along with, I worked hard, and I put the team above myself. And she valued those attributes in those she worked with.

What that resident cared most about was that I fit into the culture of her team. That I shared the same values and behaviours that both she and her team held.

You’ll notice that “knowing lots of medical stuff” didn’t come up. I’m not saying medical knowledge or skills isn’t important – certainly, aptitude for the technical aspects of medicine are important. But if you are smart and hardworking enough (as most medical students are), the technical aspects of medicine can be learned over time.

But your beliefs, values and behaviours – whether you are a good cultural fit with a team – those aren’t things you just sit down and learn. You can’t force team chemistry.

School’s over. Residency is a real job.

I’m reminded of another story.

A selection committee for a top residency program was debating a particular candidate, who by most accounts, was brilliant. The staff physicians loved him, and on paper he had a stellar resume.

However, the residents he had worked with didn’t think so. Was he incredibly smart and talented? Yes, the residents agreed. But while working with them, the candidate was arrogant and  disrespectful – there was “no way” the residents would work with him.

The selection committee had no choice – even though the decision was technically up to them, they could not risk alienating the residents on their team. This applicant was not the right cultural fit.

Residency isn’t just another “school” to get into. You’re not applying for another seat in a class, where the teacher doesn’t really care who they teach. By picking you, the selection committee is saying they actually want to work with you, side by side, for the next several years.

Applying to residency is asking to join a team.

From medicine to business and back again

Now that I am on the other side of the table at SeamlessMD, having a say in who to hire and who to reject, I finally understand why residency programs do what they do. Why parts of the process seem crazy. Why some residency programs won’t interview an applicant unless he or she spent time working with their team.

Contrary to popular belief, those programs aren’t crazy and unfair. They are actually incredibly rational. I just didn’t understand it at the time.

If I run a residency program, I need to pick candidates who I believe are the right fit for my team for the next 5 years. That is a huge decision. Pick the wrong person, and you are stuck with them for a long time. One bad apple can kill the entire team culture.

There is no way I would take a a chance on someone who “might be brilliant” based on one half day of interviews, when I have someone else who my team has worked with personally, and that we know is a strong cultural fit. It would be stupid to risk the next 5 years on someone who “might be brilliant”.

I suspect this is how many residency programs think, and why “in-person auditions” (i.e. doing an elective at that program) is crucial.

Similarly, at SeamlessMD, assessing for cultural fit is a critical part of our hiring process. It doesn’t matter how smart or talented you are. If the right chemistry isn’t there, if you don’t get along with our team – we aren’t taking a chance.

When we screen applicants, I have full trust in my teammates and their judgment. If a teammate ever feels concerned or uncomfortable about a candidate, I don’t care at all what I think about the candidate – it’s a “no”.

If you believe what your team does is important, whether you are caring for sick patients, building healthcare technology or anything else, you can’t compromise on your team culture.

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