Education Medicine Systems

Negotiating a Job Offer (II).

The second thing to ask for when negotiating a job offer is a table of organization. Like the job description, if you are able to review this during your interview, do so. That will give you the opportunity to ask clarifying (not negotiating) questions during the interview.

A table of organization is a sheet of paper with boxes and lines on it that tells you who reports to who. It shows the official hierarchy of the organization. Your position should be on the table; there should also be a line from your position that leads up to your direct supervisor. It should also indicate who reports to you. Many organizations will not share this information with you before you are hired unless you ask for it. Some organizations don’t share this information with you even after you are hired.

If you have Machiavellian ambition, the table of organization also provides a roadmap as to how you can get to the top.

But even if you are not a fan of Machiavelli, the table of organization gives you useful information. Say you want clinical consultation related to the practice of medicine. Your supervisor, however, has the letters “MBA”, “LICSW”, or “JD” after their names. You thus can expect limited assistance from them. Maybe your supervisor is a physician, but is in a different specialty. Clinical consultation may not be useful there, either. Find out before you start a job who will provide clinical supervision for you.[1. If you don’t have an official clinical supervisor, make a point of finding out where you can get help for clinical matters because we all need it sometimes.]

If you have questions or concerns about issues related to the system of care, it’s useful to know if your supervisor can help. It’s also useful to find out who your supervisor reports to (and so on up the chain) because that will affect what information you have access to, how you are treated, etc. For example, as a staff physician, the table of organization might show that you eventually report to the Chief Medical Officer, who might then report to the Chief Executive Officer. However, it is also not unheard of for staff physicians to report to a medical director, who then reports to a director of clinical services (who may not be a physician), who then reports to a deputy director, and then an executive director. If the director of clinical services doesn’t like doctors, or the medical director doesn’t advocate for the medical staff, then your requests might not get the attention they deserve.

You might also find yourself reporting to more than one person. Depending on who they are, that could be fine… or you might feel like a kid with bickering parents.

The table of organization will also tell you who you supervise (if anyone at all). Maybe you don’t want the responsibility of having subordinates. Maybe you do. Maybe you want that possibility in the future, but not now. And maybe the table shows people reporting to you that you are not qualified to supervise. For example, you might have a cadre of nurses reporting to you. There is overlap in the knowledge that physicians and nurses use in their work, but most physicians do not have the skills or expertise to provide satisfactory clinical supervision to nurses.[2. Just because you have the letters “MD” after your name does not mean that you are qualified to supervise everyone, just as someone with the letters “MHA” after their name doesn’t mean that they are qualified to supervise you.]

Do also note that the table of organization you receive from your employer is the “formal” table of organization. There exists in every organization an “informal” table of organization. You usually learn about the “informal” table through word of mouth. Maybe people are supposed to report to a specific individual, but they actually talk to someone else on the other side of the table for help and information. That’s not information you might get during the interview process, but if you have inside connections or opportunities to talk with current employees, you can ask.

For example, maybe the official supervisor doesn’t actually provide useful supervision and you’re better off talking to another staff physician. Or maybe the medical director isn’t assertive, so if people want the Vice President of Clinical Affairs to know something, they cultivate some sort of relationship with that VP or someone along that chain.

This sounds like “politics”. Where there are people, there are often politics. You, however, want to be prepared: When problems come up—and they will—you want to know who you can and should talk to.

Next post: Stuff you can negotiate for.