updates: telling an interviewer the job expectations aren’t realistic, and more

It’s “where are you now?” month at Ask a Manager, and all December I’m running updates from people who had their letters here answered in the past. Here are four updates from past letter-writers.

There will be more posts than usual this week, so keep checking back throughout the day.

1. Telling an interviewer that the job expectations aren’t realistic (#2 at the link)

I’m the one who asked about telling an interviewer that their job description expectations aren’t realistic if I received an offer for the position. As it happens, I did not receive an offer! I was informed I was their second choice. Disappointing at the time, but perhaps I dodged the bullet.

To provide a little more context: I’m an acupuncturist in private practice. I saw that a large healthcare franchise was looking for an acupuncturist to work in a clinic they had set up to transition people with chronic conditions off of narcotic pain relievers, given what was being learned about opioid dependence. Pain management is one of my specialties, which is very rewarding, but it’s stressful to be a small business owner at the best of times. I was looking at alternatives that might provide a steadier income and benefits for myself, where I could also focus entirely on helping people and less on all of the marketing and insurance billing that occupies much of my current time.

During the hiring process, once I learned who the hiring manager was, I looked up their clinic online and found a review page that gave them less than one star out of five. Review after review from disgruntled patients criticized the clinic for taking them off of the narcotics they’d come to rely on over the long term, apparently without providing anything useful for the chronic pain. I didn’t really see this as much of a red flag in working with this clinic, as it’s bound to be a difficult transition. I commended them for thinking to provide acupuncture, which can help both in cases of pain and substance dependence.

The real red flag was during the interview when I was told that the plan was to give the acupuncturist one small treatment room to see three patients per hour. Typically, acupuncture appointments last one hour per patient, and they were offering me 20 minutes, minus the necessary time for refreshing the room, checking in with the patient about how they had been doing, disrobing when necessary, getting positioned on the table, etc.

I can see more than one patient per hour, even one every 20 minutes, but it usually has to be in separate rooms. For example, someone comes in at 1 pm, I check in with them and start the treatment, then leave the room at 1:20 and let them rest quietly for the rest of the time, then start the next person at 1:20, etc., with rolling arrivals and departures. Or it’s possible to do full treatments in an open-space “community” setting, with a number of people in recliners getting treatments as they arrive and resting for the rest of the time with the needles in. Either of these approaches can be very effective. This clinic’s proposed structure of three patients per hour, one at a time, would simply never have worked the way they wanted it to. I believe it was trying to put a little bandage on the huge amount of dissatisfaction experienced by their patients, but it would have just ended up being another layer of frustration.

So I stayed in private practice for the next several years, considering one or two other jobs that I became aware of, but never applying to any. I honestly love the people I see and help in my own clinic. My success rate is quite high, I just get burned out on the all of the admin involved in keeping an insurance-based business running despite very low insurance reimbursement rates. Recently, I’ve decided to change my business model to add additional services, and this process has fired up my enthusiasm for entrepreneurship again.

Thank you again for your response to my letter. I’ve been self-employed since the twentieth century and had no idea how to navigate the world of job interviews. Now I am about to conduct some hiring for my expanding clinic, and thanks to the regular wisdom in your column, I know what it takes to be a good interviewer and boss.

2. Should I tell a community partner’s boss that he was unprofessional? (#2 at the link)

I ended up contacting the presenter’s supervisor and she looped in her boss. They were both very concerned about what had happened and asked for more detail. I sent them all the information I had from the teacher. They told me that they were going to stop school presentations and re-tool the whole program for the fall, as well as pull John from that program. I don’t know if anything more is being done with him, but I feel confident that I did the right thing. Thanks for reassuring me it was the right choice!

3. How to tell clients I’m shutting down my business (#4 at the link)

I did manage to separate from the clients, with mostly no issues. One client refused to pay me the remaining balance owed, and still hasn’t, but I wrote it off at this point. (A friend of mine who in the same field also canceled their work, so that helped take the sting away.) I remain working with one client, but they are not an issue at all and it’s not the same services as the others.

Since then, I’ve also been diagnosed with both autism and ADHD, which, while not a reason, helps shed a little bit of light on my rigidity and over-thinking.

4. Should I trade free time for more money? (#3 at the link)

Turns out there was a lot behind the scenes going on that I was not privy to — in short order we had two senior (one C-level employee, one SVP) retire and the CEO took it as an opportunity to restructure the company. My direct manager was promoted into a CPO position and took me with him — promoting me and giving me several products to run (including building one from the ground up). I am excited to say that it is a big jump up in responsibility (and pay was raised in accordance with the new role) and my job is now much more rewarding and I find my days more full with rewarding work. It’s only been a few months, but the company has already seen increased revenue, and I have already seen professional growth.

I appreciate all the comments. Turns out I wasn’t being phased out, there was just C level restructuring that had to take place.

{ 42 comments… read them below }

  1. Minimal Pear*

    I’m kind of surprised the reviews weren’t the first red flag for LW1! If the rating was THAT low it sounds like almost every single review had to be extremely negative. Combined with the unrealistic expectations, it’s clear LW1 dodged a bullet.

    1. chewingle*

      I don’t know enough about treating chronic pain to know if that is 100% a red flag — is it only people who are mad about having to stop taking the medications? (My limited experience with opioid-addicted family member indicated that they are often more disgruntled even when their pain management is going as planned because their brains want the drugs.) But I agree that would have at least given me pause.

      1. FrivYeti*

        I’m trying to find a way to say this which is respectful to OP – in my mostly second-hand experience, which involves many people in my life who deal with chronic pain, a lot of medical professionals are insufficiently concerned with the quality of life and long-term success rates of forcing patients who are taking opioids for serious chronic pain issues to go cold turkey, due to lacking firsthand experience with what that does to people. It’s extremely common for medical professionals to dramatically underestimate the negative effects on someone’s life of being taken off painkillers if they are still suffering pain.

        Acupuncture is a potentially useful tool for treating pain for many people. It’s not nearly the same as having high-grade painkillers, and I would personally consider it to both a huge red flag and unfortunately a quite common one to cut someone off from narcotics without providing them anything of a lower grade to help them. In this case, I suspect that the lack of extra things was a forewarning that this is a clinic that cuts corners to save costs at the patients’ and medical professionals’ expenses.

        1. Minimal Pear*

          Yes, I have chronic pain (and have needed opioids in the past) and that’s why I was so surprised that LW1 didn’t see all those reviews as a red flag.

        2. Feotakahari*

          A recurring post in the chronic pain community is “my friend committed suicide because they couldn’t get opioids anymore and nothing else made the pain stop.”

        3. Hrodvitnir*

          Yes. I’m very disturbed both at the lack of empathy for suffering, and at the idea that acupuncture (not without evidence but it is moderate evidence and not even on the same planet as opiods for anagelsia) alone could replace opiods.

          1. Spiders Everywhere*

            Yeah, the benefits of acupuncture are probably comparable to, like, a massage – something that might help *in addition to* medical intervention, not to instead of!

        4. Freya*

          A couple of weeks ago I had a GP tell me I should go off two of my long-term meds (both with nasty consequences if you go cold turkey) before trying to get pregnant, and did I want to take my IUD out today to start trying lest I be too old?

          I talked them into advising me to discuss it with the specialist doctors in charge of those portions of my medical care before ceasing to take my meds. Because their advice to go cold turkey was 100% wrong and if I did and suffered the adverse consequences, they’d have liability.

          1. Candi*

            I’m irritated on the GP apparently thought “baby factory” was more important than “Freya’s well being and quality of life.” Did they even ask if you want the expense, time, and labor of kids?

            (I have two. They’re adults now. They were a lot of work.)

      2. Jackalope*

        I would say that if there were multiple people writing in and saying they had their meds yanked away without proper treatment afterwards then that’s a good sign that it wasn’t being handled properly. Sure, some people might be disgruntled, but people are going there for pain treatment and taking someone off meds (esp cold turkey, although I guess we don’t know if that was the method) is a really lousy way to do that.

        1. sparkle emoji*

          Yes, if the average for all the reviews is one star, there are more than 5 reviews, and the forced cold turkey treatment is a consistent trend across reviews, that reads as a massive red flag. If it was just some disgruntled patients over what was actually best practices, I’d expect some positive reviews to balance out the negative.

      3. Andie*

        There being bad reviews isn’t a red flag; it’s a complicated and multi-pronged area of treatment. There being bad review after bad review without a noticeable number of other people who are excited to be able to get through their day without using a medication that has side effects and widespread stigma? That’s a huge red flag.

        And in this area of medicine, I think the OP should recognize the kinds of reviews they describe as a red flag because a *lot* of pain clinics operate by treating their patients badly and solely picturing success as “removed access to opioids” rather than “improved lives”. These kinds of clinics don’t offer acupuncture in order to give patients treatments that will let them reduce their opioid use (like acupuncture can), they offer acupuncture in order to “take away an excuse” for patients to use opioids (even though acupuncture doesn’t work that way for everyone, and certainly even less people in the way they offer it).

        The treatment is different for people who have actual opioid addictions, and I’m not familiar with those treatments other than that’s it a multi-pronged approach like with any addiction. My lived experience is in chronic pain and a lot of people are labelled as being addicted to opioids when what they’re actually addicted to is being in less pain! The only way to actually help those people is by treating the pain in a multi-pronged approach and making opioid reduction a good consequence instead of making it the only goal.

        1. Andie*

          For the record: my personal experience with the pain clinics I’ve attended have mostly been great.

          But my experience with doctors and other medical professionals – including those that specialize in pain conditions – has been very hit and miss. In some cases I’ve been lucky to be able to choose to work with someone else and have obtained success from those treatments. In other cases, I’ve been forced to submit to their “treatment” plan and have to deal with very serious consequences including permanent physical damage and losing – for years – my ability to be employed until I was able to find a new health provider.

        2. whingedrinking*

          Unfortunately, when it comes to opioids, a lot of people assume dependence = addiction, even when they wouldn’t confuse the two in other contexts (a person with type 1 diabetes is dependent on insulin, but they’re not addicted to it).

          1. Alice in Hinterland*

            Indeed. I have encountered numerous medical professionals who don’t understand the difference. And what is truly frustrating is the “morality” that gets injected into pain medications. So many people feel comfortable telling people it’s wrong to stick with a stable, well-supervised regimen that includes opiates, when they would never dream of saying the same to someone who required insulin, blood pressure meds, or SSRIs.

            In my experience, very few people I know would voluntarily choose treatment with chronic opioids if there were any alternative. It’s demeaning and humiliating to be judged by so many people every single time you need to refill, your life and movements are controlled by access to your prescription (can’t travel certain days because prescriptions can’t be filled even a day early), and you’re under constant threat and pressure that the medications that let you have some small semblance of quality of life will be taken away. If your doctor retires or you move, you’re liable to be completely hosed.

      4. Lobstermn*

        Yes. Anyone taking people off of narcotics for chronic pain is engaging in ideology, not medicine.

        1. Spiders Everywhere*

          It’s fairly clear that the primary benefit of giving a treatment that current science is, um, unsure of the relationship the placebo effect has to the perceived benefits to people who you’re taking off their pain medications is in the area of patient compliance. They make less of a fuss and you get to put the ones that just give up after in the “win” column.

          1. Alice in Hinterland*

            Yes, I’ve been pressured towards doing acupuncture, Traditional Chinese Medicine, reiki, homeopathy, and many other pseudoscientific treatments for years — nearly always at my own expense. One doctor snidely told me I “clearly didn’t want to get better” after I declined to start weekly $150 acupuncture sessions with a practitioner affiliated with his office. Hmm…couldn’t be that he received some benefit from referring patients? Surely not?

    2. Fluffy Fish*

      Bad reviews with medical providers can be complicated to discern whether it’s poor treatment or frustrated patients who are unhappy with the solutions their presented.

      Especially when you factor in people who are satisfied with their treatment are less likely to review (also true for products and services).

      It can be good info to have but doesn’t automatically mean red flag, and I think that’s how OP was approaching it. Good info that when paired with additional info made a more complete picture to make a judgement.

      1. Minimal Pear*

        My impression from what LW1 said was that it was pretty much every single review, since the overall rating was below one star. I’m chronically ill and research doctors a lot and yeah the ratings tend to be kind of low, but there are usually a few positive reviews pulling them up.

        1. Fluffy Fish*

          Could be but I’ve definitely personally seen Dr.s I’ve used with low review because there’s 3 or 10 or 15 reviews and simply no positive ones. I’ve also seen one review site be all negative and another review site to be glowingly positive. I personally don’t take it as an automatic red flag – I take it as an I need more info where sometimes it tracks and sometimes it doesn’t.

          Not looking to convince anyone, just sharing how I approach bad medical practice reviews in response to a question on why someone wouldn’t see bad review as a red flag.

  2. Oirishgal*

    OP1..why don’t you hire a medical secretary to do all the admin you dread? They can work remotely and free you up for more earning time so double win?

    1. HailRobonia*

      In my org we joke that a typical job posting is:

      Administrative Assistant 1: Must be proficient in Microsoft Office, Adobe products, and Desktop publishing, as well as Salesforce, Oracle DB, have a commercial pilots license, a blackbelt in hapkido, and be fluent in English, Spanish, Arabic, and Keigo Japanese. Physical requirements include ability to lift 350 pounds. Salary: $23,000 per year.

    2. Generic Name*

      Yeah, after reading the job postings (yes, multiple) to cover my responsibilities after I left my last company, all I could do was laugh. To my knowledge, those positions remain unfilled.

    3. Your Mate in Oz*

      It’s a standing joke in programming jobs. “wanted: entry level programmer with 10 years experience in language first developed 5 years ago. Must also have 10 years experience in technology first developed last year. Salary: minimum wage, some unpaid overtime expected”

      The worst interviews are where I ask about the requirement and get told completely straightfaced that the requirement is not negotiable. I have been tempted to say “neither is my $1M/year salary” but I have managed to resist.

      1. Reluctant Mezzo*

        Don’t forget that in programming, you have to have that experience and still be in your early 20’s.

  3. Ranon*

    OP#1 what you describe is so incredibly routine in clinic practice and definitely sounds like you dodged a place that had some fundamental gaps in operational sense.

    I hope you find a better partner in the future if that’s what you want!

    1. I'm just here for the cats!*

      It almost sounds like they were going to treat the acupuncture like a chiropractors office. That you can do in 20 minutes and there really isn’t much extra time.

      I wish the OP had filled us in on what the office looks like now. I hope that whoever they hired knocked some sense into them and is doing it the appropriate way like what OP would say.

  4. BecauseHigherEd*

    @Alison, I would love to read an interview with LW 1 for the unusual jobs segment–I know it’s not *that* unusual, but I’d be fascinated to learn more about what it’s like to be an acupuncturist.

  5. The Acupuncturist*

    Wow, everyone. I’m LW1. Thanks for your thoughts.

    I really emphasized that I did consider it a bit of a red flag, but not SO much. I do see people transitioning off of opioids in my own clinic. Like I said, pain management is a specialty of mine. Like someone said, it’s a BIG transition in cases of prolonged use of certain meds. I personally think people should have the option to keep the meds they find are working, and be presented with the other options if they’re fully informed and interested. I’m not anti-medication, or even anti-opioid. I’ve met a number of people, though, whose doctors have decided they don’t need the medication, and many of them are quite bitter and argumentative about it, and that was the tone I saw in those reviews, meaning it was more what I might logically expect than a surprise red flag.

    You’re also correct that margins are low in my current insurance-based business, but you’ll be happy to learn that I’ve hired a front desk person that I am able to pay a higher-than-usual wage if the expanded practice works out the way I plan. She won’t take everything off my plate, but fingers crossed it will make a big difference.

    Thanks, everyone.


    1. Andie*

      Ah, yeah, I can see how your phrasing there could be interpreted in multiple ways. You meant “this can be a red flag, so I was cautious but was interested to learn more” and I heard “I didn’t think it was a red flag until later”.

      However, I want to note that the people in chronic pain who are argumentative and bitter aren’t necessarily wrong in the information they’re sharing – they’re just still dealing with what are life-changing and possibly life-lasting consequences of their mistreatment – and you’re in a better position than most to recognize that. Are their methods of dealing with it damaging and make them harder to treat? Yes, absolutely, and it’s not fair to you. But neither is what happened to them. It’s a often symptom of the treatment they’ve received, and it’s really hard to describe your treatment without explaining all the things that went wrong! The bitter and argumentative tone is one we can gain control over, but it’s still a symptom of their mistreatment.

      I’m so glad to hear that you were able to hire someone to help you with an expanded practice! Good luck!

  6. Nica*

    As for letter #1, I ran into a similar situation when applying for jobs a few years back. I found a job that seemed to be a good match for my skills, but the salary range posted seemed REALLY low for what they were looking for. They basically wanted to pay a co-ordinator salary for a marketing manager job. I reached out anyway, thinking I could at least talk to them and see if they’d negotiate.

    The job was listed through a recruiter, so she reached out to me. We talked about the job and I said, “I’m sure you realize, as a recruiter, that the salary range is way out of line for what the company is looking for.” She sighed and said, “I know. I’ve talked to the company owner multiple times about it and he refuses to budge. Meanwhile, NO marketing is getting done and he’s losing money, I’m sure.” I said, “Well, I appreciate your candor, but the salary offered would be a cut from what I’m earning and wouldn’t work for me.” She just said “OK” and ended the call.

    I saw that job listed for another THREE YEARS, either going unfilled or people leaving when they realized they weren’t going to do ALL the marketing for the company for $50K/year.

    Eventually, the company was bought out by another, larger company. Don’t know if it was by choices or if they were forced to sell. I’m guessing the latter…

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