The only ways to stay sane here are to blindly follow the leaders or to play the politics game where you ensure you’re ahead in the exchange by virtue of doing less work to maximize your ROI. If you are anywhere between these two extremes (meaning you’re not afflicted by Stockholm Syndrome or sociopathy), then you’ll have a tough time here. One of the core values is “Put the patient first” but the patient is whoever leadership wants it to be. If they want something done to serve a high paying client, they will spin the narrative to align with this by cherry picking patients who happen to be employed by said client. The original Included Health, Grand Rounds Health, and Doctor on Demand companies were all very much out there to help the patient and the funding came naturally. Now that they’ve merged (which isn’t a cheap process) and the economy isn’t as stable, leadership is scrambling and showing their true colors. It was always about money. Engineering “leaders” are either spineless whelps or lazy task masters. They have so little understanding of their own ecosystem that they would compromise actual healthcare to serve their sales pipeline. They spin it as driving the most “impact”. This concept works in theory, when we can all agree on what that is, but we can’t so we talk past each other and then go to work on assumptions of what the highest impact could be. Trust me people.. this isn’t a stable company. We’re talking about a codebase with the complexity and scale of a large organization operating on a skeleton crew of new engineers and foreign contractors in a true startup fashion. Now let’s say, hypothetically, that you aren’t a lemming and you really want to contribute to what IH has to offer. GREAT! Now you’ll be overworked and underpaid and if you try to work cross-functionally, you’ll be bullied into focusing all your time and energy on that cross-functional project. Oh, just talk to your manager? Good luck getting anyone on your side without any data to back you up. Also, all responsibility falls to you as the IC to push back on deadlines and commitments. They pitch it as: “we should all feel empowered to push back” but what they mean is: “we’re too scared or uninformed to push back so you’ll have to do it for us… oh and we’ve already signed the contract so… sorry!” There are some pedigreed engineers and leaders here so you can learn a lot from them. You’ll get no shortage of book suggestions and dogmatic lectures about microservices or whatever the hell else Gene Kim is preaching about. Original ideas? Never heard of ‘em. Be prepared for the lengthiest and least informative conversations you’ve ever had. To top all of this off, be prepared to test (or not test) your own code - likely in production. That’s not crazy for an early stage fintech startup, but a decade old healthcare company? Quality is assured by no one so you don’t actually have to test if you don’t want to. “Release and pray people. If it doesn’t work, just rollback. Don’t worry about the patient who didn’t get the care they needed; that’s not the patient that we want to put first.”
