Published in the March 2013 issue of Today’s Hospitalist
YOU’VE POLISHED YOUR CV (to, hopefully, one page) and picked an area of the country where you want to live. With so many hospitalist groups hiring, all you have to do is breeze through some interviews and then take your pick of offers, right?
Not so fast. While your clinical qualifications are your biggest selling point, personality comes in a very close second. Intangibles that you can’t convey in a resume “the ability to relax, ask questions, present a firm handshake and be friendly to staff on a tour “play a huge part in persuading program directors and other physicians that you’d be a good fit.
“A candidate who is uncomfortable or who can’t make me comfortable raises red flags.”
That’s because while programs just getting off the ground may be desperate for any warm body with an MD or DO, groups that are already established need to find out if you could work well within their existing culture and quickly put patients at ease.
“Unlike primary care physicians, hospitalists have a very short time to gain the trust of patients and their families. This takes good communication skills “much like being on an interview.””A candidate who is uncomfortable or who can’t make me comfortable raises red flags,” says Julie Holmon, MD, medical director of the hospitalist program at Beebe Medical Center in Lewes, Del. With 14 physicians already on board, her program is in the process of hiring six more.
In addition to assessing those skills, most groups want to find out how (or if ) you’d contribute to the many nonclinical areas where hospitalists have to take the lead. Here’s a look at questions candidates should ask and discussions they should have while interviewing, as well as some “dont’s” to avoid.
Avoid “will I have to?”
What are red flags that crop up in interviews? Eric Rice, MD, MMM, assistant director of hospitalist services for the 11-hospital Alegent Creighton Health in Omaha, Neb., is put off by physicians who, early in the interview process, want to know about paid tail coverage.
“Most employers do provide tail coverage,” says Dr. Rice. “But when interviewees are already bringing up issues related to how easy it is to leave before they are even hired, that seems off to me.”
For Dr. Holmon at Beebe Medical Center, the “will I have to?” questions are a turnoff. Those include “will I have to work nights” or “will I have to do committee work.”
“Hospitalists in community hospitals have such a direct impact on patient care,” Dr. Holmon says. “So it’s essential for us to be at the table when care decisions are made. I’m looking for candidates who want the opportunity to participate on committees.”
Viviane Alfandary, MD, a hospitalist with John Muir Medical Group in Walnut Creek, Calif., participates in probably 10 of her group’s “lunch” interviews with prospective candidates a year. (Her advice to candidates? “Eat lunch before your lunch interview because you’ll be peppered with questions and won’t have time to eat.”)
One problem is when a prospective recruit leads with, “How early can I leave, or do I have to stay until 7?”
“We can leave at 4 if we’re done, but we have to come back if someone gets sick,” Dr. Alfandary says. Most people in her group have small children, she adds, so everyone wants to get home to their family. That question, particularly early on, “tells me that leaving early is going to be that person’s main focus, which won’t work toward the good of the group.”
Don’t say “cap”
As president and chief medical officer for the Tennessee-based TeamHealth Hospital Medicine, Jasen W. Gundersen, MD, MBA, doesn’t interview too many frontline hospitalists. But he certainly hears about interviews from his recruiters. And several off notes crop up.
One is the use of the word “cap.” “That’s very much a resident mindset,” Dr. Gundersen says. Physicians can (and should) finesse questions about patient volume by asking about workload expectations, how quickly the program plans to grow or what strategy it uses to handle unusually high volumes, he notes. But caps shouldn’t be mentioned.
“I’m a firm believer in keeping workloads reasonable,” says Dr. Gundersen, “but what are we supposed to do if we have a busy day?”
With so many international medical graduates in hospital medicine, another question that comes up often has to do with extended travel. Many candidates want to know: Can they be guaranteed four weeks off to travel abroad?
“Employers have to be realistic about how they’re going to handle staffing if someone is gone for four weeks at a time,” he notes. “There also has to be flexibility on the new physician’s part to be able to work within the confines of the group. Everybody can’t take four weeks off.”
Then there’s this question: If hired, can new recruits work locum in their spare time for other groups?
“Right off the bat, I’m going to say, ‘You’re working full time and you run the risk of burnout working locum too,'” Dr. Gundersen notes. Increasingly, he adds, prospective recruits make the mistake of honing in on going locum rates per day or hour and don’t understand how to compare those to a package of full-time benefits and quality incentives.
“Residency programs don’t educate new grads on the business of medicine,” he says. “Our recruiters spend a significant amount of time helping prospective recruits understand compensation plans.”
Play up lessons learned
Dean Dalili, MD, the medical director of the Hospital Physician Partners hospitalist group at Wuesthoff Medical Center in Rockledge, Fla., says that many candidates send the signal that they’re just looking for the most amount of money for the least amount of work.
“They need to show more interest in the other characteristics of the program,” he says.
Complaints about previous jobs can also be a deal-breaker, especially when they detail a candidate’s frustrations with nurses, case managers or multidisciplinary rounds. “Those are all key players in the hospital,” says Dr. Dalili. “Being able to work effectively with them is one of the quintessential skill sets in this job.”
As for what he likes to hear, Dr. Dalili looks for lessons learned from tough job experiences, as well as projects comfortable a candidate may have championed and a “plausible life narrative,” particularly for candidates who are relocating.
“I’m less drawn to them if I know in advance that they plan to be transient,” he explains. Candidates who have lived in the area or have family there, Dr. Dalili explains, are less likely “to relocate out of the blue.”
Candidates should also ask why a group is hiring. Is it due to growth, the addition of new services or turnover? Dr. Gundersen thinks that asking about group stability is particularly important for doctors angling to move into leadership.
“When the same director has been there seven years and it’s a small program, that director is never leaving,” he says. If that’s the role you’d eventually like to fill, “you need to go somewhere else with more growth opportunity.”
What are you working toward?
Dr. Gundersen asks candidates where else they are interviewing “and they usually tell him. “It can be a dicey thing to ask about, but I think it’s important,” Dr. Gundersen says. “It helps me frame up how competitive a package has to be if we get to that point.”
He also wants candidates to talk about the kind of job they are working toward. “I always ask people what they want to do when they grow up, and that can throw some people off,” he says. “But it helps me know how a candidate might use the opportunities in one job toward preparing for another position.”
In response, he notes, several people have admitted that they want his job. “Those are the ones I like to hire,” Dr. Gundersen says.
For Leah Berkery, MD, a hospitalist who’s been with St. Peter’s Hospital in Albany, N.Y., for more than seven years, it’s been a while since she went on an interview.
But Dr. Berkery says there are questions that she wishes she’d asked, all having to do with personal and group power. Who makes decisions for the group and how much say do group members have? Is the hospitalist leader the equal of other department heads, or does he or she answer to another department?
And how much influence do hospitalists exert on major committees, and what’s the relationship between administration and the hospitalist group?
“My own group has evolved from one extreme to another, from being uninvolved in the hospital power structure and viewed as glorified interns to becoming an independent department,” Dr. Berkery says. “I know now how vital it is to work for a group that’s fully integrated.”
Dr. Alfandary says she appreciates when candidates ask her and her colleagues what they’d change about their own program. Her group also responds to candidates’ overt enthusiasm for a position.
“One candidate recently e-mailed everybody he met in the group and made it clear that he was interested,” she says. “If you’re wavering between two people, the one who shows the most interest is more likely to stay and is more likely to be offered the job.”
Be real about challenges
Hospitalist veterans note that all programs have challenges and that it’s best for groups to be upfront about those. Sometimes, they say, problems are just what a recruit is looking for.
During an interview for a previous job, Dr. Dalili says he figured out that the program couldn’t hold onto either a director or frontline physicians. He saw the leadership potential amid all that turmoil and took the job. Within six months, he was program director.
But Maria Hoertz, DO, MPH, a hospitalist who’s now based in Phoenix, notes that the feel-good process of an interview going well can mask underlying issues. She’s accepted jobs, for instance, in which she was assured that call was only one weekend in eight. But once she actually started and realized all the responsibilities the hospitalists had to share, weekend call was more like three in eight.
“Ask to see the last year’s worth of call schedules so you can truly understand it,” Dr. Hoertz advises. “The call schedule can make or break your life in a community.”
Make sure too that any loan repayment package being discussed is actually available, she says, not just “eligible.” (And pay very close attention to the amount of time you’d have to commit to working in exchange for loan repayment.)
And if Dr. Hoertz is serious enough about a prospective job to visit, she stays an extra day and asks to shadow one of the hospitalists during the day or night, depending on which shift she’s interviewing for. Shadowing a colleague and seeing the frustrations she or he may have lets you know what you’re really dealing with.
“Programs will tell you, ‘We have full specialist coverage,'” she notes. “But when you’re with a doctor who’s trying to get a GI doc in for a consult and you hear someone say, ‘Good luck with that!,’ you know what’s really going on. Those are the kind of comments that never come up in an interview.”
Phyllis Maguire is Executive Editor of Today’s Hospitalist.
For more, read Interviewing candidates? Tips to help your group shine, published in Today’s Hospitalist’s Career Section.
Also, check out our article on Doing due diligence, with tips to help hospital physicians ace job interviews.