If you're on a rotational call for indigent patients or patients without a doctor, how would you feel about having to see a patient in the ED whom you had dismissed from your practice?

"Although I would not choose to see this patient electively, I would follow policy and accept him or her without any personal asides to the patient. If the patient chose not to accept me as his or her doctor for this episode, I would call the Patient Advocate and arrange a consultation with the patient to remedy the conflict."

This is a test of your willingness to comply with policy. Most physicians have dismissed patients from their practice for failure to pay or a failure in compliance. If you're fulfilling an obligatory role and a dismissed patient is assigned care by you, you have to accept it.

If you are treating a patient for whom a skin condition was diagnosed and treatment given, but the result had failed, and the patient then stated he/she had lost faith in you, what would you do?

"A patient who feels I have failed him or her can be disappointed, but there is a big difference between a trial of therapy and then fine-tuning it based on the results and being accused of being inept. Prior to any treatment, I would educate the patient on any remedy in which the results--successful or unsuccessful--would be helpful. If unsuccessful results soured our relationship to the point where I faced an uphill battle in convincing the patient why he or she should continue with me, I would recommend referral to another dermatologist, based on the absolute need for a patient to have confidence in me. The patient is already angry, and if the anger cannot be removed and replaced with good faith, discharging him or her won't make things any worse and may even limit my liability and that of those with whom I'm associated."

This is a disturbing scenario on different levels--it's a challenge to your knowledge and expertise and a distrust of you. It also has medicolegal implications, because dissatisfied and/or angry patients are the ones who feel strongest about someone else paying for their disappointing results, i.e., litigation. Your answer should reflect the deterioration of the physician-patient relationship and how you might regain it or cut your losses. You have to admit that there are some situations that you just can't win.

Are there any other types of specialties with whom you plan to work with on a routine basis?

"I rely on other specialties all the time and will have a good, working relationship with your pathologists, cosmetic surgeons, and other specialists, because many skin conditions are intimately associated with disorders of other systems in the body. If I ignore this relationship, I am not practicing the full depth and breadth of dermatology."

No one is an island, and medicine is so complicated that it takes a village. Dermatology is one such specialty that relies heavily on others, and you should answer that this is an important strategy in your practice. Physicians who announce their isolation in practice are limiting the options for their patients.

Many cosmetic surgeons and gynecologists have an aesthetician and offer the same topical services you may, such as prescription meds, IPL, or laser therapy. Do you have any personal feelings about such ancillary staff that could constitute competition?

There is a traditional antagonism between MDs whose specialties extend into common ground with other specialists. This should not be seen as a problem for you, because everyone--in your practice and theirs--contributes to the bottom line. You have to present yourself as being open-minded, because more innovations are being developed and introduced all the time. Gone are the days when a specialty can claim dominance over an area of expertise that is a "gray area" intersection between two specialties.

Do you have any hesitation referring to another specialty?

"I certainly plan to practice along the lines of dermatology, but I make liberal use of consultation for the best health impact on my patients. If someone does something better or is more qualified from a regulatory standpoint, I will willingly defer to, or partner with him or her in the case at hand. For example, I may want to involve a plastic surgeon to complete a Mohs procedure for a better cosmetic result. This would not only be appropriate, but even the best plan for my patient."

This question gets at if you plan to practice out of your comfort zone, i.e., appropriately. Your answer should be centered on what is best for your patient, not winning some turf battle. When patients end up their happiest, they are also happiest with you.

Do you accept Medicare assignment?

"Yes, I am a participating doctor in accepting Medicare assignment. Alternatively, I accept Medicare but am a non-participating doctor for accepting assignment. Alternatively, I do not accept Medicare and have opted out."

This is really no business of theirs, unless there is a policy that you must be a 'participating doctor', accepting Medicare assignment. If it's a group, this might be so; if it's a hospital, it only applies to those employed by the hospital, not independent staff.

How is your attendance at general staff and department meetings?

"I may have missed meetings from time to time--usually due to my being occupied in clinical duties or vacation. However, I realize how important the business of the hospital/group is, and will make every effort to improve my attendance."

Running a group or a hospital, unfortunately, requires significant bureaucracy. The doctors are needed to make that run, which means taking responsibility for the clerical drudgery involved. This means meetings--lots of meetings. And they're always at night or during office hours, which can cut into your income. Note that the question doesn't ask whether your attendance will be good, but how it has been in the past. This implies that your answer may be verified by a phone call or two, so tell the truth. Most likely, no one will be checking up on your answer, so even if you've been truant in the past, pledge to do better.

What would be your response to hearing a code being called in the middle of the night as you're getting ready to go home after attending a patient?

"Unless managing a clinically unstable situation or in the middle of a procedure, I would respond, and then only drop out if others were whom I felt were more qualified to attend the code."

This is a no-brainer question. Of course you would respond. It is tempting to assume that certainly someone else would be there to respond, and that is typically true, but you don't want to be seen as the type of person who would need to hear the code called repeatedly before you responded.

Would you be willing to serve on a committee investigating an issue with one of your colleagues?

"There is no easy answer for this, only a difficult one: yes, I would have an obligation to do what's right when it comes to patient care and safety, even if that means possibly being resented by a colleague. If it were a close personal friend being targeted by the investigation, I would ask to recuse myself, but I would be prepared for that not to be granted. The only thing I would want is to not be the only one making a judgement--having more than one investigator, I feel, is necessary to take politics out of such an inquiry and give it additional objective credibility."

Internal affairs and investigation are just necessary. Things happen, and when patient care is affected or jeopardized, they must be explored and dispositions made so that they don't recur. Besides Joint Commission accreditation and insurance reimbursements, a public reputation is jeopardized by uncorrected omissions or errors in care. The interviewer wants to know if you'll have the courage to step up and do what's right.

How timely is your practice to sign off on chart entries and make all of your dictations current? Have you ever been suspended from a staff for failure to do these?

"Although I've been occasionally remiss in keeping all sign-offs and dictations current, I feel it is important for me to be diligent in keeping current. It is not lost on me how reimbursement by third-party payers can be affected by incomplete charts. Just as important--to me--is the need for accuracy, and attempting to remember specifics from a procedure or rounds can become spotty if too much time has passed. For these reasons, I agree that keeping current is important and strive to do that."

This type of suspension is not a 'hard' suspension, per se: it doesn't mean there are any deficiencies in your medical care or expertise. Most physicians get a little behind from time to time, the only thing lighting a fire under them to get these clerical loose ends tied up is often suspension. Although this is frowned upon but not necessarily condemned, it does impact the hospital or group's bottom line, so the question is one of fiscal importance.

If you were to receive a communication from the Executive Committee about a practice issue of yours that it seems could have clinical repercussions, how would you address the members when meeting with them?

"Prior to my meeting, I would research the literature about what I was doing in this particular practice, be it off-label prescribing or using protocols not considered to be evidence-based. My authority allows for some latitude. If in researching this, I discover a serious problem that justifies their concern, I would report that I have learned from this and will not be repeating the practice(s) of concern. If I found that I can defend the practice based on my research, I would make my case but tell them I will abide by their decision on this."

This is more than just hospital policy, but a challenge to your clinical authority, which is traditionally up to the physician alone. Therefore, this can be upsetting. This is a question of how you handle personal challenges to your privileges. Even if you're right and they're wrong, you have to show you're willing to be a good sport about the whole thing.

How would you handle a problem in which Utilization Review wants you to discharge a patient who you feel isn't medically ready for discharge?

"If I felt it would be dangerous to send a patient home, I would write a note of necessity for continued admission, on medical grounds, so that UR could submit it for approval from a third-party payer. If the patient just wanted to stay out of convenience, I would explain that he or she has satisfied criteria for discharge, but I would also offer home health follow-up if the patient desired and it were allowed/authorized."

This pits you against the hospital to come up with a solution for everyone's benefit. UR actions are usually based on dollar issues, protecting the hospital bottom line from insurance denials.

Would you be willing to accept whatever electronic medical record process is in use here?

"Of course. If I am part of this hospital/group, I want to be 'all in' in my compliance with all the protocols."

This question is asked as another test of your willingness to comply with policy. You should feel comfortable complying with all policies of the organization to which you are applying.

Tell me about yourself.

"I have been practicing dermatology for three years at a small practice with other doctors and specialists. I have enjoyed building relationships with my patients and their families and helping to ease their worries. I love dermatology because of the wide array of ailments that I see and just how quickly I can help patients heal many of those ailments. It is a great fit for me. I am now looking for the next step in my career where I can work with new professionals and further develop my medical knowledge and practice. Aside from work, I enjoy traveling to Mexico with my spouse every chance we get!"

This should be answered briefly and succinctly, and it should include why you want this position and the circumstances behind your leaving your current situation (they will want to know--and will ask if you don't say why).

Are there any substance abuse, domestic violence, or other background items that could impact the integrity of our hospital/group?

"I have a DUI arrest in my past as a teenager. I do not have a problem with abuse, but my arrest required I partake in prevention programs, which I completed successfully."

Such situations are a reason for running away from a current situation. If there is such a damaging component in your history, own it, and explain the steps you took to eliminate the risk of it recurring, i.e., rehab, successfully completed therapy, etc. Let the interviewer know you are comfortable with a probationary period or supervision if deemed necessary.

Are you going to be doing any chronic pain care?

"As a physician, I know that I have a responsibility to believe my patient's report of pain. In an acute setting, I plan on prescribing according to my patient's need, with appropriate precautions inherent in the state guidelines, rules, and regulations. With chronic pain, I feel it best to refer the patient to a rheumatologist, physiatrist, anesthesiologist, other pain management specialists, and also a specialist who can treat the primary cause, because skin conditions causing chronic pain are often due to non-skin-related diseases, such as diabetes or neuropathology."

This answer is simple if you don't plan on managing chronic pain, but if you do, your interviewer will want to know to what extent. The opioid crisis makes for bad press from overdoses, and institutions and groups want to steer clear of the whole controversy--not to mention scrutiny from the DEA and your state board. Before your interview, you need to know that you are being asked this to see if you're overstepping into controversial practices.

How do you feel about telemedicine?

"To me, the difference between telemedicine being appropriate or not is a function of Signs-vs-Symptoms. That is, I require a patient's physical presence and an exam to document signs that are applicable to the chief complaint, but symptoms are a different matter. If the patient is established with me and I am familiar with his or her case, I can discuss and manage symptoms or medications via telemedicine. If the patient is seeking an initial appointment with me, I would need to see him or her before relegating appropriately to telemedicine protocols."

Since the COVID-19 pandemic, telemedicine is probably here to stay, and everyone--including hospitals and groups--is looking for ways to incorporate it in a fiscally prudent way. You should be seen as ready to embrace it, not blindly, but thoughtfully within the parameters of what is considered good medical care.

What invasive procedures are you planning to do?

"My invasive procedure complication rate is within acceptable standards, and I follow my specialty to satisfy all criteria for such procedures, qualifying both the need for the patient and supporting my ability to perform them. I can cite the actual complication rates when I apply for the specific invasive procedures as part of your vetting process."

This is a matter of what exact privileges you're seeking in this position. They don't want 'mavericks' who are seeking privileges beyond their training.

If you were to see a peer doing or saying something inappropriate, how would you respond?

"First, I would make sure I saw or heard correctly. Depending on the transgression, I would either confront him or her discretely to resolve it vs. report it up the chain of command. I would report up if I felt it compromised patient care, would reflect poorly on the hospital/group, or be unethical, immoral, or illegal."

This isn't your problem to fix. You can't go wrong answering this question by saying you would go up the chain of command. A hospital or group wants something like this handled a certain way, and their best assurance that this will happen (when you're involved), is to pledge yourself to that chain of command, i.e., up the ranks to department chairman, Executive Committee, administrator, etc.

Do you have any personal problems with our seeing or assigning you indigent or "charity" cases?

"Having issues with seeing anyone would go against my own values--I will see anyone who needs my services. I know that the demographic here includes the adult population--especially the elderly--so taking care of them would be my obligation if I am presented such a scenario."

Before you interview, you should learn the demographics of this group or hospital. You should be comfortable with the demographic distribution because that will determine the type of practice you will have or how you will interact with this demographic. Regardless of whether they take care of such patients, you should always state you have no personal problems seeing anyone who needs you--you can't go wrong saying this! Many groups and hospitals are required, for example, to have a 'life-and-limb' list of doctors who rotate turns seeing uninsured emergency patients. If a hospital, for example, accepts any federal funds (Medicare or Medicaid), no patient can be refused in their Emergency Department. If you're doing your duty serving on a 'life-and-limb' ED rotation, you will still be required to see such patients, as well as provide follow-up in your office, regardless of your practice preferences. Of course, many dermatology conditions involve the elderly, so it is assumed you accept Medicare.

If you're not available, due to illness or vacation, for example, how will your patients be cared for?

"I plan to serve on committees within your department so that I can enter into some reciprocal call agreements with other staff members as soon as possible. However, I won't be taking much time off as I build my practice, because the low numbers will not be too taxing before it gets built up over time."

This is a straightforward question, and the answer is always part of the by-laws of any institution. In other words, if you're on staff, your patient should never go without care if you have not made arrangements for coverage. If you're not new to the area, you should identify others on staff with whom you expect to have a reciprocal on-call relationship. If you're new to the area, you should state you intend to be full-time responsible until you can establish such reciprocal relationships. An extra overture would be to say you plan to serve on many committees in order to meet others in your specialty.

Here we have a policy of _______. Do you have a problem with that?

"I wouldn't seek a position here if I had a problem with that. My only professional stipulation is that I can treat any person who needs my services and be allowed to do what is best for him or her."

You should never have a problem with any policy of the place to which you're applying. A good example is a Catholic hospital that won't do provide pregnancy termination counseling. Before you interview, you should decide whether you can practice under such constraints. Luckily, seldom are there any stipulations that will ruin your life.

Do you have any lawsuits currently or in the past, including any settlements?

"I have three lawsuits, each one of them is due to a complication--one an allergic reaction to a dressing, another due to side effect of a medication, and another for a revision after an infection associated with a Mohs surgery. After discovery, I expect all three to prescribe without incident or settlement."

This is a straightforward question. No one wants someone certain to lose them money or jeopardize their reputation. However, it is a truism that all physicians are at risk for malpractice suits, whether these actually come to pass or not. The interviewer will not dismiss you for lawsuits--he or she just doesn't want someone who is sued so frequently, as to suggest there's a problem. That being said, not all suits come to pass, and a lawsuit filed is not a deal breaker; many are just filed against you for the purpose of initiating and accomplishing discovery to see if there really is merit to a case. If there aren't really any substantial missteps on your part, these go away or prescribe, and your interviewer will know this. A settlement, on the other hand, can be just as bad as a lawsuit you lose, because most settlements are made to mitigate the damage of a likely unfavorable outcome. If there are suits, losses, or settlements, be truthful, but half of the truth is your side of the story, so make sure you give it. Do not blame your previous institution or group--that just looks bad for you. Take ownership, but if you can explain why a lawsuit occurred due to a complication and not overt malpractice, this is something any hospital administrator will understand.

What can you bring to our group/hospital?

"The whole reason I want to be here is the pursuit of excellence and state-of-the-art medicine you're known for. Also, your continuing education fits in well with my needs for growth and my interest in teaching. It makes an excellent foundation for my special interest in autoimmune dermatology, especially the scleroderma spectrum, and its relevance to the autoimmune morbidity and mortality associated with it."

You don't just want to say that you're an expert or have a lot of experience, but be a little bold here by stating that, although you find it very impressive here, you have noticed that there are some gaps in the total picture of care rendered and that you feel you can fill these gaps. This is a way of saying that selecting you will not only get this hospital or group what it needs, but even exceed its needs. You can further state that you can bring this hospital or group additional resources that most hospitals don't have, which would make this organization stand out above the rest. (These are the offerings that will make you particularly attractive, where you tout your special interests; special interests are specific aspects of one's specialization that do not have the bureaucratic designation of certification by a board.) For example, you may be board certified or board eligible in Dermatology, or even further trained (for example, in dermatopathology and Sjogren's syndrome), but you might say you have a special interest in autoimmune skin disease, as an example. This would sound very fortuitous to a hospital with a sizeable admission rate (or a group with a department) for autoimmune disease.

What is it about this group/hospital that makes you want to be a part of it?

"I know that the values here align with my own personal values. I have done a lot of research, and I especially appreciate the dedication to community interaction, your embracing diversity, and always putting the patient and his or her family first. I think I'd be very happy here with the professional mindset, and I'd be a good fit."

You must assume the interviewer thinks his or her hospital/group is absolutely wonderful...or potentially wonderful with the addition of the right person--hopefully you. You can stroke the corporate ego and begin endearing yourself to the interviewer by invoking the Mission Statement and/or Vision of the hospital or group. Most hospitals will have these, prominently displayed on the landing pages of their websites; they are brief and easy to imbue into your interview strategy. You can tell the interviewer that you find the values you saw in the Mission Statement and/or Vision Statement align with your personal views of how you want to lead your professional life. No need to actually refer to the Mission Statement and Vision when you answer; just state that you find this group's values align with yours, and you can paraphrase the ones you saw displayed.

Dermatologist Interview Questions

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1. If you're on a rotational call for indigent patients or patients without a doctor, how would you feel about having to see a patient in the ED whom you had dismissed from your practice?
2. If you are treating a patient for whom a skin condition was diagnosed and treatment given, but the result had failed, and the patient then stated he/she had lost faith in you, what would you do?
3. Are there any other types of specialties with whom you plan to work with on a routine basis?
4. Many cosmetic surgeons and gynecologists have an aesthetician and offer the same topical services you may, such as prescription meds, IPL, or laser therapy. Do you have any personal feelings about such ancillary staff that could constitute competition?
5. Do you have any hesitation referring to another specialty?
6. Do you accept Medicare assignment?
7. How is your attendance at general staff and department meetings?
8. What would be your response to hearing a code being called in the middle of the night as you're getting ready to go home after attending a patient?
9. Would you be willing to serve on a committee investigating an issue with one of your colleagues?
10. How timely is your practice to sign off on chart entries and make all of your dictations current? Have you ever been suspended from a staff for failure to do these?
11. If you were to receive a communication from the Executive Committee about a practice issue of yours that it seems could have clinical repercussions, how would you address the members when meeting with them?
12. How would you handle a problem in which Utilization Review wants you to discharge a patient who you feel isn't medically ready for discharge?
13. Would you be willing to accept whatever electronic medical record process is in use here?
14. Tell me about yourself.
15. Are there any substance abuse, domestic violence, or other background items that could impact the integrity of our hospital/group?
16. Are you going to be doing any chronic pain care?
17. How do you feel about telemedicine?
18. What invasive procedures are you planning to do?
19. If you were to see a peer doing or saying something inappropriate, how would you respond?
20. Do you have any personal problems with our seeing or assigning you indigent or "charity" cases?
21. If you're not available, due to illness or vacation, for example, how will your patients be cared for?
22. Here we have a policy of _______. Do you have a problem with that?
23. Do you have any lawsuits currently or in the past, including any settlements?
24. What can you bring to our group/hospital?
25. What is it about this group/hospital that makes you want to be a part of it?

Dermatologist Interview Questions

1. If you're on a rotational call for indigent patients or patients without a doctor, how would you feel about having to see a patient in the ED whom you had dismissed from your practice?

2. If you are treating a patient for whom a skin condition was diagnosed and treatment given, but the result had failed, and the patient then stated he/she had lost faith in you, what would you do?

3. Are there any other types of specialties with whom you plan to work with on a routine basis?

4. Many cosmetic surgeons and gynecologists have an aesthetician and offer the same topical services you may, such as prescription meds, IPL, or laser therapy. Do you have any personal feelings about such ancillary staff that could constitute competition?

5. Do you have any hesitation referring to another specialty?

6. Do you accept Medicare assignment?

7. How is your attendance at general staff and department meetings?

8. What would be your response to hearing a code being called in the middle of the night as you're getting ready to go home after attending a patient?

9. Would you be willing to serve on a committee investigating an issue with one of your colleagues?

10. How timely is your practice to sign off on chart entries and make all of your dictations current? Have you ever been suspended from a staff for failure to do these?

11. If you were to receive a communication from the Executive Committee about a practice issue of yours that it seems could have clinical repercussions, how would you address the members when meeting with them?

12. How would you handle a problem in which Utilization Review wants you to discharge a patient who you feel isn't medically ready for discharge?

13. Would you be willing to accept whatever electronic medical record process is in use here?

14. Tell me about yourself.

15. Are there any substance abuse, domestic violence, or other background items that could impact the integrity of our hospital/group?

16. Are you going to be doing any chronic pain care?

17. How do you feel about telemedicine?

18. What invasive procedures are you planning to do?

19. If you were to see a peer doing or saying something inappropriate, how would you respond?

20. Do you have any personal problems with our seeing or assigning you indigent or "charity" cases?

21. If you're not available, due to illness or vacation, for example, how will your patients be cared for?

22. Here we have a policy of _______. Do you have a problem with that?

23. Do you have any lawsuits currently or in the past, including any settlements?

24. What can you bring to our group/hospital?

25. What is it about this group/hospital that makes you want to be a part of it?

20. Do you have any personal problems with our seeing or assigning you indigent or "charity" cases?