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Endocrinology Physician Interview
Questions

25 Questions and Answers by Ryan Brown

Question 1 of 25

Do you agree that the best way to practice is via evidence-based medicine?

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Endocrinology Physician Interview Questions

  1. 1.

    Do you agree that the best way to practice is via evidence-based medicine?

      Many third-party payers are now basing reimbursement on procedures and diagnostics that align with evidence-based 'best practices.' But medicine is an art in which judgement also applies, as well as the impact of your particular skills as a diagnostician or your technical prowess in doing procedures. Nevertheless, 'evidence-based medicine' is here to stay, even if is based on a Gaussian distribution that doesn't take into account the 'outliers' under the bell curve. For these, thinking outside of the curve is still needed, and you should say that.

      Ryan's Answer

      "Evidence-based medicine is based on the literature and you should expect me to stay current with the literature. However, for those outliers under the bell curve--those 'zebras' in medicine, I'm not forbidden to use 'off-label,' but legitimate, paths in my diagnostic or procedural protocols so that I can offer solutions that can't be found in the literature."

  2. 2.

    How is your attendance at general staff and department meetings?

      It takes a bureaucracy to run a large group or a hospital. For that, doctors are needed, which means you have a responsibility for participating in the clerical work involved. This means lots of meetings, taking you away from your office or family. But this question doesn't ask whether you will attend, but how well you have attended in the past. Tell the truth, in case your information is vetted by a phone call or two. If you have been not so great at attending meetings in the past, just say you intend to do better.

      Sample answer is of someone who has not been in regular attendance in the past:

      Ryan's Answer

      "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 (or group) is and will make every effort to improve my attendance."

  3. 3.

    Have you ever been suspended from a staff for failure to sign off on your charts or make sure all of your dictations are current?

      Not a 'real' suspension, this is a technique to light a fire under those who may be impacting the bottom line because of loose ends in documentation. Although such 'suspensions' are frowned upon, they aren't necessarily condemned; just know that this is a question of fiscal importance.

      Ryan's Answer

      "Yes, I've occasionally gotten behind on my signatures and dictations, but I know it's important for me to be diligent and to keep everything current. I'm well aware of how reimbursement from third-party payers can be delayed by incomplete charts; and for me, just as importantly, I need accuracy in the specifics of a procedure or rounds; if too much time passes, my memory can be spotty, so I agree that keeping current is important and certainly intend to do that."

  4. 4.

    How would you handle Utilization Review asking you to discharge a patient who doesn’t want to go home yet?

      Protecting the hospital's bottom line from insurance denials is the basis for UR actions, and thus is based on compliance with established insurance company formulae. Therefore, any non-compliance on your part will pit you against the hospital. However, it is usually easy to find a solution that benefits everyone.

      Ryan's Answer

      "If it were dangerous to send a patient home, I would dictate a note of necessity for keeping the patient, based on medical grounds.
      This way the UR Department can send it for approval by the third-party payer. On the other hand, if a patient just wanted to stay for some non-medical reason, I would explain that having satisfied criteria for discharge requires discharge, but that I would be happy to offer home health follow-up if his or her plan allows for it."

  5. 5.

    Are you going to be doing any chronic pain care?

      If you don't plan on managing chronic pain, this answer is simple; but if you do, your interviewer will want to know about it, because the opioid crisis makes bad publicity from overdoses and institutions and groups don't want controversy. Even less, they don't want extra scrutiny from the DEA and your state board. Know that you're being asked whether you're participating in controversial practices.

      Ryan's Answer

      "As an Endocrinologist and an Internist, I have a responsibility to believe my patient's self-report of pain, and I feel comfortable prescribing according to my patient's need in any acute setting, I don't see myself managing chronic pain but, instead, referring him or her a rheumatologist, physiatrist, anesthesiologist, or other pain management specialist."

  6. 6.

    How would you respond if you discovered a colleague doing or saying something inappropriate?

      Since this isn't your problem to fix, you should always stand by the chain of command. A hospital or group wants to handle these things only in certain ways, and you can assure them of this by stating you'll follow the chain of command, all the way up to department chairman, Executive Committee, administrator, or the Human Resources Department.

      Ryan's Answer

      "Something sensitive like this must be accurate, so I would first make certain that what I saw or heard was seen or heard correctly. Any transgression that compromised patient care, would reflect poorly on the hospital (group), or be unethical, immoral, or illegal, I would report up the appropriate chain of command."

  7. 7.

    If you had dismissed a patient from your practice, how would you feel about being assigned him or her in the ED as part of a rotational call for indigent patients or unassigned patients?

      This asks about your willingness to comply with policy. All physicians have had the unpleasant experience of having a patient fail to pay or be non-compliant. Although this may have resulted in dismissal from your practice, you still may have to accept him or her in order to fulfill an obligatory role.

      Ryan's Answer

      "Even if I had dismissed a patient, I know I still must follow policy and accept him or her without any type of attitude. On the other hand, if the patient were to refuse to see me because of our past, I would call the Patient Advocate to help solve the awkward situation."

  8. 8.

    If you see a patient who wants to be treated for obesity because of what she claimed was a congenital abnormality, what is your approach to such a patient?

      This isn't so much controversial as it is a question of where you draw the line in simply granting a patient's request. Obesity is a disease, but it's a bit murky when you figure in lifestyle choices that contribute to it. Thus, it can have a strong psychological cause, underscoring the fact that it can't just be reprimanded and blamed on gluttony or sloth. It also can have a real genetic component. Such a patient erroneously believes it is simply between his or her doctor and him- or herself, which isn't true. In this case, evidence-based medicine comes to the rescue, and your interviewer just wants to know whether you'll treat this like the disease it is or merely like granting a favor.

      Ryan's Answer

      "Obesity is very complex. I feel it is wrong to assume a genetic component just because an obese relative accompanies him or her to the appointment. I would educate this patient on the many contributions to obesity, including the genetic component which can be easily measured in levels of ghrelin or leptin or antibodies to them. I would also stress the lifestyle changes that may require psychological therapy. Although I wouldn't just write a prescription, I would tell him or her that it really needs to be treated and that begins with the things I've explained."

  9. 9.

    If parents wanted you to administer growth hormone to their child purely for a height advantage as it relates to sports, how would you react?

      There just aren't that many controversies in Endocrinology, but this is one of them. Athletes, especially from other countries, have at times been offered such therapy, but this is not considered legitimate here; and that should be your position.

      Ryan's Answer

      "There is such a thing as 'off-label' prescribing, which is prescribing a legitimate FDA-approved drug for other than approved indications. But these must be legitimate indications, which in my mind means to treat a health abnormality or disease. Not being tall enough is not a disease, unless one were treating pathological short stature, and that would have nothing to do with one's athletic plans in life, but with a proven pathology. Therefore, I would decline but give an education on the risks of being so casually medicated."

  10. 10.

    Do you have any hesitation referring to other endocrine specialists, such as gynecological or pediatric?

      They want to know if you are too tenacious, even to the point of practicing out of your comfort zone, meaning, practicing appropriately. You should always answer questions like this based on what is best for your patient.

      Ryan's Answer

      "I plan to practice along the lines of Internal Medicine when it has a direct cause-and-effect relationship with Endocrinology. I use consultation liberally when it's for the best health impact on my patient. I also will frequently partner with someone who might do something better or is more qualified than me. That's a win for everyone, especially the patient."

  11. 11.

    Do you participate in Medicare assignment?

      This only applies to those employed by the hospital or group, not independent staff, so answer accordingly. The larger the entity, the more likely they are official Medicare providers.

      Ryan's Answer

      "Yes, I accept Medicare assignment.
      Or,
      I accept Medicare but I am a non-participating doctor for accepting assignment.
      Or,
      I have opted out of Medicare. (Unlikely in Internal Medicine or its subspecialties.)"

  12. 12.

    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?

      You would respond. That's the answer, even though it's tempting to assume that someone else is already there and responding. And while that is usually the case, you don't want to be suspected of trying to get out of this obligation.

      Ryan's Answer

      "I wouldn't respond if I were attending an unstable patient or if I were in the middle of a procedure; otherwise, I'm there, no matter what."

  13. 13.

    If there were an issue with one of your colleagues, could we call upon you to serve on an investigating committee?

      Medical entities have a serious obligation to investigate anything that can affect or jeopardize patient care. Simply, such matters are explored and dispositions made so that they don't happen again. Joint Commission accreditation depends on this, as well as insurance reimbursements, and the public reputation is threatened when uncorrected omissions or errors in care recur. This question is about your having the courage to do the right thing.

      Ryan's Answer

      "I feel I would have an obligation to do this, since it can affect patient care and safety. If it were a close personal friend involved, I would ask that I be removed for objectivity's sake, but if not, I would ask that another colleague join me in my duties to give it credibility."

  14. 14.

    If you were to receive a notice from our Executive Committee about something you’re doing that may have medical or legal repercussions, how would you react?

      This is not just about hospital policy but is a challenge to your clinical discretion and privileges. Therefore, it can be upsetting. This is a question of how you handle any personal challenge. Even if you're right and they're wrong, you should assure them you would understand their rationale and want to comply with any requests intended for clinical excellence.

      Ryan's Answer

      "Beforehand, I would certainly consult the literature about what I was doing. My training does allow for autonomy, but if I learned that valid problem justified their worries, I would report to them that I've learned from this and won't be repeating my mistake. However, if I could defend what I'm doing from the medical literature, I would state my case but also tell them I will accept any decision they make."

  15. 15.

    Are you willing to accept and use our electronic medical health record system here?

      Again, are you going to 'fit in' with the way things are done? Thus, you should agree, because every organization will be using some sort of EHR.

      Ryan's Answer

      "As a staff member, I intend to comply with all of your established protocols, including EHR."

  16. 16.

    Why do you want to join [ENTITY REPRESENTED BY INTERVIEWER]?

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  17. 17.

    Are there any aspects of your background items that might reflect poorly on our hospital (or group)?

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  18. 18.

    Do you think telemedicine is here to stay?

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  19. 19.

    Are you planning to do any invasive procedures?

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  20. 20.

    Here we follow a policy of [STIPULATED]. Does this cause any discomfort for you?

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  21. 21.

    Are you willing to see 'indigent' or 'charity' cases if you are assigned one as part of your staff duties?

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  22. 22.

    How will your patients be cared for when you’re not available, such as with illness or for your vacation?

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  23. 23.

    Have you had any lawsuits currently or in the past, including any settlements?

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  24. 24.

    Would you please tell me a little about yourself?

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  25. 25.

    What do you think you have that can make our [ENTITY OR GROUP] better?

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