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 a patient with severe dementia has two equally authorized persons disagreeing with management, e.g., two children or two siblings, how will you decide whose directives to follow?

"I educate all my patients to have an advanced care directive, because it is good for everyone. I also encourage only one person being named the highest--if not the only--authoritative person, if the advanced care directive doesn't specify a particular course of action. In this case you present, if the directive doesn't specify care in a particular instance and there is no one authority, but two who are in disagreement, then it is I who will direct care."

In these days of advanced care directives and powers-of-attorney, unusual scenarios are going to happen, no doubt. This question is asked to demonstrate your logic, if such an unusual scenario were to occur. The logic here is that you won't tolerate indecision in a case of two disagreeing persons, neither of whom is the sole authority. You will, however, do what's best for your patient, re-assuming the care in the spirit of the advanced directive.

If your patient is terminal and is at home with Hospice in terrible pain, how do you feel about medicating him or her for pain relief if you know it will hasten death?

"In the case of someone who is at home dying, I have the responsibility to keep him or her comfortable, even if that means providing medication that could shorten life. Pain is harm, and 'do no harm' should therefore mean to not allow unnecessary pain or any pain at all, especially if such treatment will not change the ultimate result: death. For a terminal patient, death is inevitable, whether it is today or tomorrow. What matters most is if there's agony for another day until their inevitable death."

This is really a commonsense question disguised as a dilemma. It isn't really a dilemma though, and it is asked to see if you know the difference between 'above all, do no harm' and 'do what is needed'.

Do you feel a DNR advanced directive patient should take up a spot in the ICU?

"A DNR order does not preclude my patient's admission to an ICU spot, if he or she were to need intensive care. Intensive care is for more than just survival--it is also for recovery when feasible and even comfort. Regardless of the needs of an entire demographic or the infectious environment in progress, I will still make my decisions based on how my patient will be best served."

This is an interesting philosophical question, especially with the recent COVID-19 pandemic, during which ICU resources were scarce or in jeopardy. The question is designed to test if you avoid the temptation to alter your care for one patient, based on the needs of many. You can't go wrong putting your patient first--always!

Many people, especially family members, feel that their loved one requires intensive care. What is your feeling regarding placement, if the patient doesn't actually require this?

"I don't plan to admit any patient to any environment in which it will do no more good than a more basic setting. That being said, I won't hesitate to take an ICU spot for my patient who requires it."

There is a fiscal reason for not over-treating patients--especially the elderly, for superfluous care may not be reimbursed by third-party payers, especially Medicare. Your answer should reflect a sensitivity to this.

How would you handle a family member who disagrees with the intentions of your patient's Advanced Directive?

"I educate all of my patients on the use of advanced directives and follow the law, even when a family member disagrees with the patient's 'do not resuscitate' wishes or the opposite. This may not make everyone happy, but it's a dedication to my patient's wishes that cannot be breached."

This question tests your attitude towards advanced care directives. You need to follow the law. If the patient is/was competent at the time of the advanced directive, that plan remains, despite whatever a wife, child, or pastor may choose that conflicts with the patient's wishes.

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. It 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 for their 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 or family 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 group/hospital, I want to be all in and that includes 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 come here a few years delayed, as medicine wasn't my initial goal--I had gotten another degree. I had to go back to school to acquire some of the pre-requisites for my application to med school. Since then, I have been on track. I am married with one child. After finishing my residency, I did my Geriatrics fellowship and then joined the staff of my school for a year until I could decide where I wanted to go next. That brings me here."

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 primary care doctor in Geriatric Medicine, I know that I have a responsibility to believe my patient's report of pain. However, it is not lost on me that an elderly patient can often be confused; worse, he or she has no special protection from dependence or addiction. With chronic pain, I feel it best to involve pain specialist consultation and to keep a discerning eye out for the likelihood of diversion, due to the patient being an easy target."

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. Also, the elderly are particularly at risk to misuse scheduled drugs because of forgetfulness or diversion at the hands of family members. Before your interview, you need to prepare to be asked this and explain the special precautions you need when prescribing scheduled drugs for the elderly.

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 geriatric invasive procedures will probably be limited to occasional endoscopy, and I don't plan to do the ones most frequently used on the elderly, such as cardiovascular stenting and other similar procedures. Regardless, 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. If the procedure is better done by another specialist, I will consult him or her to perform it. 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 disrespecting an elderly patient or doing or saying something inappropriate, how would you respond?

"First, I would make sure I saw or heard correctly. I would then either confront him or her discretely to resolve it--versus reporting it up the chain of command--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, especially with the patient's whole family watching, 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 seeing anyone would go against my own values--I will see anyone who needs my services. 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. You are required to see such patients, as well as provide follow-up in your office, regardless of your practice preferences. That being said, if you're practicing geriatric medicine, everyone you see should have, at least, 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 the need for a transfusion in a patient with anemia. 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 for the elderly that you're known for. Also, your continuing education fits in well with my needs for growth and my interest in teaching others about the special challenges created by age. It makes an excellent foundation for my special interest in Alzheimer's disease, especially with medication management in dementia."

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 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 Internal Medicine, further trained in Geriatrics, but you might say you have a special interest in Alzheimer's disease, as an example; this would sound very fortuitous to a hospital struggling with a demographic heavily weighted toward the elderly.

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

"I know the values here align with my own, and I feel that is especially important in geriatric medicine. I have done a lot of research, and I especially like your dedication to the elderly who are our most vulnerable patients. I realize the elderly patient has many loved ones very interested in the comfort, dignity, and inherent worth of their family member, and I realize the care I can render only reflects on this hospital/group. The values you champion are the same as mine, making me 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. Don't 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.

Geriatric Physician 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 a patient with severe dementia has two equally authorized persons disagreeing with management, e.g., two children or two siblings, how will you decide whose directives to follow?
3. If your patient is terminal and is at home with Hospice in terrible pain, how do you feel about medicating him or her for pain relief if you know it will hasten death?
4. Do you feel a DNR advanced directive patient should take up a spot in the ICU?
5. Many people, especially family members, feel that their loved one requires intensive care. What is your feeling regarding placement, if the patient doesn't actually require this?
6. How would you handle a family member who disagrees with the intentions of your patient's Advanced Directive?
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 disrespecting an elderly patient or 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?

Geriatric Physician 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 a patient with severe dementia has two equally authorized persons disagreeing with management, e.g., two children or two siblings, how will you decide whose directives to follow?

3. If your patient is terminal and is at home with Hospice in terrible pain, how do you feel about medicating him or her for pain relief if you know it will hasten death?

4. Do you feel a DNR advanced directive patient should take up a spot in the ICU?

5. Many people, especially family members, feel that their loved one requires intensive care. What is your feeling regarding placement, if the patient doesn't actually require this?

6. How would you handle a family member who disagrees with the intentions of your patient's Advanced Directive?

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 disrespecting an elderly patient or 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?