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Infectious Disease Physician Interview
Questions

25 Questions and Answers by Ryan Brown

Question 1 of 25

Serious infections often end up being treated in the ICU. Would you have any hesitation toward an ICU hospitalist assuming control of your case?

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Infectious Disease Physician Interview Questions

  1. 1.

    Serious infections often end up being treated in the ICU. Would you have any hesitation toward an ICU hospitalist assuming control of your case?

      This is a question over both permission and responsibility, and it impacts the hospital or group, you, and the patient. Most arrangements are stipulated in the hospital's or group's by-laws, but seldom is there really an ugly turf battle, due to the severity of this life-and-death situation. They just want to hear that common sense shall prevail over inappropriate tenaciousness.

      Ryan's Answer

      "I am obligated to do what is best for my patient. While both the hospitalist and I can manage the case together, still, one of us must have final authority. This can even be a mixed authority, and all this or any other arrangement just needs is a meeting of the minds--our agreement to pursue what is best for the patient. If ugliness is unavoidable, then the Chief-of-Staff must intervene and if necessary, invite an appropriate consultant as a second opinion."

  2. 2.

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

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

      Ryan's Answer

      "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 what I'm doing from my research, I would make my case but tell them I will abide by their decision on this."

  3. 3.

    What invasive procedures are you planning to do?

      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.

      Ryan's Answer

      "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."

  4. 4.

    How is your attendance at general staff and department meetings?

      Running a group or a hospital, unfortunately, requires a significant bureaucracy. The doctors are needed to make that run, which means a responsibility to the clerical drudgery involved. This means meetings--lots of meetings. And they're always at night or--worse--during office hours that 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.)

      Our 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."

  5. 5.

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

      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 just 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 your practice does not accept patients under a federal or state program, 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.

      Ryan's Answer

      "Having issues with seeing anyone would go against my own values--I will see anyone who needs my services. In fact, taking care of them would be my obligation if I am presented such a scenario."

  6. 6.

    Would you please tell me a little about yourself?

      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).

      Our sample answer is for someone with some gaps in his/her professional path.

      Ryan's Answer

      "I come here a few years delayed as medicine wasn't my initial goal--I had gotten another degree. So I had to go back to acquire some of the pre-requisites for application to med school. However, once begun, I have been on track. I am married with one child. After finishing my residency, I joined the staff of the school for a year until I could decide where I wanted to go next. That brings me here."

  7. 7.

    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.

      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.

      Ryan's Answer

      "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."

  8. 8.

    Do you feel you have the right to choose any antibiotic you want to treat an infection?

      This is a trick question. It is asked because of a sensitivity over antimicrobial resistance, especially in institutions and communities. It is designed to identify your responsible prescribing practices. Sure, you have the right, but should you?

      Ryan's Answer

      "I base all of my medication choices on evidence-based medicine, but tempered by my own experience. I also include the patient's history of allergies and adverse reactions, and cultures and sensitivities to support any empiric therapy I've begun. Within that sensibility, while my license gives me the right of autonomy in medication choices--even 'off-label' uses--still I have a responsibility to limit the emergence of resistant organisms due to the inappropriate prescribing of medications stronger or more frequently then they need be."

  9. 9.

    If you are treating a patient with a sexually transmitted infection, do you report this to the patient’s spouse or partner?

      This is a question that puts you in the intersection between HIPAA privacy regulations and your ethical responsibility to do what is best for your patient (which, by extension, ideally includes a significant other). However, it is fraught with danger, medicolegally, morally, and ethically. HIPAA is what it is, and if your patient refuses to give permission to alert anyone else at risk, there are other remedies. Also, you do not need permission to notify the health agencies as required, and it is part of their responsibility to identify and arrange treatment for others exposed.

      Ryan's Answer

      "I cannot disclose this information unless I have my patient's written or verbal permission. However, I am allowed to write an additional prescription for his/her sexual partner, and I offer to do the follow-up of him/her. I also know that pharmacists are allowed, in most states, to duplicate a prescription to treat an STI for a partner when your patient presents to fill his/her prescription. If I find that treatment of a person who suffered significant exposure has not taken place, I can follow up with the proper health agency to notify that at-risk person that he/she has been exposed to the specific infection and should be treated. By statute (https://www.cdc.gov/std/program/final-std-statutesall-states-5june-2014.pdf p. 277), they're allowed to do this without identifying your patient."

  10. 10.

    If you are treating a patient with a sexually transmitted infection, do you report this to the appropriate agencies?

      You must follow the law, and each state has recommendations for how to report a published list of diseases. Like the mandatory reporting of child abuse, you are obligated to report the 'reportable' diseases to your state's designated agencies. According to the CDC, 'In the United States, the authority to require notification of cases of disease resides in the respective state legislatures. In some states, authority is enumerated in statutory provisions; in other states, authority to require reporting has been given to state boards of health; still other states require reports both under statutes and under health department regulations.'

      Ryan's Answer

      "I am aware of my reporting obligations, but I also know these statutes change from to time, so I am also revisiting the state web site for the compliance criteria which I incorporate into my practice on an on-going basis."

  11. 11.

    Do you accept Medicare assignment?

      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. Nevertheless, this question is another way of asking if you'll see anybody who needs to be seen.

      Ryan's Answer

      "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.

      Then...
      But if a patient needs my attention, it really doesn't matter what or if insurance is current or not at all. I'll see anyone who requires my care."

  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?

      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 it 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.

      Ryan's Answer

      "Unless managing a clinically unstable situation or in the middle of a procedure, I would respond, and then drop out if there were those there who I felt were more qualified to attend and manage the code. As my primary specialty is Internal Medicine, I am qualified; but if there were a physician there who was currently practicing Cardiology or Internal Medicine, I would defer to him or her as better qualified since I have narrowed my clinical focus to Infectious Disease."

  13. 13.

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

      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.

      Ryan's Answer

      "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 making an enemy if a disposition were 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."

  14. 14.

    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?

      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 being suspension. However, 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.

      Ryan's Answer

      "Although I've been occasionally remiss in keeping all signoffs 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 payors can be affected by incomplete charts; just as important--to me--is the need for accuracy and trying 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."

  15. 15.

    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?

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

      Ryan's Answer

      "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."

  16. 16.

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

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  17. 17.

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

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  18. 18.

    Are you going to be doing any chronic pain care?

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  19. 19.

    How do you feel about telemedicine?

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  20. 20.

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

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  21. 21.

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

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  22. 22.

    Here we have a policy of [STIPULATED]. Do you have a problem with that?

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  23. 23.

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

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  24. 24.

    What can you bring to [OUR ENTITY OR GROUP]?

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  25. 25.

    What is it about [ENTITY REPRESENTED BY INTERVIEWER] that makes you want to be a part of it?

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