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Internal Medicine Physician Interview
Questions

26 Questions and Answers by Ryan Brown

Question 1 of 26

Many third-party payers are now basing reimbursement on evidence-based medicine. Do you agree this is the best way to practice?

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Internal Medicine Physician Interview Questions

  1. 1.

    Many third-party payers are now basing reimbursement on evidence-based medicine. Do you agree this is the best way to practice?

      This is a trick question. The clich? that medicine is an art will always apply when judgement is necessary, not to mention the impact of a particular skill of a diagnostician or the technical prowess of someone doing procedures. But it is true that 'evidence-based medicine' is probably here to stay. Unfortunately, it is Gaussian and doesn't take into account the 'outliers' of the bell curve, for which thinking outside of the curve is indicated--the 'zebras' in medicine. You need to include something about that in your answer.

      Ryan's Answer

      "Evidence-based medicine is supported by the literature and being current with the literature should be your expectation of me. However, for the outliers under the bell curve, any thinking physician must not be afraid of using 'off-label,' but legitimate, indications as parts of his or her diagnostic or procedural protocols and offering solutions that the literature doesn't cite or problems it doesn't yet explore."

  2. 2.

    Are you going to be doing any chronic pain care?

      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.

      Ryan's Answer

      "As a primary care doctor in Internal Medicine, 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 patients need, implementing safeguards such as drug screens. With chronic pain, I feel it best to refer the patient to a rheumatologist, physiatrist, anesthesiologist, or other pain management specialist."

  3. 3.

    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 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."

  4. 4.

    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?

      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.

      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 the practice based on my research, I would make my case but tell them I will abide by their decision on this."

  5. 5.

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

      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.

      Ryan's Answer

      "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."

  6. 6.

    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."

  7. 7.

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

      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.

      Ryan's Answer

      "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."

  8. 8.

    If you are summoned to a code by a hospital-wide announcement and, when you arrive, it is being run by a physician who is less qualified to do so, how would you ensure the patient is getting the best management?

      There is no 'turf battle' more emergent than one during a code. Thankfully, running a code is not something most are willing to fight over, since the outcomes of codes are usually not good. You can tailor your answer any way you want as long as--according to the question-- you ensure the patient is getting the best management.

      Ryan's Answer

      "I have no reason to usurp the position of another physician running a code, even if he or she is less qualified than me; but if so, I will be watching; I won't just leave. I have a responsibility to the patient to make sure the best resuscitative measures are being implemented, even if that means I have to "

  9. 9.

    Do you have any personal feelings for or against acupuncturists who may be on staff? Or holistic practitioners?

      There is a traditional antagonism between MDs and other credentialed practitioners, such as chiropractors, holistic physicians, acupuncturists, practitioners of hypnosis, and even DOs. At the hospital or large group level, it is no longer a philosophical issue, however, but purely financial. As these specialists gain credibility and acceptance in the health care marketplace, you have to present yourself as being open-minded, because as the American Board of Medical Specialties expands (or at least the authorization by state medical boards), these providers will no doubt end up beside you treating patients.

      Ryan's Answer

      "The legitimacy of the health disciplines is not my job. That is left to authorizing and credentialing authorities. If such providers are so entitled to practice, this is not a conflict for me; in fact, I look forward to observing ways to treat patients with which I'm not familiar. However, I realize there is a credentialing process in which staff physicians participate, and I will do my part, following the established guidelines."

  10. 10.

    Do you have any hesitation referring to a cardiologist, pulmonologist, or other internal medicine subspecialty?

      This is a question that asks if you plan to practice out of some comfort zone, i.e., appropriately. Your answer should be centered on what is best for your patient, not winning some turf battle.

      Ryan's Answer

      "I certainly plan to practice along the lines of gastroenterology, cardiology, and other subspecialties, when I can; 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."

  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.

      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."

  12. 12.

    How is your attendance at general staff and department meetings?

      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.)

      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/group is, and will make every effort to improve my attendance."

  13. 13.

    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?

      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.

      Ryan's Answer

      "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."

  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 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.

      Ryan's Answer

      "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."

  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 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.

      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 parents of a child just the want the child 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 parents desired and it were allowed/authorized."

  16. 16.

    Tell me a little about yourself.

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  17. 17.

    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.

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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.

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

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  22. 22.

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

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  23. 23.

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

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  24. 24.

    Do you have any past or current lawsuits, including any settlements?

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  25. 25.

    What can you bring to our group/hospital?

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  26. 26.

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

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