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Ophthalmology Interview
Questions

25 Questions and Answers by Ryan Brown

Question 1 of 25

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?

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Ophthalmology Interview Questions

  1. 1.

    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 in a strict sense. Ophthalmology is a discipline which is constantly and rapidly evolving, both in the science and the technology, so 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."

  2. 2.

    Do you have any personal feelings for or against optometrists?

      There might seem to be a traditional antagonism between MDs and other credentialed practitioners who do some of the same things, such as optometrists. At the hospital or large group level, it is no longer a philosophical issue, however, but purely financial. As these providers co-exist in the health care marketplace, you have to present yourself as being open-minded.

      Ryan's Answer

      "I see myself partnering with such practitioners so that I can practice more exclusively within my interests in ophthalmology. In fact, I may even have an optometrist in my office as part of my team. However, 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."

  3. 3.

    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."

  4. 4.

    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, a specialty geared toward the elderly, like ophthalmology is, probably requires you to accept assignment for financial reasons.

      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. (This is likely incompatible with having a successful Ophthalmology practice.)"

  5. 5.

    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."

  6. 6.

    How do you feel about telemedicine?

      Since the COVID-19 pandemic, telemedicine is probably here to stay, and everyone--including hospitals and groups--are 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.

      Ryan's Answer

      "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 or wanting care for a new problem, I would need to see him or her before relegating appropriately to telemedicine protocols."

  7. 7.

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

      Another test of your willingness to comply with policy, so you should agree.

      Ryan's Answer

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

  8. 8.

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

      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.

      Ryan's Answer

      "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."

  9. 9.

    Medicare is increasingly basing reimbursement on 'best practices,' which is often nothing more than evidence-based medicine. Do you agree this is the best way to practice?

      This is a trick question. The catch? 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. Since Medicare is heavily invested in it as part of a 'best practices' modality, the same prior authorization constraints will be applied by the other third-party payers. Nowhere is this more obvious than in ophthalmology, where overhead keeps going up and reimbursements, down. Unfortunately, evidence-based medicine 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 "

  10. 10.

    If you are treating a patient who is experiencing a rocky course and you fear a likely lawsuit, would you still treat him/her if continuity of care were requested?

      This is just a question to see how you think on your feet when presented with uncomfortable situations. The interviewer wants to know your dedication to continuity of care, even when things are their worst or adversarial.

      Ryan's Answer

      "I would treat any patient who wanted to continue using me, unless I felt someone could address the situation better. At that point, I would offer transfer or co-management, and explain to the patient why this would offer his/her best chance of remedy in the current crisis. I would never base my decision to treat or accept a patient because of what might happen, medicolegally."

  11. 11.

    Do you have any hesitation referring to a glaucoma specialist, subspecialist surgeon, or other ophthalmological 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 general ophthalmology, but with a special interest in aspects of it. Complex eye pathology should make liberal use of consultation, and I always do this 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."

  12. 12.

    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."

  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?

      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. Nevertheless, your speciality is not typically involved in life-and-death crises.

      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 there were those there who I felt were more qualified to attend the code. This would probably include any surgical or medical specialties or primary care specialists, although I keep up with my certifications in advanced life support and resuscitation."

  14. 14.

    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."

  15. 15.

    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

      "lthough 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."

  16. 16.

    Would you please tell me a little about yourself?

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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.

    What invasive procedures are you planning to do?

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  20. 20.

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

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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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