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Behavioral-based physician interviewing.

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Asking the tough questions during a job interview with a physician candidate can help ensure you hire doctors with the right competencies for the job.

Many individuals and organizations, when interviewing physicians, do not ask questions related to the position for which the candidate is being considered. It should not be a surprise, then, when a physician is not performing well in the areas of clinical skill, or patient communication, when those areas were not part of the interview.

We tend to rely on references to determine the skills and talents of the candidate, and the interview is often used to elaborate on the physician's experience and interests and "to get to know each other." Interviews are too valuable to be used solely for this purpose.

Have you really ever gained valuable information from asking, "What is your greatest strength?" How did that information assist in your decision? In too many cases, interviews have become routine and standard, not tailored to individual candidates or organizational needs.

Now more than ever, in the time of value-based purchasing, public report cards and the increased competition and scrutiny of hospitals, it is critical to hire the person with the specific competencies to meet the needs of the employer. These needs are not generic to a position, but specific to the needs of the organization and the vacancy to be filled.

As Jim Collins stated in his classic Good To Great: Why Some Companies Make the Leap and Others Don't, "... leaders of companies that go from good to great start not with "where" but with "who." They start by getting the right people on the bus, the wrong people off the bus, and the right people in the right seats." (1)

In many cases, due to tight labor markets and an urgency to fill positions, health care organizations will hire anyone waiting for the bus, rather than vetting candidates for the skills, behaviors and competencies that are needed. Certainly, you need to get to know the candidate as a person; however in my experience many interviews stop there and do not get to the specific traits or behaviors that will advance the mission of the organization.

The sixth dimension

One approach for a more complete interview would be to base it on the six dimensions of performance as defined by the Accreditation Council for Graduate Medical Education. These have been included in The Joint Commission standards on physician evaluation. They are:

1. Technical quality of care/professional competence

2. Quality of service/patient relationships

3. Personal productivity/practice management skills

4. Resource utilization/economic efficiency

5. Peer/co-worker/team relationships

6. Contributions to organization and community (2)

Given that we are looking to determine the probability that the candidate will do well on these six dimensions, interview questions flow naturally from each one. Examples follow, and a broad range of questions across all six should be asked.

Technical quality of care/professional competence

* When do your boards expire? Do you plan on recertifying? Why or why not?

* How many hours of CME do you typically earn? Can you tell us about a couple of your most recent CME activities?

* What journals do you read regularly?

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Questions about specific medical circumstances should be asked. They need to be specialty-specific, common situations (no "zebras") and reflect issues common to practice. Remember that the candidate is probably nervous, so give some latitude. Also, it is important to ask the same questions to each candidate to compare their responses. Here are some examples:

Hospitalist

* Are you comfortable caring for ICU patients? What procedures are you privileged to perform?

* You are called to evaluate a 77-year-old patient admitted with pneumonia who has fallen on a wet floor. Briefly describe your evaluation of the patient.

* You are called to see a 56-year-old diabetic patient admitted with cellulitis. The patient had sudden loss of consciousness. Please provide a brief differential diagnosis for this change.

Adult primary care

* What questions do you ask in taking a history on a patient with chronic headaches? What are some answers or findings that would lead you to obtain an imaging study?

* On routine exam, a 63-year-old patient with a completely negative past history is found to have atrial fibrillation at a rate of 66 and is asymptomatic. What is your initial management of this patient?

* What factors would influence your decision to admit a patient with pneumonia?

Quality of service/patient relationships

* How can you tell if a patient understands what you are telling them?

* Under what circumstances would you address a patient by first name, and when would you use Mr./Mrs. etc.?

* How do you calm a patient's fears?

* A patient is afraid they have brain cancer. They have no family history, signs or symptoms of anything wrong. The fear is keeping them up at night. What do you ask and say to the patient? What action do you take?

* How do you deal with running late when a patient needs extra time?

* Under what circumstances do you feel it is okay to terminate a relationship with a patient? How often have you done so, and what was the procedure you followed?

* A mammogram returns with a 1 cm lesion highly suggestive of malignancy. Please tell us how you would start a conversation with this patient.

* How do you choose the specialist to whom you refer (other than clinical competence)? Describe the "perfect" referral relationship.

Personal productivity/practice management skills

* What strategies do you use to stay on time?

* Do you write or dictate your notes? Why did you choose this option, if it is an option?

* Do you see a conflict between speed and thoroughness? How do you personally balance this?

* Do you work with midlevel providers? If so, how closely or in what way do you monitor their work?

* What training in coding have you had?

* Currently, how is your schedule templated? (or how many patients do you see in a day?)

* If you could customize your schedule in any way you desired, how would it look?

Resource utilization/economic efficiency

* What is your approach to ordering imaging studies for patients with low back pain?

* Does the testing pattern of specialists enter into your decision about referrals?

* Generally, do you feel comfortable prescribing generic medications? Why or why not?

* There are many others on the team giving advice about the care you provide (pharmacists, utilization nurses, etc.). How do you feel about receiving such advice? Do you seek out advice from professionals other than physicians?

* Please provide examples of waste or inefficiency that you have observed. How have you begun to remedy these?

Peer/co-worker/team relationships

* A nurse makes a comment critical of you in front of others at the nurses station. How would you handle this situation?

* One of your colleagues is "up" for the next admission. You get called by mistake and tell him about the patient. He gets agitated and refuses to see the patient. How do you handle this situation?

* You see a patient for the first time. You read a prior note by a colleague and feel that they have made an error in treatment that could affect the patient adversely. What do you do?

* Tell us about a time when you have had a conflict with a co-worker. How did you handle the situation and what was the result?

* Under what circumstances would you contact a specialist consultant directly rather than writing an order for an initial consult?

* A nurse calls you to suggest a different medication than the one you ordered and gives his rationale. How do you react?

Contributions to organization and community

* What community service activities have you participated in?

* Give an example of an improvement idea you have had for your practice or organization. How did you participate and what were the results?

* What hospital or practice committees have you served on? What did you learn from the experience?

* Do you tend to be prompt in completing your medical records?

* Do you feel that physicians should support the local hospitals? If so, how?

By using these techniques, along with the more standard interview questions, the probability of finding the candidate who best meets the need will be increased. It is important to use the limited contact time with a physician candidate wisely and plan the interview carefully, matching the competencies desired to the questions asked of both candidates and their references.

Although the interview must flow spontaneously, it should be well planned. Each interviewer ideally should be responsible for questions related to one or more of the dimensions, depending on the size of the panel. The questions should, of course, be alternated among interviewers, and follow-up questions can be asked by all. The interviewers should have an opportunity to debrief after the interview, and any points that need clarification should be discussed with the candidate.

The importance of getting to know the candidate during the interview cannot be overstated, as this short period of time may be the one opportunity to evaluate a person who will have tremendous impact on your hospital or practice, hopefully for many years to come.

Candidates rarely change after you hire them, so it is critical that you gain as much information as possible pre-hire. It is also critical that if you are hiring a less-than-optimal candidate for a critical need, be honest among yourselves and do what you can to mitigate the risk.

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Now more than ever, in the time of value-based purchasing, public report cards, and the increased competition and scrutiny of hospitals, it is critical to hire the person with the specific competencies to meet the needs of the employer.

References

(1.) Collins J. Good To Great: Why Some Companies Make the Leap and Others Don't, Harper Business, New York, 2001.

(2.) Accreditation Council for Graduate Medical Education, Chicago, IL

By Richard A. Rubin, MD, MBA, FACP, FACPE

Richard A. Rubin, MD, MBA, FACP, FACPE, is medical director of physician enterprise at St. Peter's Health Partners in Albany, NY.

drrich@nycap.rr.com
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Title Annotation:Staffing
Author:Rubin, Richard A.
Publication:Physician Executive
Geographic Code:1USA
Date:Nov 1, 2012
Words:1678
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