Physician Interview and Practice Questions!

During the interview process there questions you should be asking yourself and your perspective practice. I have put together a list of these questions and thoughts for your consideration. Could be food for thought!

Practice:

Who’s in the group?  Specialties covered?

What will be my role?

What direction is the practice going?  Growth, EMR, PACS etc

Patient Make-up?

Demographics (geriatrics, athletes, work comp)

Payer mix (% managed care, fee for service, uninsured, work comp, medicaid)

How will I get my patients?  What is the referral base (Drs, size)

Is anything currently being sent elsewhere?

Average patient wait for appointment?

Medical Practice:

Number of pts/year, cases/ year?

Daily schedule, OR, office, # of patients seen?

Types of procedures? 

Peer review?  Grand Rounds?  Lectures?  Affiliations?

PT, medical consults, EMG, chronic pain, braces, MRI, Surgery center, sports coverage, implants?

Practice Finance:

Expenses shared between the group?  Overhead %?  Call coverage reimbursement?

Net income (after expenses) shared? % per productivity or shared equally?  What is production?  (Fees, xrays, etc)

How is your contribution configured in over first few years?  Is it pro-rated for certain patients (managed care, medicare/caid)

Business Management:

Ownership of group?  Wholly or partly owned subsidy of?

Assets of the group:  Lease, rent, debt, buy in?

Business manager background:  Member of practice management assoc.?

Quality assurance measures?  Who’s responsible?

Staff (barren vs. lean vs cushy)

Billing and coding?  Outsourced?  Accounts receivable @ 90 or 120?

Who makes decisions for the group?  Unity within the group?

Timing of Partnership:

Criteria? Voting  vs  financial; interim evaluations?

Buy in?  Fixed assets, good will, accounts receivable?  How long do I pay?

Option of partial partnership in additional holdings of the practice: 

Production bonuses?  What is included in production?   (Xrays etc)

Salary/ Benefits:

Salary, number of years,  Production, incentives

Malpractice insurance?  How much, claims made (occurance) vs tail, (who pays if I leave/ fired)

Medical/ Dental, Disability, RX plan

Student loan repayment

Perks:  car, phone, signing bonus, CME etc

Profit sharing, Pension plan

Relocation expenses – moving, licensing, househunting trips etc

Call:

Who takes call and how is it divided?

Shared with other groups?

Are labs/ xrays accessible from home?

Vacation:

How much? Does it increase with time?

Do I have to ask permission?

CME time and reimbursement

Hospitals:

Size, draw, any recent changes

Administration, facilities

How is OR time allotted?  Instruments, equipment, staff, implants?

Ancillary services:

Cast tech, PA, Nurses

Ortho community:

Saturated?  How much competition? Retiring? What specialties covered?

References of Group:

 How is the group perceived/ respected?

Any Malpractice cases against?

Has anyone left the group? Why?

Get references for: hospital admin, nursing, OR, local MD’s, former partners.

Community:

Local cities, how expensive, homes, schools,

Englands Government run Healthcare Fails the people!

Is a single payor system the way to go? The answer may be in the story below!

5 April 2011 Last updated at 12:00 ET

Surgeons raise alarm over waiting

By Branwen Jeffreys Health correspondent, BBC News

In England in 2009/10 there were 101,020 hip replacements and 73,378 knee replacements carried out

Surgeons say patients in some parts of England have spent months waiting in pain because of delayed operations or new restrictions on who qualifies for treatment.

In several areas routine surgery was put on hold for months, while in many others new thresholds for hip and knee replacements have been introduced.

The moves are part of the NHS drive to find £20bn efficiency savings by 2015.

The government said performance should be measured by outcomes not numbers.

Surgeons have described the delays faced by patients as "devastating and cruel". Peter Kay, the president of the British Orthopaedic Association (BOA), says they've become increasingly frustrated that hip and knee replacements are being targeted as a way of finding savings.

"We've started to get reports over the last nine months that access to these services are being restricted.

“Start Quote

We've started to get reports over the last nine months that access to these services are being restricted”

End Quote Peter Kay, president of BOA

"GPs were told not so send as many patients to hospital, maybe to delay referrals until the end of the financial year while perhaps introducing thresholds for surgery."

He says that simply delaying surgery by one means or another does not improve the outcome for patients as their condition can deteriorate.

"The double jeopardy is that patients wait longer in pain, and when they have the operation, the result might not have been as good as it otherwise would have been had they had it early. "

Limits and delays

The BBC asked orthopaedic surgeons through the BOA if they had seen delays to these operations as a result of measures introduced during the last financial year.

Overall, 692 surgeons in England sent the BBC information about the policy on hip and knee replacement of their local Primary Care Trust (PCT).

Between them they covered the majority of PCTs in England. In some areas no restrictions were being imposed, but in others the specialists reported delays or new thresholds for surgery.

106 surgeons told the BBC routine operations had been put on hold in their area. Others described new limits on when patients qualify for hip or knee replacements.

152 specialists said patients now have to be more disabled or in greater pain, and 118 told us hip and knee surgery had been regarded as a procedure of low priority.

The data reveals a picture of overlapping restrictions, with some surgeons reporting more than one new policy had been introduced in the same area.

Routine surgery put on hold

Peter Kay, president of the British Orthopaedic Association (BOA), says hip and knee ops save society money.

A number of PCTs have been explicit about their decisions to put all routine operations on hold for several months up to April to help balance their budgets by the end of the financial year. They include Warrington, Sheffield, Eastern and Coastal Kent, Bury and Warwickshire.

Alex Waring, a patient in Warwickshire, was told he was being referred for an urgent knee replacement in August of last year. Now he looks at that letter with bewilderment as more than seven months later he is still waiting for surgery.

Mr Waring has already had one successful knee replacement and says he is in daily pain waiting for this second operation.

"It's excruciating sometimes to put it mildly. And it affects you at the times when you're not expecting it. I get off my mobile scooter and nearly fall over because my knee is gone, the pain, you've to sit there until the pain just goes away."

Invisible waiting

Putting routine operations on hold means that GPs simply stop referring their patients for surgery. So although a patient might be waiting longer, this isn't recorded in the official waiting statistics.

Another way of adding invisible waiting time into the system is to implement stricter new criteria which have the effect of delaying the point when a patient can be referred for treatment. An investigation by the BBC also found evidence in many PCT board papers of new thresholds being added for hip and knee replacements.

They include introducing scoring systems for patients for pain or disability, or not allowing some obese patients to be referred for surgery until they have been on a weight loss programme.

Professor John Appleby, chief economist at the Kings Fund, says it is a mystery why these operations are being targeted for savings. "I find it difficult to understand. Hip operations are quite expensive, but patients get a lot of benefit for that money. This is actually very good value for money indeed."

These delays and restrictions are a response to the financial challenge facing the NHS in England. The scale of it was set out under the last Labour government, but the decisions on how to find those savings are being made now.

The coalition government has stopped performance managing the 18 week waiting time, although it remains a legal right under the NHS constitution.

A Department of Health spokesman said: "When clinicians and patients are making decisions about joint replacement surgery, it is right that other procedures - which could provide better outcomes for patients and provide better value for taxpayers - are also considered.

"Our modernisation plans for greater patient choice will drive improvements in quality and waiting times as we focus on the entire patient pathway, not just a narrow part of it, so that people live longer healthier lives."

The Physician Interview! You need to know this!

Interview Questions and Prep!

(Print and take to the interview)

Be clear about what you want in terms of practice.

Practice issues include the setting (single- or multispecialty group, hospital staff, or HMO), the type of medicine you are seeking to practice, the kinds of colleagues you hope to work with, the patient load you're comfortable with, the payer mix, and call and administrative duties. But they also comprise the organization's style, philosophy, and financial viability, both short- and long term.

Write down your questions. Do not believe that bringing a list into the interview will convey insecurity. It won't. Interviewers will generally view your written questions as a sign that you took the trouble to prepare and that your interest in the job is sincere.

Among the questions to ask:

• What type of person are you looking for?
• Why is there an existing need for a pediatrician, and can the area’s population support the practice?
• What's your practice philosophy (In regards to patients and physicians Quality of Life?)
• How does the practice assign patients?
• What percentage of my patients will be managed care. Medicaid? Cash/self pay?
• What's the typical age, education, and socio-economic level of the patients parents I will seeing?
• How many hours per week will I be expected to spend seeing patients in the office and in the hospital? Will I have to go to satellite locations?
• How many patients will I be expected to see in a week?
• How much call will I have?
• Will the hospital help my spouse find employment?
• Will the hospital help me find a suitable home in a good neighborhood?

Also ask subjective questions: "What do you like best about working here?" "What bothers you most about the job?" "What do you do for fun?" Don't be afraid to pose the same questions to a succession of interviewers. You may be amazed at the variety of answers. The diversity can give you a well-rounded look at the opportunity.

Talk money last. You have to ask hard questions about the dollars at stake, but resist the urge to bring up the subject in the first half of the interview. It may make you seem mercenary (money hungry), and that is not good!.

Ideally, you shouldn't have to bring up money at all; that's the interviewer's job. But be prepared to take the lead. If the subject hasn't been raised by the end of the first full day of interviewing, introduce it: "Can we discuss finances? There are issues I'd like to address before I leave." Once you've broached the subject, get out your list:

• What's the starting salary?
• What's the signing bonus, if any?
• Is there a productivity bonus. How is it figured?
• Is there an income guarantee?
• What can I expect to make in, say, five years?
• What's the income-distribution formula?
• What costs will I be expected to assume. Individual malpractice insurance premiums? Tail coverage?
• What restrictive covenants will I be subject to?
• If there is a partnership being offered: How soon will I be considered for partnership. What formula determines the buy-in price?

Give positive feedback. If forced to choose between two equally qualified candidates, a practice will virtually always make its offer to the one who shows the most interest in the position and who seems most likely to accept it. Make your positive feelings known!

Be specific in your compliments: "Your office setup is very welcoming to patients." And if you really want the job, say so in no uncertain terms: "This seems like a wonderful place to practice. I know I'd be happy here."

Dress for success. The watchword is: conservative.

Women should wear conservative business attire. Shun miniskirts, spike heels, chunky jewelry, loud colors, and anything tight or revealing. Hair should be tamed; makeup, muted or absent; perfume, sparingly used. Otherwise, your fashion statement may conflict with your professional image.

Men should favor dark gray or blue suits or navy blazers and gray slacks. Shirts should be light blue, yellow, or white. Add a dash of pizzazz with your tie, if you like, but keep the pattern conservative. There's only one acceptable material for ties-silk. Socks should be dark, and long enough to cover your calf when you cross your legs. Shoes should be dark-and polished. Be shaved and barbered; your beard or mustache should be neatly trimmed.

Bring your spouse. The prospective employer should pay for your spouse to come along. If not, call me!

Because employers recognize that moving to another part of the country is a joint decision, they may ask your spouse to be present at some of the interviews. Your spouse should avoid taking charge and becoming an overly aggressive advocate. In one joint interview, the spouse talked too much, dominating the conversation and making the candidate seem meek and indecisive by comparison. The job went to someone else. Let common sense be your guide.