Physician Interview Questions! What the physician should be asking!

Interview Questions and Prep!

(Print and take to the interview)

Be clear about what you want in terms of practice.

1) 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 ---------------, 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.

Hospitals are eliminating 1 in 4 U.S. Emergency Rooms (Since 1990)

Hospitals Eliminate 1 in 4 U.S. Emergency Rooms Since 1990, Study Finds

By Nicole Ostrow - May 17, 2011 4:00 PM ETTue May 17 20:00:00 GMT 2011

More than one in four U.S. emergency departments were closed in the past two decades, forcing the nation’s poor and elderly to seek care in fewer, more crowded facilities, researchers found.

The number of emergency rooms in metropolitan and suburban areas fell 27 percent to 1,779 in 2009 from 2,446 in 1990, according to research today in the Journal of the American Medical Association. During the study, 374 emergency departments were opened.

Departments most likely to close were in for-profit hospitals and facilities that serve high numbers of patients on Medicaid, the U.S. health plan for the poor, the researchers found. Closing an emergency room results in overcrowding at other hospitals, which can hurt patient care, said Renee Hsia, the study’s lead author.

“When people don’t have ERs in their neighborhood, it’s not like their emergency disappears,” Hsia, an assistant professor of emergency medicine at the University of California,San Francisco, and an emergency attending physician at San Francisco General Hospital, said in a telephone interview.“Emergency departments can’t pay for themselves, and it’s expensive care.”

Emergency rooms are required by federal law to treat all patients who need critical care regardless of whether they have insurance or the ability to pay.

Domino Effect

Closing a hospital emergency room “displaces tens of thousands of patients, many of them uninsured and low income, which leads to increased crowding at other emergency departments and can create a domino effect,” said Caroline Steinberg, vice president for trends analysis at the American Hospital Association in Washington.

While emergency rooms are being cut, demand for their services is rising. The number of emergency visits climbed to 127 million in 2009 from 89 million in 1991, according to the AHA.

Today’s study is the first to look at the risk factors behind emergency room closures, Hsia said. Researchers used American Hospital Association data on emergency rooms that closed from 1990 to 2009 and merged it with hospital and payer information from Medicare cost reports.

The closures “didn’t just happen in one part of the country,” Hsia said. Rather, they happened across the nation“in a very consistent way,” she said.

Health-Care Failure

The shutdown of emergency rooms represents a failure of the health-care financial system, Sandra Schneider, professor in the Department of Emergency Medicine at the University of Rochester Medical Center and president of the American College of Emergency Physicians, said in a telephone interview.

“The emergency care in this country is in crisis,” she said. “We’re crowded because we can’t get those patients into the hospital because, in many cases, the hospitals have cut down on the number of beds. We don’t anticipate that it will get any better.”

Steve Speil, senior vice president for health, finance and policy for the Federation of American Hospitals, a Washington-based trade group for investor-owned hospitals, said the study may not have captured what’s actually occurring because of the data used. If a for-profit hospital buys another, the owners might consolidate under one new provider number, making it appear that hospitals have closed, he said.

“I was disappointed in this study because the need for emergency departments and the overcrowding is, as they point out, a major problem,” he said in a telephone interview today.“This study is distorting the data and does not advance us toward a policy solution.”

Safety Net

Nassau University Medical Center in East Meadow, New York on Long Island is opening a new $36 million emergency department. The hospital, considered a safety-net facility because of the high number of Medicaid patients it treats, is hoping the new emergency department with additional private rooms will attract patients from nearby communities, said Anthony Boutin, chairman of the Department of Emergency Medicine.

“To stay competitive with other hospitals, we had to fix our front door, which is our emergency department,” Boutin said today in a telephone interview. The emergency department had about 73,000 visits last year.

Today’s study was funded in part by the U.S. National Institutes of Health and the Robert Wood Johnson Foundation Changes in Health Care Financing and Organization Initiative.

To contact the reporter on this story: Nicole Ostrow in New York at nostrow1@bloomberg.net.

To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net

U.S. obesity correlates to vehicle usage

So, here is a good reason to ride your bike or just lace-up your sneakers!

 

U.S. obesity correlates to vehicle usage

New research suggests that an increase in vehicle use for everyday tasks could explain the high levels of obesity.

Tuesday, May 17, 2011

CHAMPAIGN, Ill., May 16 (UPI) -- The surge in U.S. vehicle usage beginning in the 1950s and continuing today may explain America's surging levels of obesity, a researcher suggests.Sheldon H. Jacobson of the University of Illinois in Champaign and students Douglas M. King and Rong Yuan analyzed annual vehicle miles traveled per licensed driver as a surrogate measure for a person's total sedentary time.
"If you look over the last 60-plus years, the automobile has become our primary mode of transportation -- so much so, in fact, we have literally designed our way of life around it. It is that energy imbalance that ultimately may lead to obesity," Jacobson says in a statement.
After analyzing national data from 1985 and 2007, Jacobson discovered vehicle use correlated "in the 99-percent range" with national annual obesity rates. Jacobson used annual vehicle miles traveled as a proxy for a person's sedentary time because inactivity is most obvious when sitting in a car.
"If we drive more, we become heavier as a nation, and the cumulative lack of activity may eventually lead to, at the aggregate level, obesity," Jacobson says in a statement.
"When you are sitting in a car, you are doing nothing, so your body is burning the least amount of energy possible and if you are eating food in your car, it becomes even worse."
The findings are published in the journal Transport Policy.

Healthcare reform will never work without more Physicians!

Health care reform can't work without more doctors

By Shawn Tully, senior editor-at-large April 6, 2011: 1:08 PM ET

FORTUNE -- Late last month, the Patient Protection and Affordability Act, better known as "health care reform," quietly celebrated its first birthday. The bill has its supporters, including the millions of previously uninsured Americans who will have access to coverage because of it. But its critics have been more vocal, attacking the landmark legislation for "gutting" Medicare, drastically understating the measure's probable cost, and funding a new entitlement with early premiums from still another entitlement for long-term care that's destined to go broke.

But the biggest threat to President Obama's plan is both widely overlooked and absolutely fundamental. The measure aims to vastly increase health care coverage while effectively freezing the ranks of the already-busy providers needed to furnish all those extra check-ups, cancer screenings and angioplasties: America's physicians.

If you expand demand and cut the fees -- the main thing the law does to reduce costs -- doctors will simply say, 'I don't need you,' and take higher-paying customers," says Dr. Richard Cooper, an oncologist at the University of Pennsylvania and expert on the doctor supply issue. "It's already happening with Medicare and Medicaid patients, and will only get worse."

The looming doctor shortage creates three unintended forces bound to block the objectives the plan is designed to achieve. First, Medicare and Medicaid patients will increasingly face long waits to see a doctor, if they can find a physician to treat them at all. Second, people who need care urgently will flood already overloaded emergency rooms, just the scenario the plan is trying to avoid. Third, the tight restrictions on the number of physicians make it extremely difficult for insurers to find HMOs or medical groups craving new business, and hence willing to accept deep discounts in exchange for new patients.

The Patient Protection Act's promise to expand demand for healthcare is well known -- and amply advertised by the Obama administration. By 2019, it would cover 32 million Americans who would otherwise remain uninsured, around half by raising the income threshold for Medicaid, the joint federal and state program for the poor, and the balance by providing generous subsidies through newly created, state-run "exchanges." Don't forget that the medical market already needs an influx of providers to treat the 75 million baby boomers who start joining the Medicare rolls in 2011.

What's mystifying is the measure's approach to addressing how those new patients will actually get the care they're promised. Remarkably, the Obama plan leaves a bottleneck in place that prevents the supply of physicians from significantly growing. The number of doctors entering the workforce each year is determined by the number of residency positions or "slots" at US teaching hospitals. Most of the funding for those positions is provided by Medicare. In 1997, Medicare effectively froze the number of slots at just over 100,000, meaning that around 25,000 new doctors enter practice each year. The number hasn't increased much in two decades, while the volume of medical services has exploded.

The Patient Protection Act would effectively "add" roughly 900 residency positions by using slots that are not currently in use. That would lift the number of doctors entering the workforce each year by a paltry 200 to 300, an increase of 1% or so at best. Instead of vastly growing the overall pool of newly trained doctors, the administration concentrates on shifting the mix by limiting the number of specialists and modestly increasing the ranks of primary care doctors, a group that comprises family physicians, general internists, and pediatricians.

The vanishing primary care physician

The plan is a formula for a dire, reform-killing shortage. The reason is basic: American medicine is already suffering from a dearth of doctors, and the problem is just as bad for specialists as for the primary care practitioners the bill favors.

A revealing report by physicians recruiting firm Merritt Hawkins, prepared for the Physicians Foundation, cites a wide variety of reports, as well as its own survey of doctors, documenting the problem. In 2010, for example, only one medical school graduate in six chose primary care. Family doctors, internists and pediatricians constitute just one-third of the physician workforce today versus 50% in 1950, and the share is falling fast. Virtually every rural area in America needs more primary care doctors, and can't find them.

Nor can hospitals and practices find sufficient numbers of general surgeons, psychiatrists, gastroenterologists, and cardiologists to care for their patients. The number of openings for geriatricians who serve the elderly is four times the number available for hire.

As a result, patients of all stripes are waiting longer and longer to see a physician. Merritt Hawkins found that the average time between booking an appointment and entering the doctor's office is 50 days in Boston, 27 in Philadelphia, 24 in Los Angeles and 23 in Washington, DC.

The promise of plentiful, affordable care for Medicaid and Medicare patients, a pillar for the reform package, is gravely endangered. Of the doctors Merritt Hawkins surveyed nationwide, 92% said they would either stop taking new Medicaid patients or significantly limit those they do take because of the bill; for Medicare patients, the figure was 87%. Dr. Cooper estimates that a fourth of all doctors now refuse to take Medicare beneficiaries, and half shun Medicaid recipients.

The administration's decision to maintain the doctor freeze contradicts its effort to control costs. The bill would modestly raise reimbursement for primary care doctors while allowing fees for specialists to keep falling. Even the increases for family doctors and the like won't work. "A family doctor gets around $70 a visit from Medicare or Medicaid, and 15% more from private insurers. And those patients are a lot sicker and more expensive to treat," says J.R. Thomas, chief of MedSynergies in Dallas, which provides back office services for medical groups.

So, busy doctors will increasingly drop Medicare and Medicaid patients, and fill their days seeing privately insured clientele that pay market rates. The waits will get far longer and the emergency rooms fuller. America will turn into a two-tiered system like the one in Britain, where the wealthy pay for deluxe concierge service -- that's what tomorrow's well-off Medicare recipients will do. The poor on Medicaid will have no such luxury.

Much of the pain would be avoided if we simply agreed to expand the number of doctors to meet the growing demands of the medical marketplace. Recent proposals in Congress to increase the number of residency slots have gone nowhere, in part because the administration accepts the highly questionable argument that restricting the number of physicians holds down costs. As one wise doctor, born in India, practicing in the U.S., once told me, "We've created a famine where there should be plenty."

The H1b Physician Candidate & how to find a practice!

H-1B Visa Recruiting Season Underway

Alexandra Wilson Pecci, May 4, 2011

International medical school graduates can be a boon to rural hospitals that have trouble attracting physicians. But there are a limited number of H-1B visas—visas for people whose jobs require a minimum of a bachelor's degree—issued every year, and there are often aren't enough of them to go around, especially since that limit applies to all industries, not just healthcare.

But this year will likely mark the first time in several years that there will be enough H-1B visas for the entire year. And because the application period began April 1, now is the time for hospitals to be recruiting international medical school graduates.

"This year, my prediction is they will last all year long, so I think it's a great opportunity for employers in the U.S. who want to hire international medical graduates," Los Angeles-based immigration attorney Carl Shusterman said in an interview. "The U.S. has really used these foreign medical graduates as the device for serving people in these [rural] areas where they could not get American doctors to go and serve."

One physician executive who's experienced this first hand is Brian Bossard, MD, FACP, FHM, who is the CEO, founder, and director of Inpatient Physician Associates, LLP, a Lincoln, Nebraska-based hospital medicine group which also has programs serving two very rural areas.

"There was a provider shortage," he said in an interview. "In hospital medicine in particular, there's been a real need for H-1B visas to fill that void."

Bossard says he's hired close to 10 H-1B visa physicians as attending hospital medicine physicians. He says that one of biggest advantages for hiring these physicians is the fact that they're willing to work in rural areas.

"There's a greater willingness for them to reach out to the rural areas and provide care there," Bossard says. "No question, smaller communities around the country have a harder time recruiting U.S. graduate physicians."

That only adds to the rural physician shortage. Citing statistics from Rural Healthy People 2010, the National Rural Health Association says that only about 10% of physicians practice in rural America, despite the fact that these areas are home to nearly 25% of the population.

According to Shusterman, the lowered demand for H-1B visas can be blamed on a soured economy and the fact that companies in other industries, such as technology, aren't hiring as much.

"The last couple of years, all of a sudden, the demand really went down," he says. "When the economy goes bad, then these companies don't hire a lot of people for H-1B visas."

He says since this year's application period has just begun and residency programs are winding down, now is the perfect time for hospital executives to recruit international medical graduate candidates.

"They should be selecting people right now out of residencies and fellowship programs," he says.

Bossard says there are, of course, advantages to hiring U.S. graduates, who don't come with the legal processing and attorney fees associated with hiring H-1B physicians. But when U.S. grads aren't an option, H-1B doctors can be lifesavers.

"There are some strings attached to the visa candidates," Bossard says. "But for me I wouldn't have been able to maintain my business without their help. They've been a huge asset for me, and as a result, a huge asset for the hospital systems that we work with."

Why Physicians Are Going To Stop Seeing Medicare Patients! Read ON!

Why Physicians Are Going To Stop Accepting Medicare

January 26th, 2010 by DrStanleyFeld

REPAIRING THE HEALTHCARE SYSTEM!

President Obama’s Healthcare Reform Bill will not work. It is based on decreases in physician reimbursement while forcing physicians to increase overhead with unaffordable electronic medical records. More and more physician groups and practices are starting to realize that they cannot make a living from the reimbursement from Medicare. They are quitting taking new Medicare patients and trying to get rid of the old ones by not taking assignment.

President Obama’s idea is to force physicians to be more efficient producers. It is very difficult to force anyone to do anything they cannot afford.

President Obama also believes that physicians over test patients in order to make money. Wrong! Much of the over testing comes from the practice of defensive medicine. Many physicians have been sued for under testing. No one is sued for doing a test. Yet there is not a word about malpractice reform in either version of the healthcare reform bill to decrease testing by eliminating defensive medicine.

President Obama’s solution is to prohibit physicians from testing in their office even though it is more convenient and efficient for patients. Ancillary services can help with overhead and does increase physicians’ efficiency of care.

In fact, the fees for the ancillary services in a physicians’ office are generally much less expensive than the fees for ancillary services in hospitals. President Obama ignores this fact. He believes physicians over test for profit. This might be true in some cases. However, this abuse can be discovered with the information technology system we have at present. He believes he can force physicians to tests less if it is outsourced to the hospital.

Physicians on average earn 20% to 30% less from Medicare than they do from private patients, and many are dropping out of the program.

The administration is beginning to feel the kick back from the physician community. I think this kick back will escalate in the coming months. It will worsen the delivery of medical care.

“President Obama last year praised the Mayo Clinic as a “classic example” of how a health-care provider can offer “better outcomes” at lower cost.”

How were better outcomes determined? The question is unanswered.

“Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors.”

Mayo says it lost $840 million last year treating Medicare patients, the result of the program’s low reimbursement rates.

In Arizona alone it lost $120 million dollars. The losses are usually made up by cost shifting to the private insurers and private patients. These losses are getting harder and harder to make up by cost shifting.

“Mayo Clinic loses a substantial amount of money every year due to the reimbursement schedule under Medicare,” the institution said. “Decades of underfunding and paying for volume rather than value in Medicare have led us to this decision.”

The media has reported that Mayo Clinic has only dropped accepting Medicare in a small clinic in Glendale Arizona. It has been reported as an insignificant event by the traditional media. Mayo Clinic is being very civilized by not eliminating participation in Medicare in all the clinics at once. The Mayo Clinic is sending a message to President Obama and his future plans. It will also be a signal to physicians throughout the country.

Ninety two percent (92%) of family physicians accept Medicare. Only about 73% of those are now accepting new patients. This reduction in participating physicians comes on top of a shortage of primary care physicians.

Patients struggle to find any specialist who will accept Medicare. This experience is greatest in the specialties of neurology, oncology, and gynecology. Cardiology is next.

Last week Cardiologists filed a lawsuit in U.S. District Court for the Southern District of Florida, charging that the government’s planned cutbacks will deal a major blow to medical care in the USA. “It will force thousands of cardiologists to shutter their offices, sell diagnostic equipment and work for hospitals, which charge more for the same procedures.” The lawsuit is an attempt by a group of medical specialists to stave off steep Medicare fee cuts for routine office-based procedures such as nuclear stress tests and echocardiograms.

“What they’ve done is basically killed the private practice of cardiology,” says Jack Lewin, CEO of the American College of Cardiology (ACC), which represents 90% of the roughly 40,000 heart specialists in the USA.”

The government’s response was politeness. It will hide behind regulations made as a result of congressional mandates. The result is typical bureaucratic gobbledygook.

“Jonathan Blum, director of the government’s Center for Medicare Management, says the agency is bound by law not to increase spending when making reimbursement decisions each year.”

“Lewin and other heart specialists met with Sebelius on Dec. 8 and explained their concerns. “I thought she was very empathic,” he says, but Sebelius has yet to take action.”

Kathryn Sebelius will not take action. Neither she nor President Obama really understands the problem much less the solutions. One cardiologist said it is an efficient way of getting rid of cardiologist and ration access to care.

“It’s so absurd, it’s kind of funny,” he says. “I know ACC doesn’t think it’s funny but I do.”

It isn’t funny. It is an unintended consequence of government control of healthcare. Healthcare should be consumer driven not government controlled. Government should make appropriate rules to level the playing field for all stakeholders and then get out of the way.

A cardiologist in Silver City, N.M. not far from the Mexican border said,

“The closest cardiologist to me is 150 miles away. With all these cuts coming, it will make it impossible for me to break even seeing 40 patients a day.

Does anyone want the government and its 118 new bureaucracies to take over medical care?

What is the problem?

1. The government is broke.
2. They have to reduce expenditures .
3. Physicians are the weakest link, politically, in the healthcare system because they are ineffectively represented.
4. The government will not fight the healthcare insurance industry’s lobbying.
5. The government will not fight the Plaintiff attorney’s lobbying.
6. The government will continue to waste taxpayers dollars on stakeholders who add little value to the treatment of sick patients.

It is about time groups of physicians started to make some noise!

Malpractice reform idea!

Malpractice reform

By Ezra Klein in the Washington Post

Most talk of medical malpractice reform explains it as a concession Democrats might make to Republicans. But as Jonathan Cohn explains, a real compromise on this would be good policy, too:

While malpractice may not be a major factor in rising health care costs, the system is clearly broken. It forces doctors to operate under a cloud of suspicion, without necessarily punishing those physicians who are truly negligent. It encourages the use of tests and treatments that are frivolous, if not downright harmful. And it leaves the vast majority of people who need compensation for medical errors with no easy way to get it.

The key is finding ways to fix the malpractice system so that it helps both physicians and the patients, rather than one at the expense of the other. And there are several promising possibilities for achieving that. One is to have doctors report medical errors to hospital administrators, who would then notify patients and begin negotiations. A version of this "sorry works" model is in place at the University of Michigan Health System, where it has reduced lawsuits, cut litigation costs and sped the resolution of cases.

Another idea is to create a no-fault system, similar to the way workers' compensation works, or to channel most malpractice cases through special "health courts" that would come before jury trials. (The Scandinavian countries and New Zealand have such systems in place.) One other proposal--perhaps the most intriguing--is to tie malpractice to quality incentives, by offering some sort of legal protection to physicians who demonstrate they have abided by accepted clinical guidelines. Not only might such a scheme cut down on frivolous lawsuits. It might also improve the quality of care--which would, in theory, reduce the incidence of actual malpractice.