Sunday, April 18, 2021

Is My New Doctor Qualified?

When one applies for a job or a position, it is expected that the interviewer will assess if the applicant has the necessary skill set and experience. Doesn’t this make sense?  Consider these examples.

A clarinetist applies for a position in a symphony orchestra.  While many criteria will be assessed, he will surely need to audition to demonstrate his musicianship.  Would he ever be hired without playing a note?

A college student wants to join the swim team.  The applicant can expect to show off her speed and technique as she cuts across the pool.  Would any coach accept a new swim team member without watching her swim?

A journalist for a town paper applies for a job at a large metropolitan newspaper.  The interviewing editor will surely review the applicant’s prior work product to gauge his competence and suitability for the new position.  Would an editor bring on a new reporter without ever reviewing his writings?

A college graduates applies to the State Department as a translator.  Would such a hire ever occur without determining if the applicant has the requisite language skills?

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So how does the medical profession hire on new medical professionals?  I should certainly know this since I’ve been in the trade for 3 decades and have had enough job interviews to know how the process works.  I’ll ask readers to peruse the following 5 sample gastroenterologist applicant questions. Can you spot the ones I was asked during my prior job interviews?   

Which antibiotics do you typically prescribe for diverticulitis?

What is your age cutoff for offering screening colonoscopies?

What is your complication rate for colonoscopy and other medical procedures?

When is the right time to prescribe steroids in Crohn’s disease?

Does a patient who is having a gallstone attack and a fever need to be hospitalized?

Which ones were I asked?  None of the above.  For reasons I cannot easily explain, I have never been asked any medical question during any prior job interview.  Similarly, when I have interviewed job applicants myself, I have never queried them on any medical issue.  The profession, at least in my experience, assumes that physician applicants have all of the necessary medical skills and knowledge, even though this does not seem to make much sense.  Shouldn’t the applicant at the very least be asked to review case histories of assorted patients and to comment?  It seems it’s a lot tougher to get a job as a clarinetist than as a gastroenterologist.  Does this put your mind at ease?






Jared said...

Medical groups routinely verify whether a candidate has achieved board certification in their chosen specialty, as well as whether they have successfully completed all appropriate residency and fellowship training prerequisites. They also rely quite heavily on references from those who know their clinical ability best. All of which seems a far more reliable method to judge their qualifications than a handful of grab-bag pop-quiz questions on the day of an interview. Furthermore, it is customary for new physician hires to be on some sort of partnership track or an initial 12-24 month probationary period where their future employment is dependent on having their contract renewed after that time - a time during which their clinical judgement, rate of complications, and overall likeability/fit is cautiously scrutinized.

I agree that it is no doubt challenging to really know what kind of a clinician (and person) an applicant is (in any industry). There are plenty of "meh" physicians who eventually managed to jump through the hoops of board certification. Likewise it is challenging for applicants know from an interview day and a few conversation with a recruiter whether or not they are joining a reputable and fair group or a predatory "bait-and-switch" scheme.

But I doubt the solution to those problems is to re-invent a miniature version of an oral board examination during a 30 minute interview.

Unknown said...

Good question!

For those who have been around, we look at CV and seek out references, look at their work history, stability in a job etc.

I was in academics for my first 20 years after Hem Onc training. So I had a good CV, had advanced to Tenured Prof level. But when I decided to enter Private Practice, I asked myself a Q. How would they know how would they know what kind of a a “Doctor” amI? For all my accomplishments I could be a jerk and a terrible human being. My wife said,: “why don’t you send some of those letters?” I said what letters? We had a practice plan at the University and thus most of us had a mini private practice. Patients often sent letters of appreciation or thank you. I would bring them home for her and she had saved them all in a shoe box! I included them. A sample but they may give them some idea of how I am with patients? I was offered a job at every place I visited! No, they didn’t ask me how I treat my acute leukemia or breast cancer but they at least had an idea that I am probably good with patients.

I actually asked the first practice that invited me what prompted them to. The practice manager said : “ those letters!”

Anonymous said...

Ok so I tried posting this already but it didn’t go through but here’s the gist. If you think employers don’t screen their employees for proficiency you are either working at a terrible practice or you don’t understand what is going on and haven’t taken the time to think it through. There is no certification process in most professions let alone one that includes almost a decade (and often longer) of training. Residency completion, fellowship completion, and board certification all easily cover the question of proficiency that you raise. And even if the employer doesn’t catch this you can be sure the state medical board will hear about any malpractice when applying for a license. For the physician, that is the “audition tape”. Add in peer recommendations and hospitals requesting case logs to assess procedural competency and it’s far more rigorous to get a job than you have let on. While it may seem great to get those sweet sweet clicks by painting the profession as uncaring and apathetic please consider the consequences of your actions. Someone who just reads this and loses faith in the medical system may skip a colonoscopy for many years leading to detection of colon cancer once it has metastasized and has a far higher mortality. So I’ll ask: was the few seconds of fame for writing an extremely misleading article worth it? Or could you not be bothered to reflect for at least a minute on the actual safeguards that are in place prior to posting?

Apologies for the terseness of the post it’s my second time writing it and on my phone

Anonymous said...

Does a clarinetist take a board exam? Does a clarinetist take in service exams every year to show their knowledge? If the conductor of the New York philharmonic orchestra sent a letter of recommendation to you would you question that? This seems like a silly comparison. Interviewing for a job as a physician is about finding the right interpersonal skills for that specific job. The technical skills and knowledge base of a physician should be assured by the fact that they completed their residency. That’s hot to say that some bad doctors are able to complete residency, but this is a small minority of doctors.

General Surgeon.

Anonymous said...

This is a very over stated attempt to draw attention to a problem that does not exist. The average doctor is a highly educated and trained individual with a long track record that is readily available for anyone to access. One of the few professions on earth with high scrutiny over decades. Testing someone during an interview does not identify competence. It takes away from finding the right fit for the practice. You need to find a real problem write about.

Michael Kirsch, M.D. said...

First, let me thank all of erudite commenters for taking the time to offer their views. @anonymous, if only this blog was a click magnet! MDWhistleblower has been posting without interruption since 2009 and, alas, has only a small following. With respect, I do not agree that board certification, CME fulfillment, peer review or the state boards reliably gauge physician quality any more than the various Pay for Performance schemes measure physician quality. I surmise that most of those peer reviews are pro forma greenlighting by friends of the applicant. When you are asked to submit names for peer review, I assume that choose those whom you suspect will offer a favorable review.

You will also note that my own views are never anonymous. I wonder, but repect those who choose to opine in a more stealth manner.

Clearly, as a regular MDWhistleblower reader would know, I do not advocate a physician applicant being subjected to a play Medical Jeopardy to assess their knowledge, but I maintain that many other professions to want to closely examine work product and knowledge in the hiring process. The medical profession, at least at the physician level, does not.

The attributes in a colleague that I value and aspire to are unmeasurable. I think that our profession has repeatedly fallen prey to 'counting that which can be counted' without paying sufficient homage to the adage, 'what really counts can't be counted.'

How do you measure physician judgment, such as knowing when a CAT scan isn't necessary? Sound clinical judgement is a skill that separates decent doctors from excellent practitioners. How do you gauge someone's empathy and compassion? How will the person deal with referring physicians, patients and their families or our office staff? Do they collaborate skillfully and regularly with colleagues? Will the physician make patient's feel that their health and wellness is his highest priority?

One could have excellent credential but lack many of the above essential elements, as least as I see it.

Once again, thanks for reaching out. I value all of your views.

Anonymous said...

Interesting topic. It's difficult to get at all those necessarily hard and soft skills in an interview and we're left relying on the track record of training and the evaluation of previous mentors and colleagues. Perhaps an imperfect system. I wonder more about the assessment of NPs and PAs. Their training is vastly different than that of physicians. They have much more limited formal assessment (exams) and the oversight of their training is highly variable. And yet they are asked to work in capacities far beyond their training. While assessment of a physicians skills upon hiring is imperfect, there is much more credibility in the attainment of their license than for that of NPs and PAs. How do we assess the skills of NPs and PAs upon hiring? This is an area I'm MUCH more concerned about.

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