A physician in one of my management workshops recently asked me to name the single biggest business problem for ophthalmologists. She was stunned that my answer was unrelated to managed care hassles, discounting of fees or the Health Care Financing Administration’s (HCFA’s) abuse of physicians’ good will. The toughest business problem for physicians is the same as for all other employers: attracting and keeping good workers in every position.

Imagine the following job interview exchange:

Q:

"So why do you want to work in an ophthalmology practice?"

A:

"Well, I like working with people."

Sound familiar? It’s just the kind of innocuous banter that forms the substance of many employment interviews. Maybe that’s why physicians keep hiring such duds.

The main purpose of an employment interview is to determine if the candidate has the skills and temperament to do the job well. Yes, you need to learn facts about the candidate to know whether he or she will fit into your office and be a reliable addition to your team. But you also need to learn what the applicant already knows about the work. It’s useful to try to gauge the person’s intellect and judgment.

Keep quiet

Your mission for the interview is to find out how the candidates are different from each other, and you won’t learn that by talking. Your precious time should be spent listening to the applicant.

So, to let the candidate know about the job he or she is applying for, give a copy of the job description and employee handbook or personnel policy to the candidate before the interview. It will save you time and show the applicants that your practice is organized. That lets you stay focused on the applicant’s credentials for the job.

It can also be a waste of time to listen to the applicant recite his or her job history. That information is on the resumé or application form. Instead, zero in on the candidate’s prior work that sounds similar to your opening and get specific about what he or she knows that is relevant. The real issues are whether the candidate has the experience to do your work and whether he or she will fit in with your practice.

To find out that information, we recommend using job-specific questions. Here are some examples, by common job title, to get you thinking. Asking these targeted questions implies that the questioner knows a lot about how the work is actually done. That means the direct supervisor of that work needs to be involved in the interview process at some point. Try these on for size.

Front desk questions

Did you have to reschedule appointments on your last job? How many? How long did it take?

How busy was that office? (Patients per day or per session)

Suppose a patient requests an appointment at an hour you can’t offer — how would you switch her to a time that’s more convenient to our practice?

What are the serial numbers on the charge tickets for? How did you use them in your last practice?

What should you do if a patient was a no-show?

Imagine I’m a patient: "Gee, this bill seems high." How do you respond?

An employer calls asking whether his employee is taking birth control pills. What do you tell him?

Medical assistant/technician questions

When is it necessary to chart the refill of a routine medication such as glaucoma drops or the reordering of contact lenses?

What are the pertinent things to list when asking the patient about a current complaint?

If a patient complains of seeing ants all the time, is that germane to include in the record?

If a patient refuses dilation drops, what would you do?

Billing and collections questions

How did you submit your last insurance claim appeal? Tell me about it. What was the result?

What steps would you take if you were getting no response from an insurance carrier? A health maintenance organization (HMO)? Medicare?

What’s the CPT code for a comprehensive established patient office visit?

The patient is complaining of dry eyes upon awakening. What’s the ICD-9 code to describe this problem? (Have the ICD-9-CM available).

How and when should you bill for a patient telephone call?

Naturally, you’ll want to fill in your own practice-specific questions, but these should give you an idea. You’re looking for the applicant to demonstrate resourcefulness in coming up with the answer, utilizing material at hand.

Some candidates will fire back lots of qualifying questions to make sure they understand what you’re asking. That’s smart. The candidate who attempts to answer from the hip without fully understanding the question may be a loose cannon in your office.

Interviewing a job applicant can be a stressful process, especially if your applicants aren’t used to getting tough questions in interviews. But busy practices are stress-inducing places to work. Seeing how applicants react under some stress is reasonable. Of course, you’ll also want to reassure applicants that your practice will be a good place to work. A friendly smile and words of encouragement after stressful interview questions will go a long way toward showing you care.

Will he or she fit in?

Apart from skill is the question of cultural fit or suitability for your staff and your patients. Ask these probing questions to see how the candidate reacts. Be sure to ask about issues that have caused a problem in your office before.

• When was the last time you were trained to do something new? Describe the experience.
• What would you like to change about your current job?
• Has your previous employer ever asked you to stay late on a day when you had other plans? How did that make you feel? What did you do?
• Think of a difficult or obnoxious patient in your last job. What were the circumstances? How did you handle it?

General fitness for the job usually involves basic intelligence and education, plus a poised, confident and easy communication style. That’s not hard to determine, provided you give candidates a chance to talk. The ability to use the English language well, for example, is a good indicator of intelligence and education.

Tie-breaker interviews

If necessary, use a second interview to choose between two good candidates. It’s a good idea to raise the bar somewhat and ask the applicant to role-play a few applicable scenarios. Look for judgment and the ability to react on the spot — two qualities that are vital in most practices. Here are some sample examples that you can use to determine whether an employee knows what he or she is talking about.

• Collection call
. "I’ve owed the practice $100 for 3 months. The insurance has been billed and collected. You’ve sent statements and heard nothing from me. What would you say when you call me?"
• Appointment scheduling.
"I’m a patient who needs my appointment rescheduled for the second time. What will you say when you call? "
• Reception desk
. "I’m an angry patient at the front desk because you have kept me waiting for 30 minutes. What do you say to me?"
• Tech or nurse.
"You won’t renew my prescription over the phone and you want me to come in to see the doctor. I don’t want to come in. What do you say to me?"
• Insurance desk
. "I arrive for my appointment without an HMO referral from a primary care physician. The practice’s policy is to not see me without it. What do you tell me?"

In these real-life situations, you’re looking for quick thinking and a positive, upbeat and patient-centered attitude. It’s not so important if the applicant come up with the "right" answer or a response that reflects your own policy or preference. But you should listen carefully to his or her thought process and poise under fire. And be wary of candidates whose responses are legalistic or indicate inflexibility, especially for management or supervisory positions.

Finally, it’s only fair to ask the same questions of all applicants for a position. Remember, you’re not trying to find the perfect applicant — just the best one.

To prepare for interviews — and to be fair — make a list of the questions you intend to ask of all candidates. Then make careful notes of your impressions during the interview. That will prevent you from forgetting specifics and confusing one candidate with another.

Steer Clear of Inappropriate Questions

Most employers are now acquainted with the rules of equal employment opportunity. But some seemingly innocuous questions can lead to charges of discrimination in the workplace. Worse, they could lead you to the wrong hiring conclusions. It turns out that lots of questions about applicants’ personal lives really are irrelevant to the decision. Here are some hot-button situations:

Don’t ask:

"Are you married?"

"Do you rent or own your home?"

"How old are you?"

Do ask

:

"Why are you qualified for this job?"

Don’t ask:

"Do you have children?"

"How old are your children?"

"Do you have child care?"

Do ask

:

"We sometimes have to work past 5 p.m. and you’d need to stay until patients are gone. Will that be a problem for you?"

Don’t ask:

"Have you ever been arrested?"

"Have you ever been convicted of a felony?"

Do ask:

"We bond all employees. Will that be a problem for you?"

Don’t ask:

"What is your nationality?"

"How do you feel about foreigners?"

Do ask:

"We have some patients who do not speak English very well. Is that a problem for you?"

"Do you speak any other languages?"

Don’t ask:

"What religion are you?"

Do ask:

"We sometimes work Saturdays. Will that be a problem for you?"

Don’t ask:

"How long will you work here?"

"Do you plan to get pregnant?"

Do ask:

"What is your favorite work?"

"What is your least favorite task?"

"What is your career plan for the next few years?"

Jeffrey J. Denning is a practice management consultant with Practice Performance Group, Long Beach, Calif.; and editor of UnCommon Sense, a monthly practice management strategy and tactics newsletter. You can reach him at (562) 595-1728.