September 2011
Feature Story

Laboratory Administration for Pathologists is a new book from the CAP Press, and in it are chapters on everything from management principles and personnel management to managing information systems, financial management, quality assurance in anatomic pathology, and laws, regulations, ethics, and legal affairs. (See cap today story, August 2011). Here, this month, is part of the section on how to prepare for a job interview, taken from the chapter on “The Pathology Position,” by Gene P. Siegal, MD, PhD, Michael O. Idowu, MD, MPH, and Richard Horowitz, MD.

The format of the interview may vary. Most interviews are relaxed exchanges of information and are typically pleasant. Even in such “relaxed” interviews, you should think about your answers to the interviewer’s questions. In some cases, especially in academic institutions, the candidate is expected to make a presentation to the faculty. Such a presentation may reveal much about a job candidate’s communication skills and management of stress. Therefore, it is important that the applicant carefully prepare and rehearse the presentation. Having an experienced faculty member review and criticize “the talk” may be crucial to giving a successful presentation at the interview.

You should anticipate that questions to which you do not know the answers will be asked during and/or after the presentation. If this occurs, you should try to retain your composure and answer honestly that you do not know the answer. You are not expected to have all the answers, and some questions may be quite esoteric. In some cases, the interviewer may choose to perform a “stress interview” to see how the applicant behaves under stress or pressure. Constant interruptions during the formal presentation is one commonly used technique to determine whether the candidate has grace under pressure as well as the flexibility and adaptability to finish the presentation on time and without losing his or her mental place. In other cases, to determine the candidate’s diagnostic skills and medical knowledge and weed out “weak” applicants, interviewers may show job candidates slides or other clinical materials during a “test interview,” or there may be some discussion about relevant clinical topics. In a common (and less “in-your-face”) approach, the interviewer may say, “We’re having some debate among ourselves about several cases in Drs X and Y’s area of expertise, and I know you trained with Drs X and Y. I’d like to show these cases to you and get your opinion.” This is perhaps unfair on many levels. For example, you cannot volunteer that you actually did not spend very much time with Drs X and Y, especially after Drs X and Y wrote letters of recommendation to this very interviewer! You cannot control the interviewer’s techniques, but you should not panic; instead, you should be aware of, and prepare for, the possibilities.

A job candidate should always prepare for an interview. One should research the position carefully, anticipate possible questions, and be prepared to provide good answers to such questions. Similarly, the candidate should set aside some time to formulate his or her own questions for the interview. The job candidate should also understand the responsibilities of the position. Are there administrative duties? What about call schedules—does everyone share frozen sections, autopsies, and “call” equally? Does the position entail supervising technical staff? What opportunities will one have for advancement or partnership? One should also ask about the group’s organization and governance: Who makes the clinical, business, and financial decisions? Does the group have direct billing? How is the group reimbursed for Part A services? Are there any managed care contracts? Is there a separate fee or salary for administrative duties? Questions concerning compensation and benefits should be withheld until the end of an interview. In many cases, there will be a second interview, and the compensation issues will be discussed at that time. This is almost always the case in academic interviews; usually, only the department chair or other senior administrator actually knows what the compensation package is and has the ability to negotiate compensation.

During an interview, you should not criticize what is done in your current institution. It is also imprudent to criticize any of the interviewing group’s practices or customs. The job candidate should understand what is done and, if necessary, mention an alternative way that may work, without being critical of any given practice. If you notice something egregious that may affect patient care or that you personally cannot accept, perhaps you should not join the group. Finally, after the interview, you must remember to send a follow-up thank-you note to the inter-viewer(s), emphasizing your strong points and what your employment in the position would add to the practice or institution.

A job candidate may wonder about how he or she will be evaluated after the interview. Private or community pathology groups may have a different evaluation process than academic medical centers, which place a heavier priority on research and educational skills. The following items, which are not necessarily listed in order of their importance, provide a general idea of how potential employers evaluate job candidates.

• Is there a fit with the group’s or institution’s current needs? (You may be a superb surgical pathologist and a splendid person, but if the group needs a pathologist with subspecialty training and experience in transfusion medicine, you may fall short of the group’s needs.)
• Interpersonal and communication skills during the interview
• Board certification
• Reputation of the candidate’s residency program
• Recommendation of the candidate’s program director
• Recommendation from someone known, respected, and trusted
• Other letters of recommendation
• Additional training, qualification, fellowship, and subspecialty certification
• Prior pathology or other experience
• Reputation of the candidate’s medical school
• In academic jobs: the number of presentations, abstracts, peer-reviewed publications, grants, etc; the journals in which the candidate has published his or her research; and the candidate’s author rank order (first author, middle author, etc) on such publications

Job candidates should remember that the pathology practice universe is small, especially in academic circles. Burning your bridges may make you feel better in the short term, but one phone call damning a candidate to a prospective employer can instantly erase a lifetime of hard work without leaving the slightest trail.

When offered a position, certain elements of the offer should be scrutinized. The offer should describe the work expected and the location of the work. Whether the position’s responsibilities include anatomic pathology only, clinical pathology only, or both anatomic pathology and clinical pathology, or whether the work includes subspecialty review, should be clear. If the group covers more than one hospital, travel (eg, circuit riding responsibilities) should be described.

Other questions should be addressed. Will there be after-hour call duty, and how often? Will there be an expectation for research and medical school teaching? In academics, a key question revolves around “protected time” to pursue scholarship. It is critical to know what percentage of the total work time should be spent in academic pursuits, and how that time is structured—by the day, week, or month. In terms of percentages, 2 months may be approximately the same amount of time as 15%, but how the time is provided—in one block or by the week—may have a huge impact on probable success. A job candidate should also ask about how performance will be evaluated. Is there a job description for the position? Are there performance standards? Is there a description of the expectations regarding workload and productivity? Although some of these questions were probably answered during the job interview, it is important for a candidate to make sure that what is put on paper correlates with his or her understanding of the position. It is also especially important to pay particular attention to the terms of the employment contract.