• How interviews are really used to make employment decisions
• Categories of interviews
• Types of interviews
• Types of questions typically used
• Preparing for the interview
• Handling the dynamics of the interview
• Post-interview actions

New Age Employment
Interviews are still the tool most frequently used to select employees, irrespective of industry or occupational classification. Whether they are used for initial screening or for final decision- making, interviews are complex social tasks. As noted by Dipboye (1992), the selection interview involves a social exchange, and is subsequently fraught with great challenges. Cascio (1998) has noted that interviews remain a poor basis for making employment decisions, due to factors such as first impressions, personal beliefs about the job or applicant, political pressures, and the broad range of biases that influence most interviews.

The future of employment decision-making in healthcare, and particularly with physicians, will involve an even greater reliance on technology, with the use of video-conferencing for screening interviews becoming commonplace. Web-based assessment, which will combine the elements of a traditional application, personality test, and interview questions, will also be used to select the best candidate for a given culture. All of these challenges will require that physicians better prepare themselves for effective exchanges with potential employers.

The Employer's Strategy and Interview Techniques
It is important to remember that the goals of the applicant and the organization should be the same. Here, effective information exchange is the key. Physicians who are candidates for positions, therefore, need to better understand the strategies and tools likely to be used to obtain information about them. Generally speaking, there are two broad types of interviews: content and behavioral. Content interviews focus on the physician's ability to perform tasks and general requirements. Behavioral, or situational, interviews focus on highly specific requirements for the job, issues of culture fit, and questions of interpersonal skill. Generally speaking, the more formalized and larger the organization, the greater the propensity to use behavioral and situational interviews. As well, there appears to be a greater reliance upon behavioral interviews by administrators and HR executives. Of importance here is that candidates must be ready for both types of interviews. Remember, it is the task of the selection process to determine whether the candidate can do the job (i.e., skills, education, experience), will do the job (i.e., motivation and values), and will fit into the organization's culture (i.e., personality traits). Thus, the degree of structure and rigor at various stages of consideration and with different parties will vary greatly.

Fisher, Schoenfeldt, and Shaw (2002) have outlined several categories of interviews by degree of structure. These are:

• Unstructured - questions are not planned in advance, and the interview may cover very disparate areas of past history, attitudes, and use of "favorite" questions
• Semistructured - questions are planned in advance, but judgment on the part of the interviewer is used relative to what is actually asked of the candidate; the interview is customized for the applicant
• Structured - questions are planned in advance, with each candidate being asked the same questions; frequently, responses are recorded and evaluated in relation to pre-established criteria.
  

It is important to remember that a physician pursuing a new job is likely to encounter a number of different types of interviewers. The relative number of parties may vary widely, ranging from one interviewer, to pairs of interviews, to possibly a panel interview. It is likely that the further you get in the selection process, the greater the likelihood that multiple-party interviews will occur.

Interview types can, of course, vary by purpose. Screening interviews are primarily focused upon the basics, such as licensure, experience, etc. They can often be conducted over the phone. Past the initial screening, individual interviews are likely, followed by interviews by key decision makers (e.g., Chief of Staff, Chief Operating Officer, Practice Partners). In-depth interviews focus on issues of "can do" and "will do" (i.e., skills, motivation). Once past this stage, candidates are frequently placed in a "beauty parade," where they are given the opportunity to interact with a broad range of individuals (e.g., Chief of Nursing, Board Members, etc.) for very brief periods of time. In some cases, however, where there is a disagreement about the best applicant or questions of inconsistencies, a final interview is held. Generally, questions of "how fit" are the focus here, involving a relatively narrow range of criteria and behavioral-based questions.

Many types of questioning techniques can be used during an interview. Most trained interviewers will use a variety of question types, beginning with a topic (e.g., "Tell me about your training at XXX hospital"), followed by specific questions (e.g., "What were your major duties?"), progressing to specific yes/no or fact-based questions (e.g., "How many patients a day did you see?"). This cycle thus follows the use of open and closed question types.

Other types of frequently used questions involve behavioral or situational questions, comparison questions, or evaluation questions. Behavioral questions focus on how the candidate has acted in the past in certain circumstances (e.g., "At your last clinic assignment, tell me how you..."), or future circumstances (e.g., "If you were to come to work at this clinic, tell me how you would approach..."). Comparison questions require the candidate to compare sets of skills, experiences, or preferences (e.g., "What is the level of your diagnostic skills compared to your bedside manner?"). These types of questions are frequently used to uncover an applicant's weaknesses. Evaluation questions are also quite common, and can be used to ask the candidates to assess themselves (e.g., "How would you rate your ability to deal with chronically ill patients?") or to have others evaluate them (e.g., "How would your former Chief of Staff evaluate your attention to detail?").

Your Preparation
It is important to keep in mind that you should prepare for both structured and unstructured interviews, as well as a variety of question types. Therefore, it is critical for you to pull together your own story by preparing responses to questions, as well as questions you should ask. Here there are a variety of issues to consider. These involve assessing yourself, researching the employer, putting together your story, scripting responses to frequently asked questions, and preparing questions you should ask.

It is crucial that you assess your own skills, strengths, and needs prior to an interview. If you don't know yourself, you will not be able to effectively market yourself.

Key areas in self-assessment include:

• Key Skills - key clinical, interpersonal, and administrative skills and abilities
• Market Worth - supply and demand at your level of experience, within a given specialty, and within a defined labor market or region
• Personal Profile - comfort with bureaucracy, fit with entrepreneurial styles, decision- making preferences, security orientation, and pace of work
• Developmental Challenges - long- and short-term goals, weaknesses, and plans for development

Key areas for researching the employer are:

• Organizational History - institutional evolution, size, and founder efforts
• Market Position - growth, retention, and stability strategies, as well as market segmentation and penetration
• Business Strategies - payer mix, niche, existing and potential lines of service, and competitive edge
• Underlying Culture - leadership practices, lines of communication, decision-making techniques, openness, and innovation

Key components to establishing your personal story are:

•  Two Minute Drill - brief synopsis of your background, education, specialized training, and goals
• Strengths and Weaknesses - key clinical, interpersonal, and administrative strengths, and at least one developmental area
• Organization/Person Match - relationship between what you have to offer (i.e., skills, specialized training) and the organization's needs and plans (e.g., expansion plans, demography, etc.)
• Potential Contributions - key reasons why you may have both short-term and long-term value to the organization and/or community
• Workstyles - Your preference for structure, autonomy, professional relations, etc.

There are of course questions to which you should be prepared to respond, as well those questions that you should be prepared to ask. There are several excellent sources of such questions (Delvea & Delvea, 2001; Fry, 2000; Kador, 2002); a number of these can be highlighted here.

Key questions you should ask include:

• What are the vision, mission, and values of the organization, and how do these relate to each other?
• What are the future plans and business strategies of the organization, and how do they relate to the open position?
• What is the prevailing culture of this organization?
• What could the person selected for this position do during the first 90 days that would really make a difference?
• What personal characteristics would the successful candidate possess?
• What will be several of the major challenges to be faced by the person accepting this position?

Key questions that you will likely be asked are:

• Tell me about yourself.
• What are your strengths and weaknesses?
• What have been your biggest personal/professional challenges?
• What are your long-term plans?
• Why do you want to work here?
• What do you feel you have to offer?
• How would others describe you in terms of your interpersonal style?
• In what ways are you a team player?

Handling the Dynamics of the Interview
Responding to tough interview questions is a challenge for even the most experienced of candidates. There is no excuse for not preparing for the above-mentioned areas. However, you should also be prepared to deal with illegal questions, and perhaps overly structured or controlling interviewers. It is important to never take control away from the interviewer, even though they may appear to be uncomfortable, or even rambling. Be prepared to answer questions directly. Don't shy away or avoid questions. Be thorough, but be succinct and organized. Never interrupt the interviewer. Don't answer a question with a question, as this will appear evasive. Help the interviewer stay focused by rephrasing the question and giving a thoughtful answer. At the end of the interview, respectfully explain what you have learned about the organization and what specifically your employment could add.

Handling illegal questions, or those that on the surface may appear to be illegal, is touchy for all parties. A tremendous number of state and federal laws and regulations cover the conduct of employment interviews (Chicon & Castagnera, 2002). Unless there is a bona fide occupational qualification, asking questions reflecting age, gender, religious preference, sexual orientation, or disability is strictly forbidden.

It is quite often the case that high-level administrators are experienced in avoiding illegal questions, whereas physician executives may not be aware of legal implications. It is always a judgment call in responding to suspicious questions. Frequent questions of this nature, whether intentional or not, include:

• Given your age, how long do you anticipate being able to continue working?
• Since you are apparently practicing XXX religion, do you think you will feel comfortable in the organization or community?
• Given that you are in your prime childbearing years, when do you plan on starting a family?
• Don't you think that, given your disability, you would be more comfortable pursuing an alternative career path?

Another dynamic that can be difficult to manage involves handling issues of salary. If brought up by the interviewer, this should be taken as a positive sign, or as a sign of interest. Rely on your research, and stick within a range. This strategy will give you possible negotiation room. For example, saying, "Based on my research of physicians with similar training in this region holding this type of position, I would expect a salary between X and Y, depending upon the overall package offered." If at the end of an in-depth or final interview no discussion of salary has been forthcoming, it is appropriate for you to inquire. Simply ask, "What is the general salary range that is being considered for this position?"

Post-Interview Actions
No more than three days after an interview, it is important to communicate with every person with whom you interviewed. A brief, business-style letter or e-mail will suffice. Be sure to thank each individual for their time, noting something in particular that you learned about the organization. In particular, note a challenge or opportunity facing the organization, and how you feel that your skills, abilities, or interest could address such.

If the interviewer does not provide you with a timeline relative to decisions, it is appropriate to recontact your primary contact after 2-3 weeks. Ask the contact how the search is progressing, and whether there is any additional information that you could provide that would be helpful. If after several months, no decision is made, it is certainly appropriate to check in once every 2-3 weeks thereafter. The key here is to stay interested, not to hassle busy administrators.

If you accept another offer, it is very important to draft a brief letter or e-mail to the key decision-makers in the organizations with which you have interviewed. Even though you will be working for another organization, you should express your gratitude for their time and interest in you. This is also true if you are not offered the job. Here, you are building an alliance of colleagues for future political and professional development. It may very well happen that your paths and opportunities will cross in the future.

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