Ophthalmology Job Search, Part 2: The Interview Process

Introduction

In the previous article, we highlighted the many employment opportunities available to graduating ophthalmologists and discussed how to find these opportunities.  In this article, we will move forward in the job search process with a focus on communicating with practices and interviews.  We will save a discussion of contract negotiation and onboarding for the final article.

Communicating with Practices

After contacting prospective practices and receiving replies, you may be invited to a telephone conversation or virtual meeting.  The goal of these pre-interview conversations is to gauge the candidate’s interest and grossly assess if there is a possible fit.  Although these conversations are typically relaxed, it is important to treat these as true interviews, and, if a virtual meeting, to dress professionally.   When interviewing with a larger practice, multiple individuals may be on the call, such as a clinic manager, director of operations, or even the CEO if interviewing with a private equity (PE)-owned group.  Be prepared to discuss your career goals, clinical and surgical interests, and the reasons behind your interest in this particular practice.  You may be asked direct questions about your workflow efficiency, such as clinical or surgical volume.  Be as vague or specific as you feel comfortable with; of course, do not share information that you feel could be misinterpreted without context and do not be pressured to give exact answers.  At this stage, avoid topics such as salary, benefits, or factors specific to your employment (for example, your exact schedule).  

However, it is encouraged to discuss the following topics:

1. If there are multiple locations, what locations would I practice in?

2. What in-clinic resources are available, such as lasers (YAG, SLT, Argon); diagnostics (OCT, HVF, FA); treatment room (injections, oculoplastic procedures, etc.)?

3. What is the typical referral base?  (PCPs, optometrists, or ophthalmologists).

4. Do physicians take call for the practice?  Will I be affiliated with a local hospital at which I take call?

5. What type of pathology and surgeries can I expect?  (This being subspecialty-specific).

6. What are typical clinical and surgical volumes?

7. Where do physicians typically live?

8. Is this a partnership track position?

In-Person Interview

After the pre-interview conversation, you may be invited to an in-person interview.  Accepting an in-person interview does not mean that you are committed to accepting the position.  In fact, the only way to assess if the practice is right for you is with an interview!  It is important to interview with as many practices as you feel is necessary to understand the local job market and make an informed decision.  It is recommended to interview at a range of practice types and sizes (solo, group, PE-owned, etc.), and though highly personal, a goal of 4-8 interviews would be reasonable.

What should I look for on interview day?

On the day of your interview, dress professionally and arrive early.  You will likely be given a tour by an administrator, be able to meet with current physicians, and possibly meet with the practice owner(s).  Your goal on the tour and in your discussions with other physicians is to uncover the culture of the practice.  Culture does not simply represent the office “vibe” during a typical workday, but more importantly represents the priorities of the practice owner(s) and the goals of the practice as a whole.  Pay close attention to:

1. How do the technical staff appear - upbeat, overworked, reserved?

2. Are the front desk staff expected to answer phone calls and schedule/reschedule patients, or is there a dedicated call center for this?

3. Does there appear to be enough support staff to carry out your clinical work? 

4. Is the office space clean and organized?  Do the exam stools have torn fabric (signs of poor infrastructure)? Are all the rooms well stocked with equipment (lenses, fluorescein, etc.), or are some missing these?

5. Does the workflow appear smooth or disorganized?   Are physicians’ clinics interrupted (phone calls, questions from staff, etc.), or do physicians appear to be moving through their clinics seamlessly?

6. How old are the diagnostic equipment and laser machines?

7. What EMR is being used?  Does the EMR have the capability to import images for rapid viewing?

8. Do patients look happy?  Are they filling the waiting room to the seams and/or stepping out of exam rooms? (signs of overbooking or inefficient workflows).
   
   

Understand that each practice will attempt to sell itself a bit, and of course, will, as anyone would, highlight its strengths and downplay its weaknesses.  However, it is your job to identify those weaknesses, so that you can accurately weigh the strengths and weaknesses and how they align with your goals and priorities.  When speaking with other physicians, try to speak to a new associate who will (a) often be more forthright in their opinions and (b) may have information about other practices from their own interview trail.  Conversations with similar-aged associates often yield the greatest insights about other practices.

What questions should I ask the practice owner(s) or administrators?

When interviewing face-to-face with the practice owner(s) or administrators, be respectful and highlight your goals and how you bring value to the practice.  If you believe that this practice may be a fit, feel free to broach more personal topics that pertain specifically to your employment:

1. What would be my typical schedule?  What would be my expected hours?

2. What would be my expected clinical volume?  How will I receive referrals for my subspecialty?

3. Will I have dedicated work-up technicians, a scribe, a “workflow” technician to room patients?

4. Will I be starting from scratch, or can I expect to be busy from Day 1?

5. Where would I be operating?

6. How will my new position be marketed to the community?

7. If a partnership track position, what is the typical path to partnership?

8. Have any doctors recently left the practice - if so, why?  Could I speak to any of them?

9. What is the typical starting salary for someone in my position?  What is the typical bonus structure?

10. Is there any possibility of selling to a private equity firm in the next several years?
    

During the interview, avoid discussing contract terms such as salary, benefits, etc.  Instead, focus on obtaining a better understanding of the practice, its culture, and the details of your role within the practice.  If concrete terms are proposed to you, avoid agreeing to specifics at this point and instead politely reply that you require more time to adequately reflect on the proposals.  You may be surprised that seemingly innocuous terms that you casually agreed to may end up in your contract, terms that now may be more difficult for you and your attorney to negotiate.

After the interview, send a thank-you email, and communicate that you need to incorporate all of the information that you gathered from the interview.  Although not set in stone, a candidate has a few weeks from the interview date to give the practice an answer as to whether one would like to move forward.  Beyond that, the practice will likely begin to send follow-up communications, move on to another candidate, or at the least assume that you are not fully committed (which may be true after all).  If you have other interviews lined up more than two weeks into the future, you may need to find ways to extend the conversation.

A final point:  Always be respectful in your communications and of others’ time, and if using a recruiter, continue to communicate with the recruiter.  Ophthalmology is a small world, and the ophthalmology community within a particular locale is exceedingly small.  You will cross paths, refer patients, or otherwise interact with many of the individuals with whom you communicate even if you do not ultimately take their practice’s position.  You will likely “re-meet” many individuals (i.e. meet on the interview trail, and then “re-meet” in another context).  Of course, when declining a position after contacting a practice, a bridge is “singed”, and that is okay.  Remain courteous, and always explicitly communicate your intention to decline an offer.  Never simply stop answering a practice’s emails (i.e. “ghosting”) as this is unprofessional and may imply that the candidate was wasting the practice’s time.

What are other ways to learn about a practice?

Aside from the practice administrators and owner(s), communications, and the interview day, the channels available to learn more information about a practice are somewhat limited.  If you are seriously considering a practice, do ask to speak with current, and especially former, physicians - this is a key channel to learn about the practice.  In addition, local industry representatives often have intimate knowledge of the practices with which they do business, and if you have the opportunity and appropriate relationships, these individuals can provide a true insider’s opinion.  Online websites, such as Glassdoor.com or Indeed.com may provide useful information, with posts typically written by former staff.  Consider popular physician review websites (e.g. WebMD, ZocDoc, etc.), or even Google Reviews, to learn more about what patients are saying about the practice itself and its physicians.

What are examples of Red Flags and Golden Opportunities?

Each practice is unique, though some red flags are fairly universal, such as: 

• High physician turnover:  This may suggest limited potential for growth, a culture unsuitable for long-term commitment, or may simply suggest that the practice appeals more so to physicians searching for temporary employment.  

• High technician turnover:  This may lead to compromised workflow, as new technicians would need to be frequently trained.  

• Physicians or staff that appear overworked.

• If either a current or former physician seems unwilling to share details of his/her experience, that may suggest the presence of hidden, unsavory aspects of the practice.  

• Proceed with caution when receiving shifting or vague answers from management or the practice owner(s).  

• Exceedingly astronomical starting salaries should also be approached with skepticism - there may be a hidden, unwritten catch.
  
  

Examples of golden opportunities include any of the following: 

• A physician who is scaling down or retiring represents the possibility of inheriting a high volume of patients from the start.  

• If a physician recently left the practice, particularly in your subspecialty, there may similarly be a high volume of patients to be seen from the start.  

• Newly purchased office space suggests practice growth and usually means new gadgets and equipment.  

• A newly built OR or ASC usually signifies that ample OR block time will be available.  

• A practice that owns its own ASC typically provides its physicians with preferential scheduling.
  
  

Overall, interviewing for a job will feel quite different from the residency and fellowship interview experience.  After years of training, you have a bit more leverage, and the practices will be seeking to woo you.  You may be taken out for dinner and certainly made to feel good.  However, it is important to remain focused on the goals of the interview:  uncover the culture of the practice.  With this and the other above points in mind, you will be on your way to finding that dream job!