Interview Dos and Don'ts for Early Career Pathologists

Becca Battisfore:

Welcome to the latest edition of the College of American Pathologist CAPcast. I'm Becca Battisfore, content specialist with the CAP. Today's episode is a collaboration between the New-in-Practice and Practice Management Committees and is one of two episodes on the topic of job searching. In this episode, Dr. Varshney is chatting with Dr. Sirgi and Ditelberg about interviewing tips. Dr. Varshney is an assistant professor at the University of Mississippi Medical Center and serves on the New-in-Practice Committee. Take it away, Dr. Varshney.

Dr. Neha Varshney:

Welcome everybody. Dr. Sirgi and Dr. Ditelberg, would you like to introduce yourself please?

Dr. Karim Sirgi:

My name is Karim Sirgi. I'm a pathologist based in Denver. I currently have the pleasure to serve as the chair of the Practice Management Committee. I have been a practice leader in Denver for the last 20 plus years, in addition to chief of medical staff, chief of a hospital medical staff system. And it's my pleasure to join some of my colleagues on the New-in-Practice Committee and my friend and colleague on the Practice Management Committee, Dr. Ditelberg.

Dr. Jeremy Ditelberg:

Hi, I am Jeremy Ditelberg. I'm also on the Practice Management Committee and I'm a pathologist in Shelton, Connecticut at LabCorp. I've been practicing since 2002 after an AP/CP residency with a fellowship in GI pathology and I've worked in academic community practice and commercial settings.

Dr. Neha Varshney:

Great, thank you guys. Welcome. So this is a collaboration between Practice Management Committee and New-in-Practice Committee, and we had a lot of questions regarding interviewing. So we thought we will bring in some experts and experienced people to talk about that. So we have some questions we got from different New-in-Practice people and we would ask you for your expert advice, Dr. Sirgi and Dr. Ditelberg. Let me start with what you should never ask in an interview. What is something you would never ask?

Dr. Jeremy Ditelberg:

Well, I think the important thing is to go into an interview just trying to learn about the practice that you may work at for the rest of your career for all you know. So just go in trying to get a general sense of the collegiality, the work that everyone's doing, the expectations, what might be asked of you for future expectations. Probably as it pertains to the question directly, I think compensation is something to be avoided until later in the process, probably not even that day unless it's offered to you. Really the goal for an interview day is to get a sense of whether you would be a good fit for that particular practice and whether you want to pursue that opportunity.

Dr. Karim Sirgi:

I concur entirely with Dr. Ditelberg. I will add a flavor to it, which has nothing to do with the professional aspect of it. And the reason I'm adding it is because I experienced it in one of my interviews when I was interviewing as a fellow. And to answer your question, Dr. Varshney, I would say that you should try to stay away from religion and politics. So if you are asking about question you should never ask, I would cite these two. And in one of my fellowship interviews, I'm Lebanese in origin, I come from the Middle East and one of the attendings, in fact the program director asked me very directly what's going on in the Middle East and who do you think is right? Who are the good guys, who are the bad guys?

So it had nothing to do with the subspecialty I was seeking. It had nothing to do with the fellowship I was seeking and I answered it as politely and as directly as I could. And miraculously I got the fellowship position knowing full well that I was not answering to what this attending was expecting to hear. So again, I would stay away from politics and religion. It puts all parties in a difficult and uncomfortable situation when you're interviewing.

Dr. Neha Varshney:

So let's say somebody asked you a question like direct question about religion or politics, how do you dodge it then? Or how do you answer?

Dr. Karim Sirgi:

Yeah, I would personally not dodge it. I would answer it very politely. I wouldn't take any extreme position. I would state what's in my mind. Because if you are going to be excluded on the basis of these two or others, you want to know upfront the kind of environment you are joining. So if you're not a good fit for them and they're not a good fit for you based on that, they're not even talking about your professional qualifications, they're trying to probe your religious and political thoughts and affiliations, it may not be the group you want to join anyway.

Dr. Jeremy Ditelberg:

Yeah, and to follow up on that, for a lot of interviews you're going to be primarily interviewed by the practice manager or the president of the group or something like that. And then you'll be taken around to meet a lot of the attendings who you're just essentially being taken out of a part of their day to meet you and chit-chat with you. A lot of these people are not really a professional interviewer, so to speak. So people will try to gauge you in conversation. They may ask you about professional things and your training and people who you know in common, but it could veer off into personal things, and I don't think necessarily maliciously, but just to create conversations.

So I agree with Dr. Sirgi and probably not try to dodge that or be confrontational about it, but if it's very personal, you can always say, I just don't feel comfortable discussing that. But if it's something, if they're asking, oh, do you have kids? Are you planning on raising a family? It's not, even though it may be technically an illegal thing to ask or you could be discriminated on the basis of your answer, you can always say, I don't feel comfortable about answering that. But in general, people are just trying to get to know you and at the end of your day of interviewing, if you do feel like it's an uncomfortable place to work, then you know that and you won't work there. That's what I would do.

Dr. Karim Sirgi:

Very quickly. I think Dr. Ditelberg raises an excellent point. It's really a two-way interview. They are not only interviewing you, you are also interviewing them. So in this two-way conversation, at the end of the day, there is a certain accounting to be made. Did you feel comfortable or is this place a place where you would want to work? Are those people, people you would feel comfortable seeing day in and day out maybe for the rest of your professional career, maybe not. But it's a two-way interview. That's something extremely important to keep in mind with anything that has to do with interviewing.

Dr. Neha Varshney:

Excellent points. Thank you for that. So my follow-up question would be if something like that happens in an interview and it is actually going really badly, what do you do in that situation? How do you solve that interview?

Dr. Karim Sirgi:

So if things are going really badly in an interview and depending on how much... And when you say things are going really badly, it could be because of them, it could be because of you, and it could be because of nobody's fault. Just the setting is not a good match between the two parties. But let's take it methodically. Let's say it's because of you. For whatever reason, you arrived late, for whatever reason, you were not on top of your game on that day. For whatever reason, you had prepared your questions and once you were there, you completely forgot what you wanted to talk about. It's never too late to pause and have a frank conversation with the main person interviewing you, whether it's the practice manager or the practice CEO or the practice president and say, look, I apologize. Today, I have not been on top of my game.

This is not who I am. Usually this is not what I bring to the table. Can we reset? Can we reset this interview either today or at a later date? You are talking to human beings who have had bad days themselves and who have embarrassed themselves in different situation. Nobody's immune to that. Now, that's one situation. The other situation, it could be because of them where they're coming very aggressively, maybe demeaning, maybe insulting, maybe not even realizing that they are having a bad day. This is just part of their culture.

This speaks volumes about the practice you may join. And if you see that it's going bad because they are naturally clueless about how bad and how out of line things are, that's your answer. You may decide to finish your interview, go through the motion and then send them a very nice letter saying, thank you very much for taking the time. I have chosen to a different path. So you have to evaluate what's going on, always keeping in mind that nobody's immune from a bad day. You just want to make sure it's not modus operandi that they are bad or the interview is going bad just because the place you are trying to join doesn't have it together.

Dr. Jeremy Ditelberg:

Yeah, I completely agree with that. I really like making that dichotomy of your bad day and the interviewer's bad day. I would always go ahead with the interview until its conclusion. Just for practice. I think it's important to realize that when you're called for an interview, they really are trying to make a decision whether to hire you or not. You've made a cut. They're not going to waste their time unless they really were considering you. There is an interview tactic or method called pressure interviewing where they try to throw you off base. I guess that's probably more common in the financial industry or things like that, but I personally would not take very kindly to that. I think Dr Sirgi is correct. If they're going to essentially mistreat you at the interview, that does speak volumes to how you might be treated in the practice.

And some people don't have a choice. They're only offered one job, but most people have choices. They're flexible enough and you can choose not to work there. But I think once you're in an interview setting, you're probably interviewing with more than one person and you'll make different impressions on each of them. And some may go well, some may not go well, but it's always good experience and at the end of the day you'll figure out if you want the job or not.

Dr. Neha Varshney:

Yeah, there are places which will give you very difficult cases to look at during your interviews and things like that. So yeah, I do know that there are some pressure tactics. How do you deal with such situations, so if you're given these difficult cases at that time and you are put on a spot?

Dr. Jeremy Ditelberg:

Yeah. Yeah. So, we do that. It's not so much that these places are always looking for the right answer because these are cases that the most tenured person there has difficulty with. There definitely could be wrong answers if there's cancer there and you don't see it. But I think most of these places are just looking for your logic in approaching how you're going to sign out a case or what immunohistochemical stains you're going to order on this case or what is your differential diagnosis on this case. So that obviously would creates a nervousness, but that to me, that's not what I was talking about with a pressure interview. Pressure interview is more abusive.

But with the tests, they just want to make sure that you're literally not going to show them every single case of yours for the first six months. They want to know you're thinking logically about cases, not necessarily always the right answer. And I'll follow up with what I just said by also saying that most practices know that you're right out of residency or fellowship. They don't expect you to completely sign out independently. I've been in practice more than 20 years and every day we have a consensus conference where we bring cases and I'll show two or three or four cases a day. Sometimes it's a lot of handholding and sometimes I really don't know what's going on even though I've pretty much seen everything by now. So it's expected as someone recently out of fellowship or residency that you're going to show a bunch of cases. But I think with those tests, they're just sort of seeing how you approach your sign out.

Dr. Neha Varshney:

Thank you for explaining that to me. So now we have talked about all the negative things. Now let's talk about some positive, what you should do in interview. So what questions to ask, basically the interviewers, do you guys have any insight on that?

Dr. Karim Sirgi:

Yeah, so in an interview before you ask any question, there are some things that need to happen that are really reflective of you as a professional. As a professional, you want to present well, you want to be on time. You want to be polite and professional, not only with people interviewing you, but with everybody who's going to be there on that day, especially if it's an in-person interview. Anecdotally, I know of a hospital CEO who would invite physicians for an interview at a breakfast place outside of the hospital and would make it a point to arrive late to see how that person behaved with the waiters attending their table to see if they had been polite with the waiter, if they had been polite with the staff, if they had been on time. And the kind of reaction these applicants or these interviewees had when he arrived or she arrived late.

So as a human being, you want to present your best professional face on that day. Then in terms of the interview itself, a lot of people think about the materialistic aspect of the interview. How much money am I going to make? What are going to be my benefits? Am I going to retire rich from this place or not? And those are the last thing really you want to have on your mind. You are joining a family of professionals, a family of colleagues, and you want to know that every day you leave your house and you leave your kids behind and your husband behind or your significant other behind that you are joining a family that can fill your time with enough cultural matching to make it worthwhile to work in that environment. So I would start by really feeling them out in terms of who they are as a group, how do they cover for each other?

How do they handle maternity leaves? With concrete examples. How do they cover for disabilities, if any? If you have kids who need special attention or if you have kids who need to be taken to a school district that is a bit far from your place of work, how are other people covering for situations like that? What are your hours of work going to be? Not because you are trying to escape working or work less, but to see if there is flexibility in your work. If should an emergency happen, you could leave. I know of some places where you are expected to stay from eight to five, even if you finish your work at one o'clock in the afternoon. There are some good reasons for that. It's not only to fill a seat. Other clinicians could stop by the department and ask to review cases with you so that there need to be some presence in your office, but you need to find out those things.

Am I expected to stay in my office until five, six, seven if I finish my work early in the morning, efficiently? Am I expected to cover for other people? Am I expected to travel to other sites? And how far are those other sites? We have a facility down south and you may need to cover frozen section. It sounds great. It turns out that the facility down south is 130 miles from your primary facility. Those are the things, the everyday life that you are going to experience that you want to start with conversationally by asking open-end question and pointed question, ended questions to find out the kind of milieu environment in which you are going to operate.

Dr. Neha Varshney:

So it is okay to ask for support staff questions like what support steps? For example, if you have a frozen section, would you have somebody who will cut for you?

Dr. Karim Sirgi:

Oh, absolutely. Not only is it okay, you need to. Am I going to have PAs, the kind of complex cases that you handle? Am I expecting to work on my own credentialing and licensing? Those can kill your day. If you have a couple of state credentialing to take care of, and it's a couple of insurance companies credentials to take care of, medical staff credentialing. This is a full-time job. In my group of 35 pathologists, we had three people working full time on licensing and credentialing, administrative support, managerial support. Are you supposed to do your own billing, your own coding? Will somebody review it? It's as important as your diagnosis. You can come up with the best diagnosis in the world. If you don't use the correct CPT codes, you're not going to get paid for it. And that's going to sting big time.

Dr. Neha Varshney:

Yeah.

Dr. Jeremy Ditelberg:

Yeah. Oh, sorry. Yeah, just to add to that, what Dr. Sirgi was saying, The goal, I think the way I approached it was I just want to know what's going to happen in a typical day, in a typical week, maybe a typical few weeks in terms of what time am I getting in? What time am I leaving? What am I doing? Am I covering a CP lab? When I have more tenure, do the junior people cover the CP lab instead of me? If I'm reading cytology, are my cases going to be screened? Or if not, will some cases be screened? Paps versus non GYNs. What's the quality of the staining? Hopefully you'll see a stain. And if it's all pink, that's something you need to know. Things like that. You really want to get a sense of what it's going to be like there.

Now that may not always be completely possible in a one day interview. And it's always great if you meet with a bunch of people, if you really hit it off with someone who's close in your level of experience or the newest person or something like that to get their phone number and to call them with questions that you think of after the interview or questions that you didn't have time to answer that they didn't have time to answer. Or if you're being told something by the senior member of the group to just make sure they're telling you the truth by asking a junior member, especially for things pertaining to partnership and things like that. If the senior member is saying, oh, everyone gets it after three years, and if you talk to the person who's been there for four years, what was it like trying to get partnership? Oh, I'm not a partner. So these things are good to know. But again, there's so much to learn and so little time. And that goes both ways. It's always good to try to get at least a few people's contact information for follow-up questions.

Dr. Karim Sirgi:

If I may, I'd like to share a very quick anecdote with you to emphasize one point. It's not only what is said that you need to pay attention to, you also need to pay attention to what is not being said. I'll give you a very quick anecdote that happened to me again when I was interviewing for my fellowships. So I will start with fellowship number one. I interviewed at Southwest Medical Center in Dallas, a super, super, super busy department and hospital. And during the entire interview, cases were raining down, frozen sections, trays being brought to the attending. And during the entire interview, the attendings were handling it with calm, with polls. They were calling residents and fellow to show them the cases to discuss it with them. They were supporting their fellows who had made calls in the frozen section room. It was like a control tower in an airport where even in the face of extreme stress, the voice was even professional, friendly even.

The next day I interviewed at another facility that will remain unnamed. And during my interview, my interviewer was knitting. She was knitting while she was talking to me in the office and was explaining to me how busy their place was and how excellent I needed to be to have the privilege and the honor to join their staff, while knitting during the whole interview. And my answer was no. I can see how busy you are. Thank you very much for your time. And to answer your first question at the beginning of this podcast, I canceled the rest of my interviews at that place and left. So sometimes what is being not said is as important as what's being said to you during the interview.

Dr. Neha Varshney:

I love your experiences and thank you for sharing those. I hope she stopped knitting at work after that. So what you guys talked about to contact certain people even after to make a call to ask all these questions. So what if there are only senior people in there and some of the people are not on the agenda you didn't interview. Is it okay to talk to them and how to go about that?

Dr. Jeremy Ditelberg:

Yeah, I think it's somewhat of a red flag if you're only being interviewed by the hospital president and the practice manager and you don't get to meet other people. And I think it's a red flag if you only get to meet with partners and not junior members also. I think that goes into what Dr. Sirgi was saying about the things that are not said, collectively, trying to give you a certain impression or direction. If no one's willing to give you their cell phone and say, oh, give me a call sometime if you want, I think that's a red flag personally, because this is your life. You're often going to be moving to a different part of the country. You're raising your family there. For all and hope this is the one and done job that you'll ever have in your life. So you definitely want to have your eyes open with that.

And I always offer when someone comes to interview with me, but not everyone will just offer their cell phone or email or something like that. Sometimes you will have to ask, and I would definitely ask anyone who you seem to be getting along with really well during the interview. That doesn't mean you're going to reach out to them afterwards, but if you're really considering taking a job, usually you do have a few follow up questions and I think that's pretty much seen by most people as a normal thing before you commit to moving to a different part of the country.

Dr. Karim Sirgi:

Well, I concur with everything Dr. Ditelberg mentioned. I would add to it that not only do you want to have a nice sampling of people working in the department, you want to have a nice sampling of people working outside the department. And I'll give you an example. In my current job, I'm a consultant now I work with the pathology groups around the country, help them with different challenges. So when I'm invited to their group to analyze their internal challenges, I always ask to speak with people who are on the receiving end of their services, the operating room nursing officer, chief nursing officer or the hospital chief nursing officer, a couple of representative surgeons, a couple of representative critical clients, customers, outpatient or inpatient. Because often we work in a closed system and we think of ourselves much more than what people from outside the department think of our services.

So for example, if you talk to a hospital administrator and you hear, well this group, we really don't know them. We never see them. When we stop by their offices, they are never there. When we call them for frozen section, if a surgeon tells you when we call them for a frozen section, it's always whining and why do I have to come? And now is not the time I'm too busy to come. If you get a lot of those negative feedbacks from people outside the group, that gives you something about the reputation of the group in the community. And although we like to think of ourselves as working in a closed environment, we never are. We are always working in an environment of service, of collegiality, of interaction with others. And if that is broken, you may want to think whether you want to join this group or not. So you are also interviewing them and interviewing their community at large, not only them.

Dr. Neha Varshney:

So how do you go about asking about these people? I have interviewed, I've never interviewed or talked to the chief nursing staff or surgeons yet, but how do you contact them?

Dr. Karim Sirgi:

Directly. Like Dr. Ditelberg said. You think of two or three people from outside the group who let's say you are a hematopathologist. Wouldn't you want to talk to a couple of hematology attendings, bone marrow transplanters, nurses working in the blood bank with the blood bank or in the bone marrow transplant unit to see the kind of not only service they're getting, but the kind of expectations they have toward the services that you will be bringing to the table.

So you would ask very directly. So I am being recruited as a breast pathologist, I would love to meet your chief breast surgeon and the chief nurse of the breast operating room. If they have a subsection, I would love to meet them. And you wouldn't say it under the angle of I want to interview them to see how great you are. You would present it under the angle of, if I bring my expertise to the table, I want to make sure that it's a good match with their expectations. And then you can interview them and find out what's going on with this group. And you can find out a lot of information by going outside the group in a very polite, very professional manner.

Dr. Neha Varshney:

What timeframe would you suggest for that?

Dr. Karim Sirgi:

The timeframe, you wouldn't start by from the first minute. They call you, Hey, Dr. Varshney, we're interested to meet you. It's like, yeah, great. I'm interested to meet you too, but where is your chief surgeon kind of thing. No. You start with your general interview. And in fact you could say during my visit, considering that I'm coming to Houston, to Mississippi, to Chicago to visit you, if time allows, I would love to meet with X, Y, Z from outside the department. If you don't think the agenda allows it, would it be possible for me to follow up with X, Y, Z after my visit? So it's a two-way conversation. And if they say no, that's an answer, that's a very important answer to register. It's like, why? What is there to hide? And believe me, when people say no, there is always something to hide in situations like that.

Dr. Jeremy Ditelberg:

Yeah, I think it's important during your day of interview to figure out why they need an extra pathologist. It's basic question, but has their volume gone up? Are they developing an outreach program? Have they gained a client that's sending them a ton of work? And if you know the answer to that, then that can lead you to reaching out to certain people. Like Dr. Sirgi was saying, if they just got a new gastroenterology group that's sending them 10,000 biopsies a year and you find that out and you're a GI pathologist, it's good to ask, hey, can I talk to these guys? I want them to like me before I come on, or whatever you want to say. But that's how you can direct who to reach out to.

It depends on what you think your role in the practice is going to be if you're a hematopathologist or GI pathologist or a cytopathologist to try to figure out why they're trying to hire you in the first place. And then that becomes something that would be looked at, I think as impressive that you want to reach out to these people and introduce yourself to them.

Dr. Neha Varshney:

Sometimes they're difficult questions, so if you see there was a lot of attrition in the last few years or there has been some issues with the work division or things like that, how do you ask those difficult questions?

Dr. Karim Sirgi:

So if you have observed attritions or people who were let go before their partnership time, anything that you detect as being potentially negative before you visit them, by doing your research, by asking around about the group, if you have friends or colleagues who work in the same city in the same town and know about them. So you have to do your research. And if you find interrogation points, things that are not sitting well or need additional clarification, you find an opening during... That's the purpose of the interview really, not only about the good stuff, but also to ask them very, again, very politely, very professionally. So it seems that you offer partnership after three years. Looking into your group, because I was really interested to join your group.

I am really, not I was really, I am really interested to join your group. I realized that two out of the six people who have joined you were let go or who have left a year before their partnership. Could you tell me a little bit more about that? I'd like to understand the setting, what happened, without breaking any confidentiality. I'm not asking for specific, but what's going on here and if you could tell me about the track record with your partnership track, for example.

Or after the pandemic, it seems that your staff was cut in half. Were you very comfortably staffed before the pandemic and the pandemic was an occasion to train your staff and people voluntarily retired or what happened exactly? I'm trying to understand to see the kind of days I would have and the kind of workload I would be expected to assume in this context. You have to have a very open conversation with them and every time they don't answer those questions, even if your question is clumsy, let's say I ask the question in a very clumsy way. A smart person on the other side of the table is going to understand exactly what I'm trying to say, even if it didn't come out very polished.

The fact that they ignore it or refuse to answer it is an answer in and by itself. So don't worry about asking questions of importance to you in a clumsy way, if you think that it's coming out clumsy because the other person, the party for sure is understanding where you are going with your question and I will leave it at that.

Dr. Jeremy Ditelberg:

Yeah, and I guess I would add, I think it's super important to meet with multiple people during your day or days, and especially important to meet with junior people. So people who've been there five years, three years, one year, hopefully selection of that. It's really important to speak to the people who've been there five years, ask them what they like, what they don't like. If there's partnership involved, ask them what the deal is. I've been in interviews where I basically essentially get lied to by senior partners and I find out the truth through junior people who are there and you find out why they're there, why they've stayed there, what they thought going in compared to what's happened at the end of three or five years. I think that's really important. I think it is important to know that you can be intentionally lied to or misled or lied to by a omission by certain people in an interview. And I think that's why it's important to meet with a variety of people.

And finally, I think it's important to realize that for you, this might be the first time you've ever interviewed, it's a brand-new experience for you where these people have interviewed 10, 20, 30 people, they've been in their own interviews, they're well practiced, they're well-polished, they know what to say, they know what not to say. So I just think it's very important to just meet with a variety of people who have been in a certain practice for different time points in their career and just try to get that general sense of what's going on. I remember one interview I had where I got this impression of the practice and then one person told me what the real deal was. It totally changed the direction of what I was going to do. You do your best, but in the back of your mind, it's also good to just be aware that they may want you for reasons that aren't in your best interest. And it's up to you to kind of figure out what's really happening at a practice.

Dr. Karim Sirgi:

Very quickly. I agree with a hundred percent of what Dr. Ditelberg said. However, there is a however, I wouldn't want to give a negative slant to this podcast or to this. So far we have focused a bit more on the negative aspects or on the investigative aspect of find out what's wrong kind of thing. What we need to realize is that it's a tough one. It's a tough process on both sides. The recruiting group is also trying to find the best match for their workplace. It's a painful process, not only for the interviewee but also for the interviewer and the group. It's painful, it's an expensive process. It's a long protracted process. So people don't come usually to the table with the idea of, hey, we are going to lie to you. We are going to bring you into a bad situation and hope for the best.

They know intuitively and by experience, they know that if they're not upfront with you, you are going to look for another job six months to a year into it. And the practice will have lost time and money and resources that they cannot afford to lose. So I would advise to go into these experiences with a positive attitude knowing that both sides have a lot to lose, and both sides have a lot to win if it's done properly.

Dr. Neha Varshney:

Yeah, it has to be a good fit between both the people.

Dr. Jeremy Ditelberg:

Because it's such an important decision for you. And most practices, I agree, do want the right fit because it is very hard to recruit the right person, and there has to be a personal and cultural fit with whoever you're hiring so that it works out for the long term. No, I totally agree with that. But I think if you're fortunate enough to have multiple interviews, let's say two to four interviews, and you go through all those interviews, I think you definitely get a sense of what are the best fit, whether it's for your interests professionally or how comfortable you'll feel with your colleagues or whether you think these people will support your careers. I think the more interviews you do, the better sense you get on who's the real deal and who's not.

Dr. Neha Varshney:

Great. Thank you. That's great advice for all of us. So let's now gear away from the investigative aspect of this and go to the candidates. So what is the best way to stand out in an interview? I'm sure you have several interviews and they have several interviews, several candidates. It's such a good job market. So how do you stand out as a candidate for any practice?

Dr. Karim Sirgi:

You have to do your homework before you get into an interview. You shouldn't come to a place of work not knowing about the city in which the place of work is located, the hospital or the neighborhood in which the place of work is located. The place of work itself in terms of its not only its medical staff, but its staff in general, the kind of resources they have. Are the pathologists running the practice? Do they have a managerial team of CEOs, COOs, CFOs, PAs a good histology lab? All of this needs to be researched as much as possible. It's not that Chat GPT is going to give you a hundred percent of the information about that practice, but you have to do your homework either by researching it on the internet or by calling colleagues who work in that environment or by going to CAP meetings, other national meetings, other organizational meetings, finding out who works in that general sphere and asking your questions prior to even visiting that place.

And believe me that it stands out. When a candidate comes aware of what's going on, of who we are as a group of what we have done and what we are trying to accomplish, that stands out. So this in my mind is one way of standing out.

Dr. Neha Varshney:

I'll come back to the salary aspect again. I know you said that we have several questions on salary, so I want to just touch on that. We have several, you said not to ask in the first time, right? The first initial part. So when to ask that. And then salary transparency is another question in the group and the expectations. So then all these questions around salary, what is your advice for that?

Dr. Jeremy Ditelberg:

My quick answer to that is you kind of ask when you get a job offer. By that point, hopefully you'll know whether you want it and obviously they know they want you. So that's when I ask.

Dr. Karim Sirgi:

Yeah, I agree. It should never be the first question. So tell me, how much are you paying me? Okay, I'm out of here. Should never be the first question. I entirely agree with my friend.

Dr. Neha Varshney:

Okay, so then when do you ask? It's after you already have an offer. That's a good time to ask. So what about the expectations? Sometimes they would ask, right, what are the expectations? What do you think is their expectations? So how do you gauge that?

Dr. Jeremy Ditelberg:

There are things like MGMA, which publish data on salaries for different kinds of practices. Salaries can be different for academic practices versus community hospitals versus commercial labs. And internet helps with that. There are other things besides salary, which are benefits, which can be worth a lot, whether it's some kind of profit share bonus or partnership or stock options, things like that. So those have to be taken into account. It depends what you're offering to the practice. If you're, let's say, aborted in hematopathology and dermatopathology and you're really going to fill a big niche for this group, you can always negotiate. And I would feel comfortable trying to ask for more. They'll eventually say no. If they say no in an angry way, that's a red flag I think, unless you're just completely way out there and demand. If you ask in a kind of nice way highlighting your training and what you can offer.

And I think a big part of salary too is to try to see how your salary or compensation would increase after the first few years of practice. Because as a newbie in the group, you're showing cases to other people. You're maybe not producing as much as more senior members, but as you do produce more, then you would expect your salary to go up, at least to some extent every year, whether or not that can be written into a contract. And finally, I would just add that unless it's actually written in a signed contract, it's not really real. So I think it's always important to have your agreements reviewed by an attorney and go from there.

Dr. Karim Sirgi:

So very quickly, I think your question was also included. What if they ask you what your salary expectations are?

Dr. Neha Varshney:

Yeah.

Dr. Karim Sirgi:

So there is a little bit of gamesmanship here. It's a negotiation. There is some gaming here in this story. And if somebody asks me, what is your salary expectation, I wouldn't give them a number upfront. I would try to find out first I would want to make sure I fully understand what the position is about. Is it about reading slides and a certain volume of slides and I'm done with my day? Is it about assuming managerial function, administrative functions, leadership functions, hospital committee functions, traveling functions to different sites? So before I even formulate a number for myself, I want to have a rounded up understanding of what my job is going to be about. And then I would reverse the question. I would say, so for somebody expected to do A, B, C, D, like me in your group, what have you offered in the past? And does it include a partnership track?

Also understanding what the vacation, everything that is not money that is included. Vacation, disability, time off to go to meetings. Will I be allowed to participate in national organization committees and will it come out of my vacation days? Once I have this rounded understanding of everything that goes into my compensation, not only salary, then we can have this conversation about numbers. It's going to be 200, 250, 300 plus this list of added value. Before you have an understanding of that added value, never advance a number, not once. Let the process takes its time until you have that full understanding.

Dr. Jeremy Ditelberg:

And I also think it's important to, if you can time it well, you can have multiple job offers at the same time before you have to commit or reject it. And that's another way of getting a good sense of the market. And I think it's important to realize that even if you're not producing as many billable units as a senior partner or someone who's been there five years, if you are the one running a hundred miles to the other hospital and doing frozen sections all day, you're allowing the other people in the group to produce a lot of billable units. So you are contributing in a big way. So there are different ways to gauge your value, not just how much you're billing out.

Dr. Neha Varshney:

Those are excellent points. I don't know about others, but I'm learning a lot. Another follow-up question regarding when we are talking about salary. So I know there are a lot of different thoughts on this. A lot of people don't agree with salary transparency, a lot of people do in the group or in academic practice. What do you guys advise? So is it okay to ask everybody? Some people are open about it, some people are not. What do you guys have to say about that?

Dr. Karim Sirgi:

Transparency in everything is a good goal to reach. So, again, I wouldn't do it at the beginning of the interview. You need to establish a certain rapport with the group before you get into those sensitive situations. For example, if somebody started their interview with me asking me, okay, so you have been with this group for 20 years, how much money are you making now? I think the interview would end at that point. Very politely, I would invite him or her for a coffee and say, good luck with your career.

But once you establish a certain rapport with the group, you can tell them, okay, I'm trying to get a roadmap to understand a roadmap of what's waiting for me as I grow with the group. So if a partnership track is offered, and if I have three years to reach a partner's level, can you give me a general sense of the ballpark of where I would be growing, evolving in terms of not only the monetary aspect of it, but monetary and the added value of it, other perks that are included for partners, maybe not included for non-partner. Help me understand where I would be in three, five, 10 years with this group.

They wouldn't have to open their books for you and show you to the last cents what every person has made in the last 10 years. But a group leader who is honest and transparent could very nicely give you a roadmap. This is where you will be starting. This is the increment for year one, year two, year three. And those are the general expectations for partners. But you have to understand that partners also share in the risk of the business, not only in the benefits of the business. So should things go bad, we would still cover the salaries of our non-partner and we would take a cut as partners. So we cannot guarantee those incomes as partners. That's a very general conversation to have with general numbers and general framework of additional perks without opening the books and having you audit every single cent that went into the company.

Dr. Neha Varshney:

So that's for the partnership track. How about the employee positions?

Dr. Karim Sirgi:

It's the same principle. Tell me how I will grow with this company at year three, year five, year 10. Will I grow based on volumes? Will there be bonuses based on extra activities? What are those activities in terms of managerial, administrative, leadership? Try to get a full picture of how you are growing with the company, not only in money but in responsibilities, because often money and bonuses are accompanied with a tangential, substantial activity associated with it.

Dr. Jeremy Ditelberg:

Yeah. These are slightly different for academic, private practice, commercial, but I agree with DR Sirgi, the framework is the same and it's totally reasonable to ask for a roadmap. And it's good to approach that conversation by saying, I really like this place and I want to be here for a career or long-term or something like that. And say, if I'm here for my career, how can I expect my compensation to grow based on different scenarios? And again, just to realize there are a lot of different components to compensation. There's base salary, there's a productivity, a bonus or end of year profit sharing bonuses, there are partnership bonuses. It's important to realize that if you are on a partnership track, almost always you're expected to buy into that partnership, which takes money out of your salary for a few years during that transition. But I don't think that's a bad thing to ask once you actually are essentially offered the job or to have someone say, we're interested in you.

That's a normal conversation to have and you should have it with the practice leader. But it's okay if you made a friend along the way in your interview to call them and just say, in general, what do you think the progression is in this place? But as far as specifically asking people what they make, not many people are going to actually tell you what they make exactly. I don't think I've worked in a place where I know exactly what my colleagues make. I highly suspect we're about the same level, but usually people don't want to answer directly exactly what they make.

Dr. Neha Varshney:

But they can tell you a range, I guess.

Dr. Karim Sirgi:

Yeah, a range. They can definitely tell you a range. In private practice, people will not hide what they make, in general. In general. Now in academic centers, if it's a state academic center, for example, University of Colorado, University of Mississippi, salaries are published online by law. So the transparency is a hundred percent. One very quick point I wanted to make, not only about this question, but questions in general. Believe me when I tell you that the interviewers appreciate very much great questions, even if they're tough questions. I have been in situations where an interviewee has asked me a question for which I didn't really know the answer and I was presiding over my group. I would write it down and go back to my colleagues. It's like Dr. Varshney today asked me this question, and I think it's a great question and we look like idiots when we cannot answer this question in a good way.

And we would work together to have an answer for the next candidate. Good groups want to improve themselves, including at the interviewing level. So when you come up with questions like that, and either the group leader or some of his colleagues don't have an answer for it, believe me, that those groups will go back to the drawing table and say, look, we have to have an answer for a question like that. Let's be better prepared next time. So it's a two-way street. Going back to the beginning of our theme today, it's not a one-way street. It is a two-way street, continuous two-way street.

Dr. Neha Varshney:

That's very reassuring. But I didn't get the job, right, because asking difficult question, I guess.

Dr. Karim Sirgi:

No, you got the job because you stumped me. It's like, whoa. She has question that I cannot answer I want [inaudible].

Dr. Neha Varshney:

All right. Okay. So, I know we're running short on time. So last question. Right now, there are a lot of these virtual interviews now, this is because with COVID. And a lot of places actually are doing two step interviews. First virtual, sometimes it's telephonic, sometimes it's on some kind of audio, video, Zoom, Microsoft Team, et cetera, and then in person. Any advices for that? Any kind of suggestions, advice for that?

Dr. Jeremy Ditelberg:

Yeah, so I'm sorry. I don't think we've talked about just basic interview stuff. So, it's always important to dress professionally. That means a tie for men and professional dress for women. Try to look into the camera, not mumble, speak clearly, make sure they can hear you and just try to answer things thoughtfully and not be flustered if possible. Just knowing that it's a two-way street and you're just trying to make a human connection with the person you're talking with. But treat the video interview just like you were there in person. Be there early, five minutes early, 10 minutes early, even if you're waiting for the other person to come on. Professional dress. Blur your background or have some neutral background. Not having a bunch of kids screaming in the background. So I think those things go for both video and in-person interviews and definitely should be paid attention to.

Dr. Karim Sirgi:

And the good news is that the CAP has a dos and don'ts about video conferencing that goes along everything that Dr. Ditelberg just mentioned. And another thing to keep in mind, and there are many studies that support that. It's not only a matter of looking professional when you dress well for a Zoom conference, it's psychological too. When you dress well and you dress as if it was an in-person interview, psychologically you are primed to handle this video conference, this video interview as well with your full game on as if you were in person. If your camera is off and you are wearing your PJs and you haven't even taken a shower in the morning and you're expecting to have a great interview, psychologically, even if the person on the other side doesn't see you, psychologically, you're not going to be on your A game, you're going to be on your D, E, F, G, H game. So everything Dr. Ditelberg said, I am a hundred percent in agreement and you will be on top of your game accordingly.

Dr. Neha Varshney:

All right, that was a great and very fruitful discussion and we had a lot of advices, lot of antidotes, which were be very helpful for all the New-in-Practice people and everybody's interviewing. So thanks a lot, Dr. Sirgi and Dr. Ditelberg. We really appreciate your time and your advice and knowledge.

Becca Battisfore:

Thank you all for joining the podcast and sharing really helpful advice on interviewing. And I want to thank you all for listening to this CAPcast. The second episode in this series is about negotiation tips. So be sure to subscribe to the podcast so you won't miss this and future episodes. And for more information about the CAP, visit cap.org.

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