How To Interview For A Medical Leadership Position

In academic medical centers, deans, department chairs, and division directors are almost always filled by doing a national search. Even if there is an inside candidate at the institution that is the heir-apparent for the job, a search is done to adhere to preserve the integrity of the hiring process. Sometimes, the medical center will hire a professional search firm to seek out and vet candidates (often at a high expense) and sometimes the medical center will perform the search with internal resources. The first step is generally the establishment of a search committee which will consist of a diverse number of physicians and administrative leaders both from within and outside of the particular specialty of the person being sought. Candidate names are compiled from responses to advertisements in professional journals, requests for nominations sent to deans, department chairs, and division directors at other medical centers, and first hand knowledge of candidates by search committee members. Candidates are asked to submit a CV and usually asked to submit a letter of interest in the position. There is an initial screening of candidates by the search committee with elimination of those candidates that clearly do not fit the position’s requirements. The search committee chair (or the search firm or the dean/department chair)  will then have a phone conversation with each candidate to discuss the position in more detail and assess their level of interest.

When the candidate list is down to 6-10 people, the so-called “airport interviews” are done. During airport interviews, 3-5 candidates are brought in per day, one after another, for a group interview with the search committee and often a second interview with the dean or department chair. These are called airport interviews because they are typically held at a hotel close to an airport so that candidates can fly in and fly out on the same day. At this point in the interview process, the candidate names are kept confidential; this is one of the reasons for not having these interviews done on-site at the institution. Most of these candidates do not want their own institution to know that they are out interviewing, otherwise, it could hurt their career at their current institution if they do not get the job. The confidentiality is to protect the candidates, not to create a shroud of secrecy for the medical center that is looking for a new leader.

The search committee will then narrow the list down to 4-5 candidates who are brought for a second interview. This second interview is a much longer interview – typically lasting 2 days or more – and the names of the applicants then become more public knowledge. Each candidate is asked to give a lecture, there are interviews with many different physicians and administrative leaders, there is typically a lunch and a dinner with members of the faculty. For many second interviews, spouses are also bought along for dinner, meetings with real estate agents, etc. After the second interviews, the search committee will generally meet a final time to recommend finalists to the university president, dean or department chair. Importantly, the search committee does not choose the final candidate – that is the job of the university president, dean or department chair. The search committee’s job is only to present a final slate of candidates to the individual who will make the final decision.

At this point, a job offer will be extended by the president, dean or department chair to the top candidate and there will be negotiations about resources (start-up packages, office/lab space, administrative structure promises, etc.) as well as salary. If terms cannot be agreed upon, then the president, dean or department chair will go to the next candidate on his/her list.

Over the years, I’ve been on dozens of search committees and have chaired several. I think I’ve seen every mistake a candidate can make and have seen candidates who excelled and knew how to hit the interview process out of the park. Here are some of the points I’ve learned. First, about the initial submission of your CV and letter of interest:

1. Read the RFA (request for application) carefully and be sure that you send in the materials requested. If the RFA asks potential applicants to send in a CV and a letter of interest, then don’t just send in a CV without a cover letter.
2. In the letter of interest, check your grammar and spelling 3 times. The search committee members are mostly going to be people outside of your specialty and most of them are not going to know anything about you. So, the first impression you make on them will be the letter of interest. If the search committee members find spelling or grammar mistakes, then they are going to judge you as sloppy, no matter how many awards you have obtained, grants you have received, and papers you have published.
3. Make the right impression in your letter of interest. The letter should not just state why you want to be a leader (dean, department chair, chief medical officer, division director, etc.) but it should clearly state why you want to be a leader at that particular institution. That will require a little bit of research about the institution. If you have ties to the region or the institution make sure that those ties come through in your letter.
4. Organize your CV. Many academic medical centers will require faculty to use an institutionally-approved CV template. These are often terrible and generate CVs that look fine in the CV template computer program that they are generated in but are a mess when they are printed up. Make your CV easy to read and organize it logically. If you have grants, separate them into current active grants (that are actively funded) versus submitted grants, versus completed grants. If you have publications, number them and separate them into categories of peer-reviewed articles, non-peer-reviewed articles, book chapters, and abstracts. If you have national/international presentations, organize them by date. Do not editorialize about yourself in your CV – it should just be the facts.

The airport interview is the next big step in the process. This can be a high-stress time because the candidate will typically be surrounded by a dozen strangers who will be asking all sorts of questions.

1. The best preparation to do an airport interview is to have previously been on a search committee. Many physicians avoid being on search committees because they can be very time-intensive and it can seem like a lot of work for very little reward. But the education you get from being on a search committee will give you insight into the process that you just can’t get in any other way. You will also get a first-hand look at how successful candidates present themselves. So, if you are a junior faculty member, let your division director, dean, or department chair know that you’d like to participate on a search committee to familiarize yourself with the process.
2. The second best preparation to do an airport interview is a good night’s sleep. Think of doing the interview the way you would think of taking a board examination. You are going to need to think on your feet and be as mentally sharp as possible. Being well rested is critical. If your interview is on the east coast early in the morning, taking a red-eye flight from California to arrive that morning is a really bad idea.
3. Do your homework. Learn as much as you can about the institution before the interview. Draw from on-line sources, colleagues with first-hand knowledge, and alumni. But be careful in the interview – you don’t want to come across as bragging about how much you know but you do want to avoid sounding like a dummy when you are asked questions about institutional organizational philosophy, etc.
4. Google search committee members. You may or may not get a list of the search committee members before the airport interview. But if you do, then do your research on them. There is nothing worse than to make a joke disparaging endocrinologists, when unbeknownst to you, one of the search committee members is an endocrinologist. The interview room may be set up with the committee members’ names on name tags but if they are not, there is no way you are going to remember everyone during a brief introduction so if you know their names/faces/backgrounds ahead of time, you can personalize your comments to them.
5. Dress the part. If in doubt, over-dress rather than under-dress and be relatively conservative. You should be at least as well-dressed as the most-dressed search committee member – if only one other person in the room is wearing a tie, you need to be wearing a tie. Avoid flamboyant or provocative – all it takes is offending one search committee member and your prospects for the job are dead. You won’t know ahead of time if you are going to be seated at a large table or at an open desk so if you are a woman, avoid wearing too short of a skirt and if you are a man, leave your socks with pink bunnies on them at home.
6. Expresso, not coffee. The interview may only be for an hour or hour and a half but you are already going to have an adrenalin-fueled diuresis going on and the last thing your bladder needs is to be hit by the effects of a 16 ounce double mocha vanilla latte half way into the interview. Expresso will give you the caffeine you need without the fluid volume. Also, remember that the last thing you do before you go into the room is to make a trip to the bathroom. A wise man once said that you should always start a lecture, a presidential debate, a rush hour commute, or an airport interview on an empty bladder.
7. Everyone is either Dr., Ms., or Mr. Even if 9 committee members introduce themselves by their first name and 1 introduces themselves as Dr. so-and-so, address everyone equally and like clothing, it is better to be formal than risk being too informal. This is particularly true when it comes to gender. If you address all of the men as Dr. or Mr. and then address one of the women by their first name (or gender vice versa), then you have created a perception of gender discrimination that you likely will never get away from.
8. Make eye contact. Every search committee member is evaluating you on your communication skills. When one member of the search committee asks you a question, make direct and continuous eye contact with that specific individual for at least 20 seconds. If you look at the floor or the ceiling, the person asking the question will think you are aloof and if you look at someone else, they will think you don’t like them. If possible, try to work the questioner’s name into your answer to them so that you can make your response more personal.
9. Use your hands strategically. There are certain things you should never do with your hands during an interview: sit on them, drum your fingers with them, twirl your pen with them. Avoid crossing your arms or your posture will appear closed and defensive. Most of the time, keep you hands loosely folded on the table. But your hands can be great adjectives to emphasize key points you want to make. You don’t want to point or project your arm with the palm down. When you do want to use your hands for emphasis, position them as if you were holding an imaginary basketball in front of your chest.
10. There are certain questions you are always going to be asked. What attracted you to this job? What is your leadership style? What is your approach to improving diversity? What would others say about you? Tell me about a time that you failed at something? Tell me about a time you dealt with a disruptive physician? At many airport interviews, the questions will have been pre-scripted ahead of time so that each candidate is asked the same questions (often by the same person) in order to better compare one candidate to another. Think about these ahead of time – you don’t want your answers to sound rehearsed but you don’t want to have uncomfortable pauses while you think of something to say.
11. Be willing to acknowledge your shortcomings. There are a lot of pathways to becoming an effective leader – a successful researcher, a prolific publisher, an award-winning educator, a profit-generating administrator, an outstanding clinician. But few people, if any, are ever excellent at all of these. However, if you don’t have an RO1 grant, do make it clear that you value research and will be supportive of those who do research.
12. Skype effectively. Some of the initial interviews are done by Skype. I think in many ways, these are more challenging than an in-person interview. When Skyping, your tendency is to look at the video picture of the other people on your computer monitor and not at the camera. As a consequence, the people interviewing you never have eye contact with you. In other words, you think you are looking at them but they see you looking away at something else. Resist the temptation to look at the other people on the monitor and instead look directly into the camera. Also, be sure that the back-drop is appropriate, tidy bookshelves or walls with artwork work well. Think of yourself as an actor and everything behind you is the stage that you are setting. When you are Skyping, your movements are going to seem amplified so don’t sway or rock back and forth. Also, position yourself appropriately in front of the camera – too close and your nose will look fat and your head will appear weirdly shaped. The best thing to do is to practice with a family member so that you can get feedback on your appearance and camera presence and you can also have your family member in front of the computer you will be using so you will know the best way to position yourself and the room background for effect.
13. Avoid saying stupid things. A couple of examples from candidates I’ve seen in the past: “I like critical care because it is like internal medicine on crack.” Or, “As division director, can I put my name on the author list of all of the manuscripts that come out of the division?”. Or, “I’m debating on whether to retire or take on a new leadership job.”
14. Don’t be a potty mouth. Most people swear (with varying degrees of intensity of vocabulary) but during an airport interview, your swear words should be limited to “gosh”, “gee”, and “wow”. The only thing that will blow up when an F-bomb is dropped is your chances for getting the job.
15. Humanize yourself without self-aggrandizing. When asked about yourself, don’t come across as pompous or boastful but do present yourself as an interesting and well-rounded person.
16. Pace your answers. Limiting answers to just “yes” and “no” is ideal for giving court testimony but you will want to expound a bit more than one word answers during the interview. On the other hand, you do not want to make your answers so lengthy that some of the search committee members feel cheated if there is no time for them to ask their questions.
17. Project emotional intelligence. EI is all the buzzword these days in academic medicine. It turns out that this is a very difficult thing to teach or to prep for but it seems like some people naturally have it and others don’t. In an airport interview, questions that probe emotional intelligence often are grouped as questions that ask how you handle yourself and how you handle relationships with others. Examples are how you handle disputes, how you manage conflict, how you identify and overcome weaknesses in yourself and in others, how you handled a setback, and how you interact with others.
18. Shake everyone’s hands… at least once. The handshake often seems like a formality of social etiquette but the human touch can help establish a connection between 2 people that words cannot. But there is an art to the handshake – it should neither be too limp nor too firm. For search committee members who use their hands for a living (surgeons, gastroenterologists, anesthesiologists, etc.), an excessively firm handshake is a direct threat since even a small injury to the hand can derail their professional career. On the other hand, a flaccid handshake can make you come across as timid and a pushover. Use the same amount of force that it takes to pick up a glass of water with your hand.
19. Don’t clean out the hotel minibar. The institution will usually be paying the hotel bill if you stay overnight and that includes everything that you take from the minibar. Once, we had a candidate take everything from the minibar as she left the hotel, leaving the bill to the hospital. Needless to say, she was not asked back for a follow-up visit. What you take out of the minibar can reflect on your personality so if the institution gets a bill for 2 Snickers bars and 3 Budweisers, that is going to say a lot about you. If you order the lobster Thermidor with beluga caviar sauce and a bottle of champagne for a midnight snack from room service, that also tells a lot about you. If you want a beer the night before your interview, go downstairs to the hotel bar and pay for it in cash.
20. Send a follow up email. I get these all of the time, from medical students interviewing for internships, from physicians interviewing for jobs, and from leaders doing airport interviews. Most of the time, I ignore them but I do think that a follow-up email can sometimes make an impression. The ones that impress me the most are those that incorporate some personalized information. For example, a reference to something that we discussed or a reference to something unique about me or my career. In other words, avoid sending the same generic “Thank you for interviewing me” email to all of the committee members.

Once finalist candidates are selected from the initial airport interviews, there is a whole new strategy involved for the next round of interviews. I will write more about that in a future post.

April 19, 2019