11 November 2009

Physician Skills

We're elbow deep in the recruiting season, and it's been a real pleasure so far this year.  I've been fortunate to meet a wide variety of candidates who are incredibly accomplished.  I'm glad that I didn't have to compete against this crowd when I was coming out of residency!  It's so much fun to meet so many young, excellent Emergency Physicians, and my only regret is that I don't have jobs to offer all of them.

One interesting divide has emerged, however.  When you think about the requisite skills and qualities of an exceptional Emergency Physician, the elements that come to mind include knowledge base, interpersonal skills, communication skills, energy level, ability to multitask, decisiveness, and that sort of thing.  Most of the candidates I have interviewed so far have these capabilities, some to a very high degree, some less so.  It can make for a tricky decision -- do I rate the guy with great interpersonal skills above or below the guy with awesome academic credentials but only good interpersonal skills?  And many other permutations of the same conundrum.   Most of the time the hiring decisions are driven by these relevant skills.

There is, however, a small subset of candidates who may or may not be exceptional physicians who completely disqualify themselves from serious consideration from the very beginning: the computer illiterate.

You can spot them a mile away.  They don't email their CVs to me -- it comes via regular mail or, worse, by fax.  That's a huge red flag.  Sometimes it's just that they are a little old-fashioned, and there is something to be said for the visual appeal of a nicely designed resume on high-quality paper.  I'm OK with that.  But if I ask for an electronic copy of their CV, and they can't manage to get me one, or, worse, if they don't even have an email address listed on their CV, that's even more concerning.  It's fair to say that the likelihood I'll offer a job to someone who can't format a CV and attach it to an email is effectively zero.

Why does this matter?  We are ER docs!  We're not emailing patients, and computer skills have no bearing on one's ability to provide medical care to patients, right?  It seems wrong to base hiring decisions for highly trained professionals on an unrelated skill set, doesn't it?

Unfortunately, in this modern age, if an employee can't use a computer effectively, they are a liability.   Our group performs most of its essential communications via email.  We have a repository of key documents on our own website.   We study, take tests, and acquire new skills on computers.  More saliently, our hospital has an ED Information System which our docs must work within in order to provide care and to access old records, and soon we too will be performing patient documentation on an Electronic Medical Record.   A physician who cannot efficiently integrate a computer into his or her daily workflow will be incapable of working in the modern ER.

The vast majority of docs I interview are coming out of residency, which means that they are likely young and likely have a high degree of comfort with computers; some more than I (which is saying something!).  For those of you who are reading this blog, it is pretty likely that you, too, are computer-savvy enough to get by.  But a number of veteran docs, folks who I am sure have a wealth of clinical experience and would otherwise be a huge asset to any medical practice, simply never bothered (or actively refused) to gain basic computer skills.  And for me, they're unemployable.  Which is a pity for them and for us.

Just one more way in which we all need to continually adapt and learn through the course of our careers.


  1. How do you get a good reading on interpersonal skills in a brief interview?

  2. I would say you get a better reading on it than in a long interview. It's about as much time as an ER doctor has to spare for a patient, and I would say that the ability to get information both out and across to patients in a short time saves lives just as much or possibly more often than excellent physician skills.


  3. It really is an essential tool. Not being computer literate these days is almost as bad for a physician as not being literate at all. There's just so much information transmitted both ways through that standard channel that knowledge of it is a prerequisite.

    It'd be like applying for a heavily diagnostic career while being blindfolded, tied up, locked in a box, and only able to communicate via morse code.

  4. I can't imagine a professional in the US without at least basic computer skills. It's not like computers were invented yesterday; even older folks have had 20 years to figure out the basics.

    What else haven't they kept up with?

  5. I'm just curious, what file format is appropriate for emailed resumes in your industry? I'm used to plain text being the preferred format, but honestly I don't know if that's even true in my field anymore (vs. pdf).

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  7. Kipper,

    I would say (for me) the preferred format is PDF. It can be opened on just about any machine, and the formatting and niceness that people put (or should put) into their CVs is retained.

    I get more CVs in MS-Word format, which is fine, too, but when you send someone a .doc file you never really know how it will render in someone's machine.

  8. The technophobes will just hire someone to create and format for them. So ask.

    Where I see the problem is with physicians who dismiss the viability of knowledge consumers can get on the web.

    Just recently, I told two emerg physicians they didn't need to take the time to explain X to me, I'd google it when I got home.

    It was shorthand for I'll research it myself--you get back to the waiting room plugged with the H1N1 fear-mongered.

    They shared an eye-roll and smirk to each other as they walked away.

    "Prescrire? Cochrane Collaboration? Therapeutics Initiative? E-Medicine?" I said, to their backs.

    Most patients (including people like me, in my late 60s) have done an end run around their physicians on this. We aren't going to be little pitchers anymore folks. You better get with the program all around, not just with your CV.

    And that leads me to say, no, we do not want electronic records, thanks. There is zero confidentiality and security with anything on the internet, not even with those lame encryption apps.


  9. Canada,

    While I welcome the engaged, educated and motivated patient, I have to admit that you overgeneralize from your own experience. Sadly, most of my patients still read at a fourth-grade level and few are able to efficiently or accurately research and learn about their own conditions. Of course when I identify someone who is high-functioning, as we say, then it is incumbent on me to acknowledge and respect that facility. But it is, I can tell you, terribly uncommon among the typical ED patient population.

    It's better practice and a lot safer to explain everything clearly in the language best suited to a patient's level of understanding.

  10. I was pointing out the availability of good consumer health information on the internet, and most physician's naivete about that.

    Fourth grade reading level? Welcome to the web, doc.

    There's nothing that says "newb" faster than a doc who writes 50 word sentences filled stacked up for block after block of text.

    When you have three inches to get your information out, you better stick to Ango-Saxon, two-syllable, and subject, verb, object. If you're throwing jargon around and talking it up, you're showing off, not communicating.

    Take a look at good websies, and copy how they write, paragraph, the syntax and language.

    Grade four.

    (You failed).

  11. One thing about PDFs is you have to have software to make them. Word 2007 will do it but you have to download something from the Microsoft web site.

    A few years ago I got a freebie HP printer w/scanner when I bought a Mac. It will scan a document into a PDF so you could print something out and scan it.

    Plain text resumes look crummy. I hate corporate web sites that won't take anything but text.


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