Lisette Hilton


Yet fewer than 20 percent of physicians use e-prescribing. Find out why you should be one of them.

Soon after implementing an electronic prescribing system in his North Kansas City, Mo., practice, Richard Hellman proudly told a patient that he no longer had to write prescriptions. He'd put away his prescription pad forever. The patient was relieved, Hellman said, because she'd recently been the victim of a serious medical error due to a doctor's illegible handwriting. The woman had been prescribed Cytoxan, a chemotherapeutic agent, but the pharmacist interpreted the prescription as Cytomel, a drug used to treat underactive thyroid. 

"She ended up with a hyperactive thyroid with the error," says Hellman, vice president of the American Association of Clinical Endocrinologists. "She was very grateful [for e-prescribing]...." 

The industry group e-Health Initiative estimates only 5 percent to 18 percent of practicing physicians use e-prescribing technology, and they tend to be high-prescribers like oncologists, pain management physicians, and those in family practice or internal medicine. But it's inevitable that those ranks will rise. 

Dan Michelson, chief marketing officer of Chicago-based Allscripts, a clinical software and connectivity company, says the electronic medical information marketplace continues to evolve as it develops interoperability standards and protocols for information being transmitted from one system to the next. E-prescribing is just one piece of a fully integrated electronic health record. 

"If you view this just as an individual slice, you are missing the bigger story, which is what is going on with clinical automation in general. There is a significant movement that is being pushed by President Bush on down regarding physicians automating and using electronic health records. And there is a whole myriad of things on the market that support those efforts," Michelson says. 

E-prescribing isn't going away. It will be mandatory for drug plans participating in the new Medicare Part D prescription drug benefit by 2009, although the Centers for Medicare and Medicaid Services (CMS) is requiring an initial set of standards by January 2006, when the benefit is scheduled to begin. 

Patients are playing a big part in the transition, says Carolyn Hartley, president and CEO of Physicians EHR, LLC, of Cary, N.C. 

"The first audience driving it is women who are going to be registering for prescription benefits through the Medicare Modernization Act," Hartley says. "There was a Harris Interactive poll in 2004 [showing] that the largest group of people developing personal health records is women over 65. This is for a number of reasons: they need Medicare; they go to [about] 4.6 physicians a year; and [they or] their husbands are on multiple medications. They're also the people like my mom, who has to get on a bus to go to the pharmacy and pick up her prescription, and she doesn't want to have any problems by the time she gets there." 

Patients aren't the only ones who benefit. Jamie Steck says e-prescribing has been the norm for more than three years at Central Utah Clinic in Provo, where he is director of information technologies. It's made the lives of physicians, physician assistants, nurse practitioners, and other staff members easier. 

"Before, our nurses were spending on average about an hour and a half to two hours a day just renewing prescriptions, usually at the end of the day," he says. "Now, they are taking maybe a half-hour to do that process. We are not sitting on hold with the pharmacy and the pharmacy is not trying to reach us. It just makes it so much easier because everything is clean and done right the first time," he says. 

You can print out instructions and other educational information about what you're prescribing for patients to take home. And depending on the program, you can tell on the spot if a medication is on a patient's formulary and is preferred, not preferred, or not covered. 

Improved safety is a big lure, too. E-prescribing eliminates the ubiquitous problem of handwriting legibility, and adds real-time drug-to-drug interaction and drug-allergy alerts. 

Chris Madden, a Tifton, Ga.-based internist, also likes the idea that his Drug Enforcement Agency number isn't floating around. "The patient never sees the prescription, so they never see our DEA number." 


Saurabh Desai, MD, an internal medicine physician who practices in Douglasville, Ga., says that learning how to electronically prescribe medicines has been easy. Desai and his group of three internists and one nurse practitioner purchased the RxWriter by MicroFour, Inc. to use in conjunction with the EMR software, PracticeStudio. 

"We do not order any [prescription] pads to be printed anymore," Desai says. "And if a patient wants to change medications, we don't have to look for a chart. If you prescribe some medication which does not get along well with a medication that a patient is already taking, [it] will tell you that this is not the right choice," he says. 

E-prescribing helps ensure the prescribing process comes full circle. One in five patients doesn't bother to pick up their prescriptions, according to Hartley. "In the old way of doing things, there was no systematic way of recording whether the patient even picked up the medication. Now, it's in the system. But someone has to put it in the system; so it is either the physician at the point of care or the nurse at the point of faxing it to the pharmacy." 

Doctors still could potentially input the wrong information, so checking and rechecking work continues to be necessary. Another drawback is simply that computers go down sometimes, according to Desai. 

"[I]t is still computer-based and, sometimes, the computer acts up and you are stuck," he says. "You have to have some good computer support so [you] are never without it for a few hours." 

Adding e-prescribing to your practice definitely means doing due diligence to comply with security standards. Hartley recommends doing a risk analysis and developing a risk management plan. Be able to answer questions like: What is your process if the system goes down? How are you going to be able to access health records? What is your technical support? Are there going to be audit controls to find out who has access to the patient records? 

Consider whether you want a stand-alone e-prescribing software or one that is part of, or can be integrated into, a full EMR. Then, think about what kinds of things you'd want the technology to include, because not all systems are alike. 

"The bottom line is electronic prescribing is one part of an electronic health record. Even if you do not purchase the full electronic health record today, you can migrate there over time," Michelson says. 

According to Hartley, "It will be more expensive to just buy the e-prescribing module and then move to the full-blown EMR later on. The e-prescribing module won't let you do billing and generally speaking won't let you capture patient data. All it does is it helps you meet the e-prescribing rule. 

"[But] if you're timid and looking for an affordable way to test the waters in digital healthcare, go to e-prescribing first. It's like renting a car for 30 days to find out whether or not you like that model so that you can buy it later on." 

Look for the important basics to e-prescribing systems, including a current medication list, dosing levels, and allergies for specific patients, as well as alerts to drug-drug interactions, and drug allergy errors. 

Bells and whistles might include the ability to track levels of payer reimbursement, or the ability to call up all patients taking a certain medication in case there is a recall. 

"You should be able to figure out how to call or send an e-mail to all the people who need to come in ... . This is where the e-prescribing alone does not work well. If you have an e-prescribing database that is tied to your practice management software, then you can get all of those telephone numbers ... " says Hartley. 


She also suggests that physicians look into sharing costs of the total EHR, with a group of other practices, a hospital, or other healthcare facilities. 

"EHR software is still pretty unaffordable, although prices are coming down. Physicians that form a loosely held collaboration can have a stronger seat at the table if they go together into buying EHR software. [It gives them] an ad hoc user group; they have a support center and they can share the cost of training and implementation," Hartley says. "It is a much smarter way ... than trying to do everything in isolation." 

Physicians should also carefully select the companies they choose to do business with. According to Hartley, there are about 1,000 vendors and about 250 are considered "top flight." Already, many companies selling the software have gone out of business or into bankruptcy. Experts predict an industrywide consolidation still to come. 

And the technology will continue to evolve. One new development to look for: full electronic transmission to pharmacy systems (meaning no faxes or e-mails; instead, the prescription would go right into the pharmacy database). That could further reduce errors - there's no keying in information and there's nothing left to interpretation. 

The bottom line: if you're not among the ranks of the e-prescribing, think about signing on soon, before it's mandated - and patients no longer know what to do with that little slip of paper you've just scribbled on. 

This article originally appeared in the November/December 2005 issue of

Articles

Not using e-prescribing yet? You should be. It's easy, it saves time, it reduces risk. And by 2009, it'll be mandatory.

It's Fast. It's Easy.

Like his peers, Joel Gallant, MD, MPH, used to prescribe medications by pulling a pad from his pocket, writing the script, and handing the piece of paper to his patient. Today, while he continues to handwrite an occasional prescription, Gallant has switched to e-prescribing, and says he would never want to go back to relying on the old paper prescription pad.

Gallant, associate professor of medicine and epidemiology at The Johns Hopkins University School of Medicine in Baltimore, simply walks over to the exam room computer, pulls up the patient's name on the screen, and either clicks "refill" or chooses from menus of options to create a new prescription. The automated system sends the prescription, by fax with an electronic signature, to the patient's pharmacy.

"That way patients do not have to wait around for the drug when they arrive at the pharmacy, and there is no question of misreading handwriting. The doses of the drugs are shown to me as options, so I am not going to put down the wrong dose," Gallant says. He notes that the system can also alert physicians to possible drug interactions, a particularly important benefit for patients who are taking multiple medications. 

Physicians prescribing electronically generally do so either through a handheld personal digital assistant (PDA) or from a computer terminal. Some e-prescribing systems, like Gallant's, transmit physicians' prescriptions directly to pharmacies, using e-mail or fax. Others electronically generate prescriptions but have not yet been set up to send scripts directly to pharmacies.  

Michael Saag, professor of medicine and director of the AIDS Center at the University of Alabama at Birmingham, has been using a form of e-prescribing since August 2004. At UAB, an electronic medical record system checks for errors and drug interactions and electronically prints prescriptions that doctors hand to patients. 

"We have not yet gone to e-mailing pharmacies, but that is a relatively straightforward thing once we get it set up," Saag says. 

The American Pharmacists Association is behind e-prescribing, according to Susan Winckler, RPh, vice president for policy and communications at the Washington D.C.-based trade organization. When transmitted by e-mail, prescription information can populate the pharmacy's dispensing software, eliminating data entry and the potential for transcription errors on the pharmacy's end, she says.

Gallant says there is no more guessing about handwritten or verbally delivered drug names that look and sound similar and are a major reason for prescribing mistakes (see chart, page 58). The problem of handwritten abbreviations is also eliminated by the e-option. "In an e-prescribing system you would look up the generic or brand name and it would be printed out, with no handwriting problems," he says.  

The fact that many systems alert physicians to possible drug interactions should also serve to cut down on prescribing errors. 

Saag says that while he cannot say that switching to e-prescribing has saved anyone's life, he feels better about the decreased likelihood he will miss any potential drug interactions. 

"It's a nice reminder about interactions," he says. "Every time we prescribe a new medicine, [our] system compares the new medicine to all other medicines that the patient is currently taking and will alert the provider to the nature of the interaction and the degree to which the interaction is a danger."

Saag likes the idea that the system is educational for physicians. 

"Every time one of those interactions comes up, it reinforces for the provider that the threat of interaction exists," he says.


Saag also appreciates that the system he uses scans for any conflict between a new medication and a patient's drug allergies or intolerance, and will not allow such prescriptions to be written without a physician override.

Some systems also offer educational information for patients. "If I'm writing a new prescription for a drug, I can click on that drug name and [receive a printout of] patient-oriented information that I can hand to the patient," Gallant says.  

As a convenience to patients and physicians, some e-prescribing systems will check health plan formularies to determine on the spot whether a drug is covered under a patient's plan. 

Used correctly, e-prescribing could facilitate communication between pharmacists and physicians by providing more time for information sharing and reducing time spent on data entry, according to Winckler. "Prescribers should not assume that because they have e-prescribing they cannot call their pharmacist. If they have that clinical question, it is OK [to call]," she says.   

E-prescribing is not foolproof. "It actually introduces new sources of error, but it addresses some existing sources," Winckler says. 

A recent study in the Journal of the American Medical Association looked at computerized physician order entry (CPOE) systems in facilitating medication errors. (E-prescribing generally refers to doctors prescribing from their offices, whereas CPOE is hospital-based and systemwide.) 

The study found that a widely used CPOE system increased risk for 22 types of medical errors, including human-machine interface flaws, such as selecting the wrong patient file because names are listed close together, and selecting the wrong medications. According to Winckler, mistakes could also start at the software development stage if the wrong information about a drug or dosage is programmed into the system. An error like that could lead to not just one person getting the wrong dose, but widespread misprescribing.

As a result, experts say, physician and pharmacist diligence and clinical review are just as important with regard to e-prescribing as with handwritten prescriptions. Physicians need to keep updated patient medication lists so that they don't inadvertently renew inactive prescriptions. Users also should not assume that their systems provide services such as checking for drug interactions.

Health plans and the government are starting to push for e-prescribing, according to Peter R. Kongstvedt, MD, an internist and vice president at Capgemini Health, a healthcare consulting company based in New York City. "In the Medicare Modernization Act that was passed last year, there is a requirement that at some point in the future ... any company administering drug benefits for the new Medicare drug benefits [program] will have to have e-prescribing," Kongstvedt says. "Some health plans ... actually have programs to fund getting e-prescribing out there to the doctors." 

This article originally appeared in the May 2005 issue of

When transmitted by e-mail, prescription information can populate the pharmacy's dispensing software, eliminating data entry and the potential for transcription errors on the pharmacy's end.

Click Here for Rx

It's been said that death and taxes are the only sure things in life. But in this age of technology, a computer crash is something else you can bet will happen to you, at least once. For physician offices dependent on their computers for housing patient records, patient management systems, e-mail, and more, a computer breakdown can paralyze the practice for days -- even months.

"Can you imagine a practice trying to run with its total information source gone -- every patient record, all the demographics of all the patients, their phone numbers, names -- everything?" ponders David Wilcox, chief information officer of IntegreMed, a wholly-owned subsidiary of Pediatric Physician Alliance, an Atlanta-based provider of business services for medical practices. 

The bad news is that crashes are nearly inevitable. Whether a virus or worm creeps into your hard drive from the Internet, a fire or lightning strike destroys your system, or the equipment simply breaks down or malfunctions, there is no such thing as a crash-proof computer. The good news is that by taking simple steps, physicians (and their office managers) can rest assured that, whatever problem crops up, the bulk of their data will be safe.

"You can't avoid computer crashes," Wilcox confirms, "but you can prepare for them. The key to survival is called 'disaster recovery.' That's a concept that says, 'I know that my system will fail.' The key is to come up with a concept that protects you from that kind of loss." 

Wilcox says the most important element of disaster recovery is a "robust" backup system. Simply, it means that every day you take critical data from those files that have changed and copy them to a tape or disk. Every week, run a backup of the entire system and make sure that the tapes are sent to an off-site storage location. This, Wilcox says, protects your data in case of theft, fire, or other disaster.

John I. Sutter, a pediatrician practicing in Clifton, N.J., remembers a hard drive crash that caused him to lose about 50 patient files. "I was able to restore the data from my backup except for about five days' worth of patient data. That required entering it by hand and it took me a whole weekend of doing nothing but that," Sutter says. 

Most backup tapes used today are high-capacity magnetic data tapes, which store between 20 and 50 GB (gigabytes) each. According to Ralph Jacobs, senior systems architect with Denver-based J.D. Edwards, the average small practice should easily be able to back up an entire server onto one tape. Some practices manually set the backup to run as staff leaves for the night. Tape backup systems are fairly affordable -- especially given the cost of losing information. Jacobs says the backup systems themselves are available for $600 to $700. Tapes cost another $10 to $40 each.

Don't neglect to monitor each backup's success. Wilson suggests sampling backup tapes to make sure that everything is there and is accessible. "That entails taking the backup tapes about once a week, putting them into the system, reading them, and making sure that the information you thought was there is there and that you can read it back," he says. "It's possible that you can have a defective tape drive that looks like it's recording your data, but it can't be read back." Discard the tapes after about six months because, like VCR tapes, they wear out. 

Practices that operate their own servers often have a "redundant" disk system so that, if one of the disks fails, the information is contained on the rest of the system. In techno-speak, these systems are called Redundant Array of Inexpensive Disks, or RAID systems. What that means is, rather than having just one hard drive, a server will have two or three, so that if one fails, the server can easily back up to the second or third hard drive instead, Jacobs explains. "That way, you can survive a complete hard drive failure." 

"A lot of practices that have servers might not have this [redundant system]," Wilson says. "That's unfortunate, because if you're going to run your business off your computer, you should have a computer with that kind of reliability." RAID controllers only cost $100 to $300, according to Jacobs. Now that's truly inexpensive redundancy.

The careful, consistent backup approach works. After 13 years of practice, Debbie Grosheim, an office administrator, reports that the practice she runs, East Coast Medical Associates in Delray Beach, Fla., has never lost any data, despite one crash and occasional computer glitches. "We back up on a daily basis. We had a crash about seven years ago but we didn't lose anything because we've always backed up daily," she says.

For an added measure of safety, physicians should also consider purchasing backup power supplies in case of a power outage - although according to Rosemarie Nelson, a Syracuse, N.Y.-based information technology consultant for medical practices, many systems are already configured with an uninterrupted power supply, or UPS. Most offices, Jacobs advises, really only need a UPS for the server. But if staff or physicians enter a lot of data on workstations, you'll want a way to save work there, as well.


Typically, these systems are designed to protect computers against a "five- to 15-minute power outage," says Jacobs. A backup system for a daylong outage is probably too cost- and space-prohibitive for most practices. "They're file cabinet-sized," Jacobs warns. If, however, there is a short, sudden power outage in your office complex or community, a simple UPS system will start beeping and give users a few minutes to save their work and shut the machines down. A UPS system on a server will start the backup and shutdown process automatically if the power shuts off. A UPS costs less than $100, says Jacobs.

Antivirus software is another must-have for practices that are connected to the Web. Nelson warns that physicians should do more than just buy the software and load it on their computers. They should also subscribe to an antivirus service and configure the computer so that it updates virus definitions regularly to guard against new viruses. 

Since his system crashed, Sutter, who was backing up to a server in his office, has changed to an application service provider (ASP) model. Now Sutter's office data is sent daily over the Internet to another company's server. Sutter has nothing more than keyboards and screens at his office -- all the data is stored at another facility. He feels more confident with the ASP model. 

"The backups are not my problem; they're done automatically and on a much more high-efficiency system. There are people who are much more adept at doing hardware work who are taking full responsibility for it."

Despite the convenience of the ASP model, about 90 to 95 percent of practices are still on the in-office server model, according to Nelson. "I think there's still a wait-and-see attitude among physician practices," she says. 

"There's quite a level of comfort that the physicians feel about having that server under their own roof. There's also the financial consideration. They think, 'Why would I want to rent when I can own?' They haven't bought into the fact that technology changes so quickly that owning might not be an advantage."

Nelson considers ASPs safe but says it's important that physicians do their due diligence because of some recent instability in the ASP industry. For example, physicians should be sure the contract with their ASP addresses how the data is safeguarded, whether the data is stored off-site (and, if so, where), and how frequently the ASP does quality checks. 

"The reason you are outsourcing is that backing up is a pain in the neck. You want to be really sure that the folks you are outsourcing to are taking on that responsibility."

So, what if you've crashed and haven't had a good backup system in place? No need to lose all hope. There are services that focus on retrieving seemingly irretrievable data from hard drives and disks. 

Eco Data Recovery of Palm Beach Gardens, Fla., is one of many companies that specializes in recovering data from hard drives. According to Chuck Roover, vice president, industry averages for successful data recovery are from 50 to 90 percent, depending on the problem.

Data recovery services can help if all else fails, but it's a much less expensive and less stressful option to do daily backups and get a UPS instead. Most data recovery services charge a flat fee to see what needs to be done to retrieve data on the hard drive or tape; then charge for the data recovered. The cost can be from around $100 to tens of thousands, depending on the amount of data recovered. 

"They can be really expensive, depending on the level of damage," Jacobs confirms. "But if it's important data, it's probably worth it." 

This article originally appeared in the March/April 2002 issue of 

How to protect yourself from computer crashes

Crash Course


Kathleen Music remembers the doctor who blew her interview simply because she wasn’t forthcoming about her past. 

The physician was applying for a position in a pediatric practice. The interviewer began probing about a gap in the physician’s curriculum vitae. The physician hedged around the question and said that she just needed some time off. Not satisfied, the interviewer asked more questions, causing the physician to break down, lose emotional control, and admit that a traumatic event had caused her to go into deep depression. The interviewer concluded that the physician had unresolved issues and didn’t hire her. 

Physicians need to be ready to explain any employment gaps in a convincing manner, says Music, a principal with Denver-based JKM Consultants, which offers healthcare recruiting services. “Usually that gap tweaks a little uneasiness. There is a concern about hiring an impaired physician.” 

The most positive thing a physician in that situation can do is to be up-front. For example, Music recruited one doctor knowing that he was in a drug treatment facility. When asked about it during the interview, “this physician stepped right up to the plate,” Music says. “He told me, ‘I developed an alcohol problem after my divorce. I have been participating in the state medical board program and don’t anticipate that to be a problem.’” 

Honesty may be the best policy, but in today’s business environment, administrative and people skills are paramount - even for physicians, who have traditionally focused on their clinical skills. In the new economy, physicians are applying for positions that don’t involve patient contact - as dot-com medical directors and content reviewers, for example. “We have a lot of physicians who are now salespeople, executives, CEOs, and presidents of corporations,” says Dan Friend, PhD, managing director at Lee Calhoon & Co., a Philadelphia-based company specializing in executive healthcare recruiting. 

“Doctors are trained in an algorithmic approach to medicine: symptoms, symptoms, symptoms. They get to thinking almost inside the box. That’s exactly what you want on a clinical side, but if you’re in a sales department you need to be quick on your feet because the conversation might go in an unanticipated direction,” Friend says. 

Know the vernacular of the industry, for example. A physician who would be required to work with ASPs (application service providers) would likely lose points if he has to stop the interview and ask what they are. Friend and other recruiters do mock interviews with many physicians, and find that a little practice can go a long way. After all, “the Gores and the Bushes of the world don’t walk into the debate and hope it works. They spend hours getting grilled by their confidants,” he observes. 

Music agrees that doctors can generally be confident that their clinical skills are going to be accepted, but they will need to sell their administrative side. They need to be able to discuss how they use their time efficiently, and their ability to handle paperwork, for example. If they don’t have a lot of experience in those areas, it helps to admit that they don’t, but are willing to learn, she adds. 

Finally, candidates should provide background information that corresponds to the type of job they are seeking. Friend suggests that those who go for medically-oriented positions bring a CV, which presents medical education, published articles, board certification, and medical positions. Those in the corporate arena should have a resume, which offers much of the same medical information, and also presents the candidate’s management activity, communication and time management skills, and ability to work in groups. 

“As much as possible, listen before you speak,” urges Jeffrey Gruen, chief medical officer of Personal Path Systems, a case management firm in Upper Saddle River, N.J. “Those people I’ve most enjoyed interviewing and those times when I’ve been most successful during the interview, I’ve approached the situation trying to learn as much possible about the person I’m speaking to. If you can understand who is interviewing you, then you have a much higher chance of having a conversation go in a direction that best highlights how you can help that person,” he says. 

In the same vein, plan ahead, suggests Geoff Staub, director of marketing for St. Louis, Mo.-based Cejka & Co., a healthcare consulting and search firm. Bring a list of questions to the interview, such as: What is the practice philosophy? How does the practice assign patients? How many hours will I be expected to work? Then, ask questions of the interviewer, such as: What do you like about working here? What is your biggest challenge in the job? 

Your appearance is another important consideration. ‘Dress for success’ is not just a cliché: You can’t go wrong in a clean, pressed suit and tie or dress. “Walking in with Birkenstocks, jeans, and a tank top - which we had a physician do - is not going to send the right message to the employer. This person is going to represent the employer’s group,” Staub says. 


While those in the dot-com world might work in khaki pants and golf shirts, it’s never appropriate to come to the first interview dressed like that, according to Friend. “Appearance is 90 percent of not getting any job,” he says. 

Attitude is as important as appearance. Music recalls a physician who was qualified for a position but didn’t get it because of his less-than-serious outlook. He mentioned that all his friends worked at the facility and, therefore, he thought, “‘It would be a fun place to work and we would have a lot of fun here,’” according to Music. “Not that there’s anything wrong with that, but it was the approach that ‘I’m just going to hang out with my buddies’ that did not sit well,” she says. 

It’s also wise, she adds, for physicians not to assume that administrative types don’t have any say. “Sometimes physicians think that only physicians are going to have anything to say about their fate and that’s not true - not in today’s world.” 

According to Staub, it’s fine to talk about money during the interview. “I don’t think it should be necessarily the first thing you bring up,” he says. “We typically advise physicians to bring it up last. But to leave an interview without talking about compensation would be a mistake.” 

Address starting salary, signing bonuses, productivity bonuses, income guarantees, and what you can expect to make in five years, but don’t negotiate actual numbers until later interviews. “If it’s a multispecialty group, it’s important to find out how the income is distributed within the group and what kinds of costs are involved,” Staub says. “Ask how long it will take to become a partner and what the buy-in is.” 

Friend suggests asking how the company or practice is doing financially. “You don’t necessarily have to get a Dunn & Bradstreet report and go into huge depth,” he says, “but why go and spend your time and effort interviewing at a company that might not be there tomorrow because they haven’t gotten their latest round of financing?” Physicians can find the needed information by asking their recruiters, looking on the Web, and asking those in the industry. 

“We had one physician ask a candidate, ‘who is the last person who gave you a fruitcake?’ What they were trying to do was get at whether it was a patient, to see what kind of rapport the physician had with the patients,” Staub explains. “They might ask: ‘Describe a clinical error that was your fault.’ Physicians should understand that everybody makes errors. To say that you’re faultless - they’ll know that isn’t true. The way that you get around it is to address how you were able to rectify the situation or what you learned from it.” 

Finally, realize that there probably are a lot of other people vying for the same job. Getting hired is anything but a sure thing, so make yourself stand out. Music says she often gets up to 200 applicants for one healthcare job. Cejka & Co. has 100,000 physicians in its database who are actively seeking jobs, according to Staub. This year, about 26,000 physicians will graduate from residency and fellowship programs, according to the American Medical Association. “Think of it as a privilege to be hired for a job,” Gruen concludes. 

This article originally appeared in the July/August 2001 issue of 

What physicians do wrong and do right when applying for a new position