Questions You Must Ask the Medical Director: Uncovering the True Culture of the ICU
You've answered their questions about your clinical experience, handled the mock code scenario, and explained why you're interested in the position. Now comes the moment that separates savvy candidates from everyone else: "Do you have any questions for us?"
This isn't a formality. This is your due diligence opportunity.
Why Your Questions Matter
The questions you ask reveal:
- Your priorities and professionalism
- How much research you've done
- Whether you're evaluating fit, not just seeking any job
More importantly, the answers reveal:
- Red flags you'd otherwise discover on day one
- Whether this unit will support your growth
- The true culture behind the recruitment pitch
Questions About Team Structure and Autonomy
"Can you walk me through a typical shift for an APP on your unit?"
This open-ended question reveals daily workflow, expectations, and the reality of the role.
Listen for:
- Clear description of responsibilities
- Realistic patient loads
- Mention of support staff and resources
Red flag: Vague answers or deflection to "it depends."
"What's the APP-to-physician ratio, and how does rounding work?"
Understanding the supervision model is crucial.
Good signs:
- Defined ratios (e.g., 2 APPs to 1 attending)
- Collaborative rounding described
- Mention of APP autonomy in decision-making
Red flag: "You'll mostly be on your own" (fine if expected, concerning if not).
"How are admissions and consults distributed between physicians and APPs?"
This reveals whether APPs are valued team members or workhorses.
Watch for:
- Fair distribution vs. APPs getting "overflow"
- Whether APPs participate in complex cases
- After-hours expectations
Questions About Support and Development
"What does onboarding look like for a new APP?"
Onboarding quality predicts job satisfaction.
Ideal answer includes:
- Structured orientation period (4-12 weeks)
- Assigned preceptor or mentor
- Gradual increase in patient load
- Regular check-ins and feedback
Red flag: "We're pretty sink-or-swim here" or "You'll learn as you go."
"How do you support APPs in maintaining and expanding procedural skills?"
Procedures are often a key part of ICU APP roles.
Good signs:
- Simulation lab access
- Procedure logging system
- Protected time for skill development
- Support for credentialing new procedures
Red flag: "We don't really track that" or "The attendings do most procedures."
"What opportunities exist for professional growth—quality improvement, teaching, research?"
This shows whether you'll stagnate or develop.
Positive indicators:
- APP involvement in QI committees
- Opportunities to precept students
- Research collaboration mentioned
- Leadership pathways described
Questions About Culture and Retention
"What's the average tenure of APPs on this unit?"
Turnover tells you everything about workplace satisfaction.
Interpret the answers:
- 3+ years average: Healthy sign
- 1-2 years average: Investigate why
- "We're a new program": Different considerations
Follow-up: "Why do APPs typically leave?" (Direct, but revealing)
"How does this unit handle disagreements between APPs and physicians about patient care?"
Conflict resolution culture matters enormously.
Green flags:
- Specific examples of respectful disagreement
- Mention of escalation pathways
- Emphasis on patient-centered resolution
Red flag: "We don't really have disagreements" (unrealistic) or visible discomfort.
"Can you describe a recent challenging situation on the unit and how the team handled it?"
This question reveals real culture under pressure.
Listen for:
- Honest acknowledgment of challenges
- Team-oriented language
- Learning and improvement focus
Questions About Logistics and Compensation
"How is call distributed, and what's the compensation structure for extra shifts?"
Don't leave money and time on the table.
Get specifics on:
- Call frequency and type (in-house vs. home)
- Shift differential rates
- Overtime policies
- Holiday coverage expectations
"What's the process for requesting time off, and how far in advance do schedules come out?"
Work-life balance depends on scheduling predictability.
Ideal answers:
- Schedules published 4-6 weeks ahead
- Clear PTO request process
- Flexibility mentioned
- Coverage system explained
"How does the credentialing and privileging process work, and what's the typical timeline?"
Delays here delay your paycheck.
Ask about:
- Their timeline expectation
- What they need from you
- Any unique requirements
Questions to Avoid (Or Reframe)
Don't ask: "What's the salary?" (Save for HR/negotiations) Instead ask: "Can you tell me about the total compensation philosophy here?"
Don't ask: "How much vacation do I get?" Instead ask: "How does the team approach work-life balance?"
Don't ask: "When can I expect a raise?" Instead ask: "How is performance evaluated, and how does that connect to advancement?"
Reading Between the Lines
Pay attention to:
Body language: Do they seem enthusiastic or guarded? Specificity: Concrete answers vs. vague generalities Consistency: Does the medical director's version match what the recruiter told you? Who else is present: Did they include APPs in your interview?
The Most Important Question
End with this:
"Is there anything about my background that gives you pause, or anything I can clarify?"
This takes courage but provides:
- Opportunity to address concerns directly
- Insight into their decision-making
- A confident, professional impression
After the Interview
Within 24 hours:
- Send a thank-you email referencing specific conversation points
- Note your impressions while fresh
- Compare answers to your priorities list
- Research any topics that came up that you want to learn more about
The Bottom Line
An interview is a mutual evaluation. The medical director is assessing whether you'll strengthen their team; you're assessing whether this unit will support your career. Ask thoughtful questions, listen carefully to answers, and trust your instincts.
The right ICU will welcome your questions—because they want the right fit too.