Are you stressed by 15-minute patient visits, assembly line medicine and not having a voice? Would you like to use your clinical knowledge but not do direct patient care? If so, you may be interested in the up and coming role of the physician advisor. Before you consider opening a Subway franchise, please read on.
Physician advisors serve as liaisons between the clinical staff and the administration in the hospital. They assist with case management (length of stay, patient status), medical necessity, Medicare regulations, claim denials, and documentation. Jobs can be both hospital-based and in companies offering these services remotely for hospitals. Part and full-time work is available.
In July I attended a great Physician Advisor Boot Camp hosted by AR Systems, Inc. The event was an invigorating blend of presentations, breakout sessions, networking, and even a mock ALJ (Administrative Law Judge) hearing for a claims appeal. No boots or camping were required, and the only suffering was braving the triple-digit Texas heat to go to dinner.
One of the speakers at the conference, Dr. Phillip Baker, an OB/GYN with 31 years in private practice, described how as a physician advisor he helps other doctors. He gave the example of a surgeon whose care was being denied and the next step was for him to have a peer-to-peer call with the insurance company’s medical director. Dr. Baker said, “I remember being in that situation and I would have mouthed off and said something like, ‘What the heck do you know about caring for patients? You’re not a surgeon!’ Now I can take that burden off that surgeon, make the call myself, and do both him and the hospital a favor. I chitchat with the medical director, take time to ask about the kids and it goes a lot better.”
In the past year, Dr. Baker and his nurse assistant have been able to recoup 11 ½ million dollars for his hospital. Sounds like good job security to me!
I asked Dr. Baker his secret to success with the insurance medical directors. “I come from the perspective that we are both doctors, we both went to medical school. I’m an OB/GYN. I don’t know everything, but I know basic medicine. I take the time to get to know directors and don’t take anything personally. I love what I do.”
As you are probably realizing, to be successful as a physician advisor, emotional intelligence and a tough skin are critical. It’s also helpful to have a good reputation in the hospital system where you want to work.
My client, Dr. Helen Shields, an OB/GYN hospitalist was at the Boot Camp in preparation for a new position as a physician advisor. As of this time, she has started working remotely 20 hours a week for a private company. The Physician Advisor Boot Camp was her first toe-dip in this whole new arena and she shared this feedback, “I felt the Boot Camp provided a good introduction and overview of what a hospital-based physician advisor’s job may entail. I was impressed with the team approach to assist the hospital with legal, regulatory and financial services, and the recurrent theme to do what’s right and best for the patient.”
In the training for her new job, Dr. Shields says she enjoys learning about this other side of medicine and expanding her knowledge base of medicine in general. She adds that she is very happy to have made this transition.
At the end of the Boot Camp, I turned to my other client who was there, Dr. Timothy Owolabi, a Family Practice physician who is a full-time physician advisor, and asked him to describe in one word what he got out of the conference. He thought for a minute and then replied, “Community.” Dr. Owolabi was hired at the beginning of the year to be the physician advisor for his healthcare system. He went on to say, “Conferences such as this one, and the vibrant physician advisor community provide invaluable resources and support.” He added “Becoming a physician advisor had been a continuous exercise in patience, critical thinking, improving negotiation skills and trying to learn rules that are always subject to change. It’s been hard, but rising to the challenge is rewarding.”
You may be wondering, besides FP’s and OB/GYN’s……
Who becomes a physician advisor?
Doctors who enter this area need to be licensed, preferably board-certified, and have been in practice for a minimum of 3 – 5 years post-residency.
The most common specialties are internal medicine (especially hospitalists) and family practice. However, entrance from OB/GYN, surgery, anesthesiology, pediatrics, emergency medicine, and other areas is possible. It is very helpful to have in-patient experience.
How does one get started as a physician advisor?
- Shadow the physician advisor at your hospital (if you have one)
- Serve on committees for peer review, quality, safety, etc.
- Start doing utilization review, benefits management, and/or appeal work
- Attend a physician advisor boot camp or conference
- Join NAPA ( National Association of Physician Advisors)
- Join the ACPA (American College of Physician Advisors)
- Search on job boards for “physician advisor” positions
I’ll never forget what one veteran physician advisor told me about becoming a physician advisor. He said at first the doctors in the hospital would move to the other side of the hall when they saw him coming. But in time, after seeing that he was their advocate, not their foe, they would be flagging him down for help.
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Do you have any examples or definition as it relates to the PA role and UR committee?