If you’re not familiar with the role of the physician advisor, then grab a seat and some popcorn. This may be of interest to you. To introduce this exciting opportunity, I’m reaching back in time (and horribly dating myself) to a scene from the film, The Graduate. Benjamin (Dustin Hoffman) doesn’t know what he’s going to do for a career, and he receives some unsolicited advice from Mr. McGuire…
Mr. McGuire: Come with me for a minute. I want to talk to you.
I just want to say one word to you. Just-one-word.
Benjamin: Yes sir.
Mr. McGuire: Are you listening?
Benjamin: Yes I am.
Mr. McGuire: Plastics.
Benjamin: Exactly how do you mean?
Mr. McGuire: There is a great future in plastics. Think about it. Will you think about it?
Benjamin: Yes I will.
Mr. McGuire: Enough said.
I want to say just one word to you. Well, make that two – Physician Advisor.
I may be going out on a limb here, but I’m going to wager that the role of the physician advisor could become analogous (in its own way) to what plastic became for us – something we wonder how we ever did without.
What makes me think this?
I just returned from an inspiring conference put on by the National Association of Physician Advisors in Orlando. The buzz was palpable. With the massive changes in healthcare delivery, physician advisors are greatly needed to be the bridge between clinical staff and hospital administrators. Increased regulations, ICD-10 implementation, the change to accountable care and an increasingly data driven model, are all creating a demand for doctors who can assist as advisors and liaisons. Physician advisors wear a number of different hats, being involved in areas such as patient quality and safety, length of stay, documentation, appeals and utilization management. The role of the physician advisor first became recognized in 2005, although physicians have been working in this capacity for much longer.
Dr. Howard Stein, one of the conference speakers, started working as a physician advisor in 1993 while he was practicing as a family physician. Over time he transitioned out of practice and into fulltime work as a physician advisor for his hospital. In the Physician Advisor 101 workshop, he told us about his typical day. He rounds with the doctors in the morning and then meets with case management teams for multidisciplinary rounds. He knows every patient in his 270-bed hospital and is involved in ensuring quality care, compliance and communication among staff. The afternoon is spent on denials, meetings and other responsibilities. His job is a delicate mixture of diplomat, clinical expert, administrator and keeper of the peace. Although he uses his clinical skills every day, he is not directly responsible for patient care. His days are typically 7 am – 4 pm.
Dr. Bernie Ravitz, a physician advisor for Medstar Good Samaritan Hospital, didn’t mince words on what’s required of someone in his position, “You are going to deal with a lot of conflict.”
To be effective as physician advisor, Ravitz recommends a broad background in Internal Medicine (IM), Family Practice (FP), or Emergency Medicine (EM). The physician should be experienced with outpatient and inpatient medicine, have strong communication and interpersonal skills, and be trusted and respected by other physicians and staff. He sees education as an integral part of his job, helping physicians with documentation and difficult cases, offering feedback to reduce denials and improve care. Ravitz finds that showing physicians data can be useful in finessing relationships where physician behavior needs to change.
The third presenter in the Physician Advisor 101 course, Dr. Bradley Shumacher, is also a proponent of using data. He remarked, “One of the best things I did was go back to business school. When they [administrators] are looking at spreadsheets, statistics, and numbers, I can better participate in and understand these conversations.” A new area Shumacher is now involved in is setting up a residency program and developing quality-based care initiatives.
These three speakers all work full-time in their hospitals, but there are other options. Some physicians start out working one day a week doing utilization management or appeals. Others may work for a company that contracts with hospitals and other organizations to handle appeals and utilization review. Additional specialties besides IM, FP and EM have found niches within the physician advisor position. I know of pediatricians, surgeons, anesthesiologists and others who are working in this area.
How does one get started as a physician advisor?
- Shadow the physician advisor at your hospital (if you have one)
- Serve on committees for quality, safety or ICD-10 implementation
- Start doing appeals or utilization management
- Attend physician advisor conferences and boot camps
- Search on job boards for “physician advisor” positions
The president of The American College of Physician Advisors, Jeffrey Epstein, MD, is on fire with enthusiasm and passion for establishing the physician advisor as a highly respected and integral part of the healthcare team. As he describes it, the mission of the physician advisor is, “To be honest and transparent; to do all we can to help our new healthcare system move forward while improving quality, value, patient satisfaction, and provider satisfaction. We are provider advocates and we feel we have an important role to play in the efficiency of care, quality of care and helping populations stay healthy.”
In case you’re not convinced of the importance of the physician advisor role, let me share a story Stein recounted. While he was mingling at a hospital function, someone came up to him and said, “I heard you’re worth 11 million dollars to the hospital!” Stein knows there is a great ROI (return on investment) for physician advisors, but he had no idea he was worth that much. “Now if only I could work for a percentage!” he quipped.
There is a great future in the physician advisor. Think about it. Will you think about it? Enough said.