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My Experience Series: Physician Advisor

Have you ever wondered what a physician advisor does?

I sure have.

So I reached out to someone who has been doing it for the past couple of years, check out my interview with him/her below:

1. Why did you decide to transition into a physician advisor role?

Were you considering any other non-clinical roles?

I was looking to move away from clinical medicine. I was open to any non-clinical job but I was not actively looking for a position.

Our hospital was bought by a company that has in house physician advisors at all their hospitals.

They were looking for one adult and one pediatric physician advisor with at least 5 years of hospital based clinical work.

2. What did you do before you started this role? Did you have experience doing it before?

I was an outpatient pediatrician for 3 years and then I became a Pediatric hospitalist which I had done for 5 years before becoming a physician advisor. I had no experience.

3. Do you have any resume advice for applying to these roles?

Every hospital has to have a Utilization Management committee (CMS mandate) so a good place to start is to join that committee.

Get to know your hospital Case Management Director and find out how your hospital does secondary medical necessity reviews and how they handle insurance medical necessity denials

4. What kind of credentials are required to be a physician advisor? Is board certification required?

We are required to be board certified, but the specialty does not matter (I am board certified in Pediatrics).

We must also hold an active medical license.

5. Do you have to have a certain number of years of clinical experience?

5 years of hospital-based practice, does not have to be exclusively in the hospital. Many in our group were hospitalists but our group includes anesthesia, Endocrine, Pulmonologists, General Surgery, ENT, and OB/GYN

6. What are your day to day activities like?

I review all admissions that came in overnight. If status looks wrong I email the case manager and she talks to the residents to get more info. We then discuss all observation patients and new admits at 10AM.

I usually have a couple of meetings throughout the day. In the afternoon I attend MDRs (multi-disciplinary rounds) on 2-4 units. All patients are discussed. My afternoon Observation rounds are incorporated into the rounds.

I look for an opportunity to upgrade any observation patient that is not going to be discharged that day. For any patient that has a status change, from Observation to Inpatient or from Inpatient to Observation I have to write a secondary medical necessity review.

Throughout the day I will also be sent cases from our Utilization review nurses if they are unable to get the current ordered status to meet MCG criteria.

If I cannot determine the correct status by reviewing the chart I will call the treating physician, I will also be sent all concurrent denial cases to review. If I agree that Inpatient is appropriate I will call the treating physician and discuss the case with them.

I will give them tips on what to say to the insurance company medical director to help explain why inpatient status is appropriate. A lot of time there are key words/phrases that will help.

7. Was there training when you started?

Yes, I spent a month shadowing different physician advisors that work for our health system. It was great to see how everyone did the same job a little bit different depending on the needs of the facility and style differences.

8. Do you deal with patient care at all?

I still work one weekend a month as a peds hospitalist. In my role as a physician advisor I do not have any direct patient contact.

9. Is the role stressful?

Yes, sometimes physicians are not nice. They do not want to talk to you about status and don’t care if their patients are in the wrong status. Also I help with complex discharges and unfunded patients.

10. What do you like the most about your role?

I like the work and my colleagues are great. It is intellectually challenging, and I really loved learning about hospital finance. I see every day how my job helps our hospital financially.

11. What do you like the least?

Most physicians are very nice to me but sometimes they can be discourteous

12. What is the career trajectory like for a physician advisor?

Several people in my group have become CMO’s and system wide Vice Presidents. This is a great starting point for advancement in hospital leadership.

13. What is the salary like (if you’re comfortable disclosing)?

Starting salary is $110 an hour plus annual bonus (around $20k) with no prior physician advisor experience.

Since starting 4 years ago I have received annual raises of $1-4 an hour and then 2 other raises to help match national wage parity for physician advisors.

14. Do you still carry malpractice insurance in this role?

Yes

15. What surprised you about the role now that you’ve been doing it for some time?

I do a lot more than just status reviews, status reviews are only about 30% of my work. I attend many meetings, I am very involved in hospital length of stay, throughput and discharge timeliness projects.

I also provide regular education to attendings and residents about documentation, status and denials. I am also involved in hospital wide and pediatric quality improvement committees.

16. Is this a typical 9-5 role? More like an office job? Do you ever bring home work with you?

I do work from home in the mornings though most others in my group do not. Luckily we have a lot of flexibility so if my kids are sick I can work from home those days.

There are moonlighting shifts on evenings and weekends and those are all done from home. There are also members of the Core team and they all work from home. The Core group does retro-denials and they do status reviews for the hospitals that are too small for an on-site physician advisor or the on-site person is off.

17. Do you miss the traditional patient care role at all?

I do not miss the traditional role, I am actually looking to cut back on the number of clinical shifts I am working.

I hope that helped you learn more about what being a physician advisor is like.

If you want to learn more how to start being a physician advisor part time and transitioning into a full time role, check out Aerolib Learning Management System: an On-demand E-learning system for Clinical and Regulatory education for Physicians, Physician Advisors, Case managers, Utilization Review personnel and Hospital Administration.