Interview with Dr. Anjani Mahabashya
In today's podcast, internist Dr. Anjani Mahabashya describes her efforts to overcome adversity following a disabling injury sustained early in her medical career.
Anjali completed medical school in India. She immigrated to the U.S., completed several clinical rotations, and joined the McClaren Flint Internal Medicine Residency in Flint, Michigan. She completed her training in 2015.
After completing her residency, Dr. Mahabashya landed a job as a hospitalist. She worked as an Iowa hospitalist for 3 years. Then she moved to Harrisburg, Pennsylvania in 2018.
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Career Transition to Overcome Adversity
In 2019, she had a terrible fall. Anjani's healthcare insurance and visa qualification were jeopardized in the summer of 2020 when she could not return to her clinical position due to her injury. This is when her career transition started.
She decided to seek a utilization management physician advisor role. However, she struggled to find her first position. After becoming UM certified and speaking directly with the program director, she was hired by Geisinger Medical Center as a full-time physician advisor.
Dr. Mahabashya's Advice
…build a network, build connections, and be curious to learn new things.
Summary
Dr. Mahabashya left clinical work because of an injury. And she faced even more challenges than other physicians who decide to move to a new career. But by networking, finding a supportive sponsor in the new field, and obtaining additional certification she was able to find a fulfilling job that build on her clinical training and background.
NOTE: Look below for a transcript of today's episode.
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Links for Today's Episode:
- Dr. Anjani MahaBashya's LinkedIn Page
- Partnership for a Healthy Community in Central Pennsylvania
- Why Utilization Management Physician Advisor Is a Great Hospital Job – 230
- How to Go from UM Physician Advisor to Revenue Cycle CMO with Dr. Ralph Wuebker – 069
- The Journey From Career Loss to Physician Advocate with Dr. Stephanie Pearson – 023
- Meet the Modern Physician Advisor – Interview with Dr. Timothy Owolabi – 012
- NewScr!pt
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Transcription PNC Podcast Episode 253
How to Overcome Adversity and Find Success in a Nontraditional Career
John: I love having guests on here who have had a unique experience in transitioning to a nonclinical career. And it's not always about burnout. There are other reasons why people either choose or have to leave medicine. So, I'm really excited to have today's guests here with me. Welcome Dr. Anjani Mahabashya.
Anjani Mahabashya: Hello everyone. Thank you, Dr. Jurica for having me on today.
John: This is going to be really fun. We had a chance to talk before a little bit. Your story is very interesting and you have a lot of good insights and advice for our listeners, which is what we're all about here on the podcast.
Anjani Mahabashya: Yes, that is true.
John: All right. Let's see. Well, as usual we get right into it pretty quickly. What I would like you to tell me about a little bit is just your education, pretty much everybody on my show is a physician. So, tell us a little bit how you became a physician and about your residency, and then maybe segment at the end of that. Maybe go into a little bit about why you ended up switching out of clinical medicine.
Anjani Mahabashya: Sure. I wanted to become a doctor because I lost my father really young at age 12. And that was my only dream. I wanted to be a doctor and that's it. Because of the pain I experienced, I didn't want anybody else to lose a loved one. And I went to medical school in India and during my final year of my medical school, I also came to the US. I did my clerkships for about six months there. The fourth-year medical student rotations here. I went back, graduated in India and came back and did my residency in internal medicine in Michigan. I graduated in 2015 after which I had to work as a hospitalist in Iowa as an underserved area. It was on a JN visa waiver program at that time. And after I finished those three years, I moved to Harrisburg, Pennsylvania, again, as a hospitalist in 2018.
And the transition of my career happened just in one incident. And I would say that was a hallway that changed my life. It was 2019 of November, just a regular day as a hospitalist. I was walking through the hallway of an emergency room to admit one of my patients and I had a terrible fall. It was a rapid response and I was taken to the ER immediately. And the only way I walked out of the hospital that evening was on crutches. I went home on crutches and I couldn't sit, I couldn't stand, I couldn't use the restroom and I couldn't even get onto the bed. I didn't know getting onto the bed was so difficult. And I was by myself. I had nobody to help. I was a hospitalist who could do 20 shifts straight and not get tired. And I couldn't walk those 20 steps in my apartment.
I'm a chatterbox. You could ask anybody. But I lived inside my apartment for almost a year, all by myself, and that silence that I experienced was deafening. I kept worsening with my injury. I didn't know what was going on. Every time something new was getting added as a diagnosis, I ended up having a consequential injury in my good leg. And after that in summer of 2020, I was told that I had to be let go as a hospitalist and I couldn't return to the position. That was probably the most difficult situation for me because I had exhausted my FMLA. I had exhausted my short-term disability.
So, I had to trade my paid time off to be on the payroll and continue my healthcare insurance. That was very important because of the number of tests I was having, and the number of doctors' visits. And that was when I realized that, "Oh my God, all my years of training, this is all I know, being a doctor." I just don't know anything else and I didn't know what to do. And it did not immediately strike me to go into utilization management or physician advisor, but I had to think, I had to think something out of the box. I started looking for these kinds of roles, but again, I didn't have much success. I had some difficulties, but eventually I was hired by Geisinger Medical Center as a full-time physician advisor. And that's the reason that this transition happened.
John: Well, that is a very instructive story. I've only had maybe one or two other guests in almost 200 that I've interviewed that really had to leave because of an injury, or it could be an illness too but it's some type of disability. And we don't think about that. We never think about that when we're young and we're thinking about our future and all of this time and money and energy we've invested. And it can be taken away in a moment with something like this. The other guest that I talked to, where she was actually an obstetrician, was delivering a baby and she had an injury while she was delivering a baby, because the patient kicked her.
Anjani Mahabashya: Oh my God.
John: And she was unable to practice after that. And so, like you, then all of a sudden, you're faced with this catastrophe, like, "Okay, now what do I do?" Wow, it must have been hard at that time. Did you have some support in terms of just emotional support, friends, family, that were at least encouraging during this time?
Anjani Mahabashya: Definitely a couple of friends, but I think I was so tired of answering questions. And honestly, all my friends, nobody was in a situation like this, so nobody could guide me. I had the injury. I was dealing with worker's compensation. I was dealing with doctor's appointments. I was on a visa. I had the combination of the worst. So, I'm like, "Where am I going? Where am I heading?"
I think not that people couldn't be there, it was just too much for anybody. I had so much on my plate. And also, I'm a little bit of a private person. I'm like "Don't ask me the same story 1000 times, it's not changing." I was trying to work on more "How do I get out of this now? What is in my hand, what is not in my hand?" So, I started working towards that.
John: And the other thing you obviously have mentioned, and it just adds that other level of stress is the visa situation, because you had to find a job and do something that meant the qualifications to continue on that work visa. Correct?
Anjani Mahabashya: That is very true. That is very true.
John: Now how did you happen to choose becoming a physician advisor and working in utilization management? Did you know somebody? Did you just do some research? How did that come about?
Anjani Mahabashya: The hospital that I was working in had physician advisors, so I knew what it was. But again, that didn't strike me because I had advisors about taking up nocturnist physician or a primary care physician. But everything was very tasking. I had a boot in my leg and I had an injury in the other leg. So, I'm like, no, I cannot do justice to something that I can't really deteriorate further and I was trying to balance out something.
And when this struck me, I started looking for jobs as a physician advisor. And I wasn't having a lot of success mostly because I had absolutely no experience. I was just four and a half years out of residency. So, people were like, "You're too young. Why do you want to get out of medicine?" I couldn't convince people that, "No, I need this job. I don't care about money. I need to have a job. I need to have health insurance. I need to stay in the country."
And then I think in all honesty, it's God's timing that a physician advisor full-time role opened up in the Geisinger health system, but at a different location. And I actually took the initiative of writing to the medical director directly because he was still within the system and saying, "Hey, can we have a call?" I don't know him. And he was very kind Dr. Lesinski, he's my medical director, my boss. He was very kind to call me. And I told him very honestly, "Listen, I don't know anything about utilization management, but I will work very hard if you give me this job."
He actually set up a formal meeting with the leadership of utilization management. And I was also preparing for my UM board. So, I had the theory knowledge of UM and how it works. And I was able to answer every single question. I knew I could sense that I smashed the interview but I was just waiting to hear back from them. I did not hear back from them. And I'm like, I was preparing for the worst day, like the end of world kind of day for me alone. But then, I finished my board, I got the result. I passed my board. So, I informed my medical director "Hey, listen, I'm also board certified now." And I still did not get any confirmation. And finally, one day I was driving back from Hershey medical center after a doctor's appointment. And he called me and my heart was pounding. I'm like, "Oh my God, what is he going to say?" And he said, "Hey, I'm going on a vacation." And in my mind, I'm like, "Do I care?"
John: Yeah. Right.
Anjani Mahabashya: "But I wanted to tell you this before I leave. You got the position." I'm like, "Did you really just say that?" And that was actually my last day of trading a PTO to be on the payroll. And it was that close.
John: Wow. It worked out.
Anjani Mahabashya: It worked out. Yeah.
John: Probably from his perspective, even though you had told him that story now, he probably didn't really understand the severity or the intensity of the anxiety that you were having, the worry.
Anjani Mahabashya: Right.
John: Maybe the way I look at it too, and probably you wouldn't look at it this way, applying for the job, it's really hard to find someone that's a good physician advisor really.
Anjani Mahabashya: Yes.
John: There are a lot of jobs out there and a lot of physicians look at it as something they don't really want to do. But the reality is you know all the medical part of it, that's what UM is. You are trying to figure out what's indicated and whether this justifies something being done or not done, or admission or observation, and you have taken care of those patients. But physicians don't realize that when they're switching gears, like you did in this big way, they're like, "Well, this is brand new to me", but you have to be a physician. And you already had those years of experience. You can count what was in residency because you were taking care of patients. So, it's great. It worked out.
Anjani Mahabashya: Yes. I would like to add to that, he was aware of what was going on, but I think what was happening was the hospital that I was working in was bought by a different system. So, the contract said they couldn't take me. They had to work out those legal issues and I didn't know about it. And I'm like literally dying here of all kinds of anxiety. Once I knew why I had to wait, I was like, "Okay, now I feel better."
John: Yeah. Well, especially if you have a restrictive covenant, although technically that I think would refer to your clinical activities. It doesn't even refer to the nonclinical, but sounds like it was great that it worked out. So now, how did you happen to decide to go for the certification? I've heard of this certification through this board before. There might be others. Did you find others or is this just the one that stood out? And it was really the one that most people do.
Anjani Mahabashya: This was the one most people do. And like the physician advisor that was in the hospital where that I was working in, took these boards. So, I started inquiring about it. I had this growth mindset and I also felt that taking the boards would at least show some seriousness that I'm a stronger applicant and I'm serious about this. I started looking into it. I called the boards. I got some information from them and I started looking at Facebook forums and all these things.
And I fortunately found another physician who was planning to give this exam. So, I reached out and I said, "Hey, can we discuss topics? Can we study together?" And that was very important for me at that time, because I had injuries in both my legs. I had a procedure that I had to get done during my preparation. I was dealing with so many things, workers compensation. I needed a letter to extend my medical leave every 15 days, everything was just so stressful.
But having a study partner helped me stay motivated and be accountable and study every single day and not lose time. I got the material from the board and I literally studied every single line. I knew at the back of my head I could point out which line is there and which part of the material. And I did the questions over and over again. And before I went to the exam, I told one of my friends I will come out double board certified and I did.
John: Nice. Now, let me just ask a question about this particular board. Are there any required courses you have to take or is it basically based on an examination?
Anjani Mahabashya: It's just based on an examination. I think having a little bit of experience does help because I still found the exam very tough in spite of my vigorous preparation. But I think if you are very thorough with the material and you do the questions over and over again, and if you are a hospitalist, you do also understand how the system works. So, I think that is quite enough, for somebody like me in that timeline, I think this is enough, the material you get from the boards and the questions. Yeah.
John: And you made that point earlier, and I think it's true, we've talked about this before that if you are in the process, if you've taken the exam or if you're attending courses for a certification or you're doing something like that, that really can help psychologically to the recruiter, to the person that's looking for someone, "Okay, they're not just doing this on a whim. They are committed to this. They want to do this. It's not something where the person's going to leave in six months and do something else." And so, I should do a plug for the board. It's the American Board of Quality Assurance & Utilization Review Physicians. Right?
Anjani Mahabashya: That is correct. That is correct.
John: They're not a sponsor, but we got to plug them because they do help a lot of us physicians to get this information, that education and those jobs.
Anjani Mahabashya: And they're very approachable. I must have written a zillion emails to them at that time. And they responded appropriately and were very helpful on what to study.
John: And it has the word "physician" in it. So, it really is geared to physicians. There are other types, I've seen certifications where it's sort of any clinician can do it, a nurse, a physician, but this one is specifically for the physician reviewers.
Anjani Mahabashya: That is correct.
John: All right. Tell me what you like about this position now, or do you not like it?
Anjani Mahabashya: There is no not liking it because when I look back, I don't think I want to be anywhere else in my life other than being here. I absolutely love my role. I really enjoy my role and whatever I know today, I owe it to Dr. Lesinski, my medical director. I learned everything on the job.
John: Awesome. Tell me a little bit, maybe about what is a typical day for you doing this kind of work?
Anjani Mahabashya: I shuffled between the Geisinger Medical Center, the main hospital, which is almost a 600 bed hospital, and the five-satellite hospital, two weeks here, two weeks there. That actually gives me a lot of experience in a variety of cases. We have an inbuilt work queue system, already plugged into the epic. Based on the number of hours with different insurances, whether it is Medicare or the commercial insurances, the cases get pulled into the work queue automatically. And depending on which physician is assigned to which campus, they are just working through their work queue, the team flowing through the day. And we keep working through the work queue.
And the other thing is the utilization management nurses, who by the way, are the rock stars of our team. They're just excellent. And honestly, we couldn't do without them. They plug in some cases too, based on their reviews. And if there's something that doesn't get pulled in, or needs a manual input of what needs to be done. So, that's how the typical day is like. Depending on the campus, we see anywhere between 25 something cases in the tertiary hospital and about 20 in the satellite, because we have five satellite hospitals. That's how the typical day is. Plus, or minus five can get really busy, and can be like a lighter day. Every time after the long weekend, I'm like, "Okay, be prepared."
John: Oh yeah, yeah. On a long weekend. And then you got to catch up on all those cases that came in the last few days.
Anjani Mahabashya: Yeah, yeah.
John: It would seem to me that part of this could be done remotely because you're working on an EMR. But are you doing anything remotely or are you physically at the site usually?
Anjani Mahabashya: This is like an onsite role and I just live like one mile from the hospital, but when we are in the satellite hospitals, obviously I can't go there. I'm like an hour and a half away and stuff. So, if it's in the main campus, yeah. It's going to be onsite just to have that interaction with the physicians and it's better that way. Yeah.
John: Do you sometimes interact with physicians in an educational way? Not on an individual case, but do you occasionally get involved in doing education for the medical staff?
Anjani Mahabashya: Right. Actually, when I took up this role, it was quite challenging for me because I was a new face here and nobody knew me. My main focus was building that relationship and helping these physicians and myself know why. Why is this happening? I took up the initiative of presenting to the big guns off the hospital, the internal medicine, trauma surgery, and pediatrics, and telling them the why. Why do we need to do this? What does utilization management do? And how does it affect? Why should we stick with the Medicare guidelines and how it affects the revenue? And once the department saw the numbers, like what we lose, they were on high alert mode.
Then the third aspect was why is status important when we admit the patients? Because when they get discharged in an incorrect status, it leads to that dissatisfaction and the patient's satisfaction scores go down when they're like, "Oh, now you're going to get a bigger bill." I worked through that by going and presenting and talking to the physicians, initially my texts were super long trying to explain. And I always appreciated whenever I got their help. I was actively listening to the physicians and the medical directors of the insurance companies just to see where they're coming from. Because I was a physician and I was a hospitalist I know how cranky we can be until noon. So, I don't usually text or bug. I empathize with their busy days. I'm thinking about them before I shoot a text. Is it the right time? Can it wait? There are some charts that can wait, there's some charts that cannot wait. It depends on when we should get that done. It is always chart based, like a patient-based case. So, it's something like that.
John: Very nice. And it sounds like you're really getting good at it, getting efficient at it. You're getting to learn what the physicians prefer in terms of communication style. Do you want to call? Do you want to text? So, that sounds great. Anything new coming up with this job that you know of? I don't know if there's certain levels of things that people in that department do, physician advisors over time as they get better.
Anjani Mahabashya: As we get better, again, we focus on innovation. For example, last year, we started something called an alternate level of care, and this is to start tracking all these avoidable days when patients are waiting for replacements or their social issues. Just to see what is the dialogue we can have with the insurance companies in terms of payments instead of a complete nonpayment.
So, those are the things we kind of see. We see the trends, we see the revenues, we see where we are going. And I think these are the things usually. We take up one thing in a year, for example. And this year we wanted to look more into the Medicare short stays. We are very particular about "How do we build that? Are we going to self-deny or are we going to explain why the patient left within two midnights?"
I'm only one year, nine months into this role. This is the year that it's the short day year. Last year was the ALOC. When something like this is introduced, it comes down to, again, educating the physicians. So, we educate the physicians, we educate ourselves, it's always learning. And then we get into cruise control mode for some time, and then we have July and then all the new residents come in.
John: Oh yeah. You probably have to teach them quite a bit. Okay. So, things seem to be going really well at this point. Where do you see things going for yourself over the next few years?
Anjani Mahabashya: I struggled a few years back to answer that question. And I would also come up with these goofy answers that I would be like if I'm five years older, what would I be? But now I have a better idea. And as a physician advisor, when I talk to the medical directors, what we are all looking for is value-based care and providing care in the appropriate settings.
And added to that, my experience with partners for a healthy community, where I volunteer with senior citizens, has helped me understand what happens at a community level and the social determinants of health. And our senior citizens are very lonely. They don't have help. They don't have social support and I could immediately relate to that. I was able to spend time with them without having time constraints. And that eliminated those barriers too.
So, I see myself wanting to be a part of this changing landscape of healthcare, where I can form that connection between the health insurance companies and healthcare systems investing in the communities, because when we build a healthier community, the healthcare costs will automatically come down. Finally, I have the maturity to answer this question with all my experiences in life. So, I can answer this question with confidence now.
John: Yeah. It's good to see that there are other aspects that are related to what you're doing with your job that kind of definitely affect it and affect the care of patients. And I think you're right, we're going to have to really help the community and help keep people well, rather than waiting for them to come into the hospital. And so, this sounds like a great thing. Is this a voluntary activity? How much time do you spend doing this kind of thing?
Anjani Mahabashya: I'm actually in the leadership of the volunteer program too. I spend anywhere between 30 to 40 hours a month. Sometimes it's very busy, sometimes it's okay. But it takes a lot of behind the scenes work to get that ball rolling.
John: That is a significant commitment. And the thing is when you're doing that kind of thing, that's another thing that demonstrates your management and leadership skills and creates taking on new responsibilities, which can also help professionally. So, that is just awesome.
Anjani Mahabashya: Thank you.
John: Now let's swing back to the original thing that brought you to this job and some of the things that you had to overcome. What advice would you have for physicians, whether they're burnt out, whether they've had some issue like this? Sometimes people leave medicine because they have a sick family member they have to take care of. And then they just know they get flustered and they're not sure what to do. It sounded like you took some pretty logical steps. So, what kind of advice would you have for physicians in that position?
Anjani Mahabashya: I agree I was logical, but I was also very emotional and that's very human. And I think with COVID and how healthcare providers across the globe have stretched too far, I think it's important to take care of yourself. There are many people who go through many issues, whether it is an injury like me or you have a sick child. How can you provide care to somebody when your heart is aching? I just don't know. I couldn't imagine that.
I would say build a network, build connections and be curious to learn new things. And also add something to that new role you're thinking you're picking up because then you will feel that you are valued there. And also, you will like it, you love the role.
I think preparing for something like this has become very important at this time. And how healthcare is changing I think most importantly, all of us are trying to put the patients outside the hospital. So that is opening up new roles in terms of innovation or health coaching and many other fields. I would say if you're experiencing anything where you feel you are not able to perform at your best level, because nobody stays in the hospital. We go into the hospital, nobody is happy. You get so drained. And when you come home, you are either alone or you have more responsibilities. There is nobody to say "Are you okay?" I think it's important to take care of yourself. And if somebody has to switch to a nonclinical career, temporarily or permanently to take care of yourself, I would really say go for it please.
John: Yeah. And some of the coaches I've talked to, they said, first of all, just take a deep breath and pause. And if you have to take a few days, weeks off to really start to think about what you need. But the thing I wanted to get back that you mentioned just a second ago, and at the beginning you talked about networking, make sure you have a network of connections and friends.
But the thing is you reached out to somebody that somehow you had identified. And I talked to a lot of physicians who may be looking for a UM job or a CDI job or something for months and months and years and years. Well, they're just putting an electronic resume into a job site or something. They don't have that connection with a single person.
So, you did that. You reached out to a single person. It doesn't mean that person was going to solve your problem, but in your case, it worked out. And in other cases, it does. If you have somebody you can identify, they may or may not be the decision maker, but they can be your sponsor. They can be your supporters. They can be your connection. So, I don't want that point to be missed either.
Anjani Mahabashya: Yes. You only have a one-person chance, but that one-person chance is enough for your life. And I took that chance.
John: Yeah. And it worked out great. So, this has been a really good story. Luckily, it seems to have had a happy ending. We'll have to circle back sometime in the future and see what else you've been up to after you get a really complete pro at this job. There are usually opportunities in the hospital for leadership and management positions for physicians in this situation, if they're doing a good job and then they can help build that team and so forth. I think things are going to continue to do really well for you. And I think some of our listeners might want to get a hold of you and ask you a couple of questions. What do you think? Is LinkedIn probably the best way to do that?
Anjani Mahabashya: Yes. LinkedIn is the best way to do that. My message option is open for everybody. So, you could just shoot me a message, anything you need. If you want to even cry out to me, you are welcome.
John: Yeah. If you look for Anjani Mahabashya, you will find her, it comes right up. There aren't that many Anjani Mahabashya out there. I don't think so.
Anjani Mahabashya: Yes.
John: So, I'll put the link in, or at least make sure they have the spelling of your name and all that in case they have questions. I know this has been fun. It is a great story and I congratulate you. Yeah, I think it's a good example for others to have faith, even when there's so many things that have possibly gone wrong, that there is a way out and be hopeful and positive.
Anjani Mahabashya: That is very true. Yeah. I think the underlying message is that of hope and make sure you take care of yourself and when your cup is full, give back something to the community.
John: All right. Anjani, I really appreciate you coming on today. I think with that, I'll just have to say goodbye.
Anjani Mahabashya: All right, goodbye. Thank you everyone.
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Transcription PNC Podcast Episode 253
How to Overcome Adversity and Find Success in a Nontraditional Career
John: I love having guests on here who have had a unique experience in transitioning to a nonclinical career. And it's not always about burnout. There are other reasons why people either choose or have to leave medicine. So, I'm really excited to have today's guests here with me. Welcome Dr. Anjani Mahabashya.
Anjani Mahabashya: Hello everyone. Thank you, Dr. Jurica for having me on today.
John: This is going to be really fun. We had a chance to talk before a little bit. Your story is very interesting and you have a lot of good insights and advice for our listeners, which is what we're all about here on the podcast.
Anjani Mahabashya: Yes, that is true.
John: All right. Let's see. Well, as usual we get right into it pretty quickly. What I would like you to tell me about a little bit is just your education, pretty much everybody on my show is a physician. So, tell us a little bit how you became a physician and about your residency, and then maybe segment at the end of that. Maybe go into a little bit about why you ended up switching out of clinical medicine.
Anjani Mahabashya: Sure. I wanted to become a doctor because I lost my father really young at age 12. And that was my only dream. I wanted to be a doctor and that's it. Because of the pain I experienced, I didn't want anybody else to lose a loved one. And I went to medical school in India and during my final year of my medical school, I also came to the US. I did my clerkships for about six months there. The fourth-year medical student rotations here. I went back, graduated in India and came back and did my residency in internal medicine in Michigan. I graduated in 2015 after which I had to work as a hospitalist in Iowa as an underserved area. It was on a JN visa waiver program at that time. And after I finished those three years, I moved to Harrisburg, Pennsylvania, again, as a hospitalist in 2018.
And the transition of my career happened just in one incident. And I would say that was a hallway that changed my life. It was 2019 of November, just a regular day as a hospitalist. I was walking through the hallway of an emergency room to admit one of my patients and I had a terrible fall. It was a rapid response and I was taken to the ER immediately. And the only way I walked out of the hospital that evening was on crutches. I went home on crutches and I couldn't sit, I couldn't stand, I couldn't use the restroom and I couldn't even get onto the bed. I didn't know getting onto the bed was so difficult. And I was by myself. I had nobody to help. I was a hospitalist who could do 20 shifts straight and not get tired. And I couldn't walk those 20 steps in my apartment.
I'm a chatterbox. You could ask anybody. But I lived inside my apartment for almost a year, all by myself, and that silence that I experienced was deafening. I kept worsening with my injury. I didn't know what was going on. Every time something new was getting added as a diagnosis, I ended up having a consequential injury in my good leg. And after that in summer of 2020, I was told that I had to be let go as a hospitalist and I couldn't return to the position. That was probably the most difficult situation for me because I had exhausted my FMLA. I had exhausted my short-term disability.
So, I had to trade my paid time off to be on the payroll and continue my healthcare insurance. That was very important because of the number of tests I was having, and the number of doctors' visits. And that was when I realized that, "Oh my God, all my years of training, this is all I know, being a doctor." I just don't know anything else and I didn't know what to do. And it did not immediately strike me to go into utilization management or physician advisor, but I had to think, I had to think something out of the box. I started looking for these kinds of roles, but again, I didn't have much success. I had some difficulties, but eventually I was hired by Geisinger Medical Center as a full-time physician advisor. And that's the reason that this transition happened.
John: Well, that is a very instructive story. I've only had maybe one or two other guests in almost 200 that I've interviewed that really had to leave because of an injury, or it could be an illness too but it's some type of disability. And we don't think about that. We never think about that when we're young and we're thinking about our future and all of this time and money and energy we've invested. And it can be taken away in a moment with something like this. The other guest that I talked to, where she was actually an obstetrician, was delivering a baby and she had an injury while she was delivering a baby, because the patient kicked her.
Anjani Mahabashya: Oh my God.
John: And she was unable to practice after that. And so, like you, then all of a sudden, you're faced with this catastrophe, like, "Okay, now what do I do?" Wow, it must have been hard at that time. Did you have some support in terms of just emotional support, friends, family, that were at least encouraging during this time?
Anjani Mahabashya: Definitely a couple of friends, but I think I was so tired of answering questions. And honestly, all my friends, nobody was in a situation like this, so nobody could guide me. I had the injury. I was dealing with worker's compensation. I was dealing with doctor's appointments. I was on a visa. I had the combination of the worst. So, I'm like, "Where am I going? Where am I heading?"
I think not that people couldn't be there, it was just too much for anybody. I had so much on my plate. And also, I'm a little bit of a private person. I'm like "Don't ask me the same story 1000 times, it's not changing." I was trying to work on more "How do I get out of this now? What is in my hand, what is not in my hand?" So, I started working towards that.
John: And the other thing you obviously have mentioned, and it just adds that other level of stress is the visa situation, because you had to find a job and do something that meant the qualifications to continue on that work visa. Correct?
Anjani Mahabashya: That is very true. That is very true.
John: Now how did you happen to choose becoming a physician advisor and working in utilization management? Did you know somebody? Did you just do some research? How did that come about?
Anjani Mahabashya: The hospital that I was working in had physician advisors, so I knew what it was. But again, that didn't strike me because I had advisors about taking up nocturnist physician or a primary care physician. But everything was very tasking. I had a boot in my leg and I had an injury in the other leg. So, I'm like, no, I cannot do justice to something that I can't really deteriorate further and I was trying to balance out something.
And when this struck me, I started looking for jobs as a physician advisor. And I wasn't having a lot of success mostly because I had absolutely no experience. I was just four and a half years out of residency. So, people were like, "You're too young. Why do you want to get out of medicine?" I couldn't convince people that, "No, I need this job. I don't care about money. I need to have a job. I need to have health insurance. I need to stay in the country."
And then I think in all honesty, it's God's timing that a physician advisor full-time role opened up in the Geisinger health system, but at a different location. And I actually took the initiative of writing to the medical director directly because he was still within the system and saying, "Hey, can we have a call?" I don't know him. And he was very kind Dr. Lesinski, he's my medical director, my boss. He was very kind to call me. And I told him very honestly, "Listen, I don't know anything about utilization management, but I will work very hard if you give me this job."
He actually set up a formal meeting with the leadership of utilization management. And I was also preparing for my UM board. So, I had the theory knowledge of UM and how it works. And I was able to answer every single question. I knew I could sense that I smashed the interview but I was just waiting to hear back from them. I did not hear back from them. And I'm like, I was preparing for the worst day, like the end of world kind of day for me alone. But then, I finished my board, I got the result. I passed my board. So, I informed my medical director "Hey, listen, I'm also board certified now." And I still did not get any confirmation. And finally, one day I was driving back from Hershey medical center after a doctor's appointment. And he called me and my heart was pounding. I'm like, "Oh my God, what is he going to say?" And he said, "Hey, I'm going on a vacation." And in my mind, I'm like, "Do I care?"
John: Yeah. Right.
Anjani Mahabashya: "But I wanted to tell you this before I leave. You got the position." I'm like, "Did you really just say that?" And that was actually my last day of trading a PTO to be on the payroll. And it was that close.
John: Wow. It worked out.
Anjani Mahabashya: It worked out. Yeah.
John: Probably from his perspective, even though you had told him that story now, he probably didn't really understand the severity or the intensity of the anxiety that you were having, the worry.
Anjani Mahabashya: Right.
John: Maybe the way I look at it too, and probably you wouldn't look at it this way, applying for the job, it's really hard to find someone that's a good physician advisor really.
Anjani Mahabashya: Yes.
John: There are a lot of jobs out there and a lot of physicians look at it as something they don't really want to do. But the reality is you know all the medical part of it, that's what UM is. You are trying to figure out what's indicated and whether this justifies something being done or not done, or admission or observation, and you have taken care of those patients. But physicians don't realize that when they're switching gears, like you did in this big way, they're like, "Well, this is brand new to me", but you have to be a physician. And you already had those years of experience. You can count what was in residency because you were taking care of patients. So, it's great. It worked out.
Anjani Mahabashya: Yes. I would like to add to that, he was aware of what was going on, but I think what was happening was the hospital that I was working in was bought by a different system. So, the contract said they couldn't take me. They had to work out those legal issues and I didn't know about it. And I'm like literally dying here of all kinds of anxiety. Once I knew why I had to wait, I was like, "Okay, now I feel better."
John: Yeah. Well, especially if you have a restrictive covenant, although technically that I think would refer to your clinical activities. It doesn't even refer to the nonclinical, but sounds like it was great that it worked out. So now, how did you happen to decide to go for the certification? I've heard of this certification through this board before. There might be others. Did you find others or is this just the one that stood out? And it was really the one that most people do.
Anjani Mahabashya: This was the one most people do. And like the physician advisor that was in the hospital where that I was working in, took these boards. So, I started inquiring about it. I had this growth mindset and I also felt that taking the boards would at least show some seriousness that I'm a stronger applicant and I'm serious about this. I started looking into it. I called the boards. I got some information from them and I started looking at Facebook forums and all these things.
And I fortunately found another physician who was planning to give this exam. So, I reached out and I said, "Hey, can we discuss topics? Can we study together?" And that was very important for me at that time, because I had injuries in both my legs. I had a procedure that I had to get done during my preparation. I was dealing with so many things, workers compensation. I needed a letter to extend my medical leave every 15 days, everything was just so stressful.
But having a study partner helped me stay motivated and be accountable and study every single day and not lose time. I got the material from the board and I literally studied every single line. I knew at the back of my head I could point out which line is there and which part of the material. And I did the questions over and over again. And before I went to the exam, I told one of my friends I will come out double board certified and I did.
John: Nice. Now, let me just ask a question about this particular board. Are there any required courses you have to take or is it basically based on an examination?
Anjani Mahabashya: It's just based on an examination. I think having a little bit of experience does help because I still found the exam very tough in spite of my vigorous preparation. But I think if you are very thorough with the material and you do the questions over and over again, and if you are a hospitalist, you do also understand how the system works. So, I think that is quite enough, for somebody like me in that timeline, I think this is enough, the material you get from the boards and the questions. Yeah.
John: And you made that point earlier, and I think it's true, we've talked about this before that if you are in the process, if you've taken the exam or if you're attending courses for a certification or you're doing something like that, that really can help psychologically to the recruiter, to the person that's looking for someone, "Okay, they're not just doing this on a whim. They are committed to this. They want to do this. It's not something where the person's going to leave in six months and do something else." And so, I should do a plug for the board. It's the American Board of Quality Assurance & Utilization Review Physicians. Right?
Anjani Mahabashya: That is correct. That is correct.
John: They're not a sponsor, but we got to plug them because they do help a lot of us physicians to get this information, that education and those jobs.
Anjani Mahabashya: And they're very approachable. I must have written a zillion emails to them at that time. And they responded appropriately and were very helpful on what to study.
John: And it has the word "physician" in it. So, it really is geared to physicians. There are other types, I've seen certifications where it's sort of any clinician can do it, a nurse, a physician, but this one is specifically for the physician reviewers.
Anjani Mahabashya: That is correct.
John: All right. Tell me what you like about this position now, or do you not like it?
Anjani Mahabashya: There is no not liking it because when I look back, I don't think I want to be anywhere else in my life other than being here. I absolutely love my role. I really enjoy my role and whatever I know today, I owe it to Dr. Lesinski, my medical director. I learned everything on the job.
John: Awesome. Tell me a little bit, maybe about what is a typical day for you doing this kind of work?
Anjani Mahabashya: I shuffled between the Geisinger Medical Center, the main hospital, which is almost a 600 bed hospital, and the five-satellite hospital, two weeks here, two weeks there. That actually gives me a lot of experience in a variety of cases. We have an inbuilt work queue system, already plugged into the epic. Based on the number of hours with different insurances, whether it is Medicare or the commercial insurances, the cases get pulled into the work queue automatically. And depending on which physician is assigned to which campus, they are just working through their work queue, the team flowing through the day. And we keep working through the work queue.
And the other thing is the utilization management nurses, who by the way, are the rock stars of our team. They're just excellent. And honestly, we couldn't do without them. They plug in some cases too, based on their reviews. And if there's something that doesn't get pulled in, or needs a manual input of what needs to be done. So, that's how the typical day is like. Depending on the campus, we see anywhere between 25 something cases in the tertiary hospital and about 20 in the satellite, because we have five satellite hospitals. That's how the typical day is. Plus, or minus five can get really busy, and can be like a lighter day. Every time after the long weekend, I'm like, "Okay, be prepared."
John: Oh yeah, yeah. On a long weekend. And then you got to catch up on all those cases that came in the last few days.
Anjani Mahabashya: Yeah, yeah.
John: It would seem to me that part of this could be done remotely because you're working on an EMR. But are you doing anything remotely or are you physically at the site usually?
Anjani Mahabashya: This is like an onsite role and I just live like one mile from the hospital, but when we are in the satellite hospitals, obviously I can't go there. I'm like an hour and a half away and stuff. So, if it's in the main campus, yeah. It's going to be onsite just to have that interaction with the physicians and it's better that way. Yeah.
John: Do you sometimes interact with physicians in an educational way? Not on an individual case, but do you occasionally get involved in doing education for the medical staff?
Anjani Mahabashya: Right. Actually, when I took up this role, it was quite challenging for me because I was a new face here and nobody knew me. My main focus was building that relationship and helping these physicians and myself know why. Why is this happening? I took up the initiative of presenting to the big guns off the hospital, the internal medicine, trauma surgery, and pediatrics, and telling them the why. Why do we need to do this? What does utilization management do? And how does it affect? Why should we stick with the Medicare guidelines and how it affects the revenue? And once the department saw the numbers, like what we lose, they were on high alert mode.
Then the third aspect was why is status important when we admit the patients? Because when they get discharged in an incorrect status, it leads to that dissatisfaction and the patient's satisfaction scores go down when they're like, "Oh, now you're going to get a bigger bill." I worked through that by going and presenting and talking to the physicians, initially my texts were super long trying to explain. And I always appreciated whenever I got their help. I was actively listening to the physicians and the medical directors of the insurance companies just to see where they're coming from. Because I was a physician and I was a hospitalist I know how cranky we can be until noon. So, I don't usually text or bug. I empathize with their busy days. I'm thinking about them before I shoot a text. Is it the right time? Can it wait? There are some charts that can wait, there's some charts that cannot wait. It depends on when we should get that done. It is always chart based, like a patient-based case. So, it's something like that.
John: Very nice. And it sounds like you're really getting good at it, getting efficient at it. You're getting to learn what the physicians prefer in terms of communication style. Do you want to call? Do you want to text? So, that sounds great. Anything new coming up with this job that you know of? I don't know if there's certain levels of things that people in that department do, physician advisors over time as they get better.
Anjani Mahabashya: As we get better, again, we focus on innovation. For example, last year, we started something called an alternate level of care, and this is to start tracking all these avoidable days when patients are waiting for replacements or their social issues. Just to see what is the dialogue we can have with the insurance companies in terms of payments instead of a complete nonpayment.
So, those are the things we kind of see. We see the trends, we see the revenues, we see where we are going. And I think these are the things usually. We take up one thing in a year, for example. And this year we wanted to look more into the Medicare short stays. We are very particular about "How do we build that? Are we going to self-deny or are we going to explain why the patient left within two midnights?"
I'm only one year, nine months into this role. This is the year that it's the short day year. Last year was the ALOC. When something like this is introduced, it comes down to, again, educating the physicians. So, we educate the physicians, we educate ourselves, it's always learning. And then we get into cruise control mode for some time, and then we have July and then all the new residents come in.
John: Oh yeah. You probably have to teach them quite a bit. Okay. So, things seem to be going really well at this point. Where do you see things going for yourself over the next few years?
Anjani Mahabashya: I struggled a few years back to answer that question. And I would also come up with these goofy answers that I would be like if I'm five years older, what would I be? But now I have a better idea. And as a physician advisor, when I talk to the medical directors, what we are all looking for is value-based care and providing care in the appropriate settings.
And added to that, my experience with partners for a healthy community, where I volunteer with senior citizens, has helped me understand what happens at a community level and the social determinants of health. And our senior citizens are very lonely. They don't have help. They don't have social support and I could immediately relate to that. I was able to spend time with them without having time constraints. And that eliminated those barriers too.
So, I see myself wanting to be a part of this changing landscape of healthcare, where I can form that connection between the health insurance companies and healthcare systems investing in the communities, because when we build a healthier community, the healthcare costs will automatically come down. Finally, I have the maturity to answer this question with all my experiences in life. So, I can answer this question with confidence now.
John: Yeah. It's good to see that there are other aspects that are related to what you're doing with your job that kind of definitely affect it and affect the care of patients. And I think you're right, we're going to have to really help the community and help keep people well, rather than waiting for them to come into the hospital. And so, this sounds like a great thing. Is this a voluntary activity? How much time do you spend doing this kind of thing?
Anjani Mahabashya: I'm actually in the leadership of the volunteer program too. I spend anywhere between 30 to 40 hours a month. Sometimes it's very busy, sometimes it's okay. But it takes a lot of behind the scenes work to get that ball rolling.
John: That is a significant commitment. And the thing is when you're doing that kind of thing, that's another thing that demonstrates your management and leadership skills and creates taking on new responsibilities, which can also help professionally. So, that is just awesome.
Anjani Mahabashya: Thank you.
John: Now let's swing back to the original thing that brought you to this job and some of the things that you had to overcome. What advice would you have for physicians, whether they're burnt out, whether they've had some issue like this? Sometimes people leave medicine because they have a sick family member they have to take care of. And then they just know they get flustered and they're not sure what to do. It sounded like you took some pretty logical steps. So, what kind of advice would you have for physicians in that position?
Anjani Mahabashya: I agree I was logical, but I was also very emotional and that's very human. And I think with COVID and how healthcare providers across the globe have stretched too far, I think it's important to take care of yourself. There are many people who go through many issues, whether it is an injury like me or you have a sick child. How can you provide care to somebody when your heart is aching? I just don't know. I couldn't imagine that.
I would say build a network, build connections and be curious to learn new things. And also add something to that new role you're thinking you're picking up because then you will feel that you are valued there. And also, you will like it, you love the role.
I think preparing for something like this has become very important at this time. And how healthcare is changing I think most importantly, all of us are trying to put the patients outside the hospital. So that is opening up new roles in terms of innovation or health coaching and many other fields. I would say if you're experiencing anything where you feel you are not able to perform at your best level, because nobody stays in the hospital. We go into the hospital, nobody is happy. You get so drained. And when you come home, you are either alone or you have more responsibilities. There is nobody to say "Are you okay?" I think it's important to take care of yourself. And if somebody has to switch to a nonclinical career, temporarily or permanently to take care of yourself, I would really say go for it please.
John: Yeah. And some of the coaches I've talked to, they said, first of all, just take a deep breath and pause. And if you have to take a few days, weeks off to really start to think about what you need. But the thing I wanted to get back that you mentioned just a second ago, and at the beginning you talked about networking, make sure you have a network of connections and friends.
But the thing is you reached out to somebody that somehow you had identified. And I talked to a lot of physicians who may be looking for a UM job or a CDI job or something for months and months and years and years. Well, they're just putting an electronic resume into a job site or something. They don't have that connection with a single person.
So, you did that. You reached out to a single person. It doesn't mean that person was going to solve your problem, but in your case, it worked out. And in other cases, it does. If you have somebody you can identify, they may or may not be the decision maker, but they can be your sponsor. They can be your supporters. They can be your connection. So, I don't want that point to be missed either.
Anjani Mahabashya: Yes. You only have a one-person chance, but that one-person chance is enough for your life. And I took that chance.
John: Yeah. And it worked out great. So, this has been a really good story. Luckily, it seems to have had a happy ending. We'll have to circle back sometime in the future and see what else you've been up to after you get a really complete pro at this job. There are usually opportunities in the hospital for leadership and management positions for physicians in this situation, if they're doing a good job and then they can help build that team and so forth. I think things are going to continue to do really well for you. And I think some of our listeners might want to get a hold of you and ask you a couple of questions. What do you think? Is LinkedIn probably the best way to do that?
Anjani Mahabashya: Yes. LinkedIn is the best way to do that. My message option is open for everybody. So, you could just shoot me a message, anything you need. If you want to even cry out to me, you are welcome.
John: Yeah. If you look for Anjani Mahabashya, you will find her, it comes right up. There aren't that many Anjani Mahabashya out there. I don't think so.
Anjani Mahabashya: Yes.
John: So, I'll put the link in, or at least make sure they have the spelling of your name and all that in case they have questions. I know this has been fun. It is a great story and I congratulate you. Yeah, I think it's a good example for others to have faith, even when there's so many things that have possibly gone wrong, that there is a way out and be hopeful and positive.
Anjani Mahabashya: That is very true. Yeah. I think the underlying message is that of hope and make sure you take care of yourself and when your cup is full, give back something to the community.
John: All right. Anjani, I really appreciate you coming on today. I think with that, I'll just have to say goodbye.
Anjani Mahabashya: All right, goodbye. Thank you everyone.
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