The Truth About Medical Specialists and UM Jobs

Today's PNC Podcast Transcript

Email Download New Tab

The Truth About Medical Specialists and UM Jobs

Interview from the Archives with Dr. Rich Berning - 340

Released originally on May 8, 2019

John Jurica: Hello, everybody. This is John Jurica. You may remember that I presented a lecture or two, actually last month at the Physicians Helping Physicians Conference in Austin. While I was there, I had a chance to meet Rich Berning. He's my guest today. So, let's welcome Rich to the podcast. Hello!

Rich Berning: Hi, John. Thank you so much for having me on your podcast. I have to tell you, I'm an avid fan. I've listened to you in my car. I've listened to you riding in my tractor, cutting my grass. It's always great to hear what everybody is up to and opportunities of how you can use your medical knowledge. I really appreciate the opportunity to be on your show.

John Jurica: Well, I'm glad you're here because the area that we're going to talk about today is really... it's been around a long time. It's very popular, it's very necessary, so I do appreciate your kind words, though. It's always good to know that somebody is out there listening. It's great that you're doing that. I appreciate it.

We met at the meeting, and I found out that you're a full-time Medical Director, working for an insurance company or...I'm not sure that's the right term, but I've given a little bit of an introduction as far as your background, but maybe you want to give us the short version of what you did in the past before getting into this Medical Director role.

Rich Berning: Sure. Well, I went to medical school at University of Cincinnati College of Medicine. After graduating from there, I did a pediatric residency at Stanford in California. So, it was great to escape the Midwest and see how the West Coast lives. After that, I decided to stay for a little while longer, so I got a fellowship in pediatric cardiology at UC San Francisco. After that, I went east and married a girl from Connecticut. So, I ended up spending 20 years in Connecticut and was in private practice.

That was great. I loved my patients. I loved the practice. But with all the changes that were coming, I was ready for a change and I got an opportunity to join Anthem Healthcare and Anthem Insurance. Not knowing anything about it, I pretty much took the leap. I worked there for five years, and out of nowhere, I got an opportunity to... an invitation from a headhunter on LinkedIn to look at another opportunity at the state level. I thought it was a good learning opportunity and a good opportunity overall. So, I'm currently transitioning right now to the state level plan in the Mideast.

John Jurica: Very cool, that's great. That's neat because...you hadn't had any, let's say, dedicated time working in, let's say, utilization management or a related field while you were working clinically, is that right?

Rich Berning: No. That's correct, and I always tell people that. A couple of things I tell people, you get on-the-job training, if you get hired by a health insurance company many times, but it is good. I know you had utilization management experience. That definitely gets you found, if you're looking for this kind of a job, but they were just looking. These health plans need doctors of every specialty, and they want you for your medical knowledge. They'll teach you what you need to know in terms of the administrative plan.

To me, that was always helpful because before when I was starting to look for an opportunity, kind of a non-clinical opportunity, and I wasn't necessarily looking for a full-time one, I thought I'd get into the health informatics world, which I really still have an interest in. But I found it to be pretty hard. You pretty much had to get a Master's level degree at minimum, and you had to get hospital experience, and at least in the late...or mid-2000s, a lot of people were trying to do that. So, you'd be volunteering to work in the hospital IT department helping people learn Epic or whatever health system...or informatic system they were implementing.

As I looked further and further into it, 1. it was going to be a salary cut for me, and it was also going to be a long path to a leadership position. I was thinking, I ultimately wanted a new career path. In health insurance, everything is faster. You start out at a director level and you just pretty much come in with your medical experience and knowledge. It just seems to be a much quicker path in my opinion.

John Jurica: Very nice. Yes, I think... it depends, I guess, on the exact job. But just being a clinician, particularly if you end up doing work that applies to your specialty, which probably wasn't applicable to you per se, if you're an internist and you're doing UM and you're evaluating and talking with other internists, it's kind of a no-brainer. For you, it maybe was a little bit more interesting and challenging. How did that work? You were seeing kids with heart problems. How did that training go?

Rich Berning: Well, first of all, it was like going back to medical school because, at this point, you're learning how to implement the medical policy and the medical policy covers the entire span of medicine. At this point, I review cases for back surgery, for chemotherapy, for eye surgery. Having a subspecialty gives you definitely an edge in many ways. Before I snake into that, let me say the vast majority of medical directors primarily are primary care doctors or general surgeons. They're probably more of family practice and internal medicine-trained doctors as medical directors, than there are specialists.

When you're talking about trying to manage costs of health care, which is what this job is and also population health and population management, for me in particular, having pediatric cardiology experience and having spent a lot of my time in intensive care units and newborn intensive care units, those are the higher cost. There aren't many babies who graduate from a newborn intensive care course, if you will, that aren't $500,000 or a million dollars in cost. You come into a health plan as a medical director thinking you're going to be just on day-to-day management, which you do of the routine medical care. All of a sudden, you find yourself being invited to committees trying to figure out, how we can lower costs? Or, how can we get better care to the patient? How can we keep them out of the hospital?

That's when you really start using all your experience and knowledge, and that's the interesting part for me.

John Jurica: That's pretty interesting because I never thought about that. But if you're an internist or a family doctor, and you're trying to have a conversation about doing an abdominal CT scan or something, which they may not even review anymore, as opposed to another week in the NICU or some neurosurgical procedure or something, I could see how that would have a lot more leverage for that physician.

Rich Berning: Definitely, and the other thing is there's a process for everything. I have to be honest with you, I didn't even deal much with medical policy. In pediatric cardiology, there isn't much there as a policy. So, things are either very routine or things that are very rare, the medical policy committee doesn't write a policy about. In general, if there's not a policy, it's going to be approved. If it's going to be approved, you're not going to get a denial letter. It's the more common procedures or the ones where there's maybe not as much clinical evidence, peer-reviewed journal evidence that get medical policies, and those are the ones you get the peer-to-peer calls on.

For me, I didn't have much experience. The only time I had peer-to-peer call experience as a practicing physician was when I started to order gene testing for my patients with cardiomyopathies and certain arrhythmias. Then, I have to get on the phone because all the health plans have a medical policy around gene testing right now because there's always two sides to every story, but there's not a lot of evidence that it changes the clinical care. Certain circumstances it does, but these tests are very expensive, and they want to test for one thing. But they get panels to test, which might have 300 tests. Suddenly, you have a bill for $20,000 for a gene test, but you really only wanted one of the tests.

Anyway, I got on the phone requesting payment or coverage for my patient to get a certain gene test, especially if like one of the siblings had a genetic problem, you want to see if the other one would have it. That was my only real experience with that. The other thing...well, I mentioned already, but you get involved with case management. When you're dealing with individual patients who are in the hospital for a long time or they keep coming back to the ER, then I might get on the phone now as a medical director with those doctors. What's going on with your patient? How can we help you keep them healthy? Keep them out of the hospital? It is good to have the same specialty.

I know what I was getting into?when you get a denial for a peer to peer or a denial for a request that you make as a doctor, you put the opportunity to 1. a peer-to-peer call. A peer-to-peer call is not really an appeal level, that's a misconception a lot of doctors have. It's really a chance to say, "Let's have a conversation about maybe why the medical policy doesn't apply," or, "You didn't give me all the information so I could check all the boxes, so I couldn't approve it. But maybe you could tell me over the phone, and I can get this process expeditiously for you." If after the peer-to-peer call you still can't make the policy meet, so you still can't say, "All right, it's approved, or we're going to pay for it."

The doctor or patient has at least two levels of appeal in most states. Sometimes, it's three. The second-level appeal will go to a higher-level medical director in the health plan who, again, may make a phone call. But it also gives you the opportunity, as a physician, to send in other things you think might support your case?journal articles, recent journal articles. Medical policy, as much as they try to keep it up to date, is probably a few years behind. Things are changing all the time and you can submit papers and other support, and then at the second level, which is really the first level of appeal, the medical director might say, "Yes, this meets. We're going to overturn Berning's denial of this, and we're going to approve it.

Now, if the second level of appeal still doesn't get an approval, then there's a third level. In many states, it has to be an external review, has to be a same specialty doctor, and all the paperwork and all the supporting documents get sent to that physician. They usually are practicing full time, and they can say, "Yes, this is how it's being done now. Health plan needs to pay for this." That's the opportunity for your listeners to get experience as a medical director because that's one way. There's lots of independent review organizations that hire you and the requirements are that you're actively in practice and you're the same specialty. You'll be doing those types of appeals, and it's fairly lucrative. The nice thing is, many times you get to say, "Health plan, you're wrong. Pay for this patient's procedure or this drug." They have to do it based on your review.

John Jurica: Very nice. I need to clarify several things here, but you alluded to a lot of different things that I want to just point out, and then maybe ask a question. First of all, you mentioned LinkedIn, way back at the beginning, about how you found this most recent job. The only reason I mention that is we're talking about...I think the terms we've thrown out here as a medical director is utilization management and case management. The reason I want to clarify that for the listeners is because if they haven't don't it before, they may not really even know the difference - if there is a difference. Those would be terms that one would put let's say in a LinkedIn profile, if they're looking for something like that, right? Why don't you kind of explain the difference between those two?

Rich Berning: Okay. There's actually three that you should?

John Jurica: Okay, good.

Rich Berning: ?tell about. When we use the abbreviation UR, utilization review, that's the pre- and post-service reviews, so that's the pre-determination. You're going to do a vein ablation on your patient, every medical health plan has a varicose vein policy for treatment, whether it's sclerotherapy or ablation or phlebectomy. You want to get that reviewed by the health plan before you do anything, before you spend any money on your sclerotherapy chemical or you get an operating room set up. Those come to us as pre-determinations or pre-service reviews. Then, we will say, ?yes? or ?no,? or, "This is why we have to say ?no?," and then you can give us the supporting information and say, "Okay, now we can approve it. You can go ahead. It's going to be paid when you submit your bill using the CPT codes."

The back side is post claims or post reviews...I'm sorry, post-service, which is claims, this is after you've done a procedure. Now, you?ve submitted the bill; goes through the same process. The bad thing is a lot of times you were supposed to send certain photographs or certain measurements or something beforehand, and now you don't have the opportunity because you've ablated the vein or whatever, so it puts you in a bind. That utilization review is either pre- or post-service...that's kind of the bread-and-butter, everyday work that we all do.

Utilization management, that's the reviews of the clinical inpatient for the most part, surgeries, certain things. Is this going to be an observation? Observation gets paid at a certain level. No, it meets the criteria for full-inpatient admission, and it meets whichever criteria you're using. We typically use either MCG, which is Milliman Clinical Guidelines, or we use InterQual. Those are the two standard kinds of reviews...sets of criteria that we use. Certain hospitals, certain states, certain health plans...my first health plan, we used Milliman. At this health plan I'm working for, it's all InterQual.

John Jurica: Oh, okay.

Rich Berning: There's training on that, so it's a little different. One thing that you might have gotten really used to denying in Milliman, I'm realizing now InterQual is a little more lenient in some things, tighter in others. You basically have to just make sure you understand all the information. Sometimes we actually reach out to the provider who's taking care of the patient, and it's pretty much ongoing. If your patient gets admitted tonight, there's going to be a review tonight or tomorrow morning, and it goes to my nurse.

I have teams of nurses I work with, and they review it first. If they can approve it, then they approve it. If they say, "There's stuff that's missing, or it's a really gray area," they send it to the medical director, and then we review it. Not every case gets to the medical director. There's a team of nurses that are trained in this. I'd say 75% of reviews are done actually by nurses, but if it's...they can approve, but they can't deny. If they don't think they can approve, then they send it to the medical director. Then, we can approve or deny.

John Jurica: Got it.

Rich Berning: Case management is the one that we all talk about a lot. That's the one I really like. Every health plan's a data company, right? It's all about data, and they scan their members, their patients for diagnoses, and for inpatient or for readmission frequency or high-cost claimants, whatever criteria they're using to sort their patients. Certain patients will pop out because of the diagnosis, or the cost that their medical care is coming to. Those get...we discuss those in rounds during the day, and we also talk...we have complex case rounds every week.

We have patients who...this is, to me, my favorite part of the job because this is not about saying. ?no.? This is about saying, ?yes,? or how can we because these are patients who are having problems because they don't have the money, because they don't have the social support system. They got just a bad diagnosis, and we figure out a way to help them. We have teams of social workers, pharmacists, behavioral health therapists, obviously the nurses, dieticians, we all meet once a week as a team. We talk about four or five patients over an hour. Sometimes, we'll do a one-off. If somebody is really in need, we'll get..."Okay, everybody get on this conference call, right now," and we'll talk about somebody who's supposed to be discharged from a skilled nursing facility, but there's nowhere to go.

We get to solve problems, and that really makes me still feel like a doctor more than anything. I really enjoy that. It's UR, UM, and CM.

John Jurica: Okay, good.

Rich Berning: Utilization review, utilization management, case management.

John Jurica: That's very helpful. Now, you did briefly mention these outside organizations, where I think physicians can do some part-time remote reviews. Is that what you were talking about? Those are usually UR-type reviews. Is that right?

Rich Berning: That's correct. Those are typically always UR. They have different timeframes, so some companies seem to be focused more on the same-day turnaround. Some are more on the 72 hours or even seven days, so you basically need to do a Google search on independent review organization, or IRO, and you'll get a list of about 20 or 30 that'll quickly pop up. You just got to get on the phone with them or email them and say, "I'd like to be a reviewer for you. What credentials do I need?" Some of them will actually train you, so they'll submit fake sample cases to you, and then you get to review them, and write it up, send it back to them. It's like school, they grade you. They tell you...depending on how you do, they'll either say, "We're going to do a little remediation with you, and then you'll be hired," or, "You're onboard."

They typically always review your cases. Even my current job, we have audits all the time. They randomly pull our cases that we reviewed and see how we're doing. Ideally, any one case sent to any medical director will be the same outcome and the same reason for...that's the ideal. I can't say it happens, always.

John Jurica: Now, the other area where you could get...put your toe in the water, I suppose, is to do some UM activities. I guess it would be called at the hospital level, just helping your hospital sort of interact with either the external reviewers or at a payer. Is that correct?

Rich Berning: Absolutely. Hospitals will love you, if you go down to find out where the reviews...they get denials for continued stay, or even for the initial inpatient admission, and then fight them. They always fight them, and they should. You get trained in Milliman Clinical Guidelines or InterQual, and then put together kind of a two- or three-page statement as to why the health plan is wrong for denying this and it meets these criteria and, therefore, this should be approved. You put that paperwork together, and then there's also this situation where, especially now with more hospitalists and such, I've done peer-to-peer calls kind of with hired guns, if you will.

These guys, all they do is peer to peers. They're not the hospitalist who took care of the patient, but the patient got...with the extended continued stay, got denied or maybe they got admitted for an MI, and they had a statin. Somehow, that got denied. So, they get on the phone with us, and they go over the same criteria we use and say, "You're not reading this right," or, "You need to take this into consideration." It's effective, and that's kind of learning how to do it because to be honest with you, the hardest part of becoming a medical director, in my opinion, is learning how to do peer-to-peer calls. At least that was for me because here I am a pediatrician, a pediatric cardiologist, and I'm going to get on the phone with a neurosurgeon?

I had to get kind of the realization that we're not really talking about the fine details of neurosurgery. We're talking about a specific case, as it applies to the medical policy. We're all trained doctors, we all understand medical language, and it's basically just reading...sometimes, I literally read it to them and say, "Can you tell me, ?yes? or ?no? to this?" They don't like it, believe it or not. I would say 75 to 80% of my peer-to-peer calls are pretty smooth, cordial. I always learn something, if they give me the opportunity to kind of teach them something, which I'll share with you in a second. It's nice, but I had one today, the first thing the man said, he didn't even say, ?Hello.? He said, "What is your specialty?"

John Jurica: Nice.

Rich Berning: Yes, it was like, "Okay, this is not going to go well." Luckily, I was able to send a "yes," and we were best friends at the end of the call.

John Jurica: That was good.

Rich Berning: What I try to tell people, my friends, and the doctors who will listen, is basically I would venture to say the vast majority of physicians have a set of 10 to 20 CPT code services that they do most of the time for their specialty. I would go on the computer and I would do Google...these medical policies are probably...they have to be available. I would just Google, "Aetna sclerotherapy," and the policy will pop up. It'll show you the criteria. I would, literally, make a template for my dictation that answers every question and reminds you to put the size in and, where's the reflux? Where's the whatever?

Basically, you can put together 20 templates, if you will. You pull one or 20 for each health plan. That's kind of a pain in the neck but do it once and update it once a year, you won't have denials. You won't have peer-to-peer calls. It'll remind you to get the data why the patient is there. I've seen that. Certain doctors and certain specialties, they must hire consultants or something, but they come back with... basically looks like the medical policy with the blanks filled in with their patient's data. It makes it easy to review, too.

John Jurica: No, I've seen physicians do that, and I think I have to assume things have improved over the last several decades. When this whole process of looking over the doctor's shoulder was new, physicians were just like...couldn't deal with it, but I think most of us are now...those in training are exposed to it. They understand and you're right, sometimes the reports look like they're an excerpt from the policy and just making sure all the I's are dotted and the T's are crossed.

Rich Berning: I think that the informatic systems are going to kind of pick up on that and do the same thing. "Oh, it's an Anthem patient? Here's your template." That kind of thing. But I have to say, I've noticed a difference in physicians. When I started at this over five years ago, it seemed much more antagonistic. Now, it seems more, "Okay, we?ve got to get this done. What do I need to do to get this approved?" In defense of the health plans, there's two things I would want to say. One is that these medical policies are written by experts in the field, so I'm not a neurosurgeon, I'm applying the neurosurgery guidelines where they are. But I have nothing to say about what's approved or not. Those are just sent out to specialists.

They have whole teams. It's a big process to write a medical policy. It's a legal document. Every health plan has got lawyers involved. It's a big deal. These are not done lightly, and every policy gets updated at least once a year, or some I've seen updated every six months. They have teams of doctors. All they do is review the literature. Plus, you get the doctors sending in articles for appeal, so you kind of get fed those articles, too. It's a very serious, seriously taken process by health plans, as much as the doctors practicing out there want to ?poo poo? the validity of the medical policies, they pretty much are trying to show evidence-based medicine. That's a hot topic or hot term, right?

John Jurica: Yes.

Rich Berning: Medical necessity and something supports...I'll stop there. You could take the opposite argument because the policies do lag what's going on, but that's why the appeal process happens. I forget what the other thing I was going to mention, but anyway.

John Jurica: Well, one of the things...you were talking a little bit...you were going to talk about teaching. Was that another topic?

Rich Berning: Well, I was just talking about how to teach the doctors. I won't say, ?game the system,? but how to work with the system. That's it. The other thing I'll just say, put a plug in for myself and peer-to-peer calls, if someone is friendly and doesn't take an attitude right from the beginning and kind of wants to hear, and we work together, it definitely makes the peer-to-peer call go a lot better.

John Jurica: Have you ever had this happen? This has happened to me occasionally, where a patient asks me to order something, and I didn't think it was indicated. I tried to talk them out of it, and I ordered it. Then, the UM person or whoever called me and said, "What's going on?" They said, "Is this really indicated?" I said, "No." I just told them, "It's not. The patient coerced me, and as far as I'm concerned, there's no indication." I don't know if that happens very often.

Rich Berning: It happens often enough. It's almost like a laughing moment where the doc says, "I told a patient it wasn't going to happen, and the patient made sure I did the peer-to-peer call." A lot of these patients that are known to us, they're chronic patients, a lot of them. They've learned the system, too, and they have actual contact with a nurse in the system. In many cases, I'll have the nurse walk into my office after one of these conversations. "Patient wasn't happy that you still turned down her doctor for this request." The line communication is pretty tight between me, my nurse, their member or patient, and the member's doctor. You think it's this big, amorphous organization, but it's not. It gets down to the personal level for a lot of these things.

Again, like I said, we also do things that help the member, helps the patient. So, I keep saying, "member." One of the hardest things for me when I went from clinical practice to the insurance world was that they don't call them "patients," we call them "members." Still kind of gets me. That's right up there with provider.

John Jurica: Yes, at least I'm trying to say, "medical provider." I'm not going to say, "provider" anymore because that doesn't really mean anything to me. But I was going to ask you a question about what you like about this. You've kind of already alluded to it, but I didn't know if you wanted to go in just a minute and talk about kind of the things you like the most about doing this kind of work.

Rich Berning: Well, I like it from two angles. I like it from the medical doctor angle, in terms of as a physician, provider, whatever. You're one on one with your patient, and that definitely has its pluses, a lot of pluses, a few minuses. It's really rewarding in a personal basis. Now, you get to take it to a much higher level, so whereas you were affecting one patient, or maybe in a day 20 to 40 patients, now, you might be affecting hundreds of patients a day or more. You get to be more involved in kind of health delivery in the country because I probably process a couple of million dollars? worth of things a day. It's a big responsibility.

What I really liked to mention before was just kind of, I feel like I know more now than I knew when I was just a pediatric cardiologist. I'll put it that way. I went to medical school and learned everything they wanted to teach you in medical school. But at that point, you don't have much clinical experience. I feel like it comes full circle, so now I feel like I really, truly went back to medical school. I'm still in medical school in many ways because you kind of learn the newest, latest, and greatest. You see the requests coming through for some of the new devices, the new gene tests, and new chemotherapy, and I think you'll read about it. The health plans really support you, so we all get out the dates, subscriptions - everybody has many different resources, plus just reading the medical policy.

Honestly, it's kind of nerdy sounding, but if you did a medical policy search for...I love Anthem's policies, just in terms of reading them. You can really learn where things are at in a certain area, and that doesn't take that much time. They usually have 15, 20, 30 references, if you really want to dig deep and you can pull the references that relate to the decision. From a personal basis, it's not truly nine to five, or really eight to five. The beautiful thing is you can work from home for a lot of these physicians, and that's good and bad because you don't stop working when you're at home. There are many days when I just got up at 5:30 or 6, and I just started looking at my task list and my cases or start thinking about things before all the hubbub started and all the noise. Or, you can work late, and you can work remotely. In the United States, you have to be in the Continental U.S. or Hawaii or Alaska, and I think Puerto Rico.

We had a medical director who married a woman from Spain and was trying to do medical directing from Spain. That was a no-no.

John Jurica: That didn't work.

Rich Berning: He lost his job, he had to quit his job. The other thing is most of the health plans are based on the East Coast time, so a different medical director was working out of New Mexico or wherever. He would get up in the morning early, so he could be online by 8:30 or 9 a.m. Eastern time. H he'd be done at 2, 2:30 in the afternoon. He would say, "I do a bike ride, I do a 30-, 40-mile bike ride almost every day." You can really kind of make your life what you want your life to be, I think, and then the...I said as I began this podcast with you, it's a pretty good salary.

If you're a surgeon, you might feel like it's not as much as you were making, but you don't have call, you don't have malpractice, and that's something you should note, too. It's true you could get sued, but the health plan has their own team of legal and you get some sort of medical malpractice through your job. I don't think it's like malpractice when you're out with your hands-on patients. I like the fact that there's not that much...risk is more or less eliminated.

When I was working for the publicly traded company, I got stock options and other things and that was fun. That was new to me. Now, I'm working for a nonprofit, so our stock options, maybe a little better salary base, but it's a different focus than I... I kind of like working for a nonprofit versus a for-profit company because I feel like the for-profit company, the shareholder-traded company is a little distracted by shareholders and customers. You always wonder who the customer is, you know?

John Jurica: Right.

Rich Berning: Actually, I think we...providers, physicians like to take care of patients. That's what we want to do, so this is just a new way to do it, and it's an important part of the whole system.

John Jurica: Just to touch base again, the salary part, if you're in primary care, you're making, I don't know, 200, 220 or something, internal medicine, family medicine, whatever. You're not going to take a cut basically. I wouldn't think you would because you wouldn't be able to recruit new reviewers, if you had to take a cut in pay.

Rich Berning: I can tell you that the base salary starting out with no experience is higher than that.

John Jurica: It is? Okay, good. That just helps allay some of those concerns.

Rich Berning: Yes, but once you've been in there a few years, and again, it's different, we're talking about a publicly-traded company vs. a nonprofit. Once you're been there a few years, it doesn't take long to really get a higher salary. It's different pressures, different stresses to earn that money, but it's well remunerated... well rewarded. So, when you're changing from a clinical position in which you're paid fairly well and going to a non-clinical position...I did it at a time when my kids were starting college, had other things to pay off, and practice expenses to pay off. It was nice to have a decent salary.

John Jurica: Well, I don't think that non-physicians really understand and some of us even, as physicians, we forget until we get into the nonclinical that in the new job, there's going to be stress and you're going to have to work hard and learn. But the constant worry of not doing the right thing of patient care, it's constant when you're taking care of patients. Even if I'm at my urgent care center, I'm filling out a chart. I was like, "I've got to make sure I document every last thing." It's just intense, really. We get immune to it in a way, but it's different. When I was working in a hospital and the nonclinical, it can be busy, but it's not like the kind of relentless pressure that clinical medicine can sometimes bring.

Rich Berning: I totally agree. I totally agree. It's like I said, and you said, too, it's different stresses, but it's more typical stresses. It's getting things done on time?

John Jurica: Yes, absolutely. Let me ask you this. Any more bits of advice? We touched on things about when someone's interested, but I'm thinking of maybe, and I didn't prepare you with this, but are there organizations that medical directors belong to that help them in terms of staying up on these things? Or, other resources?

Rich Berning: I forget what the acronym stands for, but AHIP, American Hospital Insurance...I don't know what P stand for, but AHIP?

John Jurica: AHIP? Have you participated with them a bit?

Rich Berning: No, but I've been looking at them because at my previous job, I was really only doing national commercial work. At my current job, I'm learning Medicare, which is a whole different rulebook. They have courses that you can take that will teach you about Medicare, so that you do it right. Let me just...if you don't mind, I'm going to take a quick look on my computer to make sure I get that right?.

John Jurica: Sure, no problem.

Rich Berning: Should take just a second, but AHIP is a good one. I know you're familiar with American Association of Physician Leaders because I think you have a certified physician executive for them, right?

John Jurica: Yes, the APL.

Rich Berning: I think that kind of an organization is very helpful because anything you can show that you have some business sense, some knowledge about quality review? as a medical director, you can get involved in quality, you can get in just so many different avenues once you're trained as...you get the basic training of a medical director. There?re different ways you can go. Now, the hospital systems and the insurance companies are merging and becoming like one. So, there's integration issues, and I think getting leadership training is going to be very good. That's ahip.org. A-H-I-P.org, and they hide what the AHIP stands for, but I think it's American Hospital Insurance?something.

John Jurica: Well, that's a good point about the APL because you're already at a position where you're learning a lot of the management and business side that maybe you didn't know before, not to mention the UM and the case management. With the APL, then you just build on that and help accelerate your advancement within whatever business that you're in. That's some good advice.

Rich Berning: Yes, and I'm working on that myself. The advice I got was that if you're new and early in your career, getting an MBA is not bad because you'll probably get a promotion and make that investment pay off/ But, if you're later in your career like I am, getting an MBA doesn't really help much. It's your experience that's more important, but you can easily get the APL Certified Physician Executive (CPE) certificate, and that...I noticed in at least now, two insurance plans I've worked, quite a number of the physician executives have that CPE, like you do.

John Jurica: That's good to hear.

Rich Berning: Yes. So, I have some words of advice. Getting that experience any way that you can, like you mentioned, through the hospital, volunteering at the hospital, for either peer-to-peer calls for inpatient denials or for utilization management review to just help get them paid will get you experience. What you want to be able to do is put on your LinkedIn profile that you have that experience. Even if you just have a little bit of experience, if it's true and it's justified, you get on there that you've done utilization review, utilization management, or maybe you got a medical director position out of it, that starts everything rolling.

I noticed once I had my LinkedIn profile updated to my medical director position, I started getting InMails, if you will, from all sorts of headhunters. I've actually become kind of friendly with some of them. They still email me...InMail me...and say, "Do you know anybody who could fill this position? You know somebody who works in St. Louis? Somebody who works in Utah?" You just kind of have to get seen and get noticed and get found, and I think LinkedIn is key to that. I think networking...I got my position because I was talking to a friend of mine who worked for another one of the health plans, not the one I got hired by, but he knew somebody who...a medical director who mentioned to him that she was looking for more medical directors, and he gave my name to her. That led to my job.

I really think that people who know people who are medical directors who have some ?in? are going to get hired before the people who are just trying out of the blue. Having a headhunter be your advocate is one way to do that. I think that going to the conference that Michelle Mudge-Reilly had, Physicians Helping Physicians, you just get your network bigger and you start meeting people who are interested in you. It's not a competition. Here's the thing. These health plans have a budget cycle, if you will, so you might be looking in February, but they won't have a position approved until September the following year. Then, that will be for the following January, so you?ve got to constantly stay at it because you don't know when you're looking, if you're hitting there.

They do these in waves, sound like it's random. They do these hiring and firing of medical directors in waves, so you kind of have to get on the system to figure it out. One way to do that is to go to each health plan's career page on their Website. Put your email in there and a brief bio. They usually have you put some information about yourself. Search for a medical director position, and say, "Send me an email for every medical director position that opens." Try to be as general as you can because you don't know how they're going to word it. I did that for Anthem, I did that for a couple of others, and I still get emails in this position. You want to just start having things sent to you as much as you can.

My last piece of advice is to look at your medical school and residency colleagues, people you know personally, because you'll be...maybe you'll be surprised, I don't know. Many of them are going to medical director positions, and once you see that they're doing it, reach out to them and say, "Do you need some help? Can I learn from you? Can you put my name in?" Again, it's who you know that gets you in. That's how I've seen it work.

John Jurica: Someone told me that, and it was in a different field, that they said they really...they'll put their name in, but they don't really think that online resumes work as well as having a live person that you can talk to or send your resume to and that kind of thing, which makes sense.

Rich Berning: Sure. It's a big expense. Hiring a medical director hits the bottom line on a health plan pretty hard. We're expensive.

John Jurica: Yes, yes, but there's a reason they've got you there. If you have those skills, when they need one, they need one.

Rich Berning: Absolutely.

John Jurica: Rich, well, this has been very helpful. I think as you know, on the podcast, we like to get a little inspiration, but also a practical how-to. You have really given us a good idea about what the job is, why you like that, and how you might start to make that transition and make yourself available and find those opportunities. I really appreciate the time that you've spent talking with us.

Rich Berning: It's been my pleasure, John, and I thank you again for letting me get on your show. If people want to reach out to me, find me on LinkedIn, and I'll do what I can. I have some ideas. Since I've been at the conference, I've been getting lots of people reaching out. It's been, "Hi, how can I get a medical director position?" I've been actively thinking of ways to help your listeners, so reach out to me on LinkedIn, if you want, and we'll see if we can get you hired.

John Jurica: That would be fantastic. I will definitely put the reference, the link there to your LinkedIn, or at least the name and all of that, so they have that spelling correct and all. They should be able to track you down on LinkedIn. If they're not on LinkedIn, they damn well better get on it.

Rich Berning: That will inspire them, right? There you go.

John Jurica: Sometimes, I look at someone's profile, and there's no picture, and there's two sentences. "I went to medical school here." I'm like, "No. How long have we been harping on this?" You know? LinkedIn, networking?

Rich Berning: Right, absolutely.

John Jurica: Rich, anything else I can do for you today? Or, do you want to leave any last words of inspiration for our listeners?

Rich Berning: Thank you, and my words of inspiration are to just hang in there. Don't give up. I'm telling you, it took me three years, literally... over two years to get a job. I got the offer nine months before I was given a start date, so it's process. It's corporate world, so just don't give up. If you want it, just keep plugging away.

John Jurica: We have to have a little bit of patience?

Rich Berning: and persistence.

John Jurica: And persistence, so it's great. With that, Rich, I will say goodbye, and I hope to talk to you soon.

Rich Berning: Yes, thanks John. You take care.

Scroll back to top

Sign up to receive email reminders, news, and free stuff every week!

Enter your name and email address below and I'll send you reminders each podcast episode, notices about nonclinical jobs, information about free and paid courses, and other curated information just for you.

powered by

Disclaimers:

Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. I only promote products and services that I believe are of high quality and will be useful to you. As an Amazon Associate, I earn from qualifying purchases.

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. I do not provide medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counselor, or other professional before making any major decisions about your career.