Pursue One of These Part Time Nonclinical Hospital Jobs

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Transcription PNC Podcast Episode 396

Pursue One of These Part Time Nonclinical Hospital Jobs

John: I want to provide a brief overview of two part-time hospital physician advisor jobs that you might want to consider if you've decided to expand your options and begin your transition away from direct primary care for whatever reason. I’m addressing these two because they overlap quite a bit. They're both based in the hospital setting, generally started part-time, and can later become full-time jobs. There aren't a lot of barriers to starting such a position, and if you're already working in the hospital environment, it's really not all that difficult to do.

So, these are the two positions I'm talking about today: the physician advisor for utilization management and the physician advisor for clinical documentation integrity. Just so we know, using this term "physician advisor," sometimes these are called medical directors. Now, if you're doing utilization management for a large insurance company or other healthcare payer, they're typically going to use "medical director" for that position as the title. In the hospital setting, it's typically called a physician advisor. It's a part-time job that could start out as little as one or two hours a day, but they might also use that medical director moniker as well.

If you're already working in the hospital in a variety of inpatient settings, you could easily start doing one of these jobs if your organization has a need for it. So, when I talk about this kind of topic and about transitioning, I do like to generally talk about some other things to prepare us to make this kind of transition.

So, the first thing I want to do is mention some of these items and talk about how to get into the right mindset. What happens typically if you've been working clinically full-time and now you're thinking of making this change? It can be difficult because of some limiting beliefs or even some myths that we have internalized that I want to talk about right now. I'm not going to address every one of these; I actually have addressed this in other presentations. As a reminder, let's just go through two or three of these.

So, the first thing is that this is going to be a difficult process because all I know is medicine and I don't have the necessary skills to begin a new career. Here’s what I have to say about that issue: especially for these jobs, having completed medical school and residency, maybe a fellowship, you really already have a lot of demonstrated valuable skills and abilities. Okay? So whether it's focus and concentration, lifelong learning commitment, organizational skills, teamwork, analyzing data, and formulating a plan, you have a lot of background in the necessary sciences, including biochemistry, physiology, anatomy, epidemiology, etc. You're good at writing, lecturing, and speaking, teaching, and mentoring. You've done leadership oftentimes in your roles. You're great at decision-making, and you have a lot of other qualities that make you an awesome employee in general. So those exist, and these two jobs don't really have a lot of requirements for additional skills. So they lend themselves to being learned on the job. You will learn some new skills for this new career, but they'll be learned on the job. And since you're already a lifelong learner, it's going to be quite straightforward for you to do that.

The second belief sometimes is that you're wasting your medical career if you pursue a nonclinical job. The thing is, once you become a clinician, you actually have reached a plateau, and there are dozens and dozens of other jobs that you can only do after becoming an experienced clinician. It's like saying that you're wasting your training as an attorney if you decide to pursue politics or to become a judge, or you're wasting your training as a nurse if you decide to become a nursing home administrator. An administrative job is a business position, but yet you have that background as a clinician, which is very helpful for many important, fulfilling careers. Having a medical degree and board certification is a prerequisite to even being considered for that new career. So it's not wasted training. Chances are you've already applied your training in that venue, and now you want to move on to something bigger and better. In some cases, oftentimes it even pays more and has more responsibility, particularly when you're taking a leadership role.

Number three that I want to talk about is: you know, my family, my friends, colleagues, and other people I know will be disappointed if I leave clinical medicine for a variety of reasons. You think that they might not really understand it, and maybe they'll say something that makes you think that. But the reality is, particularly if you're burned out or unfulfilled with this job, it's not really satisfying you doing this clinical work. You know, everybody in your life that loves you just wants you to be happy, fulfilled, and working in a career that brings you joy. That's really the ultimate goal. Many of us think that taking care of patients is the way to do that, but for whatever reason, sometimes it's just not true. So I don't think the people that are important in your life are going to sit you down and try to convince you not to remain in a job that's tedious, unfulfilling, or producing anxiety or is unhealthy.

I know the financial aspects will be a concern at times, but really, ultimately, that shouldn't be the thing that stops you because there are a lot of positions that will equal your current financial reimbursement or compensation, and yet with less stress and more joy in doing that very job. I think that shouldn't hold you back either, unless you can find there's something simple to change in what you're doing clinically to make it more palatable that I think you should continue to move forward.

Now, there are also some caveats that I want to mention to you. Some of these are pretty obvious, and don't be offended if it seems like I'm being too obvious, but let's see here: first, no matter what job you're doing, continue to do it with excellence. Okay? So just because you're burned out or you're feeling like you're going to have to change jobs or something like that, don't sort of quit while on the job. Don't become lazy or try not to become overwhelmed and just indifferent. Your current employer and colleagues will be asked to comment on your dedication, integrity, ability to work with others, accountability, etc. If you've already started to pull away and not keep up that high level of performance that you probably are used to doing, it can harm you because it may take you a while to get that first job. Particularly, even if you're going to stay with your current employer, hospital, or health system, then that might be something that puts the hold on it, particularly if you somehow have been becoming more vocal about how unhappy you are. So try to keep everything at that level of excellence and just move forward with trying to make the change.

The second caveat is you must try to gain some experience in your new career even before applying for the new job if you can. Notwithstanding what I said earlier that these jobs are open to you already, but every little bit of information and understanding of the role you're going to step into will be helpful. And so if that means volunteering somehow, you can do that. Two areas we're talking about are utilization management and clinical documentation integrity. They usually interface with the medical staff and clinics face-to-face when you're dealing with the topic and also in committees and subcommittees that deal with the results and try to come up with plans for improving things. You can usually volunteer for one of those committees and understand the lingo better. You can meet some of the people that are currently involved in that. Sometimes you can get a little bit of experience in a nonprofit board of some type, some steering committee. So think about that.

That's the second caveat. The third is that it's always great to use a mentor, find a mentor, engage a mentor, and interact with them. Now, when I tell you about mentors, I'm always talking about something that's pretty low-key, not a lot of time. I've had mentors in my life who didn't even know they were mentors—just someone I would meet with briefly or run through, you know, briefly for five or ten minutes, ask a question, get the answer, and then use that information to help me figure out my next steps. So it's helpful to have multiple mentors and just use them judiciously to help point you in the right direction. Obviously, this mentor should usually be someone who's doing the job that you're thinking about moving into.

And so, you know, that's just the third bit of advice. The fourth is that there's probably some book or course that can help you in the process. You know, on these topics, for these two exist, and I'll talk about resources where you can find those in a minute. Fifth, there are usually places, getting, you know, kind of building on the fourth one, there are usually specialty societies or associations, professional organizations that have more resources that I'm also going to mention later.

So that's given. And then the sixth thing is that sometimes when you're doing a nonclinical career, it's helpful to have some kind of a blog or a podcast or something. I mean, as an example, if you're becoming a medical writer, then, you know, if you can create a platform where you're writing regularly and you're sharing some of that for free, in addition to posting things that maybe you've sold that you've done as a medical writer, that could be awesome. In this situation for doing these two, I would say the main thing is to get a good LinkedIn profile. You probably could find your first job directly on LinkedIn without even engaging a headhunter or something like that. You know, particularly after you've already done the job at your current organization, if that's how you choose to move forward. But having a really completed LinkedIn profile, which is something I've talked about in the past, can really help people reach out to you and actually recruit you directly off of your LinkedIn profile as long as you put in there some of the experience that you've already gotten that applies to the job that you're looking for.

So, let’s start then with the first position, and that’s as physician advisor for utilization management. So, to summarize, in the hospital setting, again, you can do this kind of job for an insurance company, but in the hospital setting, it's a little different. It's quite direct with the providers; the physicians and NPs and PAs are taking care of patients in the hospital. So basically, the physicians who are leading the patient care will need help in determining the appropriate care status—outpatient versus inpatient, for example—and work with other team members to decide if continued stay is warranted. Warranted means meeting guidelines, specific guidelines that say that they should either go or stay. They need an intermediary like you, the physician advisor, to help educate on that and to actually answer questions directly on this patient that we're considering right now.

So, you can do teaching too, where you help clinicians understand CMS and other payer rules. And that's around the appropriateness of testing and invasive procedures. Like, you know, if somebody comes in for heart failure and you've got them 90% better, is it appropriate to do a colonoscopy? Well, that can be hard to justify. That's a pretty obvious example, but you don't want to be doing those things because you really want to try to keep that admission as short as possible while using the minimum resources so that the hospital actually has a bottom line.

There are full-time and part-time positions doing just what I've described. Most of those job descriptions will say that you need to be residency trained, board certified, with five or more years of clinical experience. Sometimes they have a preference for primary care, but not always. And they may even say that they want a current hospital staff member.

Now, I'm going to read you a typical job listing for this. They don't all look exactly like this, and this is a very shortened version of it, but just so we're clear, let me describe that: Candidates have a strong clinical background with excellent communication skills and leadership abilities. The role of the physician advisor of case management services requires the review of other physicians' cases, their plan of care, and resource utilization. Case study can be necessary for various reasons, including patient outliers, i.e., extended stays, utilization review issues, reimbursement issues, or quality concerns. The physician advisor will work with hospital administration on all campuses and clinical committees as requested to develop processes and guidelines to improve quality of care and value, or the outcomes divided by the cost.

So, that is a short version of a typical job description.

So, let's talk about some real practical things you can do other than being a good medical provider right now at your current institution. First thing, the first step is to see if you can get your hands on a copy of the "Hospital Guide to Contemporary Utilization Review" by Stephanie Daniels and Ronald Hirsch. This thing is probably at least five, maybe even as long as ten years ago, originally published. I think there are multiple editions. But this is a good guide. So, this is what I mentioned earlier. There may be a book that can be very helpful. I think it's relatively expensive. I looked it up recently, and it was like $170 for a new copy, but you might be able to find a used copy or you might go to your own hospital and say, "Hey, do you have a copy of this thing?" Because the utilization management department might have it. And it can be helpful to read through it; it gives some of the background behind doing utilization management and affecting things like length of stay and how to move people through the system. And also, you know, what needs to be documented.

If possible, here are some other steps you can take. Join your own hospital utilization or case management committee if one exists. Get involved with denials management, maybe even in appeals. You may not be able to appeal another physician's case, but if you have a case that becomes denied and you know, normally you hand that responsibility over to the UM department, you could try and at least be involved in the appeal in your case, particularly, you know, if you're talking about an online or telephone appeal, live appeal, and you can learn about what's important in the terminology.

Again, I'll reach back to what I said earlier about a mentor. So, look for a mentor that's currently working in utilization management, possibly the current medical director or physician advisor for your case management. Establish that relationship and just talk with them a little bit over time. Again, don't make them feel like you're trying to own your success. You want to just chat with them, get their advice on how they got into this and are they aware of any really good resources that they found to be helpful?

Here are some of the resources I think that are no-brainers that you can get into right away: You might look at the resources in the American College of Physician Advisors. You can find them at acpadvisors.org. It's the American College of Physician Advisors. You can just Google that if you want. And they have all kinds of research sources written. They've got lectures and conferences that they do every year. I think sometimes they might even have some kind of certification. When I last looked, I mean, there were at least six or seven tabs on their website for resources for their members. You can get involved directly, and there's probably publications that you can get from them as well. And I don't think the membership fees are all that high.

When I've talked to other people about this, they always bring up the Seek Annual Non-Clinical Careers Conference because usually they have at least one speaker talking about this one, utilization management for sure. Sometimes they also have somebody talking about the second topic for today, which is the CDI or clinical documentation improvement. If you want to get really into it a little bit and understand how people use guidelines, what the guidelines look like.

Oh, by the way, to find the Seek Annual Non-Clinical Careers Conference, it's usually in October, and you can find it at nonclinicalcareers.com/conference. That's a link that I created from my website. So if you go to nonclinicalcareers.com/conference, it should bring you to the Seek Annual Non-Clinical Careers Conference. It's spelled S-E-A-K. It doesn't stand for anything in particular, but it is in the Chicago area every October, and they've been doing that for about 15 or 16 years.

You can get a copy of the Milliman Clinical Guidelines. That's one set of guidelines that UM nurses and others who are doing reviews of charts for purposes of, you know, utilization management and continued stay and so forth. That's what they use. They use Milliman Clinical Guidelines. There's InterQual guidelines as well, I believe, but the Milliman seems to be more commonly used, and you can find that at mcg.com.

And then there's an organization called the American Academy of Professional Coders. Now, when I talk to UM people and when I was doing this job as a physician advisor, I don't think I ever saw that organization or heard of that organization. But if you go to aapc.com for American Academy of Professional Coders, there are resources there that you can access, and it gives you again some of the basic nitty-gritty about becoming a physician advisor for utilization management, benefits management, and so forth.

All right. So now I want to move to the next one, which is this physician advisor for clinical documentation improvement. Well, now we call it clinical documentation integrity. And basically, if we want a short description of this, it is as follows: Physicians in this position will need to learn about appropriate coding and documentation guidelines, either in the hospital or outpatient setting, and help teach other physicians about coding and interact with them on specific cases to make appropriate changes to coding if necessary. Full-time or part-time positions are available.

Now, this one, you know, there's a big motivation to do well on this because the coding is what leads to the reimbursement. It also leads to the quality of care as observed by other people because a big part of coding is to capture pre-existing conditions, complications, and so forth. And if you find things that are present on admission and document those appropriately, then they won't be counted as a complication later on. So if somebody is admitted with some problem, let's say pneumonia, and then they develop diabetes or hyperglycemia and then they get a coding for diabetes during that stay. Now, we all know that it's probably pre-existing, but if it's not put in as a present on admission, then it's going to be counted as a complication. And that's a bad thing that can affect your reimbursement at the hospital.

They usually are going to be looking for someone who's residency trained, board certified, with five or more years of clinical experience. The typical job listing will sound something like this: As the CDI physician advisor, the PA will act as a liaison between the CDI professional, HIM (which is Health Information Management), and the hospital's medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capturing severity, acuity, and risk of mortality in addition to DRG assignment.

So, that's what you're going to see, and you're not going to see requirements for a lot of formal training. What they might look for is more experience. Now, another comment I want to make, kind of a caveat, at any time you're looking for a job and you're looking at job descriptions is that keep in mind that a job description is the new employer's attempt to get absolutely 100% of things they could get in the best possible circumstances. So, they almost never get a person that meets all those so-called requirements. And so you have to try and tease out whether the requirement they're listing is absolutely mandatory. Like, for example, they might say they want someone with five years of experience and at least two years doing a CDI. Well, what if you have four years of experience and you're only doing one year of CDI? These things are all flexible, and you have to learn how to tell the difference between something that's absolutely required as opposed to something that would be nice to have because most of this will be learned on the job.

Okay, so here are some advice for steps to take. Number one, you might get a copy of the CPT Professional 2025, which is the CPT manual that's put out by the AMA every year. Now, it's expensive, and you know what? Things don't change that much. So if you can get an old copy of the one from 2024 or 2023 or 2022, a lot of the rules will be in there; it'll be exactly the same. It's just the fine details change from year to year in terms of the definitions of the DRGs and the weighting and things like that. So just try and get a copy of that, and you can probably borrow the old one from your current CDI group and go from there.

If possible, these are some actions you can take now to position yourself: If there's a CDI team, see if you can join as a volunteer or go to some of their meetings. Spend time with the coding specialists in the Health Information Department. When you talk about coding and documentation, not only do you have yourself as a clinician doing the documentation part of that, but you have the nurse documentation specialists. And maybe some paramedical staff, you know, that aren't nurses or physicians. And then you have the billing departments, whether it's in a clinic or at the hospital, what you would call the Health Information Department. They have experts in coding and documentation. They're the ones that do the final coding on the charts.

They're usually not a nurse, but they usually work so closely with a nurse and the physician advisor to get things right. Sometimes they're in a big hurry and they don't want to take the time to do that. So you have to help set up systems where you can quickly respond when they have a question. Because again, the more accurate it is, the better off the hospital is and better paid the hospital is.

Okay, so you're going to try and just start mingling with those people. You're going to identify a mentor that's currently doing this kind of work, clinical documentation integrity, and maybe the medical director if there's a medical director in the hospital doing this, or there might be somebody who's over that in a large medical group. It's totally different coding in the outpatient and inpatient side, so you might want to end up specializing in one or the other, but most of the time, what I'm talking about are the physicians who are working for the hospital to do this job.

And then you're going to also complete your LinkedIn profile, just like I mentioned for the last position, and try and focus and list your experience and documentation and coding in the hospital setting. No question comes up on LinkedIn all the time is, "I don't want to scare away somebody, or I don't want to tip my hat, my hand, so to speak, that I'm thinking of leaving and looking for this job." So sometimes you can do a LinkedIn profile that's somewhat generic. That's focusing on your professional activities, and you know, you might put in there all the things you've done clinically, and then maybe a paragraph that talks about what you've done from the standpoint of documentation and coding and understanding how it works because all clinicians need to do this anyway. But if you focus on it a little bit more, then a recruiter is going to be more prone to notice and actually reach out to you on LinkedIn and say, "Do you want to talk about maybe looking for a job?" And it could be even a headhunter who maybe doesn't even have a job for you right now, but when they notice someone with that kind of profile, then they're going to reach out and position themselves to be ready to tap you when the time comes.

Some of the other resources which would be very helpful would be the American College of Physician Advisors, which can be found at acpadvisors.org. I think this is the same one that I said earlier. It's good for both utilization management and for clinical documentation improvement. So that's a repeat. The Seek Annual Non-Clinical Careers Conference is another repeat. Every October, you have a two-day event with a pre-conference and post-conference, so there's a lot of activities going on. You can look that up.

There is something new here: the Association of Clinical Documentation Integrity Specialists. It's a hard one to remember; it's kind of a tongue-twister. The Association of Clinical Documentation Integrity Specialists, known as ACDIS, can be found at acdis.org. Lots and lots of resources there. You can join even before thinking about doing this in a way, see if there's information in it that sounds interesting to you. And then when you do think about moving forward, then start accessing some of those. I think that one has training and even certificates, things like that.

The other big one is the American Health Information Management Association. Now, this is multi—actually, both of these are multi-professional, I guess. There are nurses, there are physicians, there are health information management workers, there are all kinds of people in both of these: ACDIS.org and the American Health Information Management Association, which is called AHIMA, A-H-I-M-A. A lot of people refer to it as AHIMA, and it's at ahima.org.

And then I've seen one mentioned several times in the past called the National Association of Physician Advisors. When I last tried to access it, it would not let me link up because of a fear of some kind of lack of security on the website. You know, some of these old websites are not really good at preventing, you know, issues with people trying to steal information and so forth. So if you can find the National Association of Physician Advisors, that might be useful. Otherwise, the other four places I talked about would be helpful for you.

But, so that's basically what I had to say about these two nonclinical positions. Again, they start part-time, they can eventually go full-time. There's a lot of jobs out there. There's lots of resources, and you can maybe find a job where you're doing 50% clinical, 50% one of these, or go 100%. There's a lot of flexibility. And if you're in a big metropolitan area, there's probably many jobs around that would be at other institutions within driving distance.

And so that's why I talk about these quite frequently. I've always had a lot of—not my most of my nonclinical jobs were in the hospital setting. These also can lead to getting a BPM or a CMO job because if you think about it, the Chief Medical Officer at a hospital is responsible for typical things that go that include these: utilization management and length of stay, quality improvement, clinical documentation integrity, which goes directly into quality improvement, and then informatics a lot of times. And so if you're involved with any of those four, it's a good starting point. And ultimately, if you end up looking for a job as a CMO, which usually pays more than a primary care clinical position with about 20% less commitment of time each week, that's an awesome job. Payments for CMOs are quite high. You're going to have to learn about all four of those plus a lot of other things.

And my usual advice for that is go to the AAPL, which is the American Association for Physician Leadership. And you can get a lot of those, which it wouldn't hurt to start that now while you're doing these other jobs or thinking about doing these other jobs. And they do have some specific courses, actually, at the AAPL, which are kind of introductions to the areas we're talking about today.

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