Today we learn about three awesome nonclinical careers for those working in the hospital setting.

But first, a story…

Ten years into my career as a full-time family physician, I began to consider moving in another direction. For the most part, I enjoyed my practice, and my patients liked me. My two partners and I had busy schedules and a waiting list for appointments.

And we had a good reputation in the community.

But I wanted something more. I enjoyed working on hospital committees. I relished collaborating with nurses, pharmacists and other professionals, to create new protocols that improved patient care. And I enjoyed assessing learning needs and planning CME activities for my colleagues.

When the first wave of managed care plans began to show up in our community, I found it invigorating to work with eleven of my colleagues to help develop an independent physician association. The goal of the IPA was to contract with insurers, develop our own patient panels, and manage our utilization.

Photo by Samuel Zeller on Unsplash

I began to think that I might pursue a career in hospital management.

Self-Limiting Fears

But I had so many fears and insecurities that surfaced with each small step I took in that direction:

How would I explain this to my partners? We shared everything equally in the practice. How could I find time to still cover all of the call responsibilities and ease into a management position?

I’m a family physician. Sure, it’s a noble calling. But surgeons, cardiologists, gynecologists, and other specialists really don’t respect our opinions. We’re treated like the proverbial “red-headed stepchild.” And our hospital had never had a physician executive, so I was sure my peers would be very skeptical of the idea.

I thought, if I move into management, I’ll need to interact with other physicians, and even lead them. What makes me think I can be a leader? I’m not charismatic. I’m an introvert. I don’t have a booming voice or any “gravitas.” For goodness sake, I’m only 5 feet 3 inches tall!

And, I could hear my brothers and sisters, maybe even my parents, saying: “What do you mean, you won’t be seeing patients any more? Why would you give up being a doctor? Why waste your medical education?”

This is just a sampling of the self-limiting beliefs I had to overcome. And with the encouragement of my close friends, and wonderful mentors and supporters, including the CEO that first hired me as VP for Medical Affairs, I slowly faced those fears.

Fears Unfounded

And I discovered that those fears were unfounded. I learned that having a good reputation in the community was important. Being meticulous in my work and committed to improving patient outcomes was appreciated. And serving my colleagues by facilitating a dialogue between hospital executives or board members and the medical staff was what mattered.

As I present a plan today for you to follow, I want to acknowledge that you’ll likely face similar self-doubts and limiting beliefs. But don’t let those stop you.

Your clinical experience is the platform upon which you can build a rewarding career. You just need to add a bit of additional expertise and nonclinical experience.

You’ll likely be helping more patients in your new career. And you’ll be supporting your community and advancing your profession.

Three Awesome Nonclinical Careers

I’m going to briefly outline the steps that will take you from practicing physician to Physician Advisor for Utilization Review, Medical Informaticist, or Physician Advisor for Clinical Documentation Improvement.

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These awesome nonclinical careers are ideal for many hospital-based physicians, including hospitalists, anesthesiologists, infectious disease specialists, and pulmonologists.

Each of these can be started part-time, if you like. But they will readily become a full-time career. They can also serve as a stepping stone to more highly paid positions as medical director, CMIO, or CMO.

Much of the information I’m going to share can be found in a free guide titled 5 Nonclinical Careers You Can Pursue Today. This guide can be downloaded for free by going to vitalpe.net/freeguide and signing up for my newsletter.

For the rest of this episode, you might want to have pen and paper handy. I’m going to provide many resources for you to access.

Utilization Management

This field is also sometimes called case management or care management. A physician advisor for UM will help determine the appropriate care status (outpatient vs. inpatient) in the hospital. As a PA for UM, you may be asked to determine appropriateness for observation care. You will work with other team members to determine if continued stay is warranted.

You’ll also help physicians understand CMS and other payer rules with respect to appropriateness of testing and performing invasive procedures. As a UM advisor, you’ll help your colleagues appropriately document their thought processes so that their patients can get the care that they need.

Finally, your work will be critical to the financial viability and the reported quality outcomes of your organization, by helping to reduce risk adjusted length of stay and unnecessary readmissions.

To begin to seek this career, you generally must be residency trained, and board certified, with 3 or more years of clinical experience. It is easiest to begin this transition if you’re currently a medical staff member at a medium to large hospital with an existing Utilization Management Department.

Typical Job Listing Looks Like This

“Candidate will 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 (extended stays), utilization review issues, reimbursement issues or quality concerns. The Physician Advisor will work with hospital administration and clinical committees as requested to develop processes and guidelines to improve quality of care and value.”

Get Started

Here are some actions you can take to begin this career journey. They don’t necessarily need to be taken in the following order.

• Purchase and read: The Hospital Guide to Contemporary Utilization Review, by Stefani Daniels and Ronald Hirsch, and Physician Advisor Handbook, by Pooja Nagpal and Ven Mothkur.
• Meet with the Director for Utilization (or Case) Management and identify the most active physicians and the committees where the work is generally done.
• Then join your hospital utilization or case management committee. Get involved with denials management, including appeals.
• Identify a mentor that is currently working in utilization review, possibly the current Medical Director or a Physician Advisor for UM or case management. Establish a relationship and a dialogue about pursuing a similar career.
• Create a complete LinkedIn profile with a focus on experience in quality and length of stay, and on clinical experiences with hospital care.
• Consider joining the American College of Physician Advisors (acpadvisors.org) or the National Association of Physician Advisors (physicianadvisors.org). Check out their websites and see which one resonates most with you.
• You might consider attending the Annual SEAK Nonclinical Careers Conference held in Chicago, Illinois each October. There is usually at least one presentation devoted to this role.
• You should look into the costs and time commitment needed to achieve certification in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians, the ABQAURP (abqaurp.org)
• Finally, to learn more, listen to my interview with Dr. Timothy Owolabi in Episode # 12 of this podcast by going to My Interview with Dr. Timothy Owolabi.

Before proceeding, I want to spend a minute talking about the American Association for Physician Leadership. I’m not an affiliate and receive no compensation for this endorsement. But I’ve been a proud member of the AAPL for about 25 years, because it’s an outstanding organization.

It helps to support and promote physicians as managers, executives and leaders. The AAPL provides live conferences, online education, books, coaching, mentoring, career services and nonclinical job postings. It also provides physician executive certification, the CPE, that demonstrates expertise and skills as a physician leader.

I’ve mentioned the AAPL in numerous podcast episodes and interviewed the Director of Career Services, Dian Ginsberg, in Episode 24.

It truly is the world’s leading organization of emerging and established physician leaders. The cost of annual membership is a little less than $300.00 per year, which is a ridiculously low price. I strongly recommend you consider joining. Check It out using this link – vitalpe.net/aapl – to find out more.

Medical Informatics

Physicians in this position will need to learn about information technology and informatics. Medical informatics is the study of the design, development, adoption and application of IT-based innovations in healthcare services delivery, management and planning.

As a physician informaticist, you will be the bridge between information technology and practicing physicians. You will be involved in converting clinical protocols for use in an EHR. And you will develop procedures for effective use of technology in health delivery. This is probably the fastest growing of these awesome nonclinical careers.

To pursue this career, you should generally be residency trained and board certified, with 5 or more years of clinical experience.

Typical Job Listing Looks Like This

“The primary purpose of the Physician Informaticist is to develop EMR application training in one on one and group settings for physicians, based on workflow analysis and evaluation. The Physician Informaticist will develop and deliver learning solutions that improve efficiency and promote business objectives. As a member of the Clinical Informatics team, this person will provide ongoing support of EMR products and will work with the team in the maintenance and enhancement of EMR software. He/she will help implement requests for system changes on all assigned modules and participate in the development of operational workflow.”

Get Started

Here are some steps you can take to begin this career journey.

• Purchase and read: Health Informatics: Practical Guide for Healthcare and Information Technology Professionals by Robert E. Hoyt (Editor).
• Meet with the Director or VP for Informatics and identify the most active physicians and the committees.
• Participate in IT or EHR committees in your hospital.
• Identify a non-physician mentor that’s currently working in the Medical Informatics Department, or a medical informaticist or the Chief Medical Informatics Officer, if one exists. Meet with them and learn more about seeking a career in informatics.
• Create a complete LinkedIn profile with a focus on experience in EMR implementation, application, protocol development, etc.
• You should check out the following organizations: The American Medical Informatics Association is devoted to informatics and has a substantial physician component; The American Health Information Management Association addresses coding, privacy, security, data analytics, and CDI, in addition to informatics. It has a smaller focus on physician members.
• You should subscribe to the Health Data Management Online Journal at healthdatamanagement.com for news related to healthcare information technology.
• Join the Healthcare Information and Management Systems Society or HIMSS. And then check out the Physician Community within HIMSS at himss.org/physician.
• You can learn even more about this career choice by listening to my interview with Brian Young in Episode #14 by going to My Interview with Dr. Brian Young.

Clinical Documentation Improvement

Physicians in this position will need to learn appropriate coding and documentation guidelines and teach other physicians about coding. You will likely need to interact with them on specific cases to make appropriate changes to coding when needed.

As coding guidelines have become more specific, the need for an expert in this field continues to grow. As a CDI expert, you will help to ensure that the severity of illness of hospitalized patients is fully demonstrated.

This is critical to proper risk adjustment and quality outcomes published by CMS and other quality reporting organizations (Truven Top 100 and HealthGrades, for example).

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Like the Physician Advisor for Utilization Management, your work will be critical to the financial viability your organization. You accomplish this by helping to optimize payments, reduce CMS-imposed penalties and demonstrate the quality of care to your stakeholders.

You’ll need to be residency trained, and board certified, with 3 to 5 or more years of clinical experience.

Typical Job Listing Looks Like This

“As the CDI physician advisor, you will act as a liaison between other CDI professionals, the Health Information Management Department, and the hospital’s medical staff. The PA will facilitate accurate and complete documentation for coding and abstracting of clinical data, in order to capture severity, acuity and risk of mortality, in addition to DRG assignment.”

Get Started

Here are some of the steps you can take, not necessarily in this order:

• You can read manuals such as Understanding Hospital Billing and Coding, 3rd Edition or DRG Expert – 2015.
• Better yet, you can go to the CMS page with DRG data at CMS Website and download the most recent DRG dataset in Excel format and sort by volume to see the most common DRGs being used nationally. Then you can look up the definitions of individual high-volume MS-DRGs at this link on the CMS website
• Meet with the Director or VP for Health Information Management and the Director of Clinical Documentation and identify the most active physicians and the committees.
• If possible, join the CDI team and attend CDI committee meetings. Spend time with the coding specialists in the Hospital Information Management Department.
• Identify a mentor that is currently working in hospital clinical documentation improvement.
• Create a complete LinkedIn profile with a focus on documentation and coding experience.
• Consider joining the Association of Clinical Documentation Specialists. It has a significant physician membership.
• The American Academy of Professional Coders may also have some useful educational and networking opportunities.
• The American College of Physician Advisors and the National Association of Physician Advisors might be useful to you. AHIMA may be more helpful for the CDI specialist than for the physician advisor for utilization management.
• And you can learn even more about this career choice by listening to my interview with Cesar Limjoco in Episode #5 by going to My Interview with Dr. Cesar Limjoco.

Closing

Well, there you go. I tried to provide actionable information and inspiration for three very important and popular nonclinical careers.

Let's close with this quote:

If you have any questions about what has been presented, please email me directly at johnjurica@nonclinical.buzzmybrand.net.

You can get the written overview of these three careers and two others by signing up for my newsletter at vitalpe.net/freeguide.

Resources

The resources mentioned in this episode are all linked below.

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If you'd like to listen to the premier episode and show notes, you can find it here: Getting Acquainted with Physician NonClinical Careers Podcast – 001