This week John spends a few minutes sharing his thoughts on one of three popular full-time careers when preparing to “level up.”

Today John delves into the idea of “leveling up”- a journey of self-improvement that can lead you to a more satisfying and financially rewarding career. Drawing inspiration from professional athletes and attorneys he shares how to take stock of your strengths, identify areas for growth, and set new goals to help you become the best version of yourself.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career you love. To learn more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

For Podcast Listeners

• John hosts a short Weekly Q&A Session addressing any topic related to physician careers and leadership. Each discussion is now posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 per month.
• If you want access to dozens of lessons dedicated to nonclinical and unconventional clinical careers, you should join the Nonclinical Career Academy MemberClub. For a small monthly fee, you can access the Weekly Q&A Sessions AND as many lessons and courses as you wish. Click the link to check it out, and use the Coupon Code “FIRSTMONTHFIVE” to get your first month for only $5.00.
• The 2024 Nonclinical Summit is over. But you can access all the fantastic lectures from our nationally recognized speakers, including Dr. Dike Drummond, Dr. Nneka Unachukwu, Dr. Gretchen Green, and Dr. Mike Woo-Ming. Go to Nonclinical Summit and enter Coupon Code “30-OFF” for a $30 discount.

Three Most Popular Full-time Careers for Physicians Seeking a Change

Suppose you’re a physician considering a career shift. In that case, John highlights three nonclinical roles that might be perfect for you: hospital Chief Medical Officer (CMO), pharma Medical Science Liaison (MSL), and insurance company Utilization Management (UM) Medical Director. These roles offer improved work-life balance, competitive pay, and full-time opportunities with major organizations. John describes each popular full-time career and how you can smoothly transition.

Your Network is Your Net Worth: Resources to Help You Succeed

Transitioning to a new career isn’t just about what you know, it’s also about who you know. In this section, Dr. John reminds us of the importance of building a strong professional network and leveraging resources like LinkedIn, the American Association for Physician Leadership (AAPL), and the MSL Society. He also recommends joining online communities like the Remote Careers for Physicians Facebook group, where you can connect with others who’ve made similar transitions and get advice on your next steps.

Summary

Sometimes it makes sense to level up your career to one that offers better pay and work-life balance. The three options described today have demonstrated that they generally meet those goals. If you're looking for full-time employment in a well-established industry John advises you to consider one of these popular options. 

Links for Today's Episode:

• How to Become CMO in a Year – 052
• 4 Things the CMO Should Never Say to the CEO – 251
• Hospital Management Career Bundle Tactics to Quickly Prepare for a Hospital Management Job
• Find Your Great First Nonclinical MSL Job
• Complete the Journey to Your First Fabulous MSL Job – 277
• Build a Rewarding Career as an MSL – Use Coupon Code HALFOFF to purchase for only $198
• How To Secure Your First Utilization Management Job
• The Truth About Medical Specialists and UM Jobs
• American Association for Physician Leadership (AAPL)
• Remote Careers for Physicians Facebook Group
• MSL Society
• Check out the 2024 Nonclinical Career Summit to learn about MORE career options.

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Right Click Here and “Save As” to download this podcast episode to your computer.

If you enjoyed today’s episode, share it on Twitter and Facebook, and leave a review on iTunes.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 368

First Consider the Most Popular Full-Time Careers

John: Okay, nonclinical nation, many of you are ready to make a change in your professional life. It may be because you're frustrated and your work-life balance is shot, or maybe it's just because you're ready to level up.

What do I mean by leveling up? Well, leveling up can be described as a process of self-development or to become a better version of yourself. This can include identifying weaknesses and strengths, setting goals, replacing old habits with new habits, focus on success, and possibly moving to a career that's more satisfying and financially rewarding.

As I was thinking about this concept, I was trying to get examples, and I have two examples that really come to mind.

The first one is professional athletes. Some professional athletes are forced to retire. Some just reach their peak and decide after they've done everything they want to do, they just retire, but they have a lot of notoriety and they have hopefully saved up some money. And again, it's kind of parallel to what physicians can do.

I think of examples like those of Magic Johnson's business ventures in broadcasting, music, film, and finance, or John Elway's investments in dealerships in the Denver area that he said later sold off, and then him investing in the Colorado Crush of the Arena Football League in 2002. And of course, many successful athletes have finished their careers as athletes, and then leveled up to do something else very powerful.

Now, those might seem like outliers. Maybe those are just a select few, but I also think of attorneys. There are many attorneys who never practice, or let's say they finish law school, they pass their bar, and they do work for a while in the industry, in law, doing something, but then they find that they can take everything they've learned in law school and with their early experiences as an attorney and segue into another career, which they level up.

You can look around and see a lot of attorneys working in C suite of various companies, not actually practicing law, but applying what they learned as leaders, as researchers, as presenters, and they apply to the new job. You're an attorney and you have a background in healthcare law, well, you can do that with a big firm, or you can actually go and become part of a team to run a healthcare organization, and obviously all those skills will come in handy.

I interviewed somebody who was trained as an attorney. He, for a little while, was helping physicians with their contract negotiations as an attorney. What he did was leverage that to become more of an agent. He helps physicians negotiate better contracts as an agent, but not as an attorney. In fact, he still has attorneys review the contracts. That's a way to level up.

I think the physicians can do the same thing. Healthcare is the largest industry in the United States, and there are positions for physicians in every major aspect of healthcare. Maybe it's natural to think after a few years of being in the trenches and seeing patients, at some point it gets old, and now you look for the next challenge, and that's what we call leveling up.

And so, I want to talk about three of the positions that you should consider, particularly if you're in a big hurry. Now, you can spend six, 12, 18 months researching all of the possible nonclinical careers out there, but if you're looking for a particular type of career that I'll mention in a minute, then maybe you should select from one of the three most commonly pursued careers and go from there, and that's what I'm going to talk about today, the pros, the cons, some of the tactics for doing this, and so forth. They definitely provide a better lifestyle, and they pay well, and so I thought I would focus on those today.

Those careers are those of a chief medical officer at a hospital or health system, medical science liaison, or UM medical director. Now, they're all full-time jobs. We're not going to mess around with starting a new business or getting a part-time job and then segwaying to maybe looking for two or three different part-time jobs that you can patch together like I've talked about before, but these are full-time jobs. They involve employment with a large organization. They have a lot of the usual benefits that only large organizations provide, and they're really seen by physicians as very, very viable options. And so, I thought, "Well, if I can provide examples of these three and tell you a little bit about each of them, maybe that can kind of jumpstart your process of leveling up."

All right, I have definitely interviewed multiple physicians doing all of these jobs. I personally have been a chief medical officer, know many other chief medical officers and other senior executives in hospitals that are physicians. I've interviewed many medical science liaisons, which represents the pharma industry. And then the third is, again, one of the most common, and maybe somewhat underappreciated, and that's being a medical director for a health insurance company, or you might call them a healthcare payer, one of the big ones. That's what I want to talk about today.

Let's talk about the chief medical officer first. What about that? How do we do that? And one of the things that comes up, because maybe I'm comparing these three directly, and it's a little bit, I wouldn't say disingenuous, but it's not correct to, let's say, talk about a new MSL and someone who's becoming a new CMO. CMO is a pretty high-level position. Now, I was going to talk about medical directors in the hospital setting, and it is the stepping stone to becoming a CMO. Both those jobs pay well, they have great benefits, and the lifestyle is much better than, let's say, a practicing physician as an anesthesiologist or an ER doctor in the hospital.

But most medical directors that work in the hospital setting are medical directors for a service line, which means they're usually practicing at least half-time as well. I wouldn't want to call that medical director position as a full-time position. Now, there are some full-time medical director positions. If you're in a large enough hospital and you can be a medical director for quality improvement or for informatics or for utilization management or, let's say, even coding and documentation, those can all be full-time jobs. They can pay well. You can replace your clinical salary for sure. And they do serve as a stepping stone, though, to the ultimate hospital environment job, which would be that of a chief medical officer or one of the other senior positions like chief medical information officer or chief quality officer, something like that.

Now, as far as getting from your medical director role up to the CMO role, which is that last step before, but you could eventually become a COO or even a CEO of a hospital. But in focusing on the CMO role, you're going to do some of these things that we will talk about with all three positions, really.

Maybe a little different here. You might want to get an executive coach or mentor. You definitely want to join LinkedIn because you're going to do a lot of your networking and looking for jobs on LinkedIn if you don't have a way to segue up to the current institution where you're already working.

One of the resources is the AAPL, which is the American Association for Physician Leadership, which is at physicianleaders.org. They have a bunch of books. There's a bunch of other books you can look at for healthcare finances and leadership and so forth.

And the question with that job is, "Does it require relocation?" If you're in a large metropolitan area, there's probably multiple systems where you could look for a job, but it's not uncommon to be able to work your way up an institution's hierarchy, work as a medical director, take on more responsibility over time while you gradually decrease your practice. And ultimately, while you might keep your license, you reach a point where you really don't need a license.

I would maintain it only because sometimes when you're looking to change to a CMO role at another organization, they want you to have the license. I think sometimes that's because they might be using your license for some things, having to do with the pharmacy or covering for ordering drugs for different units. But ultimately, you won't really need to have that license because you're no longer seeing patients. Although as a CMO, you can continue to see patients once a week or every other week or so if you want to continue to do that.

But it's one of those jobs that you should think of right off the bat if you're in a position that enables you to pursue that kind of job. It's not right for everybody. If you're a dermatologist working in an outpatient setting or if you've never had privileges at a hospital, it makes it difficult to start that job search from nothing as opposed to being one of these people in the hospital that are there all the time, the emergency physicians, anesthesiologists and various surgeons and so forth. Geriatricians and hospitalists are typical, very common to move up that path. So that's the first one.

With that, I think I'll move on to the next one, which is medical science liaison. We've talked about this before. It's a very common and attractive position. It really doesn't require any special background. I think it's helpful if you have experience in working with particular drugs or drug classes. It's kind of whatever's popular at the time. Oncologists typically can get into pharma very easily. They'll often go into more of the clinical research side of things, but as an oncologist, it would be very easy to become an MSL, but also pretty much anyone who's using certain drugs and classes of drugs, whether it's cardiology, even gynecologists and family physicians, internists for sure. There's a big push in GI drugs lately. So if you were doing GI work and wanted to transition to this role, it'd probably be fairly easily.

And there are even positions for people that don't have a residency and haven't been in practice, but we're really focusing on those who have been in practice and want to level up to something new with a better lifestyle, but actually paying equal to or more in the long run than what you're doing now. And as I said, we're going to focus on some of those drugs to help convince our new employer.

As far as resources to try and move into this role, you want to commiserate with others that are doing it, you want to go on LinkedIn, you want to have a great profile. This applies to all three. Great LinkedIn profile, networking on LinkedIn, engage with peers. You can join the MSL Society, which the link there is themsls.org. They have a lot in there for people who are already medical science liaisons, but you can imagine just taking a few entry-level courses and reading about becoming an MSL and being an MSL and exceeding and excelling as an MSL would be very helpful. And in addition, you'll learn the language that they speak.

And when you're doing interviews and submitting your resume, you want to sprinkle those and your LinkedIn profile with the vernacular that's not used outside of the pharma industry. And some of it's not even used by anyone other than medical science liaisons. I do also mention the Contract Research Organization, CRO, because you can work directly for a pharmaceutical company as an MSL, but a lot of MSLs work for contract research organizations.

A CRO has different names, it could be the Contract Research Organization, it could be Contract Resource Organization, but they provide resources to pharma companies for those things that they don't want to keep hiring for. And sometimes it's MSLs, it can be other things, it could be the components that actually provide the studies, that monitor the studies and so forth.

You oftentimes will find that CROs are hiring medical science liaisons a little quicker than the pharmaceutical companies go. And all of these things are dependent on what is going on in the industry, how much demand there is based on what new drugs are being released by various companies. And it's at that point of release that MSLs get heavily involved. It's an educational role, it's not a marketing or sales role.

I remember once talking to a guest who's a pediatrician and she didn't think there was any way she could be employed by a pharma company, but because of all the experience she had with vaccines, they happened to be looking for somebody that had that experience and she was able to get a job. And I think initially she was employed by a CRO and then later moved up to a full-time position either with the CRO or with the pharma company itself. That's the second one I wanted to mention today. Don't forget to look at the MSL Society to get some ideas on how to approach that goal.

The last one I want to talk about today, again, one of the big three, is working as a medical director for a utilization management company, working for a large payer. Again, that doesn't require any special background. If you've done chart reviews before in the hospital setting, particularly maybe you've been a physician advisor for UM in the hospital, that might help. All the big insurance companies hire these people, but they also sometimes farm this out to something called an IRO, which is an independent review organization.

And so, many people when they're starting out and becoming a UM or a benefits management medical director, they'll apply at an IRO first and they'll find a job part-time. This is the one that's a little easier to do, kind of the pilots where you're still doing your old job. You're doing some part-time chart reviews for an IRO and then some IROs will hire you full-time.

One of my colleagues really, he hasn't been a guest on the podcast yet. I'm probably going to have him on someday, but he was a surgeon and he just wanted to spend more time with his kids. And he thought, "Well, I don't know. I make a fair amount of money as a surgeon but I'm not having any time with my kids. I'm not spending enough time with my kids. They're growing up, I'm missing on that." And he said, "I'm going to level up to one of these different careers." And so, he did start working as a medical director for an independent review organization and he actually really enjoys it. In addition to doing general sort of chart review work, he's also serving as a resource for those surgical cases. So you can always get that. Even if you're a specialist, sometimes they have special roles for you. One of my other guests or the other one that was a guest as opposed to this first example, he was an invasive cardiologist for pediatrics.

And yeah, he's been working at a health system or a health insurer rather for gosh, at least five or six years now since I interviewed him. And he's very happy and he actually helps other people do that. The resources for that, besides looking around for IROs, if you want a list of some of the IROs, they're basically the ones that are certified. You can go to NAIRO, which is the National Association of IROs at nairo.org/members. You'll get a list of all the NAIRO members and you can go look at their websites to see if they're hiring the type of medical director that you might be looking at. And again, these can be for part-time positions to get you started, to get you exposed.

You can also go to Facebook and look for the Remote Careers for Physicians Facebook group. It's got at least 10,000 members now. It's pretty big group. And everybody in there is kind of talking about working as a payer or a health insurer UM medical director and other associated types of positions.

All the big insurance companies definitely will hire these people as well. Whether we're talking about Cigna or Centene or several others, any of the big ones, they all have them. But they also outsource some of the work to the IROs. Again, I will remind you that for all these positions, it's important to be on LinkedIn. It's important to have a complete profile. It's important to use LinkedIn and sometimes Doximity to locate your colleagues and network with them. See if some of them are already doing one of these jobs.

Like I said, maybe it's time to level up and this is how you can get started. And if one of these three positions sounds right for you, then you can just jump in now and start working on it and see what you think.

The other thing I would say is besides what I've already mentioned in terms of the benefits is they have great benefit packages in most of these places. You've got health insurance, disability insurance, retirement plans, four to six weeks of paid time off. And some of them will even give physicians deferred compensation benefits. So that can be nice for your retirement planning.

Well, I guess that's it for today's discussion. Thousands of physicians literally just in the last few years have found happiness in each of these three careers. They all offer full-time salaries, generally good benefits, and there are resources that can help you get started. Just check out those resources and get going. And if you have any questions, you can always contact me.

If you want to access everything that I've talked about today easily, you can go to the show notes. You'll also get a link to the podcast episode. You'll get related links, several related links actually and the transcript. And you can find all that at nonclinicalphysicians.com/popular-full-time-careers.

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Many of the links that I refer you to, and that you’ll find in the show notes, 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. And I only promote products and services that I believe are of high quality and will be useful to you, that I have personally used or am very familiar with.

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. 

The post First Consider The Most Popular Full-Time Careers appeared first on NonClinical Physicians.

Interview with Dr. Mark Olsyzk – 356

In today's interview, outstanding CMO Dr. Mark Olszyk provides his advice and that of his co-authors from The Chief Medical Officer's Essential Guidebook. 

He discusses the critical skills required for effective medical leadership and practical tips for navigating complex healthcare challenges. And he emphasizes the importance of continuous learning and collaboration among healthcare professionals to be successful.

Our Show Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast. The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

For Podcast Listeners

• John hosts a short Weekly Q&A Session addressing any topic related to physician careers and leadership. Each discussion is now posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 per month.
• If you want access to dozens of lessons dedicated to nonclinical and unconventional clinical careers, you should join the Nonclinical Career Academy MemberClub. For a small monthly fee, you can access the Weekly Q&A Sessions AND as many lessons and courses as you wish. Click the link to check it out, and use the Coupon Code “FIRSTMONTHFIVE” to get your first month for only $5.00.
• The 2024 Nonclinical Summit is over. But you can access all the fantastic lectures from our nationally recognized speakers, including Dr. Dike Drummond, Dr. Nneka Unachukwu, Dr. Gretchen Green, and Dr. Mike Woo-Ming. Go to Nonclinical Summit and enter Coupon Code “30-OFF” for a $30 discount.

The Journey to Becoming an Outstanding CMO: Insights and Experiences

John leveraged resources from the American Association for Physician Leadership (AAPL), including its Certified Physician Executive (CPE) program, to enhance his leadership skills. That is where he met Dr. Mark Olszyk, a seasoned physician leader with a rich background in military service and medical administration.

Dr. Olszyk, co-author and editor of “The Chief Medical Officer's Essential Guidebook,” shares his extensive experience in medical leadership. From his early days in the Navy to his decade-long tenure as a Chief Medical Officer (CMO), he highlights the importance of learning from successes and mistakes. The book serves as a comprehensive guide for aspiring CMOs, offering practical advice and lessons distilled from the experiences of various medical leaders.

The Role of a Chief Medical Officer: Responsibilities and Challenges

Dr. Olszyk outlines the multifaceted role of a Chief Medical Officer, emphasizing the importance of building bridges between various stakeholders in a hospital. He describes the evolution of the CMO role from the Vice President of Medical Affairs, focusing on credentialing, privileging, quality reviews, and regulatory compliance.

A CMO is a liaison between the medical staff, hospital administration, and the board of directors, ensuring effective collaboration. Dr. Olszyk also discusses his journey in medical leadership and the fulfillment he has experienced during his career.

Advice for Aspiring Medical Leaders: Steps to Take and Skills to Develop

Mark offers practical advice and steps to gain relevant experience for those considering a career in medical leadership. He encourages involvement in leadership roles within hospitals and joining professional organizations like the AAPL and the American College of Healthcare Executives (ACHE).

He also emphasizes the value of networking, seeking mentorship from current medical leaders, and continuously developing leadership skills through education and practical experience. By engaging in paid and volunteer leadership opportunities, physicians can significantly influence the future of healthcare while developing new skills, on their journeys to outstanding CMO.

Summary

In this interview, Dr. Mark Olszyk shares his extensive experience as an outstanding CMO and co-author of “The Chief Medical Officer's Essential Guidebook.” For those interested in purchasing the book, it is available on Amazon or through the American Association for Physician Leadership (AAPL) website, where volume discounts are also offered.  You can reach Mark directly via LinkedIn.

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• Dr. Mark Olszyk's LinkedIn Page 
• The Chief Medical Officer's Essential Guidebook
• AAPL: The Chief Medical Officer's Essential Guidebook
• 4 Things the CMO Should Never Say to the CEO – 251
• 6 Important Assignments of a Hospital CMO – 218
• What Makes a Great Health System Chief Medical Officer?
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 356

The Essential Guidebook to Being An Outstanding CMO

- Interview with Dr. Mark Olszyk

John: During my efforts to improve my skills as a physician leader, I naturally took advantage of the AAPL, the American Association for Physician Leadership, including its CPE program. And it was during the final week of that CPE program that I met today's guest. He's a consummate physician leader, starting with way back when he was in the military. He may still be in the military, I'll ask him about that. But anyway, he's held numerous leadership and executive positions, and he's also the co-author and editor of a new book, well, it came out last year, The Chief Medical Officer's Essential Guidebook. Let's welcome Dr. Mark Olszyk to the show. Good to see you again, Mark.

Dr. Mark Olszyk: Good to see you, John. It's been too long, but thanks for having me and inviting me to your podcast. I'm really excited to be here.

John: Excellent. I have brought up the issue of physician leadership, and especially in the hospital setting, many times over the years on the podcast. And as far as I know, there are books written about the job and different aspects. But really, when I saw this book, with excellent collaboration with the AAPL and yourself with all your experience, this is just perfect for those in my audience who are thinking about moving along those lines, and actually a "how to" to get there. I really appreciate you putting this book out there.

Dr. Mark Olszyk: Oh, well, thanks. To answer your previous question, I'm not still in the military. I got out in 2003, kind of hard to believe, but I'm a proud Navy veteran, and my son is an Army ROTC. So, get that out of the way.

John: Nice.

Dr. Mark Olszyk: Yeah, yeah. The book, I think everybody at some point in their lives, reflecting on their experiences, and their travels and their journey, say, "Yeah, I should write a book about that." And I'm no different. But I've been a CMO, chief medical officer for about 10 and a half years. But I've been in medical leadership since the first year after finishing residency, I went into the US Navy. And the military, unlike almost any other sector, will put you in to leadership positions as soon as possible. And you find a way to get the skills and find the maturity and the leadership is thrust upon you and you have to rise to the occasion. I've always been grateful for that.

But I had gone to conferences at AAPL, others where I met other chief medical officers, and we would share stories. And I thought, boy, it'd be great to write this stuff down and distill this because these are some really valuable lessons, not just the things that we had done correctly, but all of the mistakes that we had made. And wouldn't it be better for other people to learn from our mistakes rather than repeat them themselves.

I guess it came to a head in our system. Physician was made chief medical officer of another hospital. And I just kind of casually passed along here's 10 things to do, like the 10 commandments, but not nearly as inspired, but just 10 things. And about six to eight months later, I guess he lost it. It was that impactful. But he lost it and said, hey, can you send it to me again? I just didn't have it. And I thought, "You know what? If I'm going to write some stuff down, let me make it into something." And it just kind of grew. And I talked to some of my colleagues and contacts. And I said, would you guys be interested in collaborating on a book? Because I think it'll be enormously boring if it's just me telling the stories. But if we have a whole chorus of voices, I think that might really strike a note.

I just had no idea how to publish a book. I just didn't want to do it on my own. I approached AAPL. And Nancy Collins was very gracious. We actually met in a Starbucks in Maryland. And she showed me some of her other publications that came out recently, one of which was a collaborative effort. And it just kind of grew from there.

I reached out to everybody I knew in my life who was a CMO or medical leader. And there was a lot of enthusiasm. I learned a lot in trying to shepherd people together for a collective effort where I was not their boss. They were not getting paid. And there was no way I could really enforce any sort of deadlines or standards. That in itself could be a book, a book about how to write a book. But it was a fun journey. I'm glad it's out there and I've received some excellent feedback.

John: Yeah, when I look through it, of course, most physicians, actually, most clinicians, of course, they like teaching, like helping their peers and so forth. And I think many, if not all, not all of the section writers or physicians, of course, you tapped into other expertise, which I like. There's a lot covered there.

And when I think about the CMO role, it's in my mind is like this iconic what does a CMO do? But everyone does it differently. Everyone does different aspects, more depending on each job. It's unique. But yet, I think you covered everything that I could think of in terms of what questions would I have if I was thinking about being a CMO or I was and I was missing something. So tell me a little bit more about the process. How did you herd all these cats and get this thing done? How long did it take you to do?

Dr. Mark Olszyk: From start to finish, it took about a year. Some of the author contributors returned their submissions in two weeks. Others took about eight months. Some needed multiple revisions, some needed none. I did recruit two co-editors, Aaron Dupree and Rex Hoffman. They helped out a lot.

I learned a lot about copy editing and all of the back office productions and placing it and formatting it. From what had existed only as a series of, I'll say, not too well organized Word documents on my desktop, to see that transform into an actual written book was pretty fascinating and eye-opening. But originally I had an idea for a structure and like all initial ideas, it went away pretty quickly.

And so I just asked people to write about what they felt that they were knowledgeable about or passionate. And the outlines of a puzzle began to come together. And then after about 75% of the submissions were in, at least an outline form, then I could actually target what was missing.

As a frustrated or wannabe classicist, I used the model of the medieval concept of the human being. The first set of chapters, the first section is about the anatomy of the CMO, the basics, the blocking and tackling, metrics and patient experience and all the quotidian day-to-day activities that were going to be the guts and the sinews and the bones.

And then we would move on to the heart, which is all about relationships and how the CMO relates to the chief nursing officer, the chief executive officer, to the board of directors, to departmental chiefs or chairs, and also their perspectives, what they think a CMO should be, or how a CMO should act to be successful in their eyes.

And then we moved on to the brain, the strategic thinking, extra hospital relationships, like how do you deal with third-party rating agencies and auditors and joint commission and dealing with the media, especially when the memories refresh from the pandemic, what if you're asked to appear on TV, on live TV, on the radio and newspaper articles how do you prepare for that?

And then finally, the soul or the spirit, which would be the transformational values and ethics and diversity, inclusion, aspirational type things. It was kind of a journey from the very basic things that a CMO would do day-to-day to the more long-range aspirational goals or values. And I think the way it's written, you can skip around. You can say, gee, I want to learn more about how to prepare for a media interview or how to relate to the board of directors. And you can go right to that section. So it doesn't have to be read in order. It can be used as a reference or it could be read as a story in itself.

John: I think it's pretty comprehensive. And probably in anyone who serves as CMO may not even be exposed to all the things that are covered. There's so much and again, because each role is slightly different. So it's awesome. One of the things I like to do when I'm bringing on an editor and author is pick their brain. So I have an ulterior motive for having you here other than just to talk about the book, although again, it's fairly comprehensive.

But just to keep what our audience's appetite here for this job because some are a little reluctant maybe they have a negative feeling about working in hospitals being abused by somebody or another, but there are good systems out there. And the other thing is being the CMO, you can make a big difference in how that organization is run. Tell me what you would say, if you were to boil it down, what are the most common areas that a chief medical officer is sort of responsible for? Maybe another way to look at it is like who reports to them, because it kind of makes me think about, okay, well, I do this because this person reports me. So however you want to answer that question in terms of the core roles of a CMO.

Dr. Mark Olszyk: I think the CMO role evolved from what was previously and still exists, usually in a hyphenated title, Vice President of Medical Affairs. That being the mechanics and the support staff for the organized medical staff. And every hospital per joint commission guidelines and through history, has had an independent organized medical staff who are largely responsible to establish their own standards for credentialing and privileging. And that was made ever more important back in the 1960s, when there were landmark cases, lawsuits, where patients began to sue hospitals. And the hospital said, hey, we have to really have some quality standards, and we're going to ask the medical staff, almost as a guild to police itself. But the medical staff have full-time jobs taking care of patients, and it's hard for them to keep the files and the minutes and the records and organize the meetings and stay abreast of all of the regulatory changes.

There is an Office of Medical Affairs in every hospital. And the Vice President of Medical Affairs, now the CMO, is largely responsible for ensuring the quality of the medical staff, making sure the medical staff leaders understand what they're supposed to do, making sure that they do it. And it's challenging in that the medical staff can be employees of the hospital or healthcare system. They can be contractors or vendors, or they can be completely independent. And when I started out at this hospital, it was about one-third of each.

To get all those different folks with their different interests aligned in a common effort proved to be a challenge, but one I thought was very fun because I had to look at their world through their eyes and also convince them that what we were doing was necessary and important and create a team not of rivals or competitors, but of people who didn't necessarily all fall into the same silo.

We're largely responsible for the credentialing, privileging, presenting those applications to the medical executive committee and to the governing body, which is usually the board of directors, making sure everyone is completing their FPPEs, their OPPEs, the ongoing professional performance assessments, making sure they're up to standards with joint commission, reviewing and knowing the bylaws. I probably know the bylaws better than anybody in the hospital. We've rewritten them 10 times since I've been here. Quality review, and then making sure that the medical staff were involved in all of the various intra-hospital, extra-hospital committees radiation safety, prescribing, that sort of thing.

What I'd like to say is that the chief medical officer is a bridge builder between the hospital administration and the medical staff, but also between the medical staff and the board of directors, between the hospital and the community. Sometimes the CMO, I found myself as the spokesperson during the pandemic especially. It was on local radio, on TV trying to break down in very understandable terms what was happening, but also bring back to the hospital and tell them, hey, this is what the community is concerned about. Here are the questions they have.

We have to be mindful of that, responsible for that. Also within the hospital, being a bridge builder between the various departments translating the needs of the hospitalist team to nursing or between medicine and surgery and sometimes refereeing, sometimes being just the host getting folks together.

But I always come back to bridge building. And again, if you look through history, through cinema, through literature, bridges always figure prominently in history, battles of the Milvian Bridge with Constantine changing the nature of the Roman Empire, Stamford Bridge, which ended the Viking Age in England. All these great events happen on bridges. Even if you've seen Saving Private Ryan, which came out, in 1998. The last ultimate scene, Tom Hanks losing his life is actually on a bridge. And if you're a fan of The Lord of the Rings, that's where Gandalf the Grey transforms into Gandalf the White. And again, Jimmy Stewart, It's a Wonderful Life. The transformational scenes occur on a bridge.

I was a scoutmaster. When the Cub Scouts become Boy Scouts, they cross over this bridge and they don't really pay much attention to it. But I gave a little speech to the parents, like, look, this is a special time, you're going from one part of your life to another. And this is punctuated by going over a bridge. Bridges represent liminal spaces, liminal time, when you're not here, or there. Bridges are a great metaphor, because they're very narrow. And they're very risky, because if you fall off one way or another, if you don't keep a straight path, if you don't keep your eyes on the goal, tragedy can ensue. And sometimes it's foggy, sometimes it's slippery. So, it takes somebody who's been back and forth a few times, who's surefooted, who is focused to to cross that bridge.

And bringing together all those communities, translating their needs and their goals and their concerns from one party to another, can be very risky. If you don't do it correctly, it can really backfire. That's why I consider the role as bridge builder. The Pope himself is the official title is Pontifex Maximus. The greatest bridge builder. I don't think the CMO is the Maximus, but I think it's a very important bridge builder, we can all build bridges. And hopefully, the CMO can exemplify that.

John: The ironic thing is that if you go back the last 20-30 years, for a while there, there weren't that many physicians in leadership positions, at least on the community hospital side you always had academic hierarchies. But I think in the 50s, up to half of hospitals might have been owned by physicians, and then over time, it just everything got split. And so I think what you just said, it's important that physicians be in those roles. So I'm glad that there are more physicians and when I started as VPMA, our hospital had never had a VPMA or a CMO. So many hospitals now do.

Building on that, tell me in your opinion, the pros and cons of being a CMO. Like I say, I have many people that are a little reluctant to make that commitment. But to me, it was a natural thing to pursue. So, what are your feelings and some of the challenges and also just what you love about it?

Dr. Mark Olszyk: Yeah, for me,this can sound a little pollyannish or saccharine, but for me, there's no downside. I guess it just fits my personality. When I was a brand new attending physician, I would see these larger forces at work in a hospital, budget, staffing challenges. And I'm like, man, I just want to be able to fix that I want to get involved in that. So it was kind of a natural course. I got my MBA so I could talk the talk and understand some of the discussions a little bit better, and then got more and more involved.

And it's just hard for me to resist trying to represent my fellow medical staff members, physicians, but pretty much trying to weigh in. If we're planning an expansion to the hospital or adding a new service line, or how do we go about on some major quality initiative, I really want to have a seat at the table and have a voice. So the best way to do that is to get into the C-suite, you get into medical leadership, develop those relationships and connections.

What I love most about the job is probably as a CMO, I'm an ambassador, plenty potentiary, I can go to any clinical department, I can go right down to pathology right now, talk to my chief pathologist. And he's got a two sided microscope, and he'll show me some slides which look like pink and purple squares. And he'll say, what is this, and I'll get it wrong every single time. Then we talk about his family. I get to know him as a person. And that builds a bond of trust, it furthers our relationship. I can walk out of there and I can go up to radiology and look at some of the images with the radiologists. And then I can walk in to the surgical suite and get gowned up and just see what the surgeons are going through, see what their day is like. Yeah, I can do the same thing for the hospitalists, for pediatrics.

I actually like being a medical student in my third and fourth years because you have a different rotation every month. It was always fresh, it was always interesting. And that's why I went into emergency medicine where you're expected to be somewhat proficient in almost anything because you don't know what's going to walk through the door. So, you have to know about pediatric medication doses, you have to know how to treat people struck by lightning or bitten by rattlesnakes or CHF in a hundred-year-old.

So, you have to know everything you have to know enough about every specialty. And then you wind up calling every specialty, sometimes in the middle of the night, but often during the course of your shift, either for follow-up or for intervention. And so, you have to learn how to speak their languages. And I just never really wanted to give that up. I didn't want to find myself just in one specialty and not continuing to learn and stay abreast of all the others.

So, I think that's the most fascinating aspect of being a CMO is, I'm pretty much given a hall pass to go wherever I want in the hospital and no one questions that. In fact, they kind of expect that. And that carries over. I get to go to the board meetings, to the finance meetings.

I can drop in on the chief nursing officer, chief quality officer. So for a person who's emergency medicine docs tend to be a little bit restless and always looking for some new stimulus, that was just a perfect job for me. So, that's my favorite aspect and one I would not ever want to give up.

John: Excellent. Now, it's interesting. We all have our own particular things that we like. I loved interacting with the board. I was on the every board meeting. I had an official presentation and I actually love spending an hour or two preparing that. I like being alone in my office and doing things to prepare for that. Whereas other people are like I want to be out there in the public. There's so many different things that one can do.

So, if there's someone in the audience who's either thinking about, well, would I like this or should I do this? Or I'm about 50% sure that I want to do this. What advice would you have for that person early in the thought process of pursuing a leadership position, let's say, rather than and it may be eventually CMO?

Dr. Mark Olszyk: Yeah, I'll approach that a little bit obliquely. So, I've given a number of leadership talks over the years and folks are always asking, well, how do I get experience being a leader? I'm like, there's no end of opportunities. Having been in the Boy Scouts, I have three sons, and they're all Eagle Scouts now. But people are always looking for leaders. And it might not be the thing you want to do forever.

But whether it's your church or civic group, the schools, they're always looking for someone to step up. And I said, boy, if you can be a Scout leader, and hold the attention of 60, 10 and 11 year olds for 90 minutes, you can do anything. First of all, brush up your leadership skills wherever you can find the opportunity doesn't have to be in the hospital.

Secondly, the hospitals are always looking for medical leaders. I've seen a ocean sea change in the last 10 years. It used to be that our medical staff meetings, our quarterly medical staff meetings, were raucous affairs, we would have 60 or 70 people there.

As our models have become more contracted or employed physicians, I guess they don't have the same feeling of being community stakeholders as when it was mostly independent physicians in the community who had been there for decades. Now the days are long. And I think after a 12 hour shift, the hospitalists want to go home. And there's also the opportunity to Zoom into a meeting. So we don't see as many people attend in person. And it's getting harder and harder to get people to volunteer to spend an hour or two, even if it's once a month, in a peer review committee, because it does take some commitment to read over the cases and then show up for the committee. And we don't stipend or remunerate anyone except for the chair or the chief.

So it's volunteer work. We're always hungry for that. I'm sure every hospital has opportunities. If you want to get involved in peer review or bylaws or credentialing, or on the pharmacy and therapeutics committee, there's definitely opportunities there. Or the foundation or fundraising, or there's lots of opportunities.

And then you begin to network. I guess the next opportunity would be just to ask your chief medical officer. You could probably shadow him or her for the day. We all like to talk about ourselves. I'm doing it right now. If someone came to my office and said, hey, I'm interested in one day being a CMO or an assistant or vice, what's the path? And it depends on the person, on their personality, what they would like to do. Everyone does it differently. Every hospital has a different set of requirements or needs. So it's dependent, but I would be very willing to talk to them. I think anybody would.

Next you could buy the book and look through that. A little selfish promotion, or you could join one of the organizations, AAPL, ACHE. States have their own chapters. Every specialty has its own chapter as well. I think there's lots and lots of opportunities. You can write articles. Journals are always looking for articles. So there's a lot of ways to just get more involved. I don't think anybody in a medical leadership position would be reluctant or hesitant just to make the time for someone who expressed an interest and wanted to learn more.

John: The other thing I found useful, I don't know if it's still the same, but talking to the CEO, hey, what's your perspective on physician leaders and what should I do if I want to get up and be part of the senior executive team? So there's tons of opportunities.

Dr. Mark Olszyk: Absolutely.

John: But we are going to run out of time. So let's talk about the book again. Let's start with what do you think is the best way to get the book? Should we go to the AAPL? Should we go to Amazon? Are there other ways of finding the book?

Dr. Mark Olszyk: Either one of those is fantastic. If you go through AAPL and you want to order a lot, there are volume discounts or you can go to Amazon, it's easy. You can type in chief medical officer or even my last name, which is not too common, Olszyk book, and it'll pop up. You'll see a couple of Amazon reviews. Unfortunately, some were written by my children. Ignore those. And if your listeners or podcast watchers do get a copy, please do leave a review. It's important. But yeah, either way, you go through AAPL. I think there are some other platforms out there, but those are probably the two most common and easiest to go through.

John: That makes sense. What if they have a question for you? Can they reach out to you?

Dr. Mark Olszyk: They can reach out to me. Yeah, I'm on LinkedIn, as you know so you can direct message me. People have done that and I've responded quickly.

John: Okay, good. Excellent. It's good sometimes just really to talk to the editor or author. Of course, you wrote several of the sections of the book in addition to being the chief editor and you said you had some help with that. But okay, well, any last bit of advice before I do let you go in terms of the future of medicine and physician leadership therein? Any other words of wisdom before I release you from this torture?

Dr. Mark Olszyk: No, it wasn't torture at all. I really enjoyed it. It's good seeing you again. And again, thank you for the opportunity. Clearly, like everything else, medicine is going to change more in the next 10 years than it has in the last two generations. So if you want to be part of that change, get into a leadership position, let your voice be heard. I think a pessimist is someone who takes no joy in being proven right. And an optimist is someone who thinks the future is yet uncertain. So if you want to help craft the future, get involved.

John: That's awesome advice again. And I think physicians do resonate with that for the most part. I want to thank you again for being my guest. I might have to have you come back and dig into one of these topics that's in the book, maybe in more detail at some point, but it's been great talking to you again. We appreciate you sharing your expertise with us today.

Dr. Mark Olszyk: Cool. Thanks, John.

John: You're welcome.

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An Important Business and Management Tool

In today's episode, John describes why the SWOT Analysis is an important tool for physician leaders and how to use it for project and strategic planning.

The process of shifting to a nonclinical career often involves learning and applying new business knowledge and skills. Most physicians have not been exposed to formal project management or strategic planning concepts during their medical education. The SWOT Analysis is a well-known business tool that is easy to learn and implement.

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We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Did you know that you can sponsor the Physician Nonclinical Careers Podcast? As a sponsor, you will reach thousands of physicians with each episode to sell your products and services or to build your following. For a modest fee, your message will be heard on the podcast and will continue to reach new listeners for years after it is released.  The message will also appear on the website with over 8,000 monthly visits and in our email newsletter and social media posts. To learn more, contact us at john.jurica.md@gmail.com and include SPONSOR in the Subject Line.

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Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

Building a Stronger Skill Set for Career Advancement

This week, John emphasizes the importance of acquiring new skills to enhance one's professional profile. The focus is on business skills crucial for executive and management positions. John suggests that expanding one's skill set in negotiating, contracting, health law, management principles, HR principles, and leadership can significantly enhance attractiveness to employers in the healthcare sector.

Mastering the SWOT Analysis in 15 Minutes

By sharing personal experiences and using a hypothetical healthcare scenario, John illustrates how SWOT analysis can be effectively applied to make informed decisions. Below is an example discussed during the presentation.

Decision Whether to Expand Healthcare Services

Scenario: John recounted a situation where his team needed to decide whether to expand healthcare services (urgent care) into a new area.
– Strengths: The organization was the largest and most successful hospital in the community, with a significant financial advantage, brand recognition, and a successful history of physician recruitment.
– Weaknesses: Lack of experience in urgent care, ongoing strategic initiatives such as starting an open heart program, recruiting a new radiology group, and completing a new wing addition to the hospital.
– Opportunities: Rental space availability, community demand for more physicians, and a supportive medical group interested in expanding primary care services.
– Threats: Large uninsured population, potential external competitors, and concerns about the reaction of the existing medical staff.

By considering the above factors that were discovered during a SWOT Analysis, our team was better able to make an informed decision about the risks and benefits of proceeding with the planned expansion. Based on this analysis, our health system decided to move forward with this initiative.

Using a SWOT Analysis in Other Situations

Doing a  SWOT analysis is also very useful in the context of regular strategic planning meetings. When dealing with various strategic initiatives a SWOT analysis of each can be part of the decision-making process for allocating resources to specific projects. A SWOT Analysis will help identify priorities, assess the potential impact of each one, and help decide how to allocate resources effectively.

Summary

John illustrates how SWOT analysis can be effectively applied to make informed decisions in the healthcare sector. It is a simple process that any healthcare leader can learn to do. And it makes a great addition to your portfolio of management and leadership skills needed to land your first executive position.

NOTE: Look below for a transcript of today's episode. 

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Links for Today's Episode:

• How to Pursue a Nonclinical Career in Hospital Management – 080
• How to Deploy a Powerful Tool to Identify Goals – 054
• From SWOT Analysis to Inspired Goal Setting
• When to Use a SWOT Analysis
• Dr. Debra Blaine's Coaching Services

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 336

Add the SWOT Analysis to Your Growing Skill Stack

John: It's a good idea if you're thinking about moving into some other area that you might consider obtaining new skills that you can stack on your existing skills, and that makes you more attractive to certain types of jobs. And a lot of those skills and a lot of that knowledge is basically business skills and information. In fact, I was thinking about this earlier and much of what I'm going to talk about today, the types of skills that you might want to accrue, we talked about last time. You're pretty much going to find those if you happen to be a member of the American Association for Physician Leadership, including a leader in an executive position. So, you're going to need to know all of those business skills like negotiating and contracting, health law, and management principles, HR principles, leadership principles, and so on and so forth.

Today, I want to give you a little mini MBA course in 15 minutes. This is a session in which we are going to talk about SWOT analysis. What is a SWOT analysis? Now, I remember probably sitting in a room one day, I think it was shortly after I became VP for medical affairs. I was in the C-suite, and I was listening to these conversations. I was acclimating to this new job, and I heard somebody talk about, "Well, we've got to do our budgeting at the end of the year here, and we're going to be setting some management goals and so we need to do a SWOT analysis. Then we can be prepared to move forward on that." I'm thinking "SWOT analysis, that sounds pretty... Is that like a SWAT team or something?" But for those that know what it is, you're kind of chuckling because the SWOT analysis sounds like some really great tool, but it's been around forever.

The SWOT just simply comes from the acronym of what you're doing when you're doing a SWOT analysis. And that is for whatever problem you're looking at, you're trying to solve and maybe develop a set of goals or make a decision about, you're just going to look at these factors which have been shown to be important in decision making about whether to proceed with something like this or not, or choose from among a multitude of options. We got 10 different things we want to do. How do we figure out which of those 10 are the highest priorities? Well, you could do a SWOT analysis. There's lots of ways that a SWOT analysis is used.

Now, I will mention this. You may want to read about this, and actually, even Wikipedia does a pretty good job describing this, but you can look it up on Google. You can find almost any kind of business management book will have it. I'm sure it's taught in schools that provide MBAs and MMS and MHAs and things like that.

But the SWAT simply refers to the S is Strength. The W is Weaknesses. The O is Opportunities, and the T is Threats. And so, you take whatever it is that you're dealing with and you bring it through that process. I'll tell you when we use this frequently. I would use it with my managers, and sometimes the senior team would use it to develop a maybe an hour or two session at our strategic planning meetings.

Now we had biweekly or weekly strategic planning meetings. Then we would do a SWOT analysis every time at that, although we could do it at a particular meeting. But if we did an annual, you would call more of a management goal meeting, because the old days we did strategic initiatives that would be looking out three to five years. And there's still sometimes where that's important to do, but generally we're doing year by year.

And that's that short term strategic analysis and plan became really the management plan, which meant that every V line goals that the superior had decided we were going to do for that year coming up. We usually did this towards the end of the year, although not quite at the end because we wanted to know what these initiatives would be before we actually set the budget, as opposed to saying, "Well, I think we're going to extend our hours on weekends." You could do that without necessarily a huge budgetary impact. And in that case, the revenues would offset the expenses anyway. But still, even there, you might want to do that.

I've written about in the past an example of what this might look like. So, I'll just give you an example and we'll walk through it. Let's say that we were in a group, either a private group or part of a hospital medical group, and we decided that we were going to do a SWOT analysis to decide whether we should proceed with an expansion into a new primary care or urgent care service in a new area that we hadn't been in before. We're like, "Okay, we're in a hospital, we have a competitor hospital basically within walking distance. There are some other competitors out further, but basically we have that to contend with." And then we have to consider all the factors that might go into whether we can and should do this. Do we have the budget for it? Are we growing? Do we want to grow? Do we have staff for it? And so forth.

So, let's see what the SWOT analysis might look like. And this is just a partial SWOT analysis, but we're looking at this. And so, let's talk about in a brainstorm about our strengths. At the time, we were definitely the biggest hospital of the two and the most successful I would say in the community. We had a much bigger bottom line. We had $300 or $400 million net revenues, and the other one maybe had a third of that. We had employed a base of physicians. We were fairly successful at recruiting physicians. We had a very healthy bottom line for the last five years. We were making money unlike other hospitals in the state of Illinois who many were losing money.

And what are the other strengths? We had a great brand recognition. We had gone through some marketing consultations in previous years. We had some pretty tight branding and marketing. We had good logos and they had been consistent color palette and that sort of thing. Like I said, the finances were strong.

And then the other thing is, do we have physicians interested in this? And we did have those inside the medical group, the primary care doctors already interested in finding new locations to do this. And if we looked at who was in our team right now, the team that was running the group had a lot of depth. And so, we could take on, we felt in that situation, pretty readily expanding into a new territory. Now, we would also have to decide things like "Are we going to build or are we going to lease some space? How much do we want to commit to this from a budgetary standpoint? Is it going to be enough?" But so far so good.

Now, weaknesses. At the time we were looking at adding an urgent care clinic. Basically we had no experience in urgent care. We were not doing any urgent care. There were some urgent cares in the periphery of our service area. They were all either independent, freestanding, individual urgent cares or large regional groups that we're expanding. And it's a little different competing, let's say, with an urgent care that's run by an entrepreneur as opposed to an urgent care run by a hospital, which typically loses money, but they make it up on the referrals and that kind of thing. No expertise in that.

We had already several pretty pressing strategic initiatives. I don't remember exactly, but let's say that we were do starting an open heart program and we were in the process of recruiting new radiology group and we were still finishing up the addition of a new wing to the hospital. Those are weaknesses because there's a lack of depth in terms of the ability to manage something at maybe a higher level management directors and VPs because we had these other big projects going on because we didn't have the experience.

And the other thing is we were really having trouble at that time recruiting staff fast enough to maintain and keep up with our growth. The area we were looking to go and didn't have urgent care. In fact, the general area around us didn't have urgent care. We were looking at ways to prepare for value-based contracting or prepaid plans, keeping costs down basically which means keeping people out of the emergency room, which is basically what primary care and urgent care does if you have enough capacity. Shunt those people. That's one opportunity we had never pursued before.

It just so happened there was rental space available at several locations in the town in which we were looking to put the urgent care. And we had heard that the community definitely wanted more physicians. We probably should have done a little more digging on that, whether what type of physicians, but basically they just wanted physicians because there was a lack of. This place is a good 30 minute drive outside of the main area where our hospital was located, and it was pretty rural, but still had some population density there.

Now the threats. That's T. The threats for the SWOT analysis could be things like, again, you just look all those areas, finance, growth, marketing, branding, reputation, quality, staffing and HR issues. All those things. And now you look at the threats. Mostly we're looking at threats that are coming from outside, but one threat is that there was a very large uninsured population. Sometimes that could be tricky in terms of how to set it up and how to make sure that you could serve the needs but not lose a lot of money in the process.

The second threat was that we had heard there were both competitors external to our market looking to expand potentially. And then also at the other hospital and in a group of primary care physicians thinking of doing it themselves. They were probably going to start it on their own, in their own offices and expand maybe into this other thing. We need to be aware about that.

And the other threat that we came up with at that time was the fact that our medical staff might not like this idea of us recruiting more and more physicians because a lot of the medical staff at that time were still private medical staff. They were not employed. And so, they would feel threatened by us and they could do things that would make it difficult. They could say, "Okay, we're taking all our business dealer hospital because they're not hiring physicians as much as you are to compete with us. So, those are the kind of examples of some of the strengths, weaknesses, opportunities, and threats.

Now you do that for five or six or seven different projects that you're thinking about. And then by balancing those out and really get into the financial piece, you'll need a pro forma or at least a thumbnail sketch of what the cost of the different projects are, and then what's the return on a clinic or something that might take two or three or four years to really break even. If you add a new service line and get to be successful in three or four months, then you're going to get the return on investment more quickly.

What we would do from taking that SWOT analysis, we would take that to the next step of goal setting so that this is how we would translate it. We would use language like this. For my department, how can we utilize our strengths and acts to take advantage of the opportunity? That's the strengths, the S. How can we utilize our strengths in this A, to minimize the threat coming from B, or how can we take advantage of the opportunity to Z minimize our weaknesses in V.

Let me just give you some examples. This is how we would phrase things if we're going to put some of these together. Following what I just mentioned, I'd say for my department, this would be a manager talking. I had usually between four and eight departments reporting to me. But for my department, how can we utilize our financial strength and strong interest by the medical group to staff an urgent care clinic? Again, how can we utilize our strong management team? That was one of our strengths, to minimize the threat of the large percentage of uninsured in the market. Somehow take care of the uninsured, we've got a good team, we need to leverage them.

Another example, how can we take advantage of community support to minimize our weakness, which is difficulty in recruiting support staff. How do we get the community to help support us getting staff in? And there are big ways to do that. That's where I'm going to end it. But this is something that like I said, you can learn about pretty much anywhere, any business book. You can actually do some business courses at the AAPL that we'll talk about this.

But for a quick review and definition of all the terms, then I would just say go to Wikipedia and look up SWOT analysis. And whatever job you're in and you're being asked to participate in a planning session or to provide feedback. Because I've done this, I am on the board of a hospice and we were doing a strategic plan one year and I said, "Hey, if you want me to take the team through a SWOT analysis, we'll go through the whole thing, all these different areas for where the hospice is in terms of strengths, weaknesses, opportunities, and threats." And we used it for the management team to develop their goals for the following year. And since I had done several SWOT analysis and I thought, "Well, let's have him lead this one and then we can get someone next time to lead it for the rest of the team."

All right, that's all for today. Thank you for listening and I will see you next week. Thank you for listening and watching.

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Interview with Dr. Nilesh Dave – Episode 335

Today's podcast episode describes Dr. Nilesh Dave's four-year career transition to health system Chief Medical Officer. We pick up from his previous appearance 4 years ago in Episode 99, as he lists the steps he took on his interesting career journey.

Starting with his role as medical director at a regional Blue Cross Blue Shield subsidiary, he describes the steps he took to land his position as VP for Clinical Effectiveness and CMO for a large hospital system.

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We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Did you know that you can sponsor the Physician Nonclinical Careers Podcast? As a sponsor, you will reach thousands of physicians with each episode to sell your products and services or to build your following. For a modest fee, your message will be heard on the podcast and will continue to reach new listeners for years after it is released.  The message will also appear on the website with over 8,000 monthly visits and in our email newsletter and social media posts. To learn more, click this link=> SPONSORSHIPS.

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Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

Career Transitions and Leadership Growth

Dr. Nilesh Dave's evolution from medical director to CMO for a health system highlights the importance of diverse skill sets in nonclinical leadership roles:

1. Adaptability across domains
2. Cross-pollination for innovation
3. Strategic thinking
4. Learning and adapting to new technologies

Nilesh emphasized that a combination of clinical knowledge, business acumen, and the ability to adapt to new technologies is essential for success in these roles. Some of these skills developed as he pursued additional formal education, including an MBA and executive training in Artificial Intelligence in Health Care at M.I.T.

Navigating Challenges as Health System Chief Medical Officer

Dr. Dave's role as a CMO involved navigating the challenges of a complex healthcare system. It requires a combination of strategic leadership, analytical thinking, effective communication, and collaboration to drive improvements in clinical outcomes and overall system efficiency. He began developing many of these skills in his previous management roles.

Summary

If you're interested in connecting with Dr. Nilesh Dave and exploring more about his insights into nonclinical roles in the healthcare industry, you can reach out to him on LinkedIn. Dr. Dave often shares valuable perspectives on clinical effectiveness and leadership, making his LinkedIn profile a great platform for networking and staying updated on the latest developments in the field. You can find him on LinkedIn by searching for Nilesh B. Dave MD. 

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• Dr. Nilesh Dave's LinkedIn Page
• First Gain Know-How Then Secure an MBA – 099
• The Eight Essential Abilities The CEO Wants In A Chief Medical Officer
• 6 Important Assignments of a Hospital CMO – 218
• How to Become CMO in a Year – 052
• Dr. Debra Blaine's Website

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 335

What Makes a Great Health System Chief Medical Officer?

- Interview with Dr. Nilesh Dave

John: I can't believe it's been four years since I last interviewed today's guest. I wanted to have him come back because his nonclinical career has flourished since he was here before. And he's in a leadership position now of a large hospital system, which is awesome. I think he has a lot to share with you all today. With that, let me welcome back Dr. Nilesh Dave. Hello.

Dr. Nilesh Dave: Hi, John. It's great to be back. I'm looking forward to chatting with you over what's been going on over the last four years and hoping that any of your listeners out there will hopefully get some nuggets of information and hopefully that'll help them get to the similar or whatever pathway they're on.

John: I think it's going to help a lot, and I have a lot of questions. But when we last spoke in July of 2019, I think it's okay I can mention you were basically working for one of the regional Blue Cross Blue Shield companies but you're no longer there, obviously. That's why I wanted to have you come back. You've made a couple of different changes and you've also done some other things in between. Why don't you tell us what happened, why you decided to move on and what the next job that you did was that would utilize all of your skills and education?

Dr. Nilesh Dave: Yeah, sure. I'm happy to. When I was working for one of the subsidiaries of Blue Cross Blue Shield, I was outreached by another insurer to join their team. And the resources there that they had in analytics and the opportunity to get involved with more business innovation in that space, as well as population health, was too hard to pass up. And so, I literally had to just drive down the street for that when I took that position and learned a ton. I was never someone who actually liked the utilization management component, and this was a minimal part of the entire role.

A lot of jobs in the nonclinical world will sort of describe themselves as working across a matrix or working across silos, so to speak. And I have to say that doing that transition to the other insurer ended up really teaching me some of those skills that it's not anybody that is above or below you in sort of a hierarchy. It's another department and group, but you've got a common client or something like that. And that's what brings you together in achieving some of the business objectives.

And when I was there COVID was starting up. And so, I was enjoying that role. And then I thought, you know what? I want to maintain my clinical skills. And so, I signed up to do some tele ICU moonlighting shifts. With being in a corporate position and having regular hours, it was not difficult to find time to do a clinical shift.

I started doing that and it was different. It kind of checked off the box of, yeah, it's critical care, and I'm an intensivist by training, but it was in a different way. It was tele ICU. I wanted to learn more about that because things were shifting towards telehealth and certainly COVID accelerated that and made telehealth a more accepted way to also deliver healthcare. And so, I just expanded my skill and exposure to it and signed it up.

And then I guess serendipity is what happened next, because I ended up being asked to oversee that multi-state tele ICU operation. And I almost did a double take when I was asked that because this was an opportunity that aligned my clinical skills. I had gotten a business degree before. I was in charge of quality, metrics and policies for the health system that this was a part of. And so, that had some inroads to my master's in public health I did in between medical school years. It just seemed like this makes complete sense. Like why not do something like this that you can get at all these skill sets in under one roof?

John: That's impressive in a way. But also what was the old saying? What is good luck? It's the combination of preparedness and opportunity. Unless you're open to it and you're prepared, however that preparation occurred, you just never know when you take a new position or volunteer somewhere or whatever, what opportunities might show up. What were you doing there? Just to clarify, I was going to ask you about the location, but it sounds like you did not have to move to take on this new role. You said it was down the street.

Dr. Nilesh Dave: No, in fact the company's headquarters moved from Boston to Dallas. And so, their operations for their tele ICU was also located literally within a block of the other two jobs I had previously. It was just sort of a business park, I guess, and that's why. I didn't have to drive really anywhere else.

John: Another serendipitous thing in the sense that there's a lot of movement out of many states, but Texas is one where there's a lot of movement in. And that includes corporations as well as people.

Dr. Nilesh Dave: That's for sure. Yes.

John: You loop selected a good place to live and grow in your career. That's another thing to keep in mind. Tell us again, at the beginning, before you were doing the moonlighting, before you were heading down this telemedicine service, what were the actual duties that you were doing that were different from what you had been doing earlier in your career?

Dr. Nilesh Dave: At both insurance positions, there was a new program that both insurers had started in terms of a white glove population health management service for employers, employees or members of the insurance. And looking at cost of care, drivers of care, managing and understanding the population of workers and really using your medical knowledge and understanding like, okay you've got diabetes, which is a risk factor for coronary disease, and the folks that work in the different divisions of this company. The company had 400,000 people in the Blue Cross Blue Shield subsidiary that I was overseeing. And so, that was a lot of that population health more so. But when I moved to the other insurer, there was more sort of KPIs, key performance indicator, and data associated with that that we focused on as we were managing.

I was managing three different companies with very disparate populations and risk factors. And so, I had one that employees would be in remote locations building solar farms, wind farms and stadiums, and another that was building nuclear subs and the third in drug development. And these are all employees with different kinds of health problems and some very similar.

But in that second role, there was a lot more of a business focus, a lot more strategy, data-driven analytics, and the opportunity to use that data capability that the company had to think of innovative approaches to some of those problems. And so, when I pivoted away from the Blue Cross Blue Shield position, that's what I got out of that second job.

And that retrospect, I think that set me up pretty well for when I started doing the tele ICU operations across multiple states. We had the same kind of set up. We had a lot of analytics. We were in charge of quality and metrics. We had key performance indicators that we had to meet. The usual ventilator length of stay, ICU length of stay, mortality. That's in the medical clinical world, that's when you're in these sort of hybrid clinical business positions, a lot of those things are what you're looking at. And so, being able to be in that tele ICU position really solidified that. And I was able to leverage then my clinical knowledge as well, knowing what does it take to take care of an ICU patient and translate that into the business side for health system.

John: That's what I think is great about physicians that move into these more executive positions, is that they do have that understanding of the relationship with the patient, the needs of patients, medical terms and all that. And if you can just add the business side of it, to me, it's an ideal situation. I think the companies you've worked for, they've recognized that. They have CMOs and they have physicians in pretty high leadership positions unlike a lot of hospitals. Some large hospitals do, but there are a lot of hospitals out there that the first thing they did when the pandemic hit was get rid of their CMO because it was an expensive position, at least from what I've heard. That's why I think physicians sometimes get frustrated working in a health system, but I think you still have to fight for that. And if your colleagues that are at the hospital recognize that they can hopefully encourage the leadership of the hospital to get more physician leaders like yourself. Tell us the next steps. Anything else you want us to tell us about that position you were just describing? I know after two or three years then you found something new to pursue?

Dr. Nilesh Dave: Yeah. There were a few variables that sort of were in the mix, that the health system where I was doing the tele ICU had some struggles and things that were financially related. And so, the tele ICU program was being contracted and expansion was being halted. And being able to grow in that position, it was pretty clear it was going to be delayed for several years. And a lot of the planning and things that we had at the beginning of when I took it a few years later, that was all sort of cut. And so, at that point, an opportunity at a Dallas based health system, the largest one by footprint, in terms of hospitals and things, was advertising a clinical effectiveness chief medical officer position.

And so, I threw my hat in the ring. And obviously after rounds of interviews and things, they offered me the position. One of the things, my background is a divergent one. When you look at, I'm at a system level. We have a system CMO. In some ways you could say I'm an associate system CMO, but they carved out a different CMO role with different parameters. And my background does not fit the "Hey, I've been in a hospital CMO for years and now transitioning to a system level." I was at a system level with the tele ICU, and in some ways I was the critical care subject matter expert overseeing our tele ICU operations and quality and meeting all those metrics. In some ways, there was some similarity to that CMO role, but I did not follow a traditional pathway. And in fact, I think I was very fortunate to be in a company now that actually appreciated my payer experience and my telehealth experience, which they've never had that background. And they thought that that would be an advantage for them based on the personnel and skillsets that they had which was a nice refreshing thing to hear.

John: When you were looking at the job title, if they posted it as such clinically effective CMO, they could have said chief clinically effective as medical officer or something else, but I've heard the term clinically effectiveness, but I've never heard that applied to a CMO. What were you thinking when you first looked at that?

Dr. Nilesh Dave: I figured that there were probably service lines or clinical service lines that between hospitals, they were probably performing at different levels. And I'm sure I expected that there would probably be similar sized hospitals with similar availability of specialties, but their quality metrics, we're not predictably the same. And so, I was sort of trying to figure out what's driving that? And it turned out that thinking before learning more about the position, the position was a new one that they had. It wasn't one that they had established years ago. They got rid of one position and sort of reformatted it. And so, for them it was also a new thing. And it was not only clinical effectiveness from the way you would think in the service line area, but also risk management, safety, credentialing, medical staff affairs.

I'm also involved in deploying our telehealth strategy. I'm on their AI governance task force, the tele ICU. And I've always been into the tech stuff. And so, now with AI, generative AI and things really versioning and so many platforms and vendors out there trying to get a piece of the pie, we had to create a governance structure, and I helped create a framework and took some time to take a certification course from MIT on AI and healthcare as a way to just compliment that because I knew some, but I didn't think I knew enough. And I just did that on my own while in the role taking classes and things online and learning that stuff. Once I saw some of these other aspects of clinical effectiveness, and it really is just making the clinical engine run, as smoothly as it can, that's what it kind of boils down to now. And it's been a phenomenal experience.

John: Describe some of the things that you do in that role, that are more leadership management and so forth. I think it's difficult sometimes for physicians to understand what it's like to move from that strictly clinically, even if you're the head of a service line or something, to working at the level of let's say a senior VP chief medical officer. But it's going to be different for every system as well. You move from one to another. What does it look like for your system? Who are your peers? Which other senior leaders do you regularly meet with or report to for that matter? That would be interesting to hear how that's structured.

Dr. Nilesh Dave: Yeah. Interesting. I'll add one other point is that when I was in the tele ICU position, I had 40, 50 nurses, and probably the equivalent number of physicians on our internal tele ICU operations. I had a whole team, had administrative folks helping to run the operations, a nursing counterpart, and a few other internal business partners. When I joined my current role, the directive was to get things done working through the business. Other than an administrative assistant who's fantastic, I do not have a hundred person team under me or any of that. That's one big difference that I have already in the job, which was a bit strange to me, based on the projects and things.

But I came to learn through listening to interviews like this, that there are many folks who are in these sort of officer positions that work through the business and get things done. And so, on a day-to-day basis, the folks that I interact with could be other VPs who oversee our hospital channel, for example. We have all our hospitals in a channel. We have an ambulatory channel and telehealth channel. And so, we have VPs that oversee that and a lot of them are nonclinical, business trained background. And so, I work a lot with them on different aspects of my projects. I even will directly collaborate with the COO of the company, and occasionally with the CEO and CFO as well as the strategy officer.

It's not a completely sort of flat organization in that sense, but the opportunities are there, and at times necessary. And I also work with the chief medical officers of each hospital. They don't all report to me. They're sort of a dotted line to myself and my colleague. And so, we collaborate together with them. We work with the chief nursing officers, hospital presidents are sort of in the business channel, but we work with those executives at the local hospital levels and then their sort of system counterparts who are maybe senior VPs or executive VPs or whatever. It's all across the board. I work closely with the VP of care transition management who oversees all of the folks in the hospitals. And so, it really is a pokery of various officers. At all levels, it's not just officers.

John: Yeah. When I was working as a CMO, of course, it was a small, it was a hospital, so it was very contained. But we just say that was a matrix relationship. We knew that if we had something we had to get done, it wasn't that I had to go through another VP. I would just deal with whoever I had to deal with to get it done. And then hopefully we're all on the same page, had sort of the same strategic plan and management plan that we were working on. And so, at that level, you even have to learn how to give up a little bit of something. You have to make someone else's thing work, because it's for the overall improvement of the organization, not your own little fiefdom within it. That sounds really goods.

The other thing that it makes me think about is when going through some of the courses at the AAPL and what I've taught when I've heard from others doing MBAs and so forth, the importance of things like negotiation, communication, persuasion even as a thing. And it's all about doing that rather than there's no such thing really anymore for the most part of just saying, "Okay, I'm the boss, so I'm going to tell you what you're going to do."

Dr. Nilesh Dave: I think that's a great point because one of the things you had mentioned is that a lot of times folks with these opportunities sometimes struggle, and in reflection, I think there's a struggle. Part of the struggle comes from just the language. A lot of us who may be doing day-to-day clinical practice and maybe are involved in some greater hospital initiatives or maybe it's the health systems doing your cardiologist and there's some cardiovascular service line initiative, and you're doing some of that, but being able to translate that into business speak.

And in fact, when I had to do my resume as I was pivoting into the nonclinical world, I think on our last discussion, I had mentioned that it took me a while to understand how to convert "Hey, I set up a system-wide inpatient hospice program." Well, there is another way of saying that on a resume that resonates with the nonclinical business executives that you might end up working with.

And to your point about getting allies and strategizing, it's a lot easier when you have that one patient in that one room and you're talking with different consultants. For one consultant or for a combo, your hand is forced because of the clinical scenario situation and the direction it is going in. And so, you have no choice but to agree and just take care of it. On this side, you know that is going on, but you're doing things system-wide that aren't directly related to that patient and related to operations or strategy, and a lot of that maneuvering, change management negotiating, let me do a solid favor for them now and hopefully that'll be repaid when I'm in dire need of something as well. And I'm not keeping a little notebook of what I've done, but the people you work with, you kind of know, they'll remember and sometimes you have to bring it up. That's a different skillset. I had to learn a lot of it. I wasn't like one of those schmoozers who could easily just do that kind of thing naturally. That's not always the kind of people who can get things done in these roles. There are skills to learn.

John: Yeah. Yeah. If you have a culture where that's the way things are done, it helps, but there's always individual personalities and some people are more forthcoming. I remember I had a director that reported to me, and I loved her dearly, but she may be crazy because if somebody didn't do something they promised like within a week, she'd be like, "It's not my problem. But they said they were going to do it." It's like, no, you have to take responsibility beyond yourself and enable those other people to do what they are supposed to do without being so black and white. That's just another example.

I'm glad you're here because I did have one or two other things I wanted to ask your opinion on, because you have some experience with these things. For example, you did that MPH back while you were in med school or between years or whatever, you did get an MBA and at Kellogg too, I think it was. It's not a community college MBA. And you've done other things. I don't know if you've ever been a member of the AAPL. I'm just wondering your opinion on all of those things, whether there's a prioritization, if someone hasn't done any of them, or what your advice is on deciding on an MBA, deciding on doing an MPH or doing some other things. Like you said that you got some additional training in telemedicine and AI and that kind of thing.

Dr. Nilesh Dave: Yeah. Funny enough, when I was in med school, my desire was to be in infectious diseases. And at the time, I wanted to learn more about epidemiology, biostats and health outcomes. At the time that was the buzzword. And when I did mine at Johns Hopkins, they had a program for with all that, and it was just a one year program. I didn't go into infectious disease but I did learn some skills, especially with the epidemiology and the biostats that from a data analytics perspective, which I would not have predicted back then, ended up helping me out. I pursued that because in the moment it made sense for what I was trying to do.

The business degree, I've been asked and I also hear the question of, "Well, I wanted to do something nonclinical so I better go ahead and get my MBA because that's like a lot of our physician pathway, we've got to get a medical degree, or a doctor of osteopathic medicine degree or something and be able to be that doctor." But here, an MBA is not mandatory. There is the American College of Physician or I forget, Healthcare Executives or something. The ACHE or something.

John: Yes. That's the one that's more for the hospital. ACHE.

Dr. Nilesh Dave: Yeah. There's an MBA like program you can go through there. I did it because I knew I lacked the ability, and when I was doing system-wide stuff as a practicing intensivist, getting involved in some of the health system initiatives, I was having a hard time trying to communicate effectively with nonclinical business leaders. And if anything, I felt like I was just oversimplifying things and as I listened closely in meetings, I saw that there was a gap. And so, I did that.

But at the time, I was not doing it hoping that it's going to open a thousand doors of opportunities. That did not open really any doors right away. Even with an alumni network that was strong in all of that. That was not something that was automatic. You still have to hustle and try to find those opportunities and hope that one thing builds on another and sort of strategize like that. And those skills ultimately will come in handy and they have for me now.

But it's a false way of thinking if getting an additional degree is the gateway to doing things like this. There are plenty of folks that I know that don't have a public health degree or an MBA or Master's in Health Administration, or any of those, that are fantastic leaders. And whether they've done work on the side to learn that stuff, it's possible, I don't know. But it's not necessary.

John: What I'm hearing, it was like the MPH, there was a reason at the time that you did that, and then with the MBA, you were already understanding, I don't know, maybe budgets, maybe financial statements. You had the people you were talking to at that time and you thought, "Okay, this is going to help me to address that need."

Dr. Nilesh Dave: Yes. And I was also at the time thinking a little bit entrepreneurial that maybe I'll sort of do something different on my own. I wanted some of that background and I thought about should I go and pursue a healthcare related MBA or not? And I actually decided conscientiously to not do a healthcare one. I wanted to meet people from all kinds of industries because my background is divergent, my thinking is divergent. I like to cross-pollinate with folks in other industries to have a better innovation mindset. And so, I looked at it that way and chose a program.

John: Yeah. That makes sense. Because I do hear the same thing. "I don't know what I want to do. I want to get out of medicine, so I'm going to get an MBA." And it's like, well, that's a little bit of a shotgun approach in the sense that it doesn't really give you any particular direction. And I think employers too, they're going to be working for someone like a big system or insurance company or pharma. They're going to look at that and say, "Well, it doesn't really fit in any kind of logical step in your career." You just decide one day to get an MBA while you're practicing full-time in family medicine or something. I'm sure those things long-term can benefit in unknown ways as well, but it's a lot of time and money to invest without having necessarily a direction that you're shooting for.

Dr. Nilesh Dave: I wanted to add, especially for the benefit of the listeners, that when I took on this role, and even when I was in my previous role, I had started to work with an executive coach. And at first I was like, "Well, I don't know. Do I really need that? We're all smart and savvy enough. Maybe we can figure this out." But no, emotional intelligence is probably the number one most valuable skill and capability that you need to grow and mature when you're in these types of positions.

And there's frameworks of how to manage workloads and how to have those conversations and negotiating the talking with different folks and trying to not only get the stuff on your table moved forward, but a collaborative project as well. There's skills there, not necessarily soft skills, but there are some hard skills as well that for me, it was something that I thought would play into the brand that I wanted for myself. What I want to be known for and how do I want to execute on that.

An executive coach was something that continues to make sense. I've been working with the same person now on a second year, monthly, before it was more frequently, especially when I was onboarding in this new role at the end of April. I throw that out there just because not everything is in the books. You do need it. You do need sometimes some coaching. Will there be a time where I won't need it? I'm not sure. It just depends.

John: Yeah. Unless you've had a coach like that, you really can't imagine the amount of wisdom that you can get from a coach. And they're kind of like a therapist in a way. They don't just tell you what to do. They get you to generate the "aha" moments and just help you to clarify your thinking. The bottom line is it doesn't make you a better person. Everything you would've maybe eventually learned, I think just happens faster when you're in that situation.

Dr. Nilesh Dave: I agree. And sometimes in the chaos, they can help tell you "Yeah, that's not the way for your role, what it is. You should be really having this resource or support, or you should really be looking at things this way. Or you're now in a position that's different than what you did before." You got to start sort of shifting, to have executive presence or to do those things which are skills to get success.

John: No, it's a really good point. Because we know how we feel in our internal talking to ourselves. When you have someone who's objective and really has no vested interest other than in your success, it's just a different perspective that just really can open your eyes. It reminds me too of something that one of my friends colleagues, advised me, and he was a hospital leader way before I was, and he said, "The next time when you apply for a job at one of these hospital systems or something, you should ask them to provide you with a business or leadership coach as part of your contract." I thought that was a brilliant idea. I never had the chance to implement that, but I thought that is a really good idea.

Dr. Nilesh Dave: Yeah, I agree. I had been told that after a year into the job that my company also provides that.

John: Okay. Nice.

Dr. Nilesh Dave: I was like, "Whoa, really? You guys actually provide that kind of stuff?" I'm very blessed to be in a company that really invests in their own people, with innovation programs for officers and things like that, to really understand the business. That was one of the other things that I went through as I was learning the company. They're like, "Well, we're going to throw you in this program for seven weeks." And I heard from all the strategy leaders, finance leaders, and it kind of fast tracked me in my education of just knowing where am I working at? What have been their goals? Where are they trying to get to? And how do I fit into that? And that's just investing in their people. Not every company does that kind of thing.

John: Yeah. That's awesome. It really is. I think outside of medicine, it's very common for large businesses to invest in coaches for their CEOs and senior leadership team, and even managers sometimes. We're a little bit over time here, but I do want to ask you any thoughts about AI in medicine? It sounded like you have some experience. Is this something we can ignore for a while or do we have to really start to learn about AI if we want to get into clinical or nonclinical future jobs?

Dr. Nilesh Dave: Yeah, I've been involved in my own current job and just reading and talking to different folks in the AI space. I think that some of the takeaways that I would say to answer your question is, one, the physicians and the healthcare teams that learn to work with AI as a tool are going to do better than those who say, "Well, I'm not getting into this. Or maybe reject the idea or think that it's a fad and eventually it'll go away." I don't think it's going to go away.

But with that said, the most important thing is understanding how do you evaluate a proper AI partner for your clinical operations? What they're calling AI, why are they calling it AI? How do they develop it? How do they test it? How is it biased? What's the risk that it can create harm? And that's a lot of the governance, sort of points that we set up. For anyone working in the hospital side, if your health system or your independent hospital doesn't have a governance structure, you need that.

Secondly, you need a framework to evaluate all the different vendors and folks that are going to come at you with, "Hey, we've got this cool thing." And you never know, it could be half baked. And they're just looking for a partner to use data to test it and iterate on it. Well, do you want to be that partner or do you want to wait till it's baked more?

But I think overall it's going to be a very helpful tool. We're using it, we're piling it in our outpatient clinics, especially generative AI. There are ambient AI programs that can listen to in a HIPAA secure fashion physician patient interactions and create a soap note or an APSO note and then you can edit that and clean it up a little bit. But it's screened by human and then sent to you very quickly so you can just focus on talking to the patient and not even need Scribe.

We have it being used in imaging, some of our business side, like revenue cycle. And so, we're looking at that, even looking at programs that will evaluate when patients call a hospital and have a conversation, what's the tonality and what is that doing from a business side? What's the engagement? What are they mad at? What are they telling us that we may not have picked up on? Because it's otherwise done manually. There's some cost savings potentially there, but in all of these, you want to have a governance structure to work through. Because data security is also a very important thing.

Yeah, you should get on to the bandwagon, but carefully I see. With structure, with a framework and see where it can help you the most. I think all these burdens and cumbersome tasks that have been attributed to burnout, there's an opportunity here to reduce some of that. Doing all your notes at the end of the day and all that stuff. There are tools out there that are good.

John: Yeah. Okay. Good to know. We need to embrace it at some point but also to make sure there are ways to monitor it and make sure it's safe and it's secure.

Dr. Nilesh Dave: Absolutely.

John: I really thank you for being here today. I hope the listeners get the same that I got out of it. It's very interesting and it's inspiring and it's also a lot of good points to think about and remember as maybe my listeners are pursuing a career in hospital management or any kind of management or leadership position. I know that we'll probably have some questions for you. I think LinkedIn would probably be the simplest way for people to reach out. I know they can just look up Dr. Nilesh Dave and they're going to find you. If you do have a question, those of you at home listening, then Nilesh can help you out.

Dr. Nilesh Dave: I'm happy to.

John: This has been really good. I'm going to have to catch up with you again in a few years. Maybe I'll have you come back, even maybe a panel on AI. Again, I'm just afraid it's going to become overwhelming very quickly. All right. Thank you very much for being here and with that I'll say goodbye.

Dr. Nilesh Dave: Thank you very much for having me. Happy holidays and happy New Year.

John: Thank you.

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Interview with Dr. Luissa Kiprono – Episode 334

In today's episode, we explore the entrepreneurial journey of Dr. Luissa Kiprono who recently decided to start a new telemedicine service. She is a maternal-fetal medicine specialist who transitioned her traditional practice into telemedicine with the creation of TeleMed MFM.

The interview delves into the pivotal moments, challenges, and strategic decisions that led to the establishment of this innovative healthcare model. During our conversation, Luissa describes the importance of self-discipline and adaptability when making such a significant commitment.

Our Show Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Did you know that you can sponsor the Physician Nonclinical Careers Podcast? As a sponsor, you will reach thousands of physicians with each episode to sell your products and services or to build your following. For a modest fee, your message will be heard on the podcast and will continue to reach new listeners for years after it is released.  The message will also appear on the website with over 8,000 monthly visits and in our email newsletter and social media posts. To learn more, contact us at nonclinicalphysicians.com/sponsorships.

Our Episode Sponsor

Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

Evolution of TeleMed MFM: Dr. Luissa Kiprono's Entrepreneurial Journey

Dr. Luissa Kiprono faced challenges when her previous practice closed unexpectedly, leading her to choose the less-traveled path of starting TeleMed MFM. Motivated by a desire for independence and the vision to extend high-risk pregnancy care globally, she committed to a telemedicine-centric approach.

Her strategic decisions included establishing TeleMed MFM as the first to integrate telemedicine into maternal-fetal medicine services so completely. The practice adopted a hybrid model, combining consulting and procedures. Dr. Kiprono started by partnering exclusively with a prominent organization in Kansas City.

Push, Then Breathe: Dr. Luissa Kiprono's Memoir and Thought Empowerment Platform

Dr. Kiprono also described the other major project she has been working on for the past few years, her memoir, “Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor,“ revealing her experiences from the time she was a 19-year-old immigrant to becoming a successful American doctor. 

Summary

To connect with Dr. Luissa Kiprono and learn more about TeleMed MFM and her upcoming memoir, “Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor,” you can reach out to her at (210)-660-9906 or via email at DrK@TeleMedMFM.com.

Visit the TeleMed MFM for information on the practice. For updates and insights, explore Dr. Luissa Kiprono's thought empowerment platform at drluissak.com and sign up for her newsletter by emailing hello@drluissak.com. Stay tuned for the release of her memoir on February 13, 2024, available in hard copy, audiobook, and Kindle formats through major retailers in the United States.

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• TeleMed MFM
• Dr. Kiprono's New Book Website
• Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor on Amazon
• How to Be a Leader and Humanitarian Improving Maternal-Fetal Health – 204
• How Do I Generate Awesome Income with Telemedicine Services? – 222
• What Is the Best Way to Leverage Telemedicine? – 181
• What Is the Latest Telemedicine-Supported Specialty? – 173
• Debra Blaine's Coaching Page

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 334

- Interview with Dr. Luissa Kiprono

John: Today's guest first appeared on the podcast in July of 2021, and since then a lot of things have changed. She's a maternal fetal medicine specialist who's now providing care using telemedicine. I definitely wanted to hear about that. She's a University of Tennessee physician executive MBA graduate and holder. I just remind you of that because that's one of our sponsors. And she's also the author with a soon to be released memoir. This should be fun and interesting. Welcome back to the podcast, Dr. Luissa Kiprono.

Dr. Luissa Kiprono: Good morning, John. I'm very excited to be here. Thank you for inviting me back to your podcast, Physician NonClinical Careers.

John: Yeah. I think it was very inspirational last time, what you were doing then. And now some new things have happened, which I find extremely interesting and again, inspirational. Let's just get right into it. For the listeners, if you go back to episode, I think it was 204, you can learn more details of Dr. Kiprono's background and so forth. But to get us started, just go through a little bit of a list of what's happened since we talked back in 2021, if you would.

Dr. Luissa Kiprono: Okay. In August, 2022, right at the conclusion of the COVID pandemic, my organization pediatrics decided to shut doors of the practice I was leading at the time, Texas Perinatal Group. That came as a surprise, I have to say. And at that time, I really came at a crossroads, whether to sign another agreement with another organization or to take a different road, that less travel road, and that is to open my own practice. And really I realized how exhausting has been to invest in someone else's dream and in someone else's endeavor. I said I might as well just start investing in my own. So that is how TeleMed MFM was born.

John: Now, was that from the very get go going to be heavily involving or solely involving telemedicine type of interactions?

Dr. Luissa Kiprono: It was started a hundred percent with a vision to become telemedicine. I have to say that I had plenty of experience in the matter due to the way COVID kind of pushed us with medicine and medical practices. But also I was the first practice in both CompHealth agency, which is the Locum Tenants Agency, and in pediatrics medical group that as a maternal lymph fetal medicine practice would hire and maintain telemedicine in their services. Not only during the pandemic, but also up to the day that the practice closed in August, 2022.

I did have experience in the matter, and I think that's where it kind of started. I was like "I know what to do, I know how to handle it, and it works." But it was scary. I have to tell you, it was exciting and it was scary, to both start a new practice in my fifties and also to start not only just any practice, telemedicine in maternal fetal medicine.

John: Yeah, anytime you make a change like that, it's both. You've got all the business aspects of it, and then also like, "Okay, how am I going to deliver care? What's the best way to do it?" And in telemedicine, I have zero familiarity with. That's like how in that environment you deliver your services. You're to be commended for that and I think when you do that, while it's very stressful, and it probably takes some time and some money, as you mentioned, you have more freedom and independence. So, it's a trade off.

Dr. Luissa Kiprono: Yes, it is. You are your own boss. You also are doing telemedicine, you practice medicine from the comfort of your private office, home office. But I always give award to the wisest, to the newly grads, and the newly grads are excited. Let me tell you. This generation is like, "Oh, yes, this is so exciting, we're going to do telemedicine" and so forth. It does take a lot of self-discipline, and it does take a lot of fortitude to not cut corners because it's easy. Just think about what used to happen during COVID. When Zoom meetings start, you're like, "Oh, I got all this freedom. I can also check an email. Oh, I can also do this. I can also do that." So here you are at the end of the meeting, you're like, "What exactly the meeting was all about?" Those same dangers come when you do telehealth. But it comes with a price.

So you do have to be self-disciplined, you have to say "How it would be if I am the patient and the physician that can renders care on the other side, doesn't pay attention, and they don't give me the best care that is because they do it through telemedicine or they miss something?" You do have to have respect, and also you be yourself like your watchdog, "Hey, I got to do it, this is my job." It's only the place that's different. The care, the connection with the patient, the services render for the patient. They should always be there just like I would be physically in the same office with them.

John: One of the things that attracted me to want to talk to you about this, that prompted me is that I get questions all the time from I'll just say specialists. Some of them are surgeons, some are medical subspecialists. And in their minds they're like, "Well, yeah, primary care, urgent care, that's fine. Telemedicine is very common. People have low risk, colds and respiratory, and they can get treated over the phone or the telemedicine service for a UTI or something."

But it's a different type of telemedicine when you're a consultant. And I've seen surgeons and other specialists do this, but never have I talked to a perinatologist that has done this. And so, my question is, tell me a little bit more about what the interactions are like. Since you have really a close relationship normally with the obstetricians as well as the patient, are you interacting with both and do you do some consults with an obstetrician in which you don't actually talk to the patient? Or are they always involving the patient directly?

Dr. Luissa Kiprono: It is very involved. Communication is the key, at least when it comes from me. My advice is always, always communicate. I'm an over communicator. I speak with my obstetrician, that if I make any changes to the care and we switch gears, I call my referring OB provider, and I say, "Hey, this has come up. This is how I recommend." Then I speak with my patients after I discuss it with the obstetrician. Just imagine everything the same like you would go in a doctor's office. The only difference is through the screen. We are talking live here doing a podcast. Same thing I'm talking live with my patient. Patient comes in, whether it is a video consult from the comfort of their home, or it's a telehealth consultation that is in the practice in the hospital or in the MFM practice where the patient is scheduled to come.

The patient gets an ultrasound. I read the ultrasound, and then we have a consultation. And I conveyed the findings to the patient. We discuss just like you would talk face-to-face with the physician. Medical history, go through the entire finding of the ultrasound, counseling, render an assessment and discuss the plan. And then I finish a consultation through the EMR and sign it. And that's it. It's very, very doable. It goes very seamless. There will be things. Think about it when you are in the office. Does your computer need an update? Sure. Is your computer maybe going to crash and you need to reboot? Yes. Do you have EMR when you go and work in a brick and mortar office? Yes. Or in the hospital? Yes.

All those are happening. The only difference is I am not physically with the patient in the room but my sonographer are by my nurses. If I need to send the patient to the hospital, I call the nurse, let her know. I call the obstetrician and the nurse calls the hospital and the patient shows up just like that.

There are a couple of procedures that obviously I cannot do like amniocentesis, DBS. Those are for prenatal diagnosis of congenital or genetic abnormalities. But that is when the physician who is physically in the office comes into place. And that brings me to my next point, hybrid practice. The hybrid medical practices of healthcare are here to stay because you have to have the hybrid. Think about if you have a team that some of them do just consulting, but some of them do also procedures. People who do procedures have to be during the procedure in that room, in the operating room, or if I have an amniocentesis, the physician, the MFM that is in the office that day, they will go ahead and they take care of that for us.

John: Ah, okay. I've talked to people that are doing telemedicine as primary care. They're constrained by where they're licensed, states they have to be licensed in multiple states, although I know some of that during the pandemic was a little loosened up a little bit. It was a little easier to get. Do you focus on certain locations? Is it kind of local, even though it's telemed or is it countrywide? How does that work?

Dr. Luissa Kiprono: I am licensed in multiple states. Every state has its own slight differences. Now we have Compact. Compact made it easier and more streamlined to be able to be licensed faster in different states. I personally hold multiple licenses, but right now, as a matter of fact, my practice has signed an agreement, an exclusive agreement with a very well-known large organization in Kansas City, Missouri. TeleMed MFM is providing maternal fetal medicine services virtually for their patients.

John: Okay. Yeah, that kind of segues into my question I had about how do you get the word out and where do you find business? And so, it sounds like at least one way is to identify a particular organization, work directly with them. Tell me a little bit more about that.

Dr. Luissa Kiprono: We did a lot of marketing, but when I say marketing, it's not like you've got to put an ad in the paper or an ad in YouTube. That doesn't work that way. A lot has to do with your expertise. Maternal fetal medicine, it's a very close knit environment. The MFM subspecialty really was formed 50 years ago. 50 years ago next year. It is a relatively new specialty. And there are about 1,300 of us, but only about 900 to 1,000 that practice full-time. Now, if you take that to 340 million United States citizens and 77 million women between the age 15 and 49, which we consider the fertile age, you can imagine how big the need is, how tiny the group that we are in of specialists.

To go back to your question, when it comes to marketing or advertising, I started working for this organization through an agency, through my company. My company was contracted by the agency to work for this organization, and they learn how I work, they learn my practices. They were very impressed with my ethics and my expertise. They say we just would like to contract directly with you and do partnership between your company and our organization. Without saying, I was extremely excited. And we actually just executed the partnership last month.

John: Nice. Excellent. How does the lifestyle for you doing your practice this way, have you stuck pretty much to the same kind of hours? Or is there more flexibility doing it this way? That's one of the things that attracts certain physicians to telemedicine because they don't have to travel, obviously. It's very much more efficient. Tell me how it's affected your lifestyle.

Dr. Luissa Kiprono: I worked the same hours that I were before. Actually, I worked more. I work more now than I worked before. When you look at any company, any business that you start, I want to make a caveat, you will work a lot more in the beginning to start it. It just has to. It's just thinking about building momentum to have this business going. But I do work the same, if not more, because when I'm done with my clinical duties, then I start working the administrative duties after hours for my practice. And also now with my adventure, you do have to have the electronic capabilities. I do have literally six monitors in my office. And so, I high grade monitors. I have to have a high speed internet, camera video equipment, audio equipment. That is my livelihood. That's my job is to read ultrasound. I just don't have small screen laptops and have large screen monitors because I read ultrasound about 90% of the time with or without consultations.

That are the requirements that have to be in place in order to do this kind of endeavor. Yes, it is more relaxed because I work from my home office, from my private office. But again, going back to that same caveat that I made the beginning of the podcast, be your own watchdog. Stay disciplined. Because it's easy to become relaxed because you are at home. Well now, you're still at work, you are not at home, you are at work. Home is you go to the other room after your work is done.

John: I'm not exactly sure how your practice worked before. This question might be stupid, but I can imagine especially in MFM, maybe you're doing the ultrasound yourself physically, or you have ultra-sonographers that you typically work with. And now I'm assuming that you're actually getting a lot of different ultrasounds that you're reading from different ultrasonographers maybe. How is the quality? I know you've got the technology, I'm just wondering if it's affected your ability to feel the confidence in what you're looking at.

Dr. Luissa Kiprono: It is an excellent question. It is not a silly question. As a maternal fetal medicine physician, we do have highly trained sonographers. They are not radiologists and they are not OB-GYN sonographers. They are sono techs who spend about 18 months to specialize in fetal ultrasounds. When it comes to that, I had other offers prior to this and they said, "Well, you're just going to read the ultrasound, that an OB tech is going to do it." And I said, no, it just doesn't cut it because I am not there to be able to troubleshoot and I need certain images.

What happened is the maternal fetal medicine, sonographers are going by strict guidelines, imposed by AIUM. They are ARDMS certified and fetal echo certified. Think about this. Just like everything else, if you have a radiologist that reads general X-rays or general MRIs, then he'll have a radiologist who specialized in fetal MRIs, and then you go further, radiologists that have specialized in neuro fetal MRIs. That is so important for me to be able to have this at my fingertips, to trust my staff. I have to trust my sonographers because they are my eyes. And let's say they didn't get the image. I would just ask them, "Hey, can you get another image for me?" And they know exactly what I'm looking for.

Otherwise, the learning curve is very steep. Especially if I'm not there, the trust is not there. Just like you said, the liability is very high on my end because if they miss something, then I miss something, then the patient doesn't get the counseling they should have. The follow-up is not the proper follow-up. And then at delivery, the baby doesn't get the care that they should have been anticipated otherwise.

John: Yes, we don't like surprises in medicine and we really don't like surprises in maternal fetal medicine. I happen to have two daughters that are pregnant at the moment. I'm hearing a lot of things third hand. And one thing is not an ultrasound that's not given the right answers. That was very interesting. We're going to run out of time soon and we're not going to run out quickly because I have a whole other topic I want to talk to you about, but I do want you to go ahead and give the website for the telemedicine MFM business just in case there's physicians listening who may need your services or want to learn more or even contact you on LinkedIn if they're starting something similar.

Dr. Luissa Kiprono: Sure. My practice number is (210)-660-9906. My website, you can find me at telemedmfm.com. And my email is DrLuissaK@TelemedMFM.com. If you go to my website, you can always find there the contact info. And please send me an email, ask me a question. I'll be very, very happy to share my knowledge with you and my expertise. Both how to launch a telemedicine practice, and also how to navigate through the intricacies with both medical but also insurance and licensing.

John: Excellent. I will put all those in the show notes, of course, and even in the email that I send out about the episode. We'll have all those links and a few others that we're going to talk about. But in the process that you've described, you've been busy starting this, but in the meantime, you've also had another activity. I guess I wouldn't call it a hobby, something going on, and it's about a book, a memoir. And so, we definitely want to hear about that as well. When did that start to come up as something you wanted to do?

Dr. Luissa Kiprono: Five years ago I embarked on this journey writing my own memoir. This memoir takes the reader on a journey that I have started back in 1987 as a 19-year-old woman immigrant who came to America for two months. I came to America to meet and know my father. And that turned into a lifetime. And without spoiling the drum roll and transferred the book, it's been a journey. It's been a journey of a lifetime. And that journey of 15 years really takes me and it takes the reader all the way to my graduation date in 2002.

And at this time, I'm thrilled to announce the debut of this first nonfiction book. Its name is Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor. At the same time, I'm launching my platform, it's called Dr. Luissa K. And it is a thought empowerment platform in both leadership and overcoming trauma and thriving by achieving one's own potential. Date of release is February 13th, 2024, and it's going to be launched at all the major retailers in the United States in hard copy, audiobook and Kindle format.

John: Nice. Is this like a traditionally published book through a large publisher?

Dr. Luissa Kiprono: It is a hybrid publishing. The publisher is Greenleaf Publishing Group.

John: Now, we always have questions to address with authors and writers. It's not easy, it's not easy to organize. What method did you use to write? Some people will do blocks three or four hours at a time. Other people will maybe work on a weekend. How did you actually sit down to create this book?

Dr. Luissa Kiprono: I started the first chapter of this book 35 years ago in Romania. Then I wrote that first chapter and I put it aside because life got in the way big time. About five years ago, I found myself recording every morning for about half an hour. I was very intent into doing it. And it lasted about two weeks. When you run a practice, at that time as I was running that huge 52 employee practice. And then also you have a family, children. Life, let's call it. I said I really want to write this book, but there is no way I can write this in my lifetime at the pace I'm going. I started looking at ghost writers and I partnered with my book coach and ghost writer. And that is how the book was finally written through both our collaborations.

I want to tell you something that we all physicians and really some non-physicians, but usually type A personalities, we feel that we must write this book like as if I have to physically write it. But what I can tell you is that the thought out there is that it's actually smarter to work with a book coach and a ghost writer than trying to do it yourself.

It's like delegating. Think about if you are in your office and you're trying to do everything. Trying to vitalize somebody, take fetal heart tones, put the patient in the room, do the ultrasound, be the physician, check out the person, and start that again. How long can you last? You won't last. It's not sustainable. Probably you'll last about three days.

Same thing here. Can you be a full-time physician and write the book and be a mom or a dad and do it all perfectly? No, you can't. You have to A) prioritize, B) work smart. It still took us a couple of years. The book was finalized in December, 2022, which was last year. And then in March was accepted for publication by Greenleaf Publishing Group. And it's now in print, the audiobook is on the way. And it's happening. It's really, really close. The hybrid publishing it's very, very convenient. They work very well in many, many ways. It's hybrid. You do have to put your buy-in and you have to do work and also financially you will have an interest in it.

However, they will put all the wills in motion for publishing and marketing the book. You tell them how much or how little you want them to do, and they will do it for you, and you will approve everything along the way. I would be more than happy John to have a separate podcast to just talk about the process. It is an amazing process that I knew nothing about, like literally nothing. It's unnerving. And I can say it's like rapid fire sequencing. We have to do this, we have to do this, we have to do this. Why? It has to be approved by you, the author. Because at the moment, they accept you and then you sign the agreement with them. We'll also sit down and figure out when do you want this book to be released? And now everything starts dominoing backwards because you are on a schedule. And everybody's going to know that your book comes out, in my case February 13th. Well, we don't want to arrive on February 12th and realize there is no book to be presented.

John: Yeah, absolutely. If I'm not mistaken, and I've talked to other authors, some of the benefits of doing the hybrid is you definitely have more control. If you do a big publisher, one of the big three or four, number one, you lose pretty much all control and they're going to tell you what title they want and how the chapters are going to be put. And it takes a lot longer. And in a hybrid, I think you get to reserve a little bit more of the income that comes into. I'd say most of the guests I've had that have written books have gone that route. Now I've got a few that will self-publish, but I think most everybody's going the route you've gone, especially with one of the really good top-notch hybrid publishers. Boy, this sounds fantastic.

Dr. Luissa Kiprono: Well, just to put a little bit of data out there. 80% of people want to write a book. Out of which 1% finish writing the book. Out of which 1% get accepted for publication. Even with all that, there are about a million books coming on the market every year in the United States, and 4 million all comers, meaning 1 million that are accepted for publication and four millions that includes also self-publishing a year. It's crazy. That's just amazing to me how much influx it is.

John: Well, congratulations.

Dr. Luissa Kiprono: Thank you.

John: Here's what we're going to do. You're going to have to remind me about a week or two beforehand so we'll promote that at that time. And we can obviously promote it through this podcast, which it'll probably be the beginning of January when people see this and hear this. But definitely do something special for that February date. That'll be fun. Tell us where to go to look for that.

Dr. Luissa Kiprono: Okay. To learn more about my book and my platform, my website is www.drluissak.com. My email is hello@drluissak.com. If you sign up for my newsletter, you're going to get it in the mail, but also bring up the updates, any news that come out. And also just to put it out there, just in case anyone wants to join me, February 13th, that will be a destination book launch.

John: Okay. You're going to have to send me the specifics on that so I can put that in the show notes.

Dr. Luissa Kiprono: Sure, we can do that.

John: All right. I think we are getting out of time at this point, but this has been a very interesting episode. We learned a lot about how to implement telemedicine, the pros, the cons, some things to keep in mind. Definitely some good advice. And then about a memoir that's coming out... From the time this is posted about a month after this is going to be posted. So, maybe we'll have some people follow you for that as well. Any last words of advice to our listeners about anything that we've talked about today before I let you go?

Dr. Luissa Kiprono: What I would like to say is that my advice regarding personal growth, follow your heart's desire. If there is something that keeps you up at night, an idea or a goal, whether it is opening a practice, starting a business, or just open up a flower shop. And if that is what you really truly want, if when you talk about it, your eyes are sparkling and your heart starts beating faster, do it. Just do it because you'll never regret it. And don't be afraid that you're going to fail because you know what? You are never going to know unless you try something, especially when you really, really are passionate about it.

John: Thank you for that advice. Very inspirational. You've got this book pretty much in the can we would say. Are you thinking of doing another book later? I'm going to ask that question. Or are you going to rest for a while and think about it?

Dr. Luissa Kiprono: I am going to rest for a while. These last few years have been quite eventful, especially last year with the practice and the entire book publishing. So I will take a break and let's just see. I won't smell the roses for a couple before I decide where am I going to move, what's my next steps are in life.

John: Yeah. Okay. Well, I'll be watching from the sidelines and if you do something else really interesting, I'll have you back on the podcast. Thanks a lot for being here today, Luissa. It's been very fun and educational really.

Dr. Luissa Kiprono: Thank you. I really appreciate the time. And thank you for inviting me for this conversation, John. Happy holidays.

John: You too. Bye-Bye.

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Interview with Dr. Adam Robison – Episode 333

In today's episode, Dr. Adam Robison explains how he was able to found a start-up, AI Medica, while practicing hospital medicine full-time.

This interview will reveal the impact of AI Medica's software on healthcare efficiency, its integration with Electronic Health Records (EHRs), and its role in enhancing clinical decision-making. Adam provides his firsthand account of navigating the complexities of healthcare technology while practicing medicine.

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We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Did you know that you can sponsor the Physician Nonclinical Careers Podcast? As a sponsor, you will reach thousands of physicians with each episode to sell your products and services or to build your following. For a modest fee, your message will be heard on the podcast and will continue to reach new listeners for years after it is released.  The message will also appear on the website with over 8,000 monthly visits and in our email newsletter and social media posts. To learn more, contact us at john.jurica.md@gmail.com and include SPONSOR in the Subject Line.

Revolutionizing Healthcare Efficiency with AI Medica

During our interview, the founder of AI Medica discusses the journey of his software optimization company and its groundbreaking role in transforming healthcare data accessibility. With a focus on integrating with Electronic Health Records (EHRs), AI Medica streamlines medical calculations, provides coding review, and enhances clinical decision-making while using your EHR.

Navigating Entrepreneurship in Healthcare Technology

Adam also delves into the challenges of founding a company while maintaining a thriving clinical career. From overcoming the limitations of existing EHR systems to securing investments and building a business, he shares insights from his entrepreneurial journey. During our conversation, he highlighted the major steps he followed: 

1. Identifying a universal problem,
2. Leveraging personal experience,
3. Describing the technological solution,
4. Collaborating and investing,
5. Navigating the complexities,
6. Continuous learning, and
7. Balancing clinical practice and entrepreneurship.

These steps resulted in the creation of AI Medica, a company poised to streamline healthcare data accessibility and decision-making. Doing so, helps physicians work more efficiently and improve quality of care.

Summary

To learn more about AI Medica and connect with Dr. Adam Robison, you can visit the official AI Medica website. For inquiries and demonstrations, you can contact Adam directly via email at adam@aimedica.ai. Additionally, you can reach out to him on LinkedIn for further information.

AI Medica offers a revolutionary solution to streamline healthcare data accessibility within Electronic Health Records (EHRs), making clinical workflows more efficient for physicians. If you're interested in exploring how AI Medica's tools can benefit your healthcare institution or clinical practice, feel free to reach out and schedule a demonstration.

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• AI Medica website
• Apply Discovery, Innovation, Value, and Execution to Launch Your Business – 319
• Here is the Designer of the Best Medical Image Repository Ever – 125
• Top Five Start-Up Secrets for the Physician Entrepreneur – 087
• How Blockchain Technology Can Protect Your Credentials with Dr. Leah Houston – 045

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 333

How to Practice Hospital Medicine and Found a Startup

- Interview with Dr. Adam Robison

John: I'm really happy to meet today's guest because besides being a hardworking hospitalist, he's a hospital manager and leader and founder of an EHR optimization startup company, which we'll talk about for sure. Hello, Dr. Adam Robison. Thanks for coming today.

Dr. Adam Robison: Thank you so much for having me.

John: I am very happy that you're here. This is going to be very interesting. People know that I have an affinity for hospital management work. I was a CMO of a hospital and I know a lot of physicians are always trying to get away from it, but I always like to talk to people like yourself who are in hospital leadership positions and of course, also an entrepreneur. So this is going to be fantastic.

Let's just start by you telling us a little bit about your background, education and clinical career, and then we'll get into the other stuff after that.

Dr. Adam Robison: Yeah. My name is Adam Robison, like you said. I am an internal medicine doctor. I trained at the University of Louisville. I'm a big Cards fan. We did pretty good this year in football, so I was pretty happy about that. I've been working as a hospitalist clinically for the past seven and a half, almost eight years now. I work in a small community hospital out in the middle of nowhere in Idaho, in Twin Falls, Idaho. It's a great place to practice and I've been out here for a while and we are here for quite some time.

On top of that, I do work as a lead hospitalist for my group. There's about 120 providers and we cover about four or five sites right now. And so, that's been interesting work. I took that role all about almost three years ago, right at the middle kind of beginning stages of COVID. That was a very interesting time to take over as a leader of a large hospitalist group and try to navigate through that. That was good learning experience.

John: Yeah. I'm tempted to say, "Well, okay, how did you solve all those problems of people being too sick to work and not having enough PPE?" But we won't get into that. But it's been interesting, huh?

Dr. Adam Robison: Yeah, it's been interesting work. And then yeah, as you said I did found a software optimization company about five years ago, almost five years ago, 2019. And so, that's been a lot of work too. It's been a lot of interesting stuff that keeps me busy and a lot of different things to focus my attention on for sure.

John: Well, it's that second part that really got me interested. And I think our listeners are interested in things like outside work, side gig, side jobs, new careers, passive income, active income. Tell me what inspired you to start a new company? We'll see if your story jives with the others I've heard in terms of what makes people do crazy things like that.

Dr. Adam Robison: Yeah. I've been happily married for almost 20 years, and my wife, I asked her one day this crazy idea. I said, "Hey, I want to take some money. And I have this idea of how to make the EHR better." And she said, we'll have at it. And so, basically I remember sitting in front of my computer, I was using Epic at the time, using an electronic health record and going "I have to go to a third party website to finish some work. I have to go outside the EHR on a regular basis." I'm like "I have to take data from here and go kind of chart and go over here. This seems kind of stupid. Is there a better way of doing this?"

And so, initially I tried to do what I did initially within the EHR with some templates and stuff like that. And what I was looking to do wasn't actually possible within the EHR framework, the logic and the kind of advanced computing I wanted done. And so, that's what caused me to think about is there a way of doing this? And I did a lot of research. I was reading all sorts of websites, educating myself on interoperability standards. How does that work? Is there ways of doing this outside the EHR without really tight integration customized integration? And then that's what we came across. I came across something called HL7, which if you're out there is fire. And then we learned a lot about that. Really what was interesting to me was a problem that I had clinically and could I solve it. And that's what led me to found the company, realizing that we are founding a company to develop the software and to go from there. So, that's what we did.

John: That is the common thread that I've heard before. I talked to an urologist who started a company producing underwear for patients, and whatever, other different entrepreneurs. And it's always that itch that has to be scratched. You have a problem, but you're on your own, and it's like there's got to be a solution to this problem. That is very consistent. But I'm sure the way you went about it is going to be different from others because there's a myriad number of ways of doing that. We'll get into what it does exactly, but what was your next step? You had this idea, what did you do?

Dr. Adam Robison: Yeah. Whenever you have any idea, we're trying to find is there a market out there for it? Is this something that people would buy? Is this a universal or at least a broad enough problem that people run into it? I talked to lots of different physicians and people I knew, people at different hospitals I had connections with and asked them "Is this a similar problem you run into, or am I just dumb and nobody else has it?" And see if somebody else has already had a good solution for that. And realize, no, this is a fairly universal problem that everybody else has experienced. There's not a lot of solutions out there in the market. And so, that's when I go, okay. Now I don't know how to code or software. I don't have any experience with that. And I knew it would probably take me quite some time to do that. That's when I was looking around for people that knew how to do that and I was able to find some developers that had some of those skills. So, it's a lot.

There's stories about how to get licensing and getting approval through different EHR vendors. That was an interesting experience to go through, to try to convince a certain ethic that I was a company and that I wanted a license to put myself on there. Learning how to navigate all that, security protocols, yada, yada, yada. Just a lot of learning new things that I didn't know before.

John: Interesting. I just want to make sure I didn't miss another point. You checked around to see if this was a universal problem, and did that include other EHRs and the one that you were using?

Dr. Adam Robison: Yeah. I talked to a bunch of physicians because of what I have learned about, and it sounds like you talked to other doctors that have used this, but physicians are the best people at solving physician problems. Not some sort of a Silicon Valley startup by two guys out of their twenties. Like "Oh, they know how to fix our problems for us." It needs to be physicians fixing physician problems. And so, I talked to a bunch of other doctors that have been in a myriad of different EHRs. I talked to people that used the big ones in the market as well as like the VA. A bunch of colleagues worked at the VA. Is this something that you'd experienced out there? And it was a pretty universal experience.

John: Tell us about the company. Let's start there. Tell us what the company is designed to do, or what kind of product or service it provides. And then I'll come back to some of these little questions in here.

Dr. Adam Robison: Yeah. The problem that we're trying to solve was how to get data out of the EHR. It was the problem. That's a big issue. Healthcare data and how it's siloed right now is a big problem. And that's why I touched on briefly something called the HL7, which is a group, they develop these interoperability standards. It was very serendipitous timing with what I was trying to do, because during that same time, the 21st Century Cures Act had come out. And the 21st Century Cures Act for those that are familiar opens up the chart. For a lot of physicians, that meant that patients now could access certain notes in real time, which has got a lot of physicians from heartburn. All of a sudden the chart became a lot more. It used to be My Note, now it became the patient's note as well as My Note. And that was some heartburn around that.

But if you actually looked into what the 21st Century Cures Act was doing, it wasn't just making notes available to our patients, even though that's how we allowed, as physicians interpreted, it actually made the data in the EHR transparent and accessible. It had to be accessible. And it turns out, the government had adopted these things called the HL7, the standard called FHIR. And it just happened the same time while that was going on that I was trying to look to solve the same problem of how to pull data out of the EHR and do something with it meaningfully.

And so, what our tool does is it integrates directly with the patient's chart. It looks at what's going on with the patient's chart, and then pulls all the information that would be relevant to pull out, reviews the chart essentially for the user, and then provides information like MELD scores and things of that nature as well as coding recommendations all within the context of the patient's chart.

John: Interesting. Because earlier I was going to jump on the bandwagon and bad mouth some of the EHRs and EMRs. It's like you would think after helping physicians doing this for 10 or 15 years, they would've figured this out. But what you're telling me was the system wasn't necessarily ready for it and it became ready as this was implemented.

Dr. Adam Robison: Yeah. It's been interesting. I will tell a story. I have a good friend of mine who's not a physician, and him and his wife, they recently had a child and they were receiving care locally to smaller hospitals. But the child's medical condition required it to go to seek care at a tertiary care center. And what they described, even though both centers used the same EHR, they're separate EHR instances. And so, the mother and the child had two separate records that were actually very important, but then needed to talk to each other because the conditions they were seeking care for were the same at both sites. And this is just recently.

And so, for whatever reason, there hasn't been a lot of interest in the major EHR vendors to make even within their own EHR network or broadly between EHRs, that hasn't really been an interest that they've wanted to go down either maybe for economic reasons or technical reasons, for whatever reason that may be. That interoperability standard piece has been a big problem. And they haven't been willing to fix it and the Cures Act did mandate they had to open that up. But it's going to be important on companies like mine and other companies out there to do that work for them.

John: Okay. That's good. That things are progressing, and like you say, your timing was perfect. Now, I was looking at your website and reading a little bit about this, so I just want to make it clear for the listeners because some of them might actually need to use this tool at some point or tell their hospital or somebody about it. There are different kinds of metrics, there's algorithms, there's sometimes formulas that have to be used by a clinician and trying to do something. And right now you have to either do that by hand or use a separate piece of software or an app on your phone or something, and you're integrating that. So, give us more about how that works and why it's potentially a profound app.

Dr. Adam Robison: Yeah. Our two applications right now, we have two software pieces called Aicalc, Aicode that live within our Aimedica platform. And what they do is the Aicalc, you can imagine it just being your medical calculator, your cirrhosis scores, your chads bask, you name it. There's a million of these out. And they're actually propagating pretty rapidly now. With the advent of big data and smart computers, these models are coming out pretty rapidly. And our software basically looks at the patient's context, what kind of medical problems they have, is there other criteria, and says, oh, not only we'll calculate, oh, patient's cirrhosis, you'll need a MELD score. And then we'll give you the most up to date MELD score, give you that sort of stuff. You don't have to click around. You just click the button. You don't have to think of why you need the MELD score. We'll just review the patient chart and give you all the relevant scores and pull the data in to calculate the scores for you automatically.

Again, one thing I say to people all the time, I use this tool every day in my practice. I developed it for myself, and so I'm constantly trying to improve it. And then we also do the same thing with medical diagnosis codes. We try to optimize the best highest weighted codes for DRG waiting for hospitalizations, which is important because we can look at a patient's chart and say, "Oh, the patient actually meets sepsis criteria and you are treating of infections. That should be the code you put in the chart. Let's provide that." And that has a huge ramification. And anybody knows in the healthcare space, those DRG waiting is huge for hospitalizations reimbursement.

John: Yeah, absolutely. And someone like you, or many hospitalists kind of have looked at the Medicare guidelines and they realize that for some DRG level, whatever, it's like a three paragraph description of what goes into it. Oh, yeah, we have time to really learn all that.

Dr. Adam Robison: Doctors don't care. I tell us that you've got to optimize it and make it easy for me because I don't care if the patient needs sepsis or pneumonia or what. I know they have an infection, I know I want to treat it and I'm going to treat them appropriately. And I don't really care what came from the chart. All I care is that my patient got better because I gave appropriate care.

John: Well, this is really going to impact the CDI people, if this is going to really help them a lot. So, that's interesting. It sounds to me this business really is like a software business. And you said you're not a programmer.

Dr. Adam Robison: No.

John: So, how did you overcome that issue?

Dr. Adam Robison: Yeah. It was interesting. I had this idea, I got to fix this problem. This is a universal problem, how do I fix it? Well, oddly enough, I had been reading in our local newspaper, and I came across this guy here locally that I knew. I didn't know him at the time that he had a development for hire company. And so, I just kind of reached out to him and I said, "Hey, I got this problem. What do you think?" And he said, "Oh, yeah, I could do that. And by the way, I'm a partner of a venture fund. Let's see how this goes. And we may invest in your company if you like the idea." And so, I pitch it to them. And then that was kind of very serendipitous. We build a minimum viable product. And after they were comfortable with me and they're kind of filling me out to see if I was not as a fly by night operation, they decided to invest in the company my idea with me as well. And so, that was how we got married with a venture fund. It was very interesting how that kind of worked out. But just from a paper article, I just happened to come across it.

John: Sometimes things just work out. I always say the RAS in our brain, the reticular activating system, once you're thinking about something, it finds things that you otherwise would never notice. Now, how did you sort of protect or did you the intellectual property of the fact that you had come up with this idea? Was it built in your partnership? How do you do that?

Dr. Adam Robison: Yeah. That's an interesting thing. That's something we've still wrestled. When you develop software, you really can't patent software unless your approach is really unique. If you developed blockchain, if that's a whole new software thing, you could potentially pat that. But just patenting software, it's almost like copywriting software. You can copyright it, but anybody can write a piece of code. It's not a unique idea if you're writing this code using a typical programming language. That was a difficult problem. We have now developed a proprietary knowledge base and an ontology, if you will, that is IP and that is patentable. And we will be patenting that.

What has helped us right now and why we're five years into this right now, or almost five years into it, is what I'm doing is so ends up being very technically difficult. We have a bit of a mode around us because even the developers I hired, they didn't know how to do this because it's not a skillset you can hire off the shelf. And so, it was going through a lot of that. It's ended up been, like I said, a lot of it is been very serendipitous that turns out this isn't something you can even hire very easily for. And we had to train a lot of people up and work through it. But I think one thing we did was when protected the IP, we had that written to our contract with the development company. This is our stuff. And we had all well demark within the contract negotiations.

John: On the plus side, the more complicated it is, the less competitors you'll probably have doing it.

Dr. Adam Robison: Yeah. And we're many years into this. At this point, in this SMART on FHIR space, and unfortunately I'm saying it on a widely broadcast podcast. It is a brand new space. People are starting to understand and realize that that's how you talk to these EHRs. And what's great about it's EHR agnostic. Every EHR has to be compatible with these standards.

John: Now, one thing I'm not an expert on at all, and I've heard there's different ways of getting investors, like venture capital, angel investing, this kind of thing. But did you end up just getting the one entity to support this when you got your partner? Or did you go beyond that?

Dr. Adam Robison: No. We've had a raise. We've done a few raises now. It's been interesting. That's been a lot of work to raise money. I funded the initial development of the minimum viable product, but to actually bring on employees full time, that's not something I could afford to do. I don't have those kind of deep pockets. And so, what we did, we raised it through the initial investor network that we were introduced for that venture fund, and then raise through their network. And that got us a certain point.

And then when you raise money, every time you raise money, you're looking to say, "I'm going to raise money to hit these milestones." And so, every time we raise money, "This money was raised to hit these milestones. We've hit those milestones, now help us, we're going to raise money again to hit these milestones." You're trying to show forward momentum every time you're raising money that you've got this money. We did X, Y, Z with this money, and now we're going to do these next set of milestones, which you're going to further grow the company or hit these metrics and milestones. When we've raised money through different networks, that's how we've done it. And so, that's where we're at right now. We've raised I think about a million and a half over the last two years to expedite development and move to things forward.

John: Nice. Yeah, it's not like something you can build in your basement.

Dr. Adam Robison: No. And it's a lot of learning. I think anybody looking to start a business, just be prepared to learn a lot, because even though you may be smart as a doctor and you're very intelligent, be prepared to be very humble because you have literally no idea. You're going to have to learn a lot, fly by the seat of your pants. And that's kind of why people become entrepreneurs. They are interested in learning that stuff. But yeah, I've had to learn a lot and I've made a lot of dumb mistakes and all sorts of stuff. Lots of stories to share about that.

John: Oh, I can imagine. But it can be exciting and physicians can learn anything really as long as you have the time. That might be an issue for you as the thing gets bigger. Tell us where it is right now. You've been doing this for five years. Obviously, there was a whole ramp up. Do you have clients? Is this being live? Is it working?

Dr. Adam Robison: Oh yeah. Like I said, we have two clients right now. We have two head systems right now. The biggest thing actually, we just finished up our installation at the VA. That was a big deal to get our software working. If you're familiar with the VA or worked at VA, they have an antiquated system called CPRS. It's been around for a long time. And they've just recently built on a platform onto their CPRS that's called Lighthouse, that's compatible with SMART on FHIR. And so, our tool, we're the first third party vendor. They were looking for a solution like ours, and we met them and talked to them and they talked to some other people that could do something similar, but we were a better fit just because of our tight integration with the SMART on FHIR standards. And that has allowed us to work with them.

We just finished our deploy there. We are in the process of several other health systems. We have relationships with the biopharmaceutical company as well as a clinical research company that's looking to use our tool to help automate and augment a data retrieval from the EHR to help expedite clinical research. And so, that's what we're working now.

John: Okay. Is it to the point now where some of the medical caregivers, the physicians, APNs, whoever, are they seeing the benefits at this point?

Dr. Adam Robison: Oh yeah, we have. People love the tool. It's being used. We have some business intelligence software. We monitor the use of software, how are people using it so we can make sure we can improve it. It's not quite exponential growth in users, but we're seeing lots of people using it almost on a regular basis. And it's now becoming the way you do things now with our sites, because why would you go to a third party website or go to some other site if it can go to HER? And it's a button click, you don't have to do more work. So, it's obviously much more efficient.

John: Yeah. Nice. Do you have different formulas or different tools available over time? Or is there a list of 10 or 20 or 1,000?

Dr. Adam Robison: Yeah. Right now we have 50 or 60 medical functions automated within the chart. The ones that are commonly used. We're adding more as they come out in literature writing more. We're branching up a behavioral health space now with some of those assessments that need to be done. They're often done on paper or through PDF forms, so we're bringing them to the platform as well.

We are really just looking depending on what the clients need. Really I tell people all the time, the hardest part with this is actually just being integrated in the EHR and getting data out of it. For building a medical function, a medical calculator form, you need to get data out of HER. That's easy now. We can build that in a few days. You name it, we can build it because that's not hard. The hard part is actually integrating the EHR. That's the hard part.

John: I like that interface. That might not be the right term. But are you doing studies to see if this improves the efficiency of the physicians?

Dr. Adam Robison: Yeah, we will be. That's going to be next year. We have a couple sites that are interested in doing that. Our Richmond VA site, which we're in the process of finalizing that, they're interested in doing that kind of work. We'll be working with them to hopefully show that this is efficient, which anecdotally, of course it is. But we'll be able to show that and prove that with the data collected.

John: Yeah. The thing I hear from physicians, I have to go home and do an hour or two of notes or whatever. Now that's oftentimes the clinic, but still even hospital notes sometimes, you just can't get them done. You have to go back. Do you have a lot of capacity now? If people listen to this, we don't have a million listeners, but a lot of these physicians might still be working clinically. How do they get ahold of you or the Aimedica to learn more about this? Is it ready for that?

Dr. Adam Robison: Yeah. We're ready. We're actively taking on clients now. Like I said, we're in the process. That's going to be our big Q1 push. We had a couple clients that we're working with. Now, we're ready to go live with everybody else. And so, that's Q1, we're working on lining them up. You go to website aimedica.ai. It's easy. Easy website to remember. Just go there to contact our page, we'll be happy to do a demo for our clients.

John: Okay, aimedica.ai.

Dr. Adam Robison: That's correct.

John: All right. And if they have more questions, they can throw a note in LinkedIn to you, perhaps. Do you have time for that?

Dr. Adam Robison: Yes. Or you can email me at adam@aimedica.ai. It's very easy.

John: All right. This has been very interesting. I don't think I have a lot of other questions. Let me ask you this. What if I was going to go to my local hospital and say, "Hey, this thing sounds pretty cool." Who would I go to?

Dr. Adam Robison: You want to go to your chief information officer. They would request us through. Most of the EHR vendors have some sort of app store lineup that we would go through.

John: And what kind of presentation do you do at a system or at a hospital in terms of do you go on site, do you do it online? Do you just send some written materials? I'm just curious about how you're handling that part.

Dr. Adam Robison: Yeah. Typically, we'll do a demo on Zoom or some sort of video conferencing site. Wherever they want to use, we'll use that and we'll demo the software in a real environment so you can see how it works.

John: All right. Did I forget to ask any questions or is there anything else you want to tell us either about juggling being a hospitalist and a co-founder? Technically you do have a partner, but you were the one that created it, so I guess you are the founder. Juggling those things or about Aimedica?

Dr. Adam Robison: No. I do have hobbies that I use to not do work. I think it's important to have those so you're not doing it. I play piano. I do a couple of things to get my mind off when I have a couple minutes of downtime, which is I think important as you're looking to try to do other things with your time.

John: What do you think is going to happen with you? If this gets really big, it's going to take more and more management. Hopefully your employer at the hospital is not listening, but they probably know you got this thing going on. What do you kind of think will happen long term? Are you going to become like a CMIO in a hospital informatics in this technology? Or do both for a long time? What do you think?

Dr. Adam Robison: I'll tell you John. I actually love being a clinical doctor. I love taking care of patients. Maybe not as much as I've had in the past. I'd probably wind that down a little bit because I do work quite a bit. What I see myself probably doing the next 5, 10 years as they see guys up and it's profitable and we're able to keep lights on, is probably work for them full-time and work for my company full-time and then still see patients. Because as a chief medical officer of the company and using the tool, I find by me using the product and practicing patients, I really understand what are the problems we're trying to solve. I feel like if I remove myself from clinical practice 100%, my utility, the company to help make these tools better, I think it becomes limited as well.

John: That reminds me. Cleveland Clinic, it's a pretty big place. And I don't know about the current CEO, but the former CEO is still clinically practicing while he was running that monstrosity. So, you can keep practicing probably as long as you like, and if you're enjoying it.

Dr. Adam Robison: I do enjoy it.

John: All right. Well, I think that's all the time we have. I really appreciate that. I'm going to put the links in the show notes. Again, it's Aimedica and I've been talking to Dr. Adam Robison. I'm going to have to have you come back in a couple years and see where things have gone. And maybe by then I'll have invested in it as it'll be a listed stock or something. All right. Thanks for being here, Adam. I really appreciate it.

Dr. Adam Robison: Absolutely. Thank you.

John: Okay. Bye-bye.

Dr. Adam Robison: Bye.

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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. 

The post How to Practice Hospital Medicine and Found a Startup appeared first on NonClinical Physicians.

Consider This Well-Compensated Career – 323

In today’s podcast, John shares invaluable insights on the critical areas of expertise for physicians seeking hospital leadership jobs.

John recounts his transition from a clinical role to leadership within his hospital. Like others, his transition started with physician advisor and medical director roles, which provide management experience.

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Are you ready to say goodbye to burnout, take control of your schedule, increase your earnings, and enjoy more quality time with your family? You’re probably wondering how to do that without getting a new certification or learning a whole new set of nonclinical skills.

Here's the answer: The quickest way to achieve more freedom and joy is to leverage virtual medicine.

Dr. Cherisa Sandrow and I discussed this in Podcast Episode 266. Cherisa and her team are now preparing to relaunch their comprehensive program for building and running your own telehealth business.

If you want to learn the tools and skills you need to live life on your own terms – then you should check it out today. After completing the 10-week program, you’ll be ready to take your career to the next level.

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Transitioning from Physician to Hospital Leadership Roles

Transitioning from a physician's clinical role to a leadership position within a hospital system is a significant and rewarding shift. It begins with clinical-administrative roles within the hospital, such as medical directorships. These roles offer valuable management and administrative experience and a bridge to more senior leadership positions.

As physicians move through these roles, they encounter a dynamic shift in responsibilities and gain a deeper understanding of healthcare systems. Through this transition, responsibilities shift to greater leadership responsibilities. These administrative positions often involve advocating for colleagues and patients, while enhancing healthcare delivery at a community level.

Key Areas of Expertise for Hospital Leadership

Several broad areas of expertise are considered critical for physicians transitioning into hospital leadership roles. They cover the skills necessary to lead and manage effectively in a healthcare setting:

1. Leadership Principles
2. Data Management
3. Business Management
4. Talent Management
5. Quality Improvement

Summary

John shares his transformative journey from family physician to hospital CMO. He explores the advantages of hospital leadership roles, where to start as a medical director, salary expectations, the impact of your medical specialty, and the crucial areas for developing new skills.

John also extends an invitation to listeners to explore the NewScript 2023 Nonclinical Career Summit, presented in April, offering all 12 lectures with Q&A sessions for a reduced price of $199, with a special discount for NewScript members. Join NewScript at nonclinicalphysicians.com/newscript to unlock this special discount and access a wealth of nonclinical career insights from our 12 expert presenters.

NOTE: Look below for a transcript of today's episode. 

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• physiciancoaches.com: This website lists coaches for physicians.
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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 323

Why Hospital Leadership Jobs Are Both Challenging and Rewarding

John: This is what I'm talking about - Roadmap from Physician Advisor to Hospital CMO. I am going to first start by telling you my story. It seems to be a good way to start these presentations. I was a family physician. I joined two other physicians. We were in a private practice. They had full practices. I had no practice when I joined them. I had to grow my practice during that time. And as a result, I had some free time during my first two, three years of practice. And so, I looked for things to do that really was more to make some extra money. It was like moonlighting. I would work at the family planning clinic and I would work over at the local college health center. I worked in the STD clinic at the health department. And so, I got involved in other things as I was growing my practice.

And as a result of doing those things, I was often asked to become the medical director because the medical director that was there would leave, for example, the family planning clinic had a gynecologist and they got busy and so they left. And okay, I thought I would do that. And I got paid for doing it.

We had an occupational medicine clinic. Again, I started working there to make some extra money and lo and behold, they needed a medical director for that. So I thought I'll do that. I was learning as I went, and over time I became comfortable doing those kind of things. I actually kind of liked it.

Then as I got further into my career, 5, 10, 15 years in, we were all doing everything OB, pediatrics, working in the nursery, nursing home patients, routing at two hospitals. And we did cut back over time. But I found as I got into the stretch of my family medicine career became rather tedious. I had episodes of burnout and frustration. That was a time when things were changing and they were ramping up the tightening down on payment by Medicare, which continues to this day. And so, it seemed like we were doing more and more work rushing patients through, as many of you have experienced.

And I just started to think maybe I should do something else. One of the things I did in that timeframe, I was tended to say "yes" to most anything, and they needed someone to join the CME committee. I liked planning CME and providing it to my colleagues. I had done that as the chief resident at my residency.

And then when I came to my practice, I got the Illinois Academy Family Physicians involved, and they had a program where we could bring in speakers and continuing the CME for our colleagues. So I liked doing that. And then the chair of the CME committee left or he got sick or something. And so, then I was the chair. And then within six months of doing that, we were surveyed for our accreditation. So I had to learn all about that. And I guess we did well enough that the Illinois State Medical Society asked if I would join the CME committee that did the accreditation for the state, which is delegated by the ACCME. And I thought, okay, I'll do that.

And after being on that committee for a couple of years, I became the chair of that committee, all to say that it just gave me a lot of experience in running meetings and following agendas and communicating and working with people and meeting deadlines and all the different things that we don't necessarily do as physicians.

And so, at one point, I was really getting burnt out and I went to the CEO of my hospital. I said you don't have an executive level physician here. You don't have a VPMA, which was a big thing at the time. You didn't have a CMO. And so, I asked for a job and basically was given the job as a part-time VP for medical affairs. And I grew to really enjoy that job.

Now, part of the reason I'm telling this story is one of the first things I want to do today is what our other speakers have done, explain to you the pros and cons of this job because I talked to many of you when you have questions about non-traditional and nonclinical careers.

And one of the things that I find is that the last thing you want to do is to be around the hospital. It left a bad taste in your mouth because it's the administration of that hospital or a large system that employs you in a large group. It's part of this sometimes multi-hospital system. You feel like you have little control, you feel like you're being abused and you just want to get away from it.

I have found that while I thought my work was really good, and I'll get into that, what I actually did as a CMO. I want to just spend a few minutes talking about why you should consider it, and that's going to be on my first stop. But it leads into another story, and that's the story of one of the physicians. And when I was the VPMA and then moved into the senior VP and CMO role, eventually I was responsible for the medical group that we were growing.

It was very small when I started, but by the time I left, we had 80 physicians and another 40 PAs and NPs. And one of the benefits of me being the chief medical officer is I could really stand up for our physicians. I had an internist who was a geriatrician who was generating a lot of RVUs and the CFO had it in his mind that we really shouldn't pay that physician the same rate per RVU, which hopefully most of you understand, that's kind of how physicians can be compensated in certain contracts.

And in any event, he was doing the work of one and a half internists based on the population that he had, and he wasn't getting paid for it. When I took over the management of the group, over a period of five years, he got two significant raises because I got his RVU compensation rate brought up to the rest of where the rest of our colleagues were.

And so, that's the first big pro for me is that if you're in a position like this, you can advocate for your colleagues, you can advocate for your patients, and you can be the counterbalance to decisions that are made sometimes by the board, sometimes by the senior executive team to cut certain programs or to de-emphasize certain programs or to abandon certain types of patients because they're not lucrative. And when you're in a nonprofit hospital like I was and you're looking out for the community and for the patients, you have much more leverage in that position than as an employed physician or someone on the medical staff.

That's the first thing that I would think about in terms of why it's good to move into a position like this. There's other good reasons as well. And they're going to fall in the areas of leadership, income, intellectual challenges, and helping the community in different ways. That's kind of the way I look at it.

The title of this is From Physician Advisor to CMO. So, what are the jobs? I'm going to get into some of the jobs in a minute, some of the more entry level jobs, but let me just tell you what the higher end jobs are, where you get most of the benefits of working in the hospital system. That's where they accrue.

Obviously, most of us know what a chief medical officer does. We've maybe heard of chief medical information officer. Those are pretty common. But you've got chief quality officers. You've got chief clinical officers, which in many institutions, historically have been nurses. We've got chief patient safety officers, chief population health officers. The CMO can move on to become the COO, chief operating officer, or chief executive officer for that matter. And then there's even something called a chief patient experience officer, which sometimes is physicians in very large organizations.

There's a lot of good jobs, leadership jobs, high paying jobs in the healthcare system. The healthcare system is responsible. When we talk about mainly the hospitals part of it, approximately 25% of all healthcare dollars. It's the biggest chunk of money because we know that when people get ill at the end of their lives, they spend a lot of money. And that means there's a lot of jobs and there's a lot of jobs for physicians.

I mentioned salary. The average chief medical officer in any size hospital is going to make typically well above $300,000. It's not unusual for a CMO, especially one who's more seasoned to make $400,000 to $600,000 or $700,000. You can do your own research on this. You can try and find surveys that are difficult to find. Executive physician surveys. You have to pay a lot of money.

But you can go to something called guidestar.org, which is where all the 990 tax forms are put for nonprofit organizations. Every nonprofit organization has to report these things. And in those reports, they list the salaries of the most highly compensated members of those teams. Sometimes it's a board member, although most nonprofits don't pay their boards unless they're a big system. And then it's the CEO, the COO, the CFO, all those people. And usually you can go in there and look up the CMOs salary. There's less data available now because with a lot of the merging of different systems, you'll only get the top earners for the whole system. You might have six or 10 hospitals, but you might catch one CMO plus the CEO, the CFO and some of the board members.

But you can do that. Find a small community hospital or a medium sized community hospital near you that's a nonprofit, and go in there and just look up their salaries. They're published there every year. Guidestar.org is free. If you want to get more up to date report, you have to pay, but it doesn't really matter because the salaries don't change that much. So, it's a very good, well-paying job.

Now, as far as the intellectual stimulation, if you've worked in a hospital setting, I'm sure you've come across all kinds of challenges that would be very interesting to work on. Usually you don't have time, you got to get back to the office, you got to get back to the OR, you got to go to the ER. But some of the areas where physicians are really important, and you see this on the medical staffs because they ask you to get involved, but everything from quality improvement, patient safety, you learn about sentinel events and root cause analysis, lean process improvement, protocol development, top 100 hospitals, leapfrog, CMS hospital compare, health grades. It's all in the realm of quality improvement. It's all very important and it's interesting.

And we all have a background in epidemiology and statistics. We learn that in medical school, sometimes in residency. We know what quality is. We've been on different committees. I think it's very intellectually stimulating. Then you've got clinical documentation integrity, utilization management and length of stay, case management. I was always involved in the pharmacy formulary decisions and medication errors and how to minimize those.

Informatics has been huge in the last decade in growing. And healthcare law because you got the regulatory, you got to deal with the DOJ, CMS regs. And then there's the contracting, which I really got into heavily during those last five years when I was in charge of the medical group for our hospital.

And I could pick and choose any of those to work on any given day. And they were all very interesting and mentally stimulating to me. And so, it's just fun to do those kinds of things. To me, seeing patients one after the other for a mundane problem, that worried well, the sixth influenza patient in a row, that gets boring. But there's so much more that you can get into in the hospital setting when you're dealing with some of these areas that they need physicians to deal with.

Now, I often get the question, "What are the best specialties for doing something in the hospital management, hospital leadership?" I actually get that question about other areas too, like UM, like pharmaceutical companies. Any number of jobs. What about nonclinical jobs? What specialties will have the best opportunities? And really what I usually tell people is it doesn't really matter. You can be in any specialty and do UM. You can be in any specialty and get through into pharma. Same thing in the hospital.

Now, the way that I went about it, and the easiest way to segue into a hospital management position is to be in the hospital. I wouldn't say that a dermatologist who's doing only outpatient or a pediatrician who hasn't set foot in the hospital in 10 years, probably would want to pursue something like this because they're not in that milieu.

But anybody else who's in that, whether it's full-time, you're an ER doc, you're a radiologist, you're another type of surgical specialty that's there several days a week, you're going to committee meetings, you're already participating on quality and pharmacy meetings and things like that. It's just a natural transition that you can make. And it does take time. And I'm going to go through the process that I would recommend you follow to do it.

But if you plan it properly, you can make that segue before you get too burned out, before you reach that point of no return where "You know what? I just can't step a foot in that place again." So, you want to do this, begin that process if you think it's something you consider a little bit earlier rather than later. Pretty much any specialty that's in the hospital.

Also, if you happen to be, let's say the managing partner kind of role, or the medical director for let's say a big medical group that's part of a hospital system, you could segue from that as well, because you're going to be going to meetings and rubbing elbows with the other leaders in that hospital system.

But in general, it's someone who's going to be in the hospital. Probably fewer family physicians these days than when I did it, because when I did it, I was in the hospital every day making rounds, going to committee meetings, and volunteering for some of those things. And then working, getting paid to do some of those medical directorships part-time. So, what are the areas that you need to learn as you're going from that physician advisor or even a medical director role into more of a leadership role?

Because the physician advisor role, really, you're not doing any management or supervision at all. Nobody reports to you. You just show up, look at charts, electronic medical records. You might call physicians. You might just approve things based on what you can find in the record and move on.

But when you get to a medical director role, now you're doing a little bit of management. You can be, and I'm going to list some areas where you can be a medical director, but now you're starting to get into that. And if you're thinking about that, let's say you're having a good time, you're working 20% time as a medical director, and you're thinking, "Well, I want to go further and I want to start to pull back on my clinical and increase my leadership", then these are the five areas you need to learn more about.

I get this from the AAPL, the American Association for Physician Leadership. I'm going to maybe talk really briefly in a minute about the CPE designation, certified physician executive. But the AAPL has a subsidiary called the CCMM, which puts out the CPE designation, and basically they describe what they feel are the five areas that we need to learn about as physician beyond the clinical that we know. So, it's pretty straightforward.

The first one is leadership principles. That one is a little bit nebulous, but it includes things like motivating people and persuading people. It includes things like understanding strategic planning and that kind of thing. And it's probably of the five areas, the least concrete, but you kind of know when someone's a good leader and not when they're good leaders. Most people now kind of follow the path of servant leadership where you're trying to create teams and motivate people and work together. If you have a little bit of charisma, or at least again, the ability to persuade people, that's a big part of it.

The second is what they call data management. Now, for us, that's usually quality improvement. Those are the data that we usually deal with. We already have some experience in that just from our clinical practice. We know that we're being measured usually in what we do. Most of us have been exposed to maybe some of the data that the hospital shares with us when we're admitting and discharging patients or when we're doing procedures.

And so, there are some part of data management spills over into financial management because finances are data too. But usually we consider that as separate. And basically what that is, just understanding basic accounting principles, maybe P&L, balance sheet. And for me, and for you, if you're going to be in a hospital setting, understanding hospital financial reports because they're unique, because of the way they're paid. You have your gross revenues, which is what you bill. Then you have your net revenues, which is sometimes up to a half of that. You can say some hospital has a gross revenues of $900 million, but their net revenues is closer to, let's say, $600 million. And then you have write-offs. These are just unique to the healthcare system. So you have to learn that if you're going to be a leader in a hospital.

And then you've got the business management part of it, and that is just the management skills that you need to motivate people. One of the biggest things I had to learn when I started moving up into that area, was all of a sudden now I've got three, four or five, maybe up to six or seven directors reporting to me.

Well, how do I interact with them and what's my role? It's a little different from, let's say, leading a team as let's say an ER doc in a code or leading a team in the OR or something. When you're leading a big organization, it's more of a vertical thought process. How are we going to help each other? How are the directors that are reporting to me going to work together to get our division working and moving in the right direction? It's understanding how to set goals, how to plan projects, and how to keep projects moving forward with timelines and deadlines. I would say that's an area that physicians need a lot of help with at first is in the business management sphere.

And then the last area, and it does overlap a little bit with the leadership and the business management, and that's the human resources, or you might call it talent management. That's when you're getting a little more into "How do you recruit people? How do you train people? How do you monitor their performance? How do you resolve disputes?" Those are all areas where most physicians have some knowledge, but not a lot. So you need to get more exposure to that, and you can do that by some of the ways I've mentioned already and then some that I'll mention shortly. I just wanted to point that out that you got to think about how you're going to get experience in those areas.

The other thing I like to remind physicians about is sometimes we can get pretty cocky. We're pretty confident people. We've had a lot of education, a lot of experience, and so we kind of feel like we know a lot and we do, but we don't really know everything about finances and business management and that sort of thing.

I think it's good when you're making this transition to be a little humble and just suck all the information, all the knowledge that you can from those around you. And they're happy to tell you and show you how to do things. They don't expect a physician moving into a new leadership or management role to know how to do that. We basically have 70 or 80% of the knowledge and the skills to do the job, but that last 10, 20, 25%, we have to sometimes learn on the job, even going to classes and courses.

Getting an MBA doesn't really teach you day to day how to interact and how to work on a team because you have to do it. And that's where doing those things I talked about earlier about managing a committee, being the chair, leading meetings, leading projects. They may be ad hoc projects that just come up, you volunteer and then, oh, okay, you can be the chair and you help us get this thing done. We got six months to do it.

Where do you start as you're going on that path to that senior executive position? Well, the most common jobs that I have seen in the hospital setting are the ones I've mentioned already with a couple of others. They always need UM docs to do the physician advisor, but then someone has to lead that group, particularly if it's a large hospital. You can become a medical director in utilization management. Clinical documentation, integrity. It used to be called clinical documentation improvement. Every hospital has to have a CDI team. They have to. If you're not documenting properly, you're losing a lot of money. And the bigger thing is the quality of your care is going to be misrepresented.

Quality improvement. I talked to one of my guests who was a hospitalist. He was in a big organization, a big group of hospitalists working at multiple hospitals, and he had a halftime job as a medical director for quality just for the hospitalists.

Now most of the time, if you're going to get into quality improvement, you're going to be the medical director for quality improvement at an entire hospital. But if the system is big enough, then you can have even multiple medical directors and associate or assistant medical directors working just on quality, just on safety, just on informatics is another one. Those are the big four that are sort of not clinical areas that I have experienced people starting in.

I hope you enjoyed that excerpt from my summit lecture. All of the other 11 lectures were even more inspirational, informative, and educational. They were really excellent. One of the reasons I chose to present that audio today is that we opened up the all access pass for lifetime access to the NewScript 2023 Nonclinical Career Summit lectures last week at a special low price of $199. The usual cost is $249, and for that $199, you will have access to all 12 lectures, which also includes their Q&A. I think there's also some bonuses with the all access pass.

Now you can get an even better deal. If you're a NewScript member, the price is just $139 for everything, for a total savings of $110 from the usual price. If you're not a NewScript member, you still have time to join NewScript at nonclinicalphysicians.com/newscript. And then once you're a member, you can use a special coupon code to get that $110 discount off the usual summit pricing.

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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. 

The post Why Hospital Leadership Jobs Are Both Challenging and Rewarding appeared first on NonClinical Physicians.

This week's episode is a replay of the second most popular episode since the podcast was launched discussing a great hospital job: utilization management physician advisor. It was first posted in January of 2022 and featured Dr. Robert Craven. 

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He serves on the executive council of the physician advisor special interest group (SIG) for the Society of Hospital Medicine. He still works clinically as a hospitalist two to three shifts a month and also does medicolegal consulting. Rob currently resides in Murrells Inlet, South Carolina, with his wife and two daughters.

Unexpected Opportunity

He had no intention of working as a physician advisor. However, a previous employer contacted him unexpectedly and offered him the position when it decided to expand its UM Program. 

Today he tells us what his job entails, why he thinks this a great hospital job, and how you can land a similar position.

A Great Hospital Job: Utilization Management Physician Advisor

Rob explained the details of his job as a physician advisor. It is somewhat unique that he is working remotely for a large system, with occasional opportunities to go on-site if needed.

The job is more flexible than a full-time hospitalist position, and it accommodates his efforts to spend more time with his family. It is intellectually stimulating. And in this job, he provides value to his employer, its physicians, and patients.

Summary

After working nine years as a full-time hospitalist, Dr. Robert Craven finds that his role as utilization management physician advisor is intellectually stimulating and fulfilling. He works remotely from home on most days. And he still works a few clinical shifts each month, which enables him to maintain clinical skills and relate better to his physician colleagues.

NOTE: Look below for a transcript of today's episode.

Links for Today's Episode:

• Connect with Dr. Rob Craven on LinkedIn
• Dr. Robert Craven's email address: cravenmedical@email.com
• American College of Physicians Advisors
• Society of Hospital Medicine
• How to Go from UM Physician Advisor to Revenue Cycle CMO with Dr. Ralph Wuebker – 069
• Meet the Modern Physician Advisor – Interview with Dr. Timothy Owolabi – 012
• How to Find a Top Remote Nonclinical Career – 188
• NewScr!pt – the BEST place to find mentors and experts to advance your career

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 230

Why Utilization Management Physician Advisor Is a Great Hospital Job

John: Hello, Dr. Robert Craven.

Dr. Robert Craven: Hi, thanks for having me.

John: I'm just glad to talk to physicians but number one, I've wanted to talk to more hospitalists. I came from a background in family medicine, but I was a hospital administrator. And so, I worked with lots of hospitalists, particularly in those last 10 years or so after that whole specialty became a thing. I like to see what hospitalists are up to and how they transition into leadership positions and management positions. So, that's why I'm really excited to talk to you today, Rob.

Dr. Robert Craven: Excellent.

John: We'd like to hear a little background at the beginning, so you can give us a nutshell description of where you went to school and why you chose being a hospitalist and how that career went, and then just finish up with what you're actually doing today.

Dr. Robert Craven: Excellent. Well, I grew up in Tennessee and grew up really outside of Chattanooga. I went to undergrad at UT Chattanooga and then medical school at the University of Tennessee, in Memphis. I finished there in 2008 and then matched and did my residency in internal medicine in Charlotte, North Carolina, with what is now called Atrium Health. Back then we called it Carolina's Medical Center. I felt like I got excellent training there.

Initially, my plan was to go into pulmonary and critical care, but while I was there, that was right around the time that hospital medicine was becoming a big thing. And the temptation just to come on out and practice and have a week on - week off lifestyle was great. And I got offered an excellent job right out of training in Charlotte. I really liked the inpatient side of medicine. I liked the acuity of it. I liked the flexibility of it. I liked the schedule, the week on - week off schedule. At that point in time, I was still single. I didn't have any children. So, it was really a great lifestyle for me coming out of training in Charlotte.

I worked for about five years for a system in Charlotte and really enjoyed that, and really loved hospital medicine. Got married, settled down, started having children. And that's when my wife and I wanted to get a little bit closer to family because neither of us was from that area. And her parents live in Murrells Inlet, South Carolina, which is where we live now. Around early 2016, we started migrating closer to the coast of South Carolina. And I took a hospitalist position, with the system I currently work for and worked there for about four years.

This was in a small town and while I loved working for that employer, we just didn't really like the town. We wanted to be closer to my wife's parents and didn't really fully adapt to the small-town life in South Carolina. So, about 2019, we decided to move further to the beach. I made the decision to join another group, out this way and that was right before the COVID pandemic hit. And things didn't really pan out that well in that group, as we might talk about more later. But while I was there, the system I had previously worked for reached out to me and said, "We have this opening available as a physician advisor and we know you and you know us and the team you'd be working with, you're very familiar with."

They approached me to see if I would be interested and with everything going on and with the COVID pandemic, it seemed like too good of an opportunity to pass up. Even though I previously would never have told you, I was interested in doing physician advisor work. I interviewed for the job and ended up getting the job. And it has allowed me to work for the system that I work for now, and previously had excellent experience with. But yet I still live where I do now with my family, close to my in-laws, and enjoy the coastal life of South Carolina. Now, I've been doing that for about a year now. I transitioned in December of 2020. A little over a year ago, I made the transition to the nonclinical world and it hasn't been perfect, but it's been great. And I have no regrets.

John: Well, let me see, let me jump in here. One question I have is, are you doing any clinical work currently, even if it's just once a week or a month or anything?

Dr. Robert Craven: I do. The job I'm in is technically 100% admin, which I'm trying to work out to where it's more like 80% admin, 20% clinical. But the way it stands right now, I'm doing an average of two to three shifts a month as a hospitalist. Just more so for my own benefit to make sure I continue to have a foot in the game and continue to have clinical relevance in what I do.

And typically, what I'll do is do a Friday, Saturday, Sunday stretch, and I work throughout the system. So, it's opened me up to get exposed to some of the smaller hospitals in the system I work for. And that's been refreshing and fun to meet new people and work in a bit of a different environment. But typically, I'll do a Friday, Saturday, Sunday stretch. And then back to my administrative role Monday morning.

John: Okay. As I was following that timeline, there was some relocation in there somewhere. The Friday, Saturday, Sunday, is that something that's at a distance? Is it fairly close to where you live? Do you just stay on-site when you're doing those weekends, how does that work?

Dr. Robert Craven: It varies. There are some weekends where I work locally and I just come home every night, and then there are some weekends where I might be two, two and a half hours away. In those situations, I'll stay in a hotel for the weekend.

John: Okay. Let me ask you this about the whole situation as a physician advisor. As a hospitalist, I'm assuming you had interaction with people that were doing that role or could be nursing they were doing the UM and case management. Was this something that you were very familiar with when they asked you? Was it something you had to get up to speed on? How did that work?

Dr. Robert Craven: I was familiar with the very basics of it. I was practicing there before they had a physician advisor and back then, if there was a denial that requires a peer to peer, the attending hospitalist would handle that peer to peer. And maybe I did a couple a month back then. It wasn't that frequent, but it was enough to understand the process. But I'll tell you what really led me to it was that the denial team that I work with, I probably knew 80% of them from my time as a hospitalist there. It largely is comprised of one nurse that is their denials coordinator, their chief physician advisor, who was there before me, who I knew and worked with because he was a former hospitalist and now myself. It's really the three of us. And then the administrative leadership over that, I also knew fairly well with my previous work.

Knowing them and them knowing me, I think led to a lot of that. They knew that I would fit well with the team. They knew my work ethic and they also wanted a bit more of a presence towards the beach because they had facilities out here, and I was able to fill that void as well. It worked out well for them and it's worked out great for me.

John: I want to get into what the day-to-day activities of your job entail. And you can tell us what you like, what you don't like. But one of the first parts of that, is this something that you do pretty much as a remote physician advisor? Do you do any on-site? How does that work out?

Dr. Robert Craven: Most of what I do is remote. I do have an office nearby. It's about 30 minutes from where I live. I might spend one or two afternoons in that office. The rest of the time I'm working from home. I typically commute to our main campus, which is about an hour and a half away, and usually spend a day there a week. Just to keep up to speed with everything that's going on, make sure that I'm seeing the other people in the department, make sure I'm seeing the other physician.

I do think there's value in being seen and having conversations at lunchtime in the doctor's lounge. You'll get different opinions about that. There are some physician advisors that work entirely remote and they'll tell you there's no value at all to being on campus, and then you'll meet others that say that you should never be remote. You should always be on campus. And I like having a bit of a balance. But my schedule is very loose and I get to dictate a lot of it, which I like. I can coordinate with my family if there are certain days that week where I really need to be home, then I'll adjust my schedules to accommodate that and make sure that I'm not working a clinical shift or planning on commuting to a different campus.

John: Now, when we talk about UM and physician advisors on the podcast, a lot of times we're talking to someone who's working for an insurance company or I guess I would say a middle man. Someone who's on the outside trying to get things authorized or that kind of thing. And I only bring it up because sometimes they tell me, "Well, any physician can do that work working for an insurance company. It's basically knowing the protocols, knowing the criteria takes about anywhere from six to 12 weeks to learn it." Okay. So that's cool. I mean, pretty much any physician can do that. I just want to know what your on-ramp was? What was your learning curve at the beginning, and what would you tell others to expect if they're going particularly into a full-time physician advisor role?

Dr. Robert Craven: Right. It is a bit of a learning curve. I think certain specialties adapt to it quicker than others. And I'll say that in this role, I've dealt with medical directors with different insurance companies from a whole host of backgrounds, from OB-GYN to surgery, to ophthalmology. It's possible for anyone of any background to do this. But I think if you're in a specialty that is not so inpatient centered, hospital-based, that sort of thing, I think it's going to be a bit more of a learning curve for you. The people that tend to make the transition easier, and are more common to make this transition, usually come from hospital mass and emergency mass and intensivists that sort of thing. But there's not a whole lot of educational resources out there for this type of work.

The American College of Physician Advisors exists and they're excellent. I don't represent them in our conversation today. I'll say that I'm a member, anyone can join. And they have a lot of video tutorials on their website that are excellent. A lot of explanations on their website, and resources.

There's a lot of self-learning that you can do if it's something you're interested in, but most systems will have some sort of process for bringing you up to speed, with either a third party or some sort of educational program that they have. The system I work for used a third party to educate both me and the physician advisor that I was joining. He went through the same education that I got a few years before. And then when I was onboarding, he went through it again, just to have that extra benefit.

But the training I went through, the actual online training that I went through with this third party was about two days. And then there was a lot of kind of apprenticeship type training with the chief physician advisor, just learning their workflow, which was a big part of it, just how my system in general handles denials.

But then also learning the ins and outs of the two-midnight rule and CMS rules and regulations and the various commercial insurers and how they operate, all those things. Like most things in medicine, you learn by doing. And so, the first peer to peer I would do, he would be in the room with me. He would review the case as well, and give me some pointers. I would make that phone call, put it on speakerphone so he can hear everything that's being said.

And the first ones often didn't go well. And then afterwards, he would be able to teach me and say, well, you really should have emphasized this point or that point. It was very much a learning-by-doing environment.

But I would say, after two or three months, I was pretty comfortable. The first month I spent a lot of time on-site, on our main campus just to have that constant resource of the other physician advisor, someone to bounce things off of. But as time has progressed, I've gotten more independent. Whereas now rarely do I bounce something off of him. Usually, if we're communicating about a case, it's because it's something highly unusual and not because I'm looking for his advice or feedback.

John: Excellent. Now that gives us a good picture of how to work into it. You know the environment. You know what it means to be in the hospital and the different types of admissions and observation and so forth and inpatient-outpatient. It's then learning the language, the jargon they use, and then the criteria that they use, I would imagine.

So, what is your day-to-day now? I know it's probably hard to put it in simple one, two, three, these are the three or four things I do. But what would you say if someone were to ask you that question? What is it you'd spend most of your time doing? Is it something that takes a lot of planning? Is it laid out for you? How does that work?

Dr. Robert Craven: Sure. The past two weeks have been a bit abnormal because my kids are out of school. And when you're working from home and your kids are out of school, it can be a bit challenging. But on an average day as a hospitalist, I was not that involved in my kid's day-to-day routine, but now I am because my day starts later.

So typically, my wife and I will get up around the same time, to help get the kids ready for school. We have a carpool with our neighborhood. Sometimes I drive, sometimes other people drive. But I'm very involved in getting them ready in the morning, getting them off to school. And then now I go to the gym in the morning or try to, after they're ready for school.

John: Nice.

Dr. Robert Craven: I do about 30 minutes of cardio or other exercises. And then I come home, get ready for work. And usually, I'm sitting at my desk, logged in to our system by about 9:00, 9:30 in the morning. I'll be on and off the computer until 4:00 or 5:00 PM, usually. Technically until 5:00, but some days things wrap up a little earlier, our denials coordinator will tell us, look, there's nothing else in the queue. And then, you know you can leave early.

And an interesting thing about physician advisors is it's such a new thing, every system uses them a little differently. My experience as a physician advisor could be very different from another physician advisor in a bigger system, a smaller system, a different area of the country.

But the way it works with our group, the bulk of what we do is review denials, it's what we call denial management. There are multiple cues that I'm following online in our computer system. And one of them is where any denial from an insurer that comes through our system, it will get reviewed by our denials coordinator. She will do a little brief summary as to why it got denied and any specifics about the case. And then it gets put in this queue.

And then myself and four of the other physician advisors, we just work through that as we can and sign up for these denials, claiming it as our own, labeling that we're going to be the one to review it. And when we review it, this is where you get a lot of deviation from one system to another. The way we do it is, we actually will write a report usually about half a page or a one-page report summarizing the case and also stating if we feel like it is really inpatient appropriate, or if we don't and why.

And then we file that report in a couple of different places, both in our electronic healthcare record and on our hospital's systems drive on their internet. So that way, if we were to get audited, if an insurer were to audit us and want to see our review process, we have it very well documented that we thoroughly reviewed it. And we felt like it was inpatient for the following reasons. And sometimes we'll reference CMS guidelines or other criteria like MCG or Interpol, but a lot of times we're re-reviewing it at a bit of a higher level than those things. That's one cue that we're managing.

There's another one full of what we call short stays. And those are discharges within the system that were put in as inpatient but discharged from the hospital before crossing the second midnight. And so, that queue fills up a little slower, but there's usually two or three of those a day that we review, and determine, is this something that was inpatient appropriate that we should release the inpatient bill? Or should we self-deny that and just bill it as observation to try to minimize the risk of us getting audited on the back end? And so, that's a process that we do as well. We also write a report. Usually, there's communication with the attending that we feel if they were placed in the wrong status, we will communicate with them, that they did so, and why we thought that was an error, that sort of thing.

And then there's the third queue and the final queue is secondary reviews or concurrent reviews where a case manager in a hospital is having trouble getting a patient to meet inpatient criteria that the physician put in inpatient. And they'll want us to review that and see if it needs to be downgraded to observation, or if we think inpatient is appropriate. And oftentimes that requires a conversation with that attending.

We're kind of managing these three different queues all at one time. And an average day between the two of us, we might generate 15 to 20 reports a piece. A busy day I'd say is 30 to 40 total between the two of us. But it's not uncommon for us to generate 15 reports a piece for that day.

John: Okay. Now, I probably know just enough to become a little bit dangerous, but I'm going to ask you some questions just because I hear these things come up and because my daughter is a social worker who did UM for a long time and was managing inpatient discharges. You don't have a whole lot of let's say mental health issue denials or admissions or behavioral health units. Those seem to be a little different from the typical medical I would think.

Dr. Robert Craven: They are, but they still, we do have behavioral health hospital. And so, we still deal with that. It is rare, but it does still come up.

John: Okay. And then when you were saying, and this is probably in the weeds, but in terms of inpatient, are you talking about the initial admission, like on day one that they are inpatient as opposed to out? Or let's say each additional day where the insurer might be saying, no, they should have a three-day length of stay and now they're on day four, we're going to deny it?

Dr. Robert Craven: It varies. Both. It's all based on the contractual agreement that your system has with the insurer. Some of them will give you a lump sum for a DRG for the whole hospital stay. And whether you have them there for two days or seven days, they don't really care. They're giving you the same amount and then others will have a per diem component.

And that's where having some negotiation skills can be a benefit because you might end up having a peer-to-peer discussion with that insurer. And they're saying we're not going to pay for the last five days and you're trying to negotiate. You'd like them to pay for all of it, but you end up compromising, and at the end of the conversation, they're not paying for the last two days. It ends up still being a win for the system.

It really goes down to what contractual agreement you have with the insurer, and that is another complexity of all of this because all of them vary and are different.

John: Is there a way that you have that information in front of you when you're having these conversations? Or is it something the nurse relays to you or do you have to look it up?

Dr. Robert Craven: Some systems that have been doing this a while often will have some sort of Excel sheet or Flowsheet where they can glance at it and see the specifics of each insurer and what their agreement is. We don't have that yet. We're working on that, but a lot of it I've learned just by trial and error. And you'll learn from talking with the different medical directors of these insurance companies, because sometimes they'll have the contract in front of them and they can say, "Yeah, we have a per diem component with you all." And then you just learn by repetition, which insurers have a per diem component and which do not. But ideally, I should have a spreadsheet with all that right on it so that I can glance at it for reference.

John: Interesting. Yeah. That makes sense. It's unfortunate that things are so complex that you actually have to create an entire system to deal with it, but that's the way it's been for quite a while.

Dr. Robert Craven: That's right.

John: Tell me more about the things that you like because I think I got the idea that you probably like being more involved with your kids. You like having the flexibility of starting a little later in the day. What are the things you like with what you're doing now?

Dr. Robert Craven: I think I was doing some case review before I made this transition. I was doing some medical malpractice reviews. I was doing and still do some standard of care review for the State Medical Board. I've done disability appeals before. I don't really care to go back to that, but it was something I dabbled in briefly.

I've always enjoyed case reviews. And I think that's critical for this kind of work because it's the bulk of what you do. You're just reviewing it for different details. Instead of reviewing a case to look for a deviation of standard of care or causation of harm, that sort of thing, you're reviewing a case to see can I make an argument for inpatient status with this particular insurer?

But the principles of reviewing a case and how to do it efficiently, I think carry over from one aspect of that to another. That I enjoy. I enjoy the flexibility as we had touched on earlier. I did some traveling over the summer and didn't take any PTO because mostly what I was traveling for was occurring in the evening. So, I would just work in my hotel room during the day. I had excellent internet and cell service and I didn't even have to take PTO. With this kind of work, as long as your employer's okay with it, you can be extremely mobile and even go on vacation, let your family enjoy it, while you're working out of the hotel room.

John: Anything you don't like about it?

Dr. Robert Craven: I think there's a bit of a lack of connection sometimes. On the campus I used to work at full time, I know most of those people. So, if I have an issue and I call one of those physicians, more than likely they remember me, we had a good relationship. But if I'm having to deal with a physician at a campus that I haven't worked at, I feel like there's a disconnect there.

And especially as a physician advisor, which is a fairly new thing, the doctors that don't know me are a bit uncertain of what it is I'm doing. Am I really on their side or am I not? You get a little bit of hesitation from some doctors when they hear what you do. Some of them view this as selling out and becoming a suit, becoming an administrator. But I still very much feel every day that I'm really fighting for the patient, advocating for the patient, and trying to get their insurer to pay for the care that they needed.

John: Yeah. I hear that from some physicians that are thinking about doing it and not sure they want to be seen as an adversary in some ways. But to me, the most successful UM physician advisors have been more looking at it as "I'm just trying to educate the physician so they can document what needs to be documented and put the patient in the right setting in the first place rather than have to go and fight the insurance company later." That's definitely a trend.

Dr. Robert Craven: Right. And it's so much easier if you can get the patient in the right status on the front end, in a controlled environment, in the hospital where you can explain things to them, what it means to be an observation. It's so much easier on the front end than on the back end where maybe they're already home and now they're getting a letter saying, "By the way, your copay is going to be higher and you've got to pay for all these meds that you got in the hospital that you initially thought your insurance was going to pay for, but the doctor puts you in the wrong status. And therefore, now this all comes back to you." That can be a huge dissatisfier for the patient. Hospitals have a lot more control over it and the optics of it, if you're doing it in real-time while the patient is there.

John: Right. Yeah. That makes sense. If somebody you knew came to you and said, "I've been practicing for a few years and it's okay, but it's not as fulfilling as I thought it was going to be. I need to get a little more freedom, a little more flexibility in my life. And I think I'd like to do what you're doing." But as far as you can tell that person has not done anything to really learn about it or get the necessary skills. What would be the things you might advise that mentee to try or to do, to get some of the skills that would position them to potentially move into a part-time or full-time position?

Dr. Robert Craven: Right. That's an excellent question. And I get asked that a lot on different social media forums where people are talking about this kind of work. What I usually tell people is every hospital has to have a process of some sort for this kind of work. And usually, they're overburdened and they would like more help.

I usually tell people to figure out what the process is at your hospital. Do they have a physician advisor? Do they outsource that? Do they have a committee of docs who take turns? There's a number of different ways that a hospital or a system can do this. And try to see if you can participate. Even if it's half a day, every other week. That's still some experience that you previously wouldn't have had. And a lot of times I think systems would be open to that.

Another thing is, like I mentioned, the American College of Physician Advisors. They're an excellent resource. You could become a member there and they have some excellent online content and resources, including several books that they or other people have written that are very well written and informative about this kind of work.

I will say as I read one of these books prior to taking the job. Reading these types of texts before you've actually done the work is kind of like reading Harrison's Internal Medicine before doing an internal medicine residency. The context of it and how it all applies to real-world scenarios is a bit lost on you when you're just reading the book cold.

However, I do think it was helpful for me, but having those books as a reference afterwards to go back and look up certain chapters, certain things have been invaluable. And there's going to be growing content, educational content online for people interested in this kind of work.

I know the Society of Hospital Medicine. I'm a member of the Society of Hospital Medicine but I don't speak for them. They have a special interest group in physician advisors, which I'm a member of, and they are working to develop some educational curriculum, not just for hospitalists, but really for anyone that is interested in learning about the physician advisor world, maybe to get them more interested in it and eventually, to train them into how to become a full-time physician advisor. They already have excellent educational content, but they're talking about adding more specifically for those interested in the physician advisor world.

John: That's very useful. I hadn't heard that. So that would be good to know. And it would seem like you said, you mentioned hospitalists and ER docs in there, but hospitalists probably make up a decent percentage of physician advisors. Something you mentioned earlier really struck the chord with me as an awesome way to get your feet wet in a way is to do other types of chart reviews.

Dr. Robert Craven: Correct.

John: If you're doing peer reviews and you're doing let's say quality reviews in the hospital setting, or like you said, for State Medical Society or something like that, or medical, I guess it would be the licensing board more than a medical society. Those are great ways to say, "Okay, not only do I know how to look through a chart, discern what I need to discern, but I like doing it." If you sit down and do that and look at that page and go, "This is boring as hell. I can't do it" that would weed you out.

Dr. Robert Craven: Right. Yeah. And that's an excellent point. Because if you can't sit in front of a computer all day, you're probably not going to be happy doing this. Just like I would make a horrible radiologist because I wouldn't want to sit in a dark room and look at pictures all day. That's part of it too.

But the other thing too is if sometimes I get bored in my home office, I get my laptop and I go out on the porch or the deck or I go somewhere remote where I'm not going to violate HIPAA, but I know I'm going to have nicer scenery and solid Wi-Fi. There are ways that you can mix it up a bit, but at the end of the day, the majority of your day is reviewing cases.

I should probably point out, there are some misconceptions out there that even I had about what it's like to be a physician advisor. I had thought that, and I hear this from a lot of people who are considering it as well, that there's a lot of arguing. People will say, "Well, I would probably enjoy it, but I just don't like arguing with people." I really don't argue that much at all.

The other common misconception is that the physicians who are working for the insurance company have completely sold their soul and they have gone to the dark side and they are evil people that we should have nothing to do with. And that's not true either, because what I've found, we deal with the same medical directors over and over again, you end up developing a relationship with them.

There are a couple of them that I talk with almost on a daily basis. And you learn about your children. You learn about families. You learn about where they live. It becomes very collegial and really there's not much arguing. You build a case for why you feel the patient should be inpatient. You present that case and usually, they'll agree with you. And if they don't, they'll give you a reason why they don't. And often it's "Look, I'm sorry, but per our protocol, we have to have X, Y, and Z, and you don't have, Y. You just have X and Z." Even they are often apologetic about it. But they're just doing their job. And then instead of arguing, you just kick it to the next level of appeal. Getting all fired up about it and yelling and stomping your feet, I have found doesn't bring any benefit. And developing more of a collegial relationship with these physicians on the other side, I think has a lot more benefit in the long run.

To go back to the two misconceptions, you don't argue a lot at all. I think maybe I've had two argumentative conversations with a physician in a peer-to-peer over the last year. And as a hospitalist full-time I feel like I was having argumentative conversations all the time just to get various consultants to help you out or whatever.

I feel like in that regard, it's a lot less stressful. You realize that the docs on the other side of the phone are much like yourself who maybe didn't have the opportunity to work for a non-profit healthcare system, but the only opportunity they had was for a large national commercial insurance company. I've learned to appreciate the people on the other side of the phone as well in this whole process. Some of them are probably listening to this podcast.

John: No, it's true. And it's true in life in general, even just working on a medical staff. Some people just like to be oppositional, it's part of their personality. But most people want to just get along, help the patients, move people through the system and move on to the next case.

Dr. Robert Craven: Right.

John: All right. I think we're about out of time, really, probably going over a little bit, but that's okay. The last question I have for you is what advice you have for physicians, my listeners in particular, who many of them are burned out or they're frustrated, COVID has had an impact on their lives and they're just getting a little frustrated and looking for different options. Any general advice for people that are getting a little burned out and don't know what to do?

Dr. Robert Craven: A couple of things. First and foremost, I would tell people to keep an open mind, because sometimes the way a job is described can sound really boring and unfulfilling. And then when you actually do it, you actually really enjoy it.

I would've said that about physician advisor work. If you had asked me two or three years ago, would I ever see myself doing that? I would've told you "Absolutely not. It sounds completely boring." So, keep an open mind. I would tell people to try to dabble in different things. Healthcare informatics is a really big thing and there's a lot of people that are transitioning over to become consultants for EHR companies or chief medical informatics officers.

So, dabbling in that can be a benefit. I dabbled some in that and realized it's okay, but it's not something I would want to make my career out of. I ended up not going down that road. Dabbling in administration and asking to become an assistant director of your group or in charge of scheduling or whatever, and see if you like more of the administrative side. I've done some of that and felt like the more I was responsible for other physicians' behavior, the more frustrated I became. So, I felt like that was not really good for me. And there are all sorts of side gigs out there. People starting up concierge practices, medical spas, doing expert witness work. You're not really going to know what you like, what you're good at, unless you try some of it, and talk to people who are doing it. I would definitely tell people to keep an open mind.

Another thing, especially if you're looking at making the jump into more of an administrative role within your system or another system is to always remember, people are always looking at you as a physician and critiquing how you handle stress and how you interact with nurses, how you interact with case managers.

I probably would not have been selected for this job if the case managers that I'd worked with had a bad opinion of me, if I had been volatile or temperamental. Same with the nursing staff. If a physician came to me that I know is temperamental or blows up at medical staff meetings, and they're thinking about transitioning into administration, I'd probably tell them they need to either reconsider that or admit that they might need to have some anger management counseling and work on their demeanor.

Especially if you've worked there for a while, people have already felt you out and decided if you're someone that would be able to fit into the culture there as an administrator or not. That's one of the benefits of working in a system before transitioning to administration. And it's one of the negatives. If you've been there for a number of years and haven't made a good impression on people then trying to get into a position like that is going to be more challenging.

John: Yeah. I think you can try and transfer, let's say, the way an OR works with the surgeon at the head of that team to management and administration, but usually, it's a little different. We usually look at it more as a servant leader when we're talking about actual management and leadership in a more corporate setting as opposed to more of a militaristic approach sometimes in the OR, or surgical center. But it's not that big of a transition if you look at it differently. Those are good bits of advice.

I want to thank you for going into so much detail here in what it means to be a physician advisor in a hospital setting, but in a remote position primarily. I don't think it's unique, but it's a little different. We either think of them and like you said, in a single hospital, they're going to be on site. And if they're working for an insurance company, it's a whole different thing. So, this has been very interesting.

Dr. Robert Craven: Excellent. Well, thank you so much. And I should just clarify that everything that I've mentioned in the podcast are my own thoughts and opinions, and don't reflect my current or previous employers or Society of Hospital Medicine or the American College of Physician Advisors.

John: All right. We appreciate that. But I think it's been very insightful and useful. With that, Rob, I will say goodbye, and I hope to talk to you again down the road sometime.

Dr. Robert Craven: Absolutely. Thank you so much.

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The post Revisiting Why Utilization Management Physician Advisor Is a Great Hospital Job – 305 appeared first on NonClinical Physicians.

Dr. Andrew Tisser is an emergency medicine physician and physician career strategist. He also hosts the Talk2MeDoc Podcast. 

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Emergency Medicine, Leadership and Podcasting

Andrew has been featured on NBC, NPR, and MTV News. He is a popular podcast guest. He was recently named as one of the “50 Best Doctors to Follow on Instagram in 2021” and “Top 21 Medical Podcasts.” Dr. Tisser lives in Western New York state with his wife Alysia, daughter Marlowe, and dog Lillie.

Realize that you have options… The first step is figuring out who you are. The second step is what you want. The third is going and getting it. – Dr. Andrew Tisser

Today Dr. Tisser and I will be talking about his experiences with burnout, nonclinical side gigs he has done, how he is helping other clinicians as a career strategist, and three limiting beliefs that hold physicians back from finding their best career.

Physician Career Strategist Offers His Advice

I like Andrew’s approach to his career and to helping others with theirs. During our conversation, we covered several topics, including:

1) His experiences with burnout during med school, residency, and early practice years;

2) What he did to overcome burnout;

3) The part-time nonclinical jobs he has tried;

4) How he now balances clinical and nonclinical work;

5) His podcast and how it helps early-career physicians learn strategies to advance their careers and overcome burnout;

6) His work as a physician career strategist;

6) And three common limiting beliefs that hold us back and how to address them.

Summary

Andrew Tisser describes the burnout he experienced from medical school through his early clinical career. He then explains what he has done to overcome burnout. He still practices emergency medicine and provides leadership at his hospital. Finally, he assists other burned-out physicians as a career strategist.

NOTE: Look below for a transcript of today's episode.

Links for Today's Episode:

• Talk2MeDoc Podcast
• Dr. Andrew Tisser's Website
• Sisters of Charity Hospital in Buffalo, NY
• Dr. Andrew Tisser's Free Video Series

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Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 220

Three Top Tips from a Physician Career Strategist

- Interview with Dr. Andrew Tisser

John: Nonclinical nation, Andrew Tisser, DO, specializes in emergency medicine and is the host of Talk2MeDoc podcast. The podcast and Dr. Tisser's work as a career strategist focus on unique issues pertaining to the early career physician.

He works tirelessly with his clients to accelerate their goals to completion. Andrew earned his medical degree at the New York Institute of Technology college of osteopathic medicine. He then completed his residency at Upstate Medical University in Syracuse, New York.

He is currently the associate chair of emergency medicine at Sisters of Charity hospital in Buffalo, New York. Andrew has been featured on NBC, NPR and MTV News as well as multiple podcasts. I was actually on his podcast twice. He was most recently named as one of the 50 best doctors to follow on Instagram in 2021 and top 2021 medical podcasts. Andrew lives in Western New York with his wife, Alysia, daughter Marlowe, and dog Lillie.

Today, Dr. Tisser and I will be talking about his experiences with burnout, nonclinical side gigs he's done, how he is helping other clinicians as a career strategist, and three limiting beliefs that hold physicians back from finding their best career. Here we go.

Some of you may know Dr. Andrew Tisser because I have been a guest on his show twice, and I think I've let you know about that and you probably have listened and that's on Talk2MeDoc podcast.

I recently posted an episode about coaches and consultants and strategists. I mentioned Andrew as being a coach that I had interviewed. And then I realized looking when I tried to put a link to it, there was no interview. So, I felt like I've been talking to him so much off and on in the last few years that I had interviewed him and I hadn't. So, he's here today. Andrew Tisser, welcome to the podcast.

Dr. Andrew Tisser: Hey John, thanks so much for having me.

John: Yeah. I couldn't believe it. I felt like a fool, like, man, I thought I had interviewed him, but it was the other way around. So, this is going to be fun. I want to hear what you've been up to and also your background and everything else and get a lot of good information for the listeners today. And so, why don't we start as we usually do by just giving us a short summary of your background from let's say med school through what you're doing now and maybe touch on some of the things you're doing.

Dr. Andrew Tisser: Yeah. Thanks, John. I just want to start off by saying this is a real treat and a real honor for me because you were the first medical podcast that I listened to. When I found your podcast I went back and listened to every episode, and you got me through some really lonely, long drives in residency. So, I want to thank you for that. And really my interest in alternative careers started with you. So, thank you for that.

I was telling my wife this morning, I was like, "Oh my God, it's John Jurica". And she's like, "All right, yeah, but you talk to him all the time". I'm like, "I know". But anyway...

John: Thanks for that. I appreciate it. That's a good testimonial. I have to cut that out and use that somewhere.

Dr. Andrew Tisser: Oh yeah, please do. Anyway, I went to the New York Institute of Technology college of osteopathic medicine, for medical school on Long Island. Graduated and moved on to emergency medicine residency at Upstate University in Syracuse, New York. After that, I followed my wife out to Chicago, where she did her rheumatology fellowship. And I worked at a lot of different hospitals during that time.

I didn't really know what I wanted to do. I suffered from a lot of burnouts actually in med school and residency. And so, I decided I was going to take a whole bunch of different locums and part-time jobs to see what I liked. And I knew that we were only there temporarily. So, that's what I did. And so, I worked from little tiny places up to massive teaching hospitals and everything in between, that was all drivable from inner-city Chicago because there are just so many hospitals.

During that time, I was extreme, my burnout got way worse. I was at this point where I'm sure a lot of your listeners are where they're just like, if I could just replace my salary, I would do literally anything. I would put the labels on whiteout containers if that's what it took to get out of clinical medicine. And I had just graduated, so it was a little bit more jarring to me. And also, I had close to half a million dollars in student loan debt.

I started looking at everything. I had listened to all your episodes like I said. I knew certain things that didn't interest me like the pharmaceutical industry I had heavily researched and I just was not interested. I tried a whole bunch of different things. I actually shadowed an aesthetics person at one of their spas and that was not for me. I got into some utilization work.

I was doing everything. And my wife was getting really upset because it was like today, I was going to do this, and tomorrow I was going to do this and the next day was going to do something else. And she's like, "Just figure it out. And when we move back to Buffalo where we are now, you can go after it", which was really sage advice.

And then, following that, we moved back to Buffalo, New York. I took a position at a small rural hospital, which was actually a really good organization, and started working on getting involved in administration, which is something that I do enjoy. And then, I quickly became the urgent care director over there. I also continued to do utilization work on the side. I started my podcast. I started my consulting business. And really recently as of August, I took a position as the associate chair of emergency medicine at another hospital here in Buffalo. And so, that's kind of where I'm at now.

John: Nice, nice. Do you feel a little more balance and comfort with the clinical side now with all that you're doing?

Dr. Andrew Tisser: Absolutely. I think a lot of people, and we'll get to this later. But a lot of people think it's all or nothing, right? Like you have to either leave clinical medicine, or you have to stay. And that's not really true. I've hodgepodge a career together at this point that is financially good enough for me and my family, it's personally rewarding. I remember in one episode, you talked to somebody who does a whole bunch of stuff and you said, "Well, aren't you so busy?" And he was like, "Yes, but that also brings me personal fulfillment". Yeah, I'm about 50% clinical these days and it makes the clinical shifts a lot better doing all the other stuff.

John: Awesome. Yeah. That is a good plan I think for some people. It works out really well. I think it's difficult to keep having a different schedule once you can get to something that's a little bit more routine. Habits are good for humans. It helps make things go more smoothly and easily and lowers the level of chaos and stress. When you can get into that rhythm and have two or three different things that you enjoy doing, rather than one thing that you hate doing, it can really work out.

Dr. Andrew Tisser: Yeah, absolutely.

John: And then along the way you have other options in terms of saying, well, maybe 10 years, 15 years, whatever down the road, I'm going to segue into doing this

one really mostly over everything else as I sort of approach retirement. But it's not really retirement. It's just simply trying to get a little more freedom in your schedule after a while. And when you've paid off those bills and families halfway grown and you can think about other things and about yourself.

Dr. Andrew Tisser: Yeah. And what I've found along the way is that each of those things lends itself to other opportunities. If I didn't do the urgent care directorship, yeah, sure. That's some administrative work, but also, I was recruited for this job because of my consulting business and because of my social media presence. Because they wanted someone young and up to date, and someone who's got a finger on those types of things. That really granted me medical directorship, not just the standard administrative work.

And now I'm starting to do in-house utilization for my current place as well, which the utilization work helped with. It's just one thing that builds on the other thing. and leads to really, really fun opportunities I feel.

John: Yeah. Other people have told me that sometimes they don't know where it's going to go, but you stack certain scales, get certain experiences that don't seem to be directly related to what you might do in three to five years or so. But ultimately, they often come up as another good skill that will apply to a new position or even a hobby or a side gig or whatever.

Dr. Andrew Tisser: Absolutely. Yeah. It's been fun.

John: We try to be, as physicians, lifelong learners. I think that helps. And if we can stick with that, but just expand our horizon to other types of learning like maybe writing, I don't know, just different things that don't seem directly related. But even the whole thing, like understanding finances or understanding how to be a consultant. Those things will come in handy in almost any job that you decide to pursue.

Dr. Andrew Tisser: Yeah. It's stacking skills as you said. Physicians have a core set of qualifications that make them really marketable people in general, but then you start adding other little sprinkles on top and it really gets some opportunities open for you.

John: As you mentioned that you've been doing some either coaching or consulting. I'm using the term career strategist. Tell us about that. What interests you about that? Is there a difference between a coach, a strategist, and a consultant? Or do they all kind of overlap?

Dr. Andrew Tisser: Yeah, there is some overlap for sure. I don't call myself a straight coach because I don't only coach. Because coaching really entails helping people come to the answer from within so to speak. And there are a lot of times when I'm working with clients that I tell them what to do. That's more of a consultant. You put on your consultant hat or your coach hat. But a lot of the strategy is strategy. It's figuring out what the next best move is for the person and what that entails. And whether that is restructuring their current position, whether that is leaving their clinical job for another clinical job, whether it is profitable side gigs or leaving clinical medicine or whatever. There is just a lot that goes into careers. And that's why I feel strategist is the appropriate hat to wear, the umbrella term.

Like I said, I started talking to my own mentors, my own coaches when I was so burnt out, to figure out what I wanted to do. And I did a lot of soul searching and kind of inner work when I was trying to figure out what it was that I wanted to do. And then after I started designing a career for myself, once we got back to Buffalo, some of my colleagues and friends from growing up and from medical school were like, "Hey, you're not miserable anymore. What happened?"

I started talking to them through a similar process that I had done and it worked well for them. And then after a while, my good friend from growing up was like, "Hey, you could charge for this". I was like, "That is true". I've always loved getting people jobs. Even all the way back to college. I love making connections. I love the networking and the strategy itself that goes into getting someone a job. That's really what my platform is based on. Getting people their next job and figuring out what will be the best fit. And it goes to career design more so than just what's the next job to add to their resume, so to speak.

John: Whether it's with some of the informal mentoring you've been doing and the actual career strategist activity, does it seem like the people that you're working with have similar challenges or is it just unique to each individual when you kind of step back and look across who you've been working with?

Dr. Andrew Tisser: Yeah. I think there's a theme. I mostly work with early-career people. And I define that as like 7 to 10 years out. And I've worked with a couple of non-physicians as well, that also are in the early career space. But right now, student loans are a big hot-button topic.

I've asked this question before, "If your loans are wiped out tomorrow, but you were never allowed to be a doctor again, would you take that deal?" And a lot of people say yes, which after a million years of training and how much time you've spent and sacrifices you made, it's kind of jarring to hear that. But I was in that place.

Student loans are big. Increasing hours and decreasing compensation. Increasing administrative oversight and requirements. I think my generation was brought into medicine with this kind of charting. So, I think that's just expected. And then people don't want to work 80 hours a week and be on call every third day anymore. That was the expectation back in the day. But people want to have time with their family and they want to have a couple of weekends off here and again and enjoy life once they've deferred it up until their thirties at this point. I think that's a big one.

And the other really big thing I hear as well is "All right. Well, what do I do?" That's the biggest question I get. "I don't like this, but what do I do?" And that's not an easy question to answer. I was like, "Well, I don't know, but let's try to figure that out". And that depends on a lot of different things.

John: Interesting. Interesting. I don't know. It seems like I'm kind of put aside because I'm in an older generation. A lot of times with the people I'm talking to are kind of closer to retirement, so they don't have the student loan issue. It sounds like that's kind of an integral part. Like you've got to deal with that while you're dealing with the other emotional things. And I'm assuming having those monstrous loans doesn't help just the emotional state of somebody because you just feel like you're trapped.

Dr. Andrew Tisser: For sure. I think golden handcuffs apply here too. But it's certainly the case and I try to work with people there too, to just get a plan together. Whatever the plan is, whether it's all the different things you can do with your loans. And then it becomes like another bill instead of like, "Well, I have this monster. - Nope, this is how you're going to pay it off and now let's move on". And that may be a 15-year plan and it might be a 20-year plan. it really just depends on your situation. But yeah, it does not help.

John: You kind of compartmentalize that it exists, but it's not good or bad. It's just something you have to deal with and deal with the other issues at the same time.

Dr. Andrew Tisser: Exactly. Yeah. I think that's the main thing right now with the student loans. They are. And I don't think anyone assumes that we're ever going to get student loan forgiveness for doctors unless you're in public service loan forgiveness. I don't think that's going to happen. It needs to be dealt with, and then you got to move on.

But I think the other big issue I run into is this "all or nothing" effect that we talked about before. It's that I have to leave or I have to stay and there's no in between. And sometimes when you bring up this issue to people like, "Well, what about cutting back and trying something else on the side?" A lot of people are like, "Oh, I can do that". Like, well, yeah, you can do anything. You can do anything you want.

John: I know some of us are so indoctrinated. We just have one view of what medicine is. Like you said, it's the 80 hours, it's the being on call. Or if you're doing, let's say more shift work, well, it's doing three or four or five, 12-hour shifts until I get my loans paid off. Yeah, there are situations where you can say no. Maybe I'm going to do eight-hour shifts. I'm going to do something else. Or I'm going to work only two or three days a week in that setting like an ER. Lot of people do maybe a little bit of emergency medicine, and some do maybe urgent care which I don't know how that feels going back and forth, but it's just something different.

Dr. Andrew Tisser: Yeah. There is literally an unlimited amount of options. And that's the point of your show. There are so many options for people. Whether that's part-time, per diem, whether or not you're trying to find a non-clinical job and you do locums as a bridge, or what have you. There are just so many options. And people want to be told what they should do.

A lot of people want to be told, "Well this is what's going to happen". And I can't tell people what's going to happen. I could just help them realize that there are other options and there are an unlimited amount of options. There are people that completely change. I forgot her name. There's that one doctor who decided she was wanting to sell cars instead of being an OB-GYN. She makes more doing that because she loves cars. You have to figure out what's right for you and what's right for your family and not get pigeonholed into "This is all there is".

John: Well, I hadn't heard that one. That one sounds pretty interesting. I know a lot of docs have gone into real estate and left medicine. I know one who became a disability insurance broker and she's doing very well. But yeah, pretty much we can do anything. I kind of liked that. That maybe physicians will go into something related to healthcare, but they don't have to, of course.

One of the ways I like to look at this sometimes when I'm talking to someone who's helping others is to turn it around and kind of look at it from, "Okay, what are the three mistakes or blunders?" And you may have touched on it in talking about the people that you've helped, but are there trends in terms of the big mistakes, if everyone could just deal with this and just know not to do this would help with their career transition or not even transition, but improvement?

Dr. Andrew Tisser: Sure. I think the big one is to not just assume that you're just screwed. For lack of a better term. I hear a lot of physicians that are like, "Well, I hate my specialty but this is just how it is. And this is what I picked. It's just my life and it sucks. But I have these financial obligations and I have to make X amount of money. Or this is just how the administration is everywhere or they won't be willing to work something out with me where I cannot work on Fridays and exchange for longer days".

People don't even try. And you never know until you ask. A big one is just remaining stuck, and remaining in your position where you just feel like there's no hope. I heard it a lot also, "You're too young to be burnt out", which is a really kind of annoyance to me because I hear it all the time. I used to hear that at every stage.

When I was a medical student, they're like, "Well wait till you get on the wards, then it will be better". And then you get on the wards and they're like, "Oh, well, you don't have any real responsibility. Wait until you are an actual resident, that will be better". And then in residency they're like, "Oh, it's residency. It's supposed to be terrible. Wait until you're out there and then it'll get better".

And then you get out and a lot of people have this existential moment where they get out of residency and they're attending and they don't like it. And they're like, "Oh my God, I got to do this for 50 years. What now?" And then it's like, "Oh, you're just a first-year attending. So, it's really hard. It'll get better". And it just goes on and on and on and on, or maybe it won't get better and you have to change your current situation because it doesn't fit with who you are as a person, or it's disparate to your core values or your belief system. So, maybe it won't.

John: I can't really think of too many other professions where it's just that awful. It just doesn't make sense. How could there be any kind of longevity in this business when medical school residency and practice for many people are something that you just despise? You think that it's just the way it is and you can do it, but you can only survive that for so long. So, it's just sad.

Dr. Andrew Tisser: It is sad. And you see it all the time from, again, your supposed superiors that are just like, "Oh, well". I don't understand that either. I think the lawyers are also kind of miserable, so they have it with us too. I was talking to my brother-in-law who was miserable at his corporate attorney job. And we did some of this stuff too. And he actually got a new job as an in-house counsel at a food company. And he's super happy now.

The first big issue is remaining stock. Number two is saying you're too young and you get burnt out and just grin and bear it. Because I hate that. The next thing I see with people is that there's only a couple of other things I can do, and I don't like any of them. And they tend to be the big three of utilization, pharma, and medical writing. They tend to be the ones that people say, "Oh, that's the only nonclinical career I can do". Well, have you listened to John Jurica's podcast? There are a lot more. But people get stuck in, and then you see these threads on Facebook groups with somebody posting a utilization job. And there are like 5,000 replies in 30 seconds.

John: That's true. People don't know what they don't know. And people have said to me, listeners and others, "Why don't they teach us this in med school? Why don't they tell us about these nonclinical careers in residency?" It's like, well, I don't expect them to do that. Number one, there's no time to add that to the curriculum. The curriculums are already packed with more than you can possibly learn. So, they're not going to even carve out an hour just to explain that to you, unless it's something on a weekend when you do it on your own. So, that's not going to happen.

But it is unfortunate that if you don't know those exist, then you feel fairly hopeless. And so, it's people like you and me and others. That's just part of the whole process, just opening their eyes, the fact that there are lots of options. And if we were really scientific about it, we might sit down and do some personality tests and checklists and try and figure out what fits with your personality and your desires, your mission in life, and all that. But I don't know too many people that have gone through that kind of a process. Basically, it's a matter of just starting to do your research, starting to dig and learn and getting a coach or a strategist or consultant or someone to help you if you need it. Just find out what's out there, take control of your life and then see what you can work out.

Dr. Andrew Tisser: Yeah. Careers should be designed in my opinion. A lot of people just let their career or their job happen to them instead of going out there proactively and designing a career. I'm happy where I am right now, but it could be even better. And that's a process. But I know my trajectory and my clients know their trajectory. And even if after 8, 12 weeks of working together they're not in their dream job, they've moved so far along that they know where they're going.

And don't get me wrong. I want people to stay in clinical medicine because I want somebody to take care of us, take care of me when I'm older. I don't want all the doctors to leave. And that's possible too, to stay and just restructure, like I did.

John: That's a good point too, about planning your career. Because I'll tell you, when I was working as chief medical officer, of course, I got to be exposed to a lot of nonphysician CFOs and CEOs and COOs. Many of them had a plan. They really knew when they were just coming on as a director of some small department, that they wanted to move up to the next directorship and then they wanted to be a VP, and then they wanted to do this and they wanted to do that. And it was a lot more planned out.

I guess when you compare it to clinical while we plan to go to med school and then pick a residency, maybe a fellowship, that's basically as far as it goes, I think. And it should continue as you're saying.

Dr. Andrew Tisser: Yeah, I agree. Especially when we are talking about the administrative pathway too. I know many people encourage others to join committees. But you just can't just join a bunch of committees and expect something to happen. You want to target committees that you have an interest in so that you can potentially chair. There is a pathway instead of just letting things happen. I recently gave a lecture at my wife's residency, she's a program director for internal medicine, about career design.

And I had a resident come up after the talk. She was like "Thank you because I just assumed that this was the path that I was on and I didn't really have any choices. And now it's given me so much to think about". And she was I believe either a first- or second-year resident. And I was like, yeah, start thinking about this stuff now so that your first job could be planned very well. And not just like, hey, give me the biggest sign-on bonus or something.

John: Yeah. Oh, man. I think they are probably just so happy to have their eyes opened by hearing what you had to say. All right. We're going to run out of time here. I want to talk a little bit about some other things just for a minute.

Now you've been doing a podcast for quite a while. And so, I know it started out initially with more talking about communication, and that sort of thing. What is the theme of your podcast for the last 6 to 12 months or so?

Dr. Andrew Tisser: Yes. We've shifted into just issues relating to the early career physician in general. The communication topic was great. And we had a lot of really interesting speakers from all different disciplines, but it got kind of stale just because everybody is saying the same thing. Everybody's part of the team. Everybody has a voice. And I agree with all that. It was a great first season, but then as my interests have changed and I realized that my demographic has certain other challenges I moved into just talking about everything and anything that could be related to the early career physician.

John: Okay. That's good. The thing we're talking about today, if people are interested, they should just go to Talk2MeDoc podcast and listen in on those. And mostly it's interviews. Is that right?

Dr. Andrew Tisser: Yeah. A couple of solo shows, but the vast majority are interviews.

John: Okay. And then you've got a website that probably links to that as well as other things that you do at andrewtisserdo.com. Correct?

Dr. Andrew Tisser: You got it. Everything's there.

John: All right. I will definitely put links to those two for sure. And if the listeners want to learn a little bit more about either what you do or get a little more advice from you, just an entry-level, I think you have some kind of video series. Tell us about that.

Dr. Andrew Tisser: Yeah, thanks. I have a four-part video series on my website. It's andrewtisserdo.com/video or there are links all over the site you'll find it, which really describes my pathway through burnout, where I am today, starting from medical school. Each video is about six, seven minutes long. It's just talking about what I went through and then I give a career strategy tip embedded into each video, and it's totally free.

John: Okay, awesome. I will put a link to that directly too, in case someone just wants to take a look at that. Well, before I let you go, any last advice for physicians who are feeling just frustrated and burnt out right now that might sum up a little bit of what we talked about today?

Dr. Andrew Tisser: Yeah, thanks. Just realizing you have options. The options are unlimited for what you want to do, what you want your career to look like. You just have to figure out what it is you want, and then you can go get it. The first step is figuring out who you are. The second step is what you want and the third is going and getting it. So, don't remain in your position, go change your life.

John: Excellent. Words of wisdom. I love it. And I liked the three steps. That's a little in a nutshell how to do the process. Of course, each step might take a little while, but it's a good summary.

All right, Andrew. I'm so happy we had a chance to talk today on my podcast for a change. This has been great and I hope to maybe see you again in the future.

Dr. Andrew Tisser: Yeah, John, thanks again so much. I'm honored.

John: All right. Best of luck. And I'll see you down the road.

Dr. Andrew Tisser: Bye-bye.

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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. And I only promote products and services that I believe are of high quality and will be useful to you.

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. 

The post Three Top Tips from a Physician Career Strategist – 220 appeared first on NonClinical Physicians.

Today I will present factors affecting your decision to become a Certified Physician Executive.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

What Is the Business School Mindset?

Dr. Patty Fahy states that the BSM reflects these beliefs:

• “…graduates are assured that an MBA degree has prepared them to manage in any industry: a tattoo parlor, a government entity, or a hospital system (emphasis mine – JJ).
• “Managers are an elite caste, separate from those who are managed, monitored, and controlled.
• “Efficiencies gained by controlling the behavior of professionals and other workers garner financial rewards…
• “The principle that… an action is rational only if it maximizes self-interest…”

Not all hospitals are managed in this way, all of the time. But, when I was Chief Medical Officer, there were definitely times when I could feel the BSM “vibe” coming through… even though I worked at a non-profit hospital.

This leads me to believe that Business School Mindset leads to a different kind of BSM… Bulls**t Medicine. – Dr. John Jurica

To counter this, I implore my colleagues to pursue a career in hospital management. Such a career is intellectually stimulating, pays well, and is the only way we’re going to steer this industry in a new direction.

Getting Ready to Become a Certified Physician Executive

One way to accelerate your career progress as a leader is to become a Certified Physician Executive.

The Certifying Commission in Medical Management grants the Certified Physician Executive designation. It demonstrates to employers that the holder of the certification has the knowledge, skills, and core competencies to be an effective manager and leader.

Listeners have asked me to compare earning the CPE to obtaining an MBA. However, one should not compare the two, because the CPE can only be obtained after completing the MBA or equivalent business and management training.

Summary

There is evidence that employers use the CPE as a factor when considering job candidates. And there are several ways to meet the requirements for the CPE. But they all include getting the basic business and management education, plus real-world healthcare management experience. Physicians should consider several factors when deciding how to best acquire the CPE designation if they choose to pursue it.

NOTE: Look below for a transcript of today's episode.

Links for Today's Episode:

• 3 Reasons to Pursue the CPE Qualification – 033
• The Ultimate Resource to Spark Your Transformation to Physician Leader with Dian Ginsberg – 024
• Certifying Commission in Medical Management
• Canadian Certified Physician Executive Website

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 219

Are You Ready to Become a Certified Physician Executive?

John: Today, I thought I would discuss another topic related to the pursuit of a job in hospital management. I mentioned this topic in a recent daily email and episode #33 of the podcast back in 2018.

Let me paraphrase what I wrote in the recent email related to this topic. It's really related to physicians working in the hospital environment, both as a clinician and then possibly as a leader. This is what I wrote about. I had read an article on Kevin MD by Patty Fahy MD. So, Dr. Patty Fahy. In it, she said that she was talking about BSM. It's an acronym for Business School Mindset. She thought I had a big impact on physicians and how they're working and the environment that they're in, which oftentimes is not very favorable.

The author, Dr. Fahy gives examples of the BSM mindset. Here are quotes from her article.

"Graduates are assured that an MBA degree has prepared them to manage any industry, a tattoo parlor, a government entity, or a hospital system. Managers are an elite cast, separate from those who are managed, monitored, and controlled. Efficiencies gained by controlling the behavior of professionals and other workers garner financial rewards. And the principle that an action is rational only if it maximizes self-interest".

Those are the characteristics that Dr. Fahy says represent BSM or the Business School Mindset. I don't know if all hospitals are managed in this way all of the time, but when I was chief medical officer, there were definitely times when I could feel the BSM vibe so to speak coming through, even though I worked at a nonprofit hospital.

This leads me to believe that the business school mindset leads to a different kind of BSM, what I call BS medicine. The approach that doesn't recognize a physician-patient relationship, or that puts quality safety and dignity behind the bottom lines. That's the BSM that I'm talking about. And I think we're caught in that. We're caught sometimes in that business school mentality and it leads to really miserable working conditions.

And so, the question is what are we to do? And I see three logical answers to that question.

The first is to keep working in the medical-industrial complex until we can't take it anymore and then retire. I think I've had a lot of colleagues that have done that. They've toughed it out and then just retired as soon as they could.

Number 2 is to leave for a nontraditional career, which of course, that's something that I talk about all the time.

And number 3, is to work your way into hospital management as either CMO, COO, or CEO and fix the system from within. And you probably already know that I'm partial to option number 3 because I believe we need a whole lot more physicians leading health care if we want to reduce both forms of BSM in our healthcare system.

Please consider a career in hospital management because it's intellectually stimulating, it pays very well and is the only way we're going to steer this industry in a new direction.

And by the way, as far as the income goes, I just went to salary.com today. And the median salary for a CMO is $418,000 with a range of $319,000 to $549,000. When I say it's lucrative, I'm really serious. It pays well over any primary care practice. And even for specialties, it's a much better lifestyle and you still make a good income.

One of the things that I'm convinced of is that if you want to consider a hospital management career, it's important for you to understand what the CPE is. That's what I want to talk about today. We all know what an MBA is. An MBA is a business degree. And then there is the MMM and MHA and other types of business degrees.

But the CPE comes up from time to time because it represents something that employers are sometimes looking for in the hospital setting. CPE stands for Certified Physician Executive.

As I was going through some CMO job descriptions before preparing for today's presentation, I looked specifically to see if the CPE was listed. And I found two hospitals in North Dakota and one hospital in Pennsylvania, just in a short review of the job ads that I saw. And they listed the CPE as a preferred designation. And the reason is that it represents something that puts the holder in a position perhaps a little bit better than simply having completed a business degree.

But the thing is, it takes more time and it takes some money to achieve. And so, I want to talk about this. And part of this came from a question that I received from a reader or listener back a few months ago, specifically asking whether I thought it was important to proceed with getting the CPE.

I want to try and answer that again. I addressed this, like I said, back in 2018, but let me bring things up to date today and really take a moment to walk through this for those of you that might be interested. This is how I look at the CPE as compared to an MBA. And it's not a fair comparison, I'll explain why in a minute. And these are my thoughts. These are my opinions as a holder of the certification and a former CMO and a member of the American Association for Physician Leadership, which is the AAPL, which originally created the certifying commission in medical management to create and to provide the designation of CPE.

Keep in mind, I am not speaking for the AAPL, although I've been a member of the AAPL for more than 25 years. And I have actually been involved in several of the committees that are involved with evaluating those that are sitting for the CPE, so to speak, by participating in the capstone.

Let's back up and talk about some definitions, and then we'll get into some more detail on this.

What is the CPE? The Certified Physician Executive designation. It's granted by the certifying commission and medical management. And it's designed to show that the holder of the certification has the knowledge, skills, and core competencies to be an effective manager and leader.

And to me the CPE is valuable because it demonstrates that not only does a holder have that MBA training. Now, remember MBA is a degree. It's kind of book learning, but the CPE has the MBA or the equivalent degree or the equivalent training and demonstrates experience in management and or administration.

And also, has sat through what they call a capstone, which is an opportunity for these applicants for the CPE to demonstrate that they can apply all of these principles in real-life situations, rather than simply take some curriculum and pass a few exams.

Let me get into a little more detail on it. An MBA is granted like any other degree. You complete a certain core curriculum plus some electives, and it ensures a certain level of knowledge. It's usually finances, marketing. In the programs that address physician executive MBA, they do focus on things like healthcare finances and the situation that we find ourselves in, the business principles in healthcare itself. Some programs do have a mandatory project that gets completed during the term of the schooling. So that gives them a little bit of real-life application of what they're learning.

But again, I'm going to mention why the CPE is distinguished from that. Because the CPE requires not only the knowledge base, which you can get from an MBA and MMM, and MHA or a similar degree, but it also requires that you have at least a year of clear management and leadership experience that does not include running a small private practice. And it has to be in a setting where you're really in a matrix with lots of other people. You're interacting. You're applying your communication skills, your marketing skills, your finance skills in a real-life situation. And so, it's more than just the book learning.

And in fact, you have to get a letter acknowledging and attesting that you have demonstrated these skills that are being sought for the CPE during those activities. If you've served as a medical director for a year or two or three, or you've been a CMO already, or you've done other things, let's say chair of a big committee at an academic institution and you've had exposure to management, to finances, to HR issues, to legal issues, then you can qualify for the CPE.

And on top of that, then you also need to spend four days doing what's called the capstone where you're getting a little bit more education about some of these topics, just to pull it all together. And you're actually being assessed for your ability to communicate and to lead teams and other skills of that nature.

To compare the CPE to the MBA is not really valid. The MBA or its equivalent is required to be even qualified to request certification for the CPE. That's why it's different. It does give you a little edge. If you have the CPE, it indicates that these skills are demonstrated, and it gives you a little edge. As I said, there were at least three hospitals just to my 10-minute review earlier today that said that the CPE would be recommended or preferred.

If you're competing with two or three or four people, and they all have the equivalent of an MBA or an MMM or something like that, and you have the CPE designation, which really attests pretty well to the fact that you've got the skills and experience to apply those skills, then you're going to have a bit of an edge over those others. That is I think primarily where it comes in handy.

The other thing to keep in mind, though, when we talk about this is that you can meet the requirements without having one of those degrees. In a way, if you were going to get the MBA or the MMM, or MHA, anyway, my case was actually an MPH. I got some credit for that. Well, then that's fine. And you can use that as the basis for proceeding onto the CPE if you're in some kind of leadership or management position.

But sometimes you can meet the same requirement by taking the equivalent courses through the AAPL. The AAPL is known for providing education and training and management and leadership for physicians since it was called the American College of Physician Executives.

They have a lot of ultra-high-quality courses that many physicians have taken. You can use this alternative pathway. Many hospitals and health systems provide leadership training through the AAPL, or physicians themselves will seek the training on an as-needed basis through the AAPL. And so, they do these courses and over time, there is a core curriculum through the AAPL, that if you accomplish that, then you've basically shown that you have the equivalent book learning that would be obtained through the MBA or other similar degree.

You can think of different scenarios here. If you've already taken, let's say one half to two-thirds of the CPE coursework through the AAPL, it may definitely be quicker and less costly to simply complete the curriculum through the AAPL than to enter an MBA program and spend $50,000 - $70,000.

I'm not saying that the AAPL courses are cheap, but even if he had to do another 5 or 6, 7, 8 courses, it's going to be much quicker and less expensive than matriculating in a business degree program.

The other thing to keep in mind is that sometimes the AAPL, or actually the certifying commission on medical management, which grants the CPE will accept courses done for a business degree that maybe you didn't complete. That's the other way that that can be effective.

You want to be efficient. You want to use and get the information you need. But there is no reason if you've already taken a course in healthcare finance to take another course in healthcare finance as part of your MBA or vice versa. You should be able to get credit for that in whichever direction you go.

It can be complicated. If you find yourself in a situation where you have some of the AAPL courses and you're contemplating going to a degree program, then you would check with the degree program, see if any of those courses would apply to the degree, and then you might get a reduction in your tuition, and it would speed things up.

And vice versa, if you've done let's say six months on a business degree, and now you've already got some other AAPL courses and you want to apply for the CPE, you can find out if those courses from the other business degree would apply to that.

There are certain business degrees that are aligned with the AAPL. For example, the master of medical management is a specific program geared for physicians only. And there was a lot of overlap in the content of the MMM and the courses through the AAPL.

So, you would want to really ask both sides of that if it would apply. In other words, you would check with the AAPL. They have a career or education department that will tell you if you've done some of the work for the MMM that would apply for the CPE if let's say you decided to finish it up with the AAPL courses.

Now, if I was just getting started, I would investigate my options. I would look at the cost, the location, the time commitment, and I would just figure out which one is the most efficient way to go. If you haven't been exposed to any of those, then you can make a valid decision.

On the website at the AAPL, which I'll put a link to in the show notes, for those that are listening to this on the podcast, you can go there and it will give you pretty clear which direction to go in. And it explains which of the business degree programs have courses that would cross over, or which ones would accept the AAPL courses.

Again, to find out for sure, it'd be best to check with staff at the AAPL. I think if I were starting out, this is like the master plan you might have in your mind if you were going to do this. I would look around, find a good low-cost convenient option to get your business degree. I would probably go to something like the University of Illinois, or even a smaller public university.

There's one nearby that's called Governor State University. And I know many people that have gotten their MBA through that. It's a four-year college. It's not a big-name college, but you get the MBA. And then if you want to go ahead and move on to the other requirements for the CPE. And then while you're doing that, you should acquire some clear management experience either by finding a paid medical director position, being on one or two really important, big committees where you're involved in big projects, let's say in a hospital.

And that way, when the degree is done, or the coursework is done, then you'll have the management experience. And then you can apply for the capstone and things will move forward very smoothly. If you get the MBA, but you really don't get any management experience in the meantime, you can't apply for the CPE.

Before I go, I do want to mention, I found this just recently. I didn't know this existed, but there's something called the Canadian Certified Physician Executive - CCPE. I don't know that it's exactly equivalent to the CPE that we're talking about today, but I know it does exist and you can look that up online. I will put a link in the show notes, again, for those who are listening to the podcast.

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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. And I only promote products and services that I believe are of high quality and will be useful to you.

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. 

The post Are You Ready to Become a Certified Physician Executive? – 219 appeared first on NonClinical Physicians.