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.

Download This Episode:

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

Email Download New Tab

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.

Scroll back to top

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

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

powered by

Disclaimers:

Many of the links that I refer you to, 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.

The post The Amazing Field of Life Insurance Medicine – A PNC Classic from 2018 appeared first on NonClinical Physicians.

This week you will hear priceless advice from an expert in biopharma, Dr. Michelle Mudge-Riley. She also brings her experience as a physician career coach and mentor to bear during our conversation.

Over the past five years, Michelle has made significant strides in her biotech career. And she offers valuable insights and advice for physicians looking to transition into the industry.

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.

The Power of Relationships in Career Transitions

Michelle highlights the critical role of networking in securing nonclinical roles. “These jobs are all about relationships. Often, you end up getting a job not because you’re the best fit, but because you know someone,” she explains.

She recommends using platforms like LinkedIn and Doximity to connect with industry professionals and seek advice and opportunities.

Priceless Advice from an Expert

When pursuing a job in the biopharma sector, Michelle advises against additional certifications or degrees as the first step. Instead, she suggests focusing on building transferable skills and relationships within the industry. “You shouldn’t have to jump through hoops to get a job. You likely already have the knowledge and skills needed,” she assures.

She also advises us to explore the Medical Affairs Professional Society for useful advice and information.

Encouragement for Aspiring Biopharma Professionals

Don’t lose confidence in yourself. We all face rejection and setbacks, but remember, you are good enough for these roles. Keep believing in yourself and stay persistent. – Michelle Mudge-Riley

Summary

To connect with Dr. Mudge-Riley and learn from her experiences, you can find her on LinkedIn, another resource for priceless advice from an expert. She also recommends checking out the Medical Affairs Professional Society (MAPS) as a fantastic resource for networking and professional growth in the medical affairs field.

Links for Today's Episode:

• Dr. Michelle Mudge-Riley's LinkedIn
• Medical Affairs Professional Society (MAPS) 
• The Best Biopharma Positions For Motivated Practicing Physicians
• Find Your Great First Nonclinical MSL Job
• Land a Pharma Clinical Development Job: A PNC Classic from 2021
• Landing Your First Pharma Industry Job May Be Easier Than You Think – 311
• Research and Development in Nonclinical Pharma Careers
• The Wonderful World of Nonclinical Pharma Careers

Download This Episode:

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

Email Download New Tab

Transcription PNC Podcast Episode 364

Priceless Advice From An Expert In The BioPharma Industry

- Interview with Dr. Michelle Mudge-Riley

John: I'm so happy to welcome today's guest back to the podcast. She's been on the podcast before, but it has been quite a while. She's known as an expert in career transition through coaching and live events, but really she has become an expert in biopharma because she's been working in biopharma and doing some pretty interesting things. I'm really happy to welcome Michelle Mudge-Riley here to the podcast. Hi, Michelle.

Dr. Michelle Mudge-Riley: Hi, John. So nice to be back with you again.

John: It's great to see you. We were just reminiscing before we started our interview here, but why don't you fill us in a little bit with the highlights of what has transpired in the last five years, let's say, because that's almost as long as it's been since we spoke on the podcast.

Dr. Michelle Mudge-Riley: Sure. Sounds good. And it really is unbelievable that it's been five years. I know it seems a long time when you're looking at it day to day, but there's so many things you look back and you think, wow, it's been five years or it's been 10 years or it's been years. And yeah, this is a perfect example of that. Yeah, I was the doctor's doctor known as that probably 10, 8 years ago, as I had a thriving business as a career transition coach for physicians. I ran an online and in-person conference. And I also worked for a small boutique consulting company at the time, which enabled me to do a lot of these extra things on the side.

And in my role in that consulting company, I was the medical director for small, medium and large biotech companies. I really enjoyed doing that as well as my side gigs. When COVID hit, that changed everything for everyone. And I won't get into the things that I did with my side gig at that point, but I made some personal decisions that I wanted to look back at my career and have something a little bit different than what I was currently doing. It was like a lot of people, a good time for a change. And that biggest change was that I really wanted to go to the client side, work for a biotech company and experience what it was like on that side versus the consulting side. That's where we were back in 2020.

John: Yeah. Yeah. Now that's a big commitment to make, because you had been doing different things. And of course, even way back before all that, you had a master's degree and did other things as a physician, but that's a big commitment. And as I saw what you were doing, because I could always look on LinkedIn and hopefully you were keeping that up to date. I could see that you were getting involved in more and more different things. I thought you'd be perfect to give us another perspective. I've interviewed a few people working in pharma, but it's usually a specific position we focus on, but I think you can give me a little more of a better perspective, because knowing how physicians are searching for jobs that are more fulfilling and satisfying, and a lot have thought about how can I get into biopharma? So that's why I thought I'd have you come back and enlighten us a little bit today. What is it that interested you about biotech and pharma personally?

Dr. Michelle Mudge-Riley: Yeah, great, great question here. When I started to make my transition over 20 years ago from clinical practice, I considered biotech and pharma and device, and actually did not consider it as seriously as I should have. I thought it was the dark side. I thought it's an easy choice. If you don't want to be a practicing physician, you think about insurance, or you think about pharma. And I didn't want to be such a clich�.

I dabbled a little, but ended up, you're right, getting a master's degree, getting a nutrition, additional training there. I worked for a number of different firms, an employee benefits firm, and then multiple consulting firms. I started some other businesses. And I slowly was always seeing this common thread of being involved with biotech in some way. And I can tell you that what I have done for the past five years has been so fulfilling and so much fun. It's completely changed my life being working directly for a biotech company. And I will most likely finish out my career doing this.

I still have some side gigs. I think that's important. I've always talked about multiple irons in the fire, because it's really easy to get so caught up in the day to day. And you never really know what's going to happen. COVID's another great example, never saw that coming. So making sure that you're diversifying yourself and your career, I still maintain that that's really, really important within compliance, of course, if you're working for a company, that's going to be an issue, which we won't go into today. But it's really fascinating how much fun it is working for biotech. And I know we're going to talk a little bit about that today.

John: Yeah. Well, what's so fun about it? What is it that you personally find to be the fun parts? Because something that's fun for you might not be fun for somebody else. But for you personally, what is it that you like about being involved with the type of company that you are?

Dr. Michelle Mudge-Riley: Yes, there are two big things that I love about my job. And one is the actual work. And that was something that I've always talked about as being really important, but really hard to find with a career, because you may be influenced by your boss or your colleagues or the autonomy or lack thereof, or all of these other little things, which are also important, by the way. But if you don't like the work, that will drive you to burnout and to just being not your best self.

And so, for me, the work is something I love. I love being able to be able to understand the scientific articles and explain them to others, talk amongst my colleagues about the science and the medicine aspects, learn the new things that we don't learn in medical school about clinical trials and all the aspects. Working with the FDA, looking at the different clinical endpoints, inclusion criteria, talking about the criticisms of different trials and how they compare or don't, and working with other physicians who are experts in the field.

We should get into that too, because that's really interesting working with other physicians, because most people in my position at a pharmaceutical company or device company, they are physicians or their PhDs. And so, how does that differ from the physicians that I work with that are still in practice? But that's an aspect I really, really like as well.

The last part about what I really like about my job is working with very smart and really quirky colleagues. Anyone who's really smart, I feel like has some unique aspect about them that kind of makes them quirky. And I love that about people, just finding out what their unique characteristics are and being able to talk with them about science and just really high level complex stuff, but also get to know them as people and what their hobbies are, what they like to do. They like to go axe throwing or something else that you wouldn't think about. And most people would never think about doing either. Typically people in these companies, they have these really cool hobbies that you then get to learn about.

John: It reminds me about some of the things when I was chief medical officer and thinking back, what did I really like? I really liked the science behind the quality improvement. I would sit in my office by myself creating reports for the board and that. And so, I'm more of an introvert, but that's what I liked. And I had no trouble spending two or three hours doing this report and then explaining it to, let's say, the board or somebody else.

The other thing you mentioned, like the quirky people, our CMO was a nurse. CMO, he was a nurse of course. And he raised chickens. I'm like, okay, there's a weird quirky thing to do. And he'd go to not conferences, but they'd have these shows where he could find the best new chicken breed out there. It's like, you got to be kidding me. But yeah, it's good. It's different than being face-to-face with patients all day. And you do get to interact with physicians in other realms clinically. And the thing again about the pharma and the biotech, it's so scientific. If you have a scientific mind, I think you really fit in well there.

Dr. Michelle Mudge-Riley: Yes. Yes. I completely agree. I have a colleague who likes to fix coffee makers. How interesting is that? And how different? I would not really thought about doing that, but yeah, just buying coffee makers that may have a small problem and fixing them, making them look really good and selling them. It's interesting.

John: That's interesting. And if yours breaks down, well, you know where to go.

Dr. Michelle Mudge-Riley: Right. Exactly.

John: To be an entrepreneur and to have to build something yourself is one thing, but tell me, there was something very comforting about being part of a large corporation and probably most pharma companies are massively larger than let's say a hospital that I worked for, but there was just a consistency and the hours were regular and there was a nice IRA or whatever, but that wasn't a pension anymore. But yeah, they had that all worked out. So you find some of that helpful and beneficial as well?

Dr. Michelle Mudge-Riley: Yes. I think the constant struggle of an entrepreneur is can get old and that grind can get to be something that I've spoken with other physicians who have started companies, sold companies, and then moved into more of a corporate job or just a job where they receive a regular paycheck. It's part of that. Yes. But I will say that in biotech, it's not a massive company all the time that there are really small biotech pharma device companies and they have a different culture than the larger companies. So if someone has tried this before and they haven't really flourished in the way that they want, maybe it's just a matter of a small company versus a large company.

John: How do you prepare for that? What advice do you have? Is there something I can do ahead of time that gives me just a little bit of exposure, maybe a little certain skills that would be good for biotech versus a large pharma company, something like that. Any thoughts on that?Dr.

Michelle Mudge-Riley: It's really hard because you'll hear about physicians and others who have tried for years to get into a biotech company or an insurance company or just to get into this nonclinical career space and have had a lot of difficulty. And so that's a common question. What sort of certifications do you need? What sort of degree? Should I go get an MBA? What have you done to make you successful? And I think the number one thing is that this is really not what people want to hear, but this is what I see over and over and I experienced myself. It's talking to others. It's getting out to people that you don't know that are working in the space and talking to them about what they do.

All of these things are relationship driven type jobs. And often you end up getting your job, maybe not because you're the best fit, but because you knew someone. I don't know, for better for worse, that's how it goes. Because with all of these applicant tracking systems and people not knowing others, you may be the perfect fit for a job or multiple jobs, and you won't even get an interview and that gets people really down. I get it. It's so humbling, but it's not you. It's the system and the system is not perfect. And so, the more people you can talk to and find out about keywords to use, what the industry is actually like, what sort of transferable skills you have. I know you talk about transferable skills on your podcast a lot, and who's there at the company that maybe went to your universe. It could be as simple as that to get that interview. And then everyone likes you when they're talking to you because physicians are typically likable people and we all have the ability to go work at a biotech company if we wanted to.

John: Yeah, I think that's really good advice. Between LinkedIn and Doximity, you can probably locate most of your former med school cohorts, your residency, your fellowship, whatever it might be. And chances are someone out of all those hundreds of people that you know, is doing something kind of maybe what you're thinking about. So I've heard that before. And I'm being an introvert. I don't like to really necessarily reach out to people, cold call them, but an email or call they really, they always respond positively in my experience and what I've talked to people about.

I was going to ask you another thing, and it's maybe more about pharma than biotech. See what you think about this. But I imagine if I go on to Pfizer's website and try and apply for a job, I've got about a one in a million chance. But I know pharmaceutical companies use something called the CRO, which we've talked about here before, contract research organization is one definition. But in your experience, whether yourself or with others in businesses you've been involved with, is that something that it can be a bit of a shortcut, or a little easier to get hired than to go directly for one big company?

Dr. Michelle Mudge-Riley: Yeah, I think it's all about timing. There's some good TED talks that really speak to this. It's all about timing. There are some people who apply to jobs at Pfizer, J&J, or some of these massive companies that you might think of off the top of your head that are pharmaceutical companies when you're starting to think about it. And they're applying, they get the job. But yeah, you're right. In general, these positions, there are hundreds, maybe thousands of people applying. And so, it's a numbers game in a lot of aspects. And if you're finding a CRO, or maybe a smaller biotech company that people haven't heard of before, it's numbers game, it's just going to be less applicants. And maybe your application, your resume will catch someone's eye. A lot of this, again, is luck, timing, and you can increase your chances by talking to people in those relationships.

John: It's always better to have someone you can actually send your resume to, even if you go through the electronic version of that, it's still nice to have a human that might be able to sit through them and find yours. See, with the pandemic, it really kind of blew things up a bit. But there used to be some large national meetings that would occur every once in a while. And you could just show up or maybe attend the meeting, maybe it was on some topic related to a diagnostic class or something. And then you could run into people and meet them, take their cards. Does that still happen, do you think?

Dr. Michelle Mudge-Riley: Yes, yes. I think that still happens a lot. The Medical Affairs Professional Society, or MAPS, is a great example. They have an annual meeting every year in the US. They also have one in the EU every year. That's a great place to maybe start that networking or go to the meeting. It's not a guarantee. So just knowing that ahead of time is important.

John: Let me ask you a definition issue. Because one thing you can do is you can maybe look up people on LinkedIn, again, see if it cross paths with something else you've done in life. But the thing is, what are you looking for? Like medical director, it's a common term in pharma, biotech, medical devices, it doesn't mean that much per se, because it's such a general term. Would that be something you would shoot for right away? Or are there other entry level positions one might usually go to?

Dr. Michelle Mudge-Riley: Yeah, that's a tough one. Because you're right, medical director is such an ambiguous term. And it can mean something different in a lot different industries and at a lot of different companies. It's a good term, but it's going to be tough to use to search and find what you need there.

Medical Science Liaison is more of an entry level sometimes type job into these companies. The thing about an MSL is it's quite different from a medical director. And working as an MSL means you are working within medical affairs, whereas maybe some physicians will be a better fit to work for clinical development, or maybe even clinical operations. Or they may feel like the MSL role is a little bit of a demotion. So, you really have to balance all of those things.

If you're looking to find people in a medical director role, which I think is a really doable and achievable entry level role for most physicians, because we have the degree, we have the background, we have the clinical knowledge, and that's really looked at in a positive way, is to search by different companies. Maybe make a list of companies and then do that cross check and cross reference on LinkedIn. And then you can find people maybe a little bit easier within these different departments at that company.

John: Now, here's the question I've never asked anyone. But again, I'm always noticing these terms and trying to keep them all straight. But I've seen a number of people that the word global is in part, like global medical director, global this, global that. I assume that means because it's international. But what the heck does that really mean? Does it mean you're traveling the globe to do your work? Or what's your experience with that?

Dr. Michelle Mudge-Riley: You mean something different at every company. It most likely means that you are on the global team, which means you'll interact with colleagues in the EU or Asia, just somewhere other than the United States. But doesn't necessarily mean that you're traveling there. But it may, it may mean you're traveling there a lot. So it's very different depending on the company.

John: See, I talked to somebody about medical device, he teaches people how to do the MDR stuff in Great Britain. And his comment was though, let's say you're on that side of the pond, and you're looking for a job like this, because we get people that go back and forth. And he said, whatever you're doing there in Europe usually is going to apply in the United States, because all the companies in Europe that make drugs and biotech, they want to also sell in the United States. That can be a good thing to know that there's options on both sides of the Atlantic.

Dr. Michelle Mudge-Riley: Absolutely, yes, there is a lot of money in drugs in the US for better for worse. We could have a whole conversation about the ethics behind that. And is this the right thing? And how does this work needed for R&D? Let's not go down any of those routes. But you're right. Yes.

John: But I think they're big businesses. And so, they either hire a lot of people directly or indirectly. So that's good. It's a good option for physicians, we're scientists, and we most of us use drugs and medical devices so that kind of makes for a natural transition.

I think you alluded to this next question, but I have it on my list. I'm going to double check. That has to do with how to prepare or to increase your chances. I know we both don't tell people to go out and spend $60,000 or $100,000 on MBA just to get a job in a pharma company. But is there anything out there in terms of maybe a certificate exposure to research? I don't know, ways to get a little bit on your resume that might be might demonstrate some knowledge?

Dr. Michelle Mudge-Riley: Yeah. I wish but not really. It really comes down to all the things that I talked about before. The timing, the knowing people the right place, right time, you can get certifications just to make sure that you know about these different topics, or you're well educated, you can do a good job in the interviews. And that's great. And maybe that will help you a bit. But it's nothing is a slam dunk guarantee. That's the really hard part about all of this. I wish there was. But if there was, we would already know about it now, I guess, right?

John: Yeah, I think it gets back to what you said earlier, if you can have a connection and find out, narrow your search down based on talking to people, you may find in that particular job that this particular certification might help you get that job, but it's not going to apply across the board.

Dr. Michelle Mudge-Riley: Yes, yes. And if you're truly interested in that topic, getting that certification is only going to help you. And that's good, you should never just be doing things to get the job. In two years, you're going to be tired of it, you're going to be moving on anyway. So, try to also check your own self and make sure that you're doing these things, because you want this information. And would you do it anyway? Maybe if it's a little bit? Well, no, probably not, a little bit it's okay. But if it's you're just doing this to get the job, that may be also a little bit of a signal that this isn't the right field, or maybe looking at an easier way to do it, because you shouldn't be killing yourself to try to get that job.

John: Yeah, you should have the knowledge and a lot of the skills that already that would apply in that job.

Dr. Michelle Mudge-Riley: Yes.

John: Because like you said, so many of them are filled by physicians. So there is a demand there. And it's just a matter of getting that communicated across to the company in the HR department that you're applying to. Okay, Michelle, well, I think I've bent your ear for long enough here. So why don't you close by giving our listeners here some any last minute advice or positive words of encouragement for those that are thinking "I do want to try something different. And I do think it's in the biotech or biopharma area."

Dr. Michelle Mudge-Riley: Yeah, I think the biggest thing is something that I usually mentioned, so people have heard me speak before they've heard this, and they'll be like, yeah, yeah, yeah. But it's lose confidence in yourself. And I'm just as guilty of it as others. We go through these phases where we're so beaten down by rejection, and things not working out, it's really easy to start thinking that you're not good enough, you don't know enough, you're not smart enough, not good looking enough, not tall enough, you're never going to make it. I hate those periods, but we all go through them. And that's what's going to just bring you down even more. Because when you're when you're in that place, you can't be the person that you are. And I think all of us as physicians, we got into med school, we got through at least a year, most of us all the years and all the residency, but whether you cut it short or not, you still were able to get there. And you are good enough to be in one of these jobs.

So don't lose confidence in yourself, do whatever it takes, have your support system, find a therapist, find a coach, find whatever it takes to just kind of get yourself to the point where you're able to talk about your strengths and your weaknesses, but be able to articulate what you want to do, and why you want to do it and why you're a good fit. And then it's a numbers game. It's annoying like that, but it is.

John: Yeah, and I know that you and I both could give dozens, if not hundreds of examples of physicians who have done that, and they thought it was kind of impossible at first, and then they realized "No, it's not." And now they're having great careers and loving it. So that's excellent reminder.

All right, Michelle, with that, I think it's time to say goodbye. I will tell people, I have links in the show notes, just reminding them that they can find you at LinkedIn. And that'd probably be the best way to reach out to you if they have any questions or things they want to double check. Maybe they went to school with you, and they've lost touch. Maybe you can help them get a job in pharma. But anyway, with that, I'll say goodbye.

Dr. Michelle Mudge-Riley: That sounds great. Thanks, John. Thanks for your time. Thanks for having me.

John: You're welcome.

Scroll back to top

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

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

powered by

Disclaimers:

Many of the links that I refer you to, 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 Priceless Advice From an Expert in The BioPharma Industry appeared first on NonClinical Physicians.

In this week's show, an interview from the archives with Dr.Laura McKain explains how to land a pharma clinical development job.

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 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 on any topic related to physician careers and leadership. Each discussion is 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 a 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.

From Clinical Medicine to Clinical Development

Laura received her medical degree from Georgetown University in Washington, DC, and completed her training in obstetrics and gynecology at Virginia Commonwealth University in Richmond, Virginia. She was in private practice for twelve years where her clinical interests included well-women care, contraception, HPV, menopause management, as well as general and high-risk obstetrics.

Anybody that feels miserable and trapped… You may feel like you have no options but, I promise you, you have a thousand different options. – Dr. Laura McKain

Subsequently, Laura transitioned her career to the pharmaceutical industry. There she was involved in clinical development projects encompassing various therapeutic areas. During her tenure, she brought two new therapeutics to market.

Land a Pharma Clinical Development Job

She recently retired from full-time work. That allowed her to focus on helping other physicians find new nonclinical careers. She does that in several ways. And she is very confident that almost any physician in practice can make a move to a pharmaceutical job.

She is a career coach and resumé expert at mckainconsulting.com. And, she founded the Physician Nonclinical Career Hunters Facebook Group. Opened 8 years ago, it now serves 30,000+ members. It is the premier group to connect with other physicians, find job openings, and obtain valuable advice and mentorship about nonclinical careers.

During our interview, she described the tactics she recommends to find a clinical development job. She also defines job descriptions used in the pharma industry, and which jobs are the easiest to secure.

Summary

Dr. McKain provides lots of actionable advice in today's interview. She is a great resource for information and coaching about nonclinical careers. And she continues to grow her popular Facebook Group where you can learn more about how to land a pharma clinical development job.

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. Laura McKain's Website
• Physician Nonclinical Career Hunters Facebook Group
• The Best Biopharma Positions For Motivated Practicing Physicians
• Landing Your First Pharma Industry Job May Be Easier Than You Think – 311
• Research and Development in Nonclinical Pharma Careers
• Medical Science Liaison Is Still a Fantastic Pharma Job – 261
• Highlight These 5 Experiences to Land Your First Pharma Job – 242
• Use These Simple Tactics to Land a Fantastic First Pharma Job – 209
• How to Find a Job in Pharma That You Love – 184
• How to Claim Your First Job in Industry – 168
• Nonclinical Physicians YouTube Channel
• 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

Email Download New Tab

Transcription PNC Podcast Episode 214

How Does a Physician Land a Pharma Clinical Development Job?

John: Today on the podcast I really hope to bring more clarity to the issue of jobs and pharma, particularly those in clinical development. My guest today is definitely an expert in this topic. She's a physician coach. She's a resume consultant or expert, whatever you want to call it. And she's also the founder of The Physician Nonclinical Career Hunters Facebook group, which I think most of you know about. Dr. Laura McKain, hello, and welcome to the podcast.

Dr. Laura McKain: Hi John. What a great pleasure to finally be here with you today.

John: I know. We've known each other for quite a while and it's like, why have we not been able to get together on this thing? But it just happens that way sometimes. Yeah, I've been really looking forward to talking to you, and my listeners probably know this, but you have so many areas of expertise and you've been doing this for so long. It's not just the pharma part, but the helping physician's part that I'm already going to put a bug in your ear about coming back on the podcast to cover another topic sometime in the future.

But we're going to really pick your brain today. First thing we need to do is just learn a little bit more about you. I have a separate intro that I did, but give us high points of your background and your career and what you're doing now.

Dr. Laura McKain: Absolutely. I'm a board-certified obstetrician gynecologist. I practiced in private practice for 12 years before transitioning over to pharma more than 13 years ago actually. I worked first in a couple of contract research organizations. And then I took a big leap and moved over to a startup biotech company on the west coast. Actually, I just recently retired from that company, after my drug got approved. I'm just tremendously passionate about my own career. Actually, I think I've had two careers, as well as my career transition from clinical medicine. And I am just incredibly passionate about assisting other physicians to make sure that they're really satisfied in their professional life.

John: That's fantastic. There has been such a demand over the last few years. And I don't know about you, I assume you've seen the same thing, but it was sort of something that people didn't ever talk about or didn't know about until now there are just physicians all over the place, including in the Facebook group looking for help and making the transition. That maybe doesn't bode well for the practice of medicine and all the hardships that are driving that, but it's definitely something that's growing.

Dr. Laura McKain: I absolutely agree. And I'm hoping that physicians can find perhaps other ways to find work-life balance without necessarily completely leaving clinical medicine.

John: Yeah. I think we talked a lot about making a transition, but always building it on that background in medicine, the knowledge of healthcare. Pharma is an awesome place to do that in my opinion. I've never worked in pharma, but we've interviewed MSLs and medical monitors and others, but really have had minimal exposure to the topic I hope to talk to you about today, which is clinical development or drug development. Tell me a little bit about what is that? I think we have our own understanding about it. It has to do with bringing drugs to market, but tell us what clinical development is as a division in pharma and what it does.

Dr. Laura McKain: Absolutely. Clinical development truly it's a blanket term that is used to define the entire process of bringing a new drug or a device to the market. It includes everything from the folks in the lab that are doing drug discovery, actually looking for molecules that might work, to the folks that are in product development, including the preclinical research, that may be done in microorganisms or in animals to early-stage clinical development where people are doing first in human studies to the later phases of clinical development, which involved the large clinical trials on humans that lead more directly to approval of a new drug. It's a broad range and there are actually a lot of different roles for physicians across clinical development.

John: Now, when I think about physicians in clinical development, I think about those maybe who went directly into academics, or they were doing research as part of their training. But what I think you and I tend to run into are physicians who have already been in practice for a while, they're thinking of leaving and now they want to transition back into some aspects. Maybe give us a little bit more of an idea of what jobs are in there that would be the most appropriate for physicians looking to go from clinical into that division of work.

Dr. Laura McKain: I think there are a lot of options and some of them may actually be things that physicians haven't even really thought about, particularly ones that still actually rely upon a lot of physician's clinical skills. One of them to start out with, and I'm going to start before a physician actually becomes employed by either a contract research organization or actual pharma company is to be a principal investigator in clinical trials. While you're still interacting with patients, it's very different than having a sick patient come to you for an answer.

When you're a clinical investigator, you're actually conducting industry sponsored clinical trials that are aimed toward getting a drug approved. And it is a fabulous role for somebody who feels like they have no experience in pharma or they feel like they don't have anything that they could put on a resume to get them their foot in the door with pharma. It's a great way for physicians to work on building that book of experience to make that transition.

And there are a lot of different settings for principal investigators that they can use their skills and to build this experience. For instance, they could work for actually large phase one units, which there are many across the country, where you're actually a full-time employee and you are enrolling patients, oftentimes, folks who are participating first in man trials, or they are doing studies like pharmacokinetic studies, to understand how new drugs are metabolized. Many of these types of facilities are actually inpatient facilities because they sometimes need to keep the patients for days in order to do the needed studies on them. They love employing emergency medicine physicians in this role, because again, it's a first demand drug. So, it's a great use of skills.

But there are also a lot of freestanding dedicated research sites that are either privately held or that a lot of physicians develop on their own to do later phase clinical trials. Think about like "Where did all of our trials that got us COVID 19 vaccines come from?" They were not done at academic institutions. Some of them definitely were done at academic institutions, but a lot of them were done in freestanding clinical research sites with principal investigators that were family practice docs or internists or from other specialties.

John: Okay. I'm going to dig into this a little bit, just to clarify for me and the listeners. Let me just give an example. I'm at a hospital where I was a CMO and we had an IRB and I sat on the IRB and we had these protocols come through. Most of those were external. And then we had people that were on staff at the hospital as part of that study, but would they be called a principal investigator or they would be an actual site from a study that was being produced either by the company directly or a CRO? How does that work?

Dr. Laura McKain: It really kind of depends upon how things are contracted, but you're right. Some physicians who are acting as a principal investigator, they may use their local institutional review board, the IRB, the committee that's required to review protocols to ensure that they are appropriate for patients. They may use a local IRB to conduct this research, but something that you may not know is that there are a lot of what we call central institutional review boards. IRB is that free standing units, not associated in any way with a hospital or an academic institution will use as their approval body for conducting this research.

Again, it really varies. There are some physicians that even act as a principal investigator within their own practice. They use a central IRB to get that approved. And they do it just part time. I've conducted many studies with lots of investigators who have that sort of setup. And then some of them love it so much they transitioned more and more away from actually seeing regular care patients and move toward doing clinical research on a full-time basis.

So, there are a lot of different settings where clinical research gets done. Academic institutions, hospitals, privately held investigational sites and then mom and pop organizations that physicians have started on their own.

John: All right. I hope I wasn't confusing anyone that's listening about the IRB. I think our IRB when we were involved with, let's say a national study and we happened to be at site, we were more just monitoring it. And there was a central IRB that approved the overall protocol, but we might have an oncologist on staff who was just enrolling patients into a study or urologist. I think he was more involved with procedures or in ortho doing certain implants. So, that did give them an exposure. And I didn't personally know anyone that used that and went into more of a full-time, but you're saying that's definitely a segue where you can say, "Look, I've been doing these studies, I've been monitoring patients. And so, why not do that full-time or something like that?"

Dr. Laura McKain: Absolutely. I've worked with lots of folks that have been principal investigators for industry sponsored research, and have used that as leverage to get a job with a pharma company. Absolutely. It's a great way because you already know how protocols work. You know so much that you would need to be able to know from the other side to be a medical monitor or what have you.

John: Would those people look at the firms, the companies that they were helping with their own study, or they look somewhere else? They say, "Look, I've got this experience in oncology" as the easiest way to use the company that they're already affiliated with, or could they just go to a CRO or some other company?

Dr. Laura McKain: Oncology is kind of a separate beast in terms of clinical development. Let's kind of just set that aside because a lot of oncologists, as part of their regular practice, do offer their patients the opportunity oftentimes last-ditch effort to enroll in study. So that's a little bit different. Let's talk about developing a new diabetes drug, or as I said, a vaccine. I did women's health studies. Those spokes are how they get their studies, how they find them really varies. Generally, some of them begin because they have relationships with contract research organizations, or they may work through what's called an SMO - Site Management Organization who helps them to find studies. And then there are some people who have just been doing it for so long that the companies come to them when they have a potential study. So, there are a variety of different ways here.

John: Okay. I guess that brings me to the question then, how would a physician other than being involved in something like that position themselves to move into pharma more directly? Are there things they can do beyond that that would help bolster their resume? What kind of suggestions would you have for that?

Dr. Laura McKain: You mean beyond being a principal investigator?

John: Yes. Or instead of if they haven't happened to be a principal investigator.

Dr. Laura McKain: I think there are a number of things that physicians can do to demonstrate that they have an understanding of how clinical trials work and what the work that they may be doing at a contract research organization or a pharma company. It definitely helps if you've got some clinical research experience but it could be something just as simple as being a real supporter of clinical research and being somebody who refers your patients to potential clinical trials. Getting great familiarity with clinical trials through that sort of pathway. So, physicians, let's say gastroenterologist. They have patients who have Crohn's disease which is very difficult to treat and they haven't found the right drug. They may help their patients find clinical trials to enroll in to offer them other potential options for successful treatment. That's definitely one way.

Other ways if you're a physician and you have absolutely no experience, would be to do a lot of reading, quite frankly. Really pay attention when new drugs are getting approved. Really look at sort of what the end product of new drug approvals are. And specifically, that's the prescribing information. Those long little leaflets that come that come with the drug. They're like 27 pages long. That's the end result of a clinical development project and really understanding what's in those documents and studying those sorts of documents and understanding the lingo and how they get to it. Looking at the published trials that come from new drug development, the pivotal phase three trials that are submitted as part of the new drug application.

Just getting that education and being well versed in it, being able to speak about it is great. If you're involved with drug reps at all, getting the word out that you're potentially an early adopter of a particular product and asking to speak with your regional medical science liaison to develop relationships with an MSL, to maybe get on a speaker's bureau for a drug. Actually, that was one of the ways that I got into the industry. I had been part of a number of speakers' bureaus for products that I really, really, really believed in. And that counted for me as being industry experienced, believe it or not.

I think another important thing is to potentially become a key opinion leader in your area. Choose some niche in your practice, something that's really of interest. Particularly, it's kind of nice if it's something where they're doing ongoing research. And become an expert. You should be the person that people refer patients to, have passion for it, really specialize in it.

And then last, but certainly not least what I always say is you should be networking. You should be networking. You should find people in the industry, find out what they do, do informational interviews with them, et cetera, et cetera. And those sorts of experiences can help you get your foot in the door with either a contract research organization or with a pharma company.

John: Does it seem like one works better than the other in terms of a CRO versus directly with a pharma company or does it just depend?

Dr. Laura McKain: I think there are certain specialties that can leap over to pharma much more easily. We already mentioned it, oncologists. If you're an oncologist out there listening, getting a job in pharma, it's as easy as falling off a log. I'm exaggerating, I know I'm exaggerating, but there are some specialties that are in tremendous domains. There are other specialties that I think have a much more difficult time. I've worked with a couple of folks like radiologists. I have really had a hard time trying to find an avenue for radiologists to get in. I'm not saying it's impossible because I know radiologists who've worked in clinical development, but it's probably a little bit more tough. Although even with that, there are angles for their careers.

We're kind of getting off on a tangent here, but there are companies that provide services to clinical trials, where they do very standardized assessments of certain diagnostic studies. A radiologist could go to work for one of these companies that does what we call "centralized readings" to make sure everyone's x-rays or what have you gets read in exactly the same way using exactly the same criteria. And I've worked with many radiologists who've gotten into that business. So, there are a lot of different avenues. There are lots of possibilities depending upon your specialty. Nothing's really off the table.

John: Very interesting. It can be overwhelming in a way. But you mentioned the KOL or key opinion leader and influencers and so forth. I mean, that's kind of the jargon they've heard from MSLs for example, and I'm sure there's a lot of other jargon. So, what about the titles themselves? What would be the jobs that a physician is looking at getting? Is it a medical director position? Is it a clinical scientist? If they're just trying to look around now, maybe look on Indeed or LinkedIn or somewhere just to look at a job description, what should they look up if they're looking for that kind of a job at a CRO or a pharma company?

Dr. Laura McKain: Sure. It does depend upon how much experience you have and where you might need to aim if you're looking to work for a contract research organization or for a pharma company.

I would say that generally speaking, a board-certified licensed physician who's looking to make this transition but maybe you don't have a lot of experience. I think a safe job title to pull up is an associate medical director position. And if you're entering it into LinkedIn, I put "Associate medical director clinical development", very specifically to look for those sorts of jobs. At a contract research organization, you're that type of role. You're really going to be serving as what we call a medical monitor.

It's actually not very common to find jobs titled as medical monitors. You can find them, but they're less common. Typically, the overarching term is an associate medical director or a medical director. But you would be performing that sort of role. You would be monitoring clinical trials, providing medical oversight to clinical trials in an associate medical director role in clinical development.

Going up the food chain from their medical director, senior medical director, executive medical director, some companies do or do not have this would lead them into a VP role. And then ultimately to a chief medical officer role. Obviously, those are all demanding experiences, but associate medical director is a good place to start.

For some people, even that may be kind of too high to aim. And another role that you can look for is a role as what's called a clinical scientist. And you can find those at pharma companies and also some contract research organizations. A clinical scientist is kind of the right hand to the medical monitor on a clinical trial. They still need to have a lot of clinical experience. They need to be very familiar and know a lot clinically to be able to review data.

They will play supportive roles to medical monitors, particularly on really high-volume studies. Again, I keep going back to our recent example of, "How did we get these COVID vaccines?" I guarantee there was like an army of clinical scientists out there that were helping to monitor the data, and to summarize it for the applications which got us emergency use authorization.

But clinical scientist is a great entry role. You'll find some physicians in that role, you'll find potentially foreign ex-US trained physicians in that role, but you'll also find PharmDs and even PhDs in that role. But it can be a potential place to get your foot in the door.

And then let's talk about the person who perhaps graduated medical school, but didn't do a residency or somebody who didn't complete a residency, or again, I'll even go back to somebody who graduated or trained outside of the US who's never been licensed here.

You talk enough about this, or we don't talk enough about that group of people, but there are roles in clinical development for those folks also. And I have worked with many people with the background that I've just described who serve as a role as a clinical research associate. And they often work for contract research organizations and they are fully trained on clinical trial protocols. And they actually go to the sites that are conducting the research. I'm really simplifying this, but they ensure that the data has integrity, that it's not fraudulent data, that it's been entered into the database correctly, that the site has conducted the study according to the protocol, with like I said, great integrity and they reported everything that they need to report.

Those clinical research associate roles are extraordinarily important. They definitely require a great medical background. I often see nurses in that role, other paramedical people in that role, but I've also, like I said, I've seen foreign trained MDs in that role. And it can be a foot in the door for pharma.

I built a drug safety team at one of the companies that I worked at. And I actually promoted a couple of people who had served as CRA's clinical research associates to drug safety physicians because they had all the medical know-how and they knew about clinical trials and they were great people to promote up to a more traditional physician role. So, there are lots of opportunities out there.

John: Oh, that's very helpful. I don't want to digress too much, but you mentioned this person, just this last bit here, that they were promoted into a safety role. This is just because in my mind, I'm trying to keep the parts of a pharma in my head and I tend to break them down into sections. So, I kind of think of the safety as standing by itself. It's not really part of clinical development. I don't think it's part of medical affairs. It doesn't kind of straddle all those things because it's maintaining safety.

Dr. Laura McKain: It does. Think about the role that safety plays in clinical development. When a company is developing a drug, there are two things that they are trying to establish. They're trying to establish the efficacy of the drug and also the safety of the drug. If the drug isn't safe, it doesn't matter if it's effective or not. You can't approve it. The pharmacovigilance department, the drug safety folks played an enormous role in clinical development.

And in fact, the clinical development people work very closely with the safety folks. And there is a ton of communication that goes on between the two groups. They review and analyze data together. Although the clinical development people are responsible for collecting the data, the pharmacovigilance people are really important in terms of meeting the regulatory requirements during development, but also, they play a huge role in the development of the actual applications when they go in. There is a ton of overlap.

And I'll tell you, John, that folks who work at contract research organizations, their positions that they get as a medical director are oftentimes really hybrid positions where they are responsible for medical monitoring, but they also can play a huge role in safety and they get very well versed in the regulatory requirements about both of those.

Of course, it's my experience, but I think contract research organizations are an amazing learning field for physicians who want to get into industry because you really get a broad view of things and you get to work with a bunch of different pharma companies to see how things are done differently at different companies. And it makes it much easier I believe to go onto pharma from there.

John: That is very helpful because we need to know how to get our first job. That's the hardest part I think from what I understand. Once you're in, then you can look around, you can continue to grow and learn and maybe shift. I just want to summarize things here though. I want to go back to the beginning. I'm in a position where

I'm thinking about doing something like this, but at the beginning, as you said, do your research, learn as much as you can, network. And I would assume also in some cases like physicians you've helped, get a coach, maybe that can help navigate this with you, if necessary, because it can get very confusing. Are you still doing coaching for physicians at this time?

Dr. Laura McKain: Absolutely, I do. I do work with individual physicians. And I'll be honest, I've really sort of narrowed my focus. I was kind of taking all commerce for a while, but I really have honed in on folks that are more interested in moving into pharma. I work with them to help them really mine their own background, their own experience to find those transferable skills that make them qualified for pharma. But I also can coach them on finding opportunities to build that runway to make the leap over.

John: All right. I do have to put the plug in now. It's at www.mckainconsulting.com.

Dr. Laura McKain: Yes. And check the show notes to make sure you get my last name spelled because it's a tricky one.

John: Right, right. So, that's one way you're helping people. Now, you're also helping them through the Facebook group so we have to spend a few minutes talking about that. Give us the entire history of the Facebook group in two seconds. No, I'm kidding. Just give us an overview of what's going on there.

Dr. Laura McKain: I established it five years ago, really just because of my own passion around this amazing second career that I've had. I really love my clinical career but I just feel like I've had this amazing second career I've gotten to. I've had two drugs that have gotten approved. I've literally traveled the world. I've gone to see how medicine is practiced all over the world. It's really been phenomenal. I just feel really privileged to have been able to do this. And after I got out of clinical medicine, I had lots of physicians, friends, and whatnot coming to me, "How would you do? How would you do it? How would you do it?" And I started the group to try to answer that question. And it has grown extraordinarily organically.

John, you've been an absolutely important administrator for the group for many years that have really helped us to truly grow organically. I mean, the group has sort of grown on its own. I will say. There has not been a lot of effort that's gone towards building it. We're up to almost 17,000 members at this point. We're fortunate that we've got a number of different experts in a variety of nonclinical settings that are really offering expertise to the group.

And then most recently, I made some changes in the group. And now because it's becoming more work to administer the group, we have a number of awesome sponsors for the group. John, you're one of our platinum sponsors for the group because of all of the contributions that you've made. But there have been a couple of individuals and one company that have stepped up to provide a little bit of financial support to kind of keep the thing moving and rolling.

But it's a great place for physicians to come to get exposed to people that are doing a variety of different things, non-clinically, as well as getting advice about navigating a transition. I think more and more our group is also helping to assist physicians who are just really feeling burnt out and maybe transitioning out of medicine isn't the right thing. But I think some of them are all saying they are finding appropriate connections within the group. "Maybe I just need to change my clinical practice and stay". So, I think we're beginning to kind of service that group also.

John: Well, that's good. That's awesome. And you're right. A lot of it is basically just people that are unhappy and they'd need support and they're getting encouragement with all physicians, 100% physicians, obviously. Yeah, I like all the new changes that you've made in the last several months and I think there are more coming. But it's a great place to go if you just don't know where to go, who to ask for advice on how to move into a nonclinical career or something like direct patient primary care or concierge med. All these things that are alternatives to the traditional practice that may be causing your brain to fry physically.

Dr. Laura McKain: A lot of the stressors seem to come from some sort of corporate medicine right now. People really do need to know that there are alternatives there and for anybody out there who's listening that feels miserable and trapped, you have to know that you may feel like you have no options, but I promise you, you have a thousand different options. It just takes some courage to find the thing that'll work for you. It may be something nonclinical, but you know what? I think there is also a great chance that there are answers if you want to stay in clinical medicine. Probably not what you expected me to say today, John.

John: No, no. I have guests on frequently that it's like if you can figure out a way to practice that isn't corporate medicine, because it's just killing you then by all means, do it. I certainly want to have a doctor for myself.

Dr. Laura McKain: Oh, yeah. And there are maybe people that can do things part time. Like I said there are a lot of people who have a clinical practice, but they also act as a principal investigator and that variety in their life makes things more doable for them. There's a lot of different ways to find happiness professionally. And I encourage everyone to do it. Don't wait. This is not a dress rehearsal.

John: Absolutely. I'll put a link to the Facebook group, but if you look up "Physician Nonclinical Careers" or "Nonclinical Careers", you'll find the Facebook group. I would encourage if you're not already a member to join there. There is a little vetting. You have to answer some questions, but if you're a physician, you can join. Is there anything else I'm missing in terms of places we should look for you? I think you're on LinkedIn, for sure.

Dr. Laura McKain: I think that's plenty. I'm in the Facebook group every day, now that I'm retired. Of course, once I've retired, I've got little quotation marks. I'm still doing pharma consulting and some other things, but I'm really doing it on my terms now. But the Facebook group definitely is a place to find me and mckainconsulting.com is another place.

John: All right. Well, it looks like we're about at the end here. Any last bits of advice for the listeners today?

Dr. Laura McKain: The last piece I would say is that if you're really seriously considering transition, I accomplished my transition solo and I don't recommend that. I think that now there are so many more resources and places to go for help. Rather than groping your way in the dark, reach out for help. It's worth it. I swear to you, I'm not trying to sell coaching services. I just hate to see people struggle. There are opportunities for people to get real professional help that can make the process much more efficient.

John: Very good words of wisdom there, reach out for help. And it goes all the way back at the beginning, when you were talking about networking and talking to others and learning. So, that's great. All right, Laura, thank you very much for joining us today. I'm definitely going to hold you to come back again and talk about some other things. So, with that, I'll say goodbye.

Dr. Laura McKain: Bye John. Thank you.

John: You're welcome. Bye-bye.

Scroll back to top

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

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

powered by

–

Disclaimers:

Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. 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 Land a Pharma Clinical Development Job: A PNC Classic from 2021 appeared first on NonClinical Physicians.

PNC Classic Episode with Dr. Rich Berning – 340

Today's podcast episode features Dr. Rich Berning, who explains the truth about medical specialists and UM jobs. It is loaded with practical advice on how to pursue a job as a health plan medical director. He also describes how to find similar positions at an Independent Review Organization or hospital UM department.

Dr. Berning graduated from the University of Cincinnati College of Medicine. He completed his pediatrics residency at Stanford University and his cardiology fellowship at the University of California San Francisco, and he practiced pediatric cardiology before moving to his first nonclinical position.

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 john.jurica.md@gmail.com and include SPONSOR in the Subject Line.

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.

Navigating a Non-Clinical Career Journey in Healthcare

Rich Berning's insightful discussion covers two crucial aspects: his journey from clinical practice to full-time utilization management work, and the multifaceted role of medical director in the healthcare industry. Berning shares his experiences navigating nonclinical career paths within healthcare organizations, shedding light on the opportunities that arose when he transitioned to a state-level plan in the Mideast.

The discussion seamlessly transitions into an exploration of the responsibilities of the medical director role. Rich provides valuable insights into utilization review, case management, and the collaborative efforts required to succeed in this position. 

Negotiating Salaries in Nonclinical Positions

In this segment of the conversation, Rich discusses how the base salary for nonclinical positions can surpass that of clinical roles and the potential for salary growth over the years. They compare the stresses associated with clinical and nonclinical roles, highlighting the distinct pressures in each domain.

Dr. Berning's Advice

Physicians like to take care of patients. That's what we want to do. So, this is just a new way to do it, and it's an important part of the whole system.

Resources and Networking for Aspiring Medical Directors

The conversation shifts to valuable advice for physicians aspiring to become medical directors. Rich describes organizations like AHIP and the American Association for Physician Leadership (AAPL) that provide courses that aid in professional development. 

The discussion concludes with practical tips on enhancing visibility, such as updating LinkedIn profiles, attending conferences, and networking. Rich stresses the importance of leveraging personal connections and reaching out to colleagues in the field for mentorship and job opportunities.

Summary

Dr. Rich Berning shares practical insights on transitioning from clinical practice to nonclinical roles, focusing on medical director positions with large healthcare insurers. He underscores the importance of networking, updating LinkedIn profiles, and attending conferences for career advancement. Rich provides a realistic view of the responsibilities and challenges associated with being a medical director, encouraging listeners to connect with him on LinkedIn for further guidance.

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. Rich Berning's LinkedIn Profile
• Milliman Clinical Guidelines (MCG)
• InterQual
• AHIP
• American Association for Physician Leadership
• The 5 Most Popular Home Based and Remote Careers – 291
• Dr. Debra Blaine's Coaching Services

Disclaimers:

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. 

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 information presented on this blog and related podcast is for entertainment and/or informational purposes only. It should not be construed as 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 counsellor, or other professional before making any major decisions about your career. 

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

The post The Truth About Medical Specialists and UM Jobs appeared first on NonClinical Physicians.

Interview with Dr. David Feig – Episode 332

In today's episode, John interviews a podcast listener who describes his search for fulfillment and flexibility in a nontraditional job.

Dr. Feig completed his medical degree and his Master’s Degree in Public Health at Emory University. Then he completed a Family Medicine Residency at the University of Michigan and a Sports Medicine Fellowship at Rush University Medical Center. 

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 john.jurica.md@gmail.com and include SPONSOR in the Subject Line.

Find Fulfillment and Flexibility

He worked for 4 years before branching out into chart reviews, and part-time medical director roles in various settings. He also tried locums and telemedicine along the way. David also explains why he decided to move away from full-time clinical practice to find fulfillment and flexibility in his work.

David has faced the challenges that many listeners face. He described how his attitudes and feelings about each new job can shift from enthusiasm to burnout or indifference. We heard the rationale behind the choices he made as he moved from traditional clinical practice to locums and telemedicine to his current nonclinical job.

Fully Nonclinical Position

In his most recent job, he reviews claims as a Medicare contractor. During our conversation, he describes his thoughts on the different jobs he has tried since leaving clinical medicine. And he explains how working as a Medicare claims reviewer is different from the usual utilization management positions.

Summary

If you have any follow-up questions about any part of his journey, you can reach out to Dr. Feig on LinkedIn by searching for David Feig, MD. A link to his LinkedIn profile and other related content can be found in the show notes below.

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. David Feig's LinkedIn Profile
• What Is It Like to Be CMO for a MAC? – 165
• Revisiting Why Utilization Management Physician Advisor Is a Great Hospital Job – 305
• The 5 Most Popular Home Based and Remote Careers – 291

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

Email Download New Tab

Transcription PNC Podcast Episode 332

How to Find Fulfillment and Flexibility in Your Nontraditional Job

- Interview with Dr. David Fieg

John: I invited today's guest because I think he represents many of you. He practiced medicine for a while, decided to try some other things part-time and full-time. And he tried locums, he tried telemedicine, and recently he's been performing claim reviews for Medicare. I'm really interested in hearing what he has learned from all these jobs he's done and what advice he has to share with me and with you. So, welcome and hello, Dr. David Fieg.

Dr. David Fieg: Hello, John. Thank you for having me today.

John: I'm really glad you agreed to do this because, again, so many of us reached a point where we thought, "Well, maybe I should do something else", or for whatever reason, we maybe get into your reasons today. And then we just look around and try different things. Sometimes part-time, sometimes full-time. And so, I think it's just going to be really interesting to hear what motivated you and what you learned along the way. So thanks for being here.

Dr. David Fieg: Oh, again, my pleasure. I was a listener before I became a guest.

John: Yes. And that's a good way to go for me because then it's so relevant to the other listeners to hear your perspective. But tell us a little bit about your early education and your clinical career before you started thinking about making a change.

Dr. David Fieg: I had a little bit of an atypical path to medicine in the sense that I went to college. I was pre-med. I thought, "Oh, I'm always going to be a doctor." Growing up I had a very gifted pediatrician who took very good care of me and my brothers. And he was definitely an inspiration. Just as an aside, I guess he was trained clinically as a neurosurgeon but apparently, he had some issue operating. Back in the day, I guess the way they did lighting and the ORs, it gave him sneezing attacks. And obviously during brain surgery, that's a big problem. And he had to retrain essentially in pediatrics because he couldn't operate. But that level of skill translated into his pediatrics because he was quite brilliant. And he always had a moment to answer my questions. And he was very much a great role model for me.

I went off to college, and was in the pre-med track. And I tried to distinguish myself by trying not to be as cutthroat as the stereotypical pre-med students. And I had some moments. I already had notions of taking a year off. I was going to take a year off. My mistake was looking back on it was, what was I going to do in that year off? Because if you're looking for a job, a lot of places are like, you're going to go in a year and start school, and not a lot of places are excited to hire you in those scenarios. So I was able to get some work and I did apply to medicine.

And I think for my first application cycle, I was very ill prepared in terms of where I applied. I applied to a bunch of very selective schools. Maybe I was a little over confident, who knows? I think I got two interviews and one wait list and it didn't work out. And then I'm like, "Oh, this is terrible. I didn't get in. What am I going to do?" And I applied one more time. This time I was a lot more broad in where I applied. I'm remembering, but I'm pretty sure I was on seven wait lists. And I thought "Seven wait lists?" This has got to be made and I'll get in somewhere. And seven became six and five and four and three, then two. And then I was like, "Oh dear."

I went back and got a master's in public health with the notion that either I was going to get a job in healthcare if I couldn't be a doctor or it would be enough to hopefully get me over the hump and an acceptance somewhere. I did that and I applied one last time. And after some trials and tribulations with two more wait lists, I got offers in both places and everything started. And it was quite the shock when I finally got accepted.

John: Well, we have more in common than I knew about even from talking to you before. I was not accepted. I was out for two years. What I did was I took a micro course because I think that was the area I was weakest in. And lo and behold, when I applied two or three years later, I got in. But who knew? And we both have master's in public health. So, keep going. Tell us more now. You've made it through med school. You went into family medicine, but then you did a fellowship after that, from what I know.

Dr. David Fieg: Yeah. Medical school was definitely really hard for me. And I think it's hard for a lot of people. Coming from probably very academically talented and most people that go on to medical school have great academic credentials that they wouldn't have gotten in. The one footnote maybe to this story that I do get a kick out of later on was at times, I think I caught the ire of some of my professors because of my yawning. I would yawn a lot on rounds, and it got enough that it was noticed and I really couldn't put my finger on it. But it definitely didn't make things simple, I guess what I would say. But I persevered, get to Michigan, get a fellowship, and then sort of go on from there. That was sort of everything. That's sort of why I gravitated a bit towards family because of the connection to sports.

John: How was that program?

Dr. David Fieg: Oh, that was a breath of fresh air. In medical school, depending on the size of your class, it could be 50 people, it could be 100 people. I'm sure there are some schools that have even larger classes. But it was a breath of fresh air and a lot of struggles that I had in medical school, really I think were different in residency. And then the funny thing is, after getting some concern, that I was on call and I was snoring so loud on call, in the call rooms, people would pick me up physically and move me to the outside of the call room and kind of lay me by the door. Other people began to notice and then the thought was "You also kind of stopped breathing when you're sleeping. Maybe you should get that sleep study." And I was like, "Oh, get out of town. That can't possibly be. I've been doing this since I was in medical school." And it's like, "Oh, okay, go get it."

I got a sleep study and they did diagnose me with very bad sleep apnea. Very bad. And I was the resident that when I was on call, I would carry my CPAP machine with me to the hospital in case I got a chance to lay down for a while. I would put my CPAP on because that way if I slept, I actually could get restorative sleep for a change. It was definitely a wake up call. And then everything got a lot easier after that, shockingly. I was doing better. My in service exams got much better, my performance on rotations got better.

I did finish up with my family medicine training and I went off to do a sports medicine fellowship. And that was eye-opening just in the sense of the nature of the practice and how you want to maximize how much you're getting out of that one year to get the skills you need to sort of build forward.

And I think at times it was a struggle because it is one year, it's only really one year to acclimate in some cases to a new city or a new environment. But all the while you kind of have to be on your toes in terms of dealing with a new system in some cases, and then also your professors, the athletes you're taking care of. So, it was a very busy year, and it definitely was a long year as well.

And after finishing up, basically decided I had enough for the winter being in the Midwest for a few years. That's when I was looking for jobs on the West coast to get away from snow at least for a little while. And lo and behold, I did find something and I was off to the west coast to try to hopefully escape the Midwest winters that I had gotten used to over a couple of years.

John: What did you find? Was it something that was geared mostly in sports medicine or was it family medicine too or something else?

Dr. David Fieg: Oh, definitely family medicine. And that was maybe the strange thing as I was going through my fellowship. I had realized that I still enjoy the practice of all spectrums of medicine. Maybe not as much obstetrics, but certainly the primary care component was what I think called to me the most. But I still enjoyed the musculoskeletal part two. Instead of trying to do sports med only, I had gravitated to more traditional practice.

In that particular group, it was me who had the sports background and then we had an orthopedist who had decided to stop operating. He was really doing non-operative stuff. So we sort of had a nice relationship, a synergistic relationship that we would sometimes see each other's patients and I'd ask him questions and vice versa. Although mostly I asked him questions when I was starting out. And he had to go out and about and he had patients that needed say synvisc injections on their knees or something. I'd be happy to jump in and help out with that. So, that was a great initial experience as my first job out fellowship.

John: Nice. Well, how long did you continue doing that and what caused you to make a change?

Dr. David Fieg: It was about four years. And I think I come to the realization that they say your first job out of training is going to be the job where you figure out what you want your job to be. And as with everything, there are some always some really good stuff. And then there's stuff that's not so good. And ultimately working in a big system carries a lot of benefits in the sense that there's a billing department, there are other departments that can support you, there's a credentialing department. All these things that you can take advantage of. They are often CME that they'll pay for and other benefits that you get from working in a large system. But you also have to realize that you also work in a large system with your other doctors and your other coworkers, nurse practitioners, PAs. Everyone that kind of forms the team. You definitely have to be part of that system.

And if you say have an entrepreneurial spirit or you want to maybe spread your wings or if you're like me and you're also very technical and you get very frustrated by maybe the electronic medical records that you use, and most physicians have strong opinions about it obviously, you're not really in a position where you can get them to give you your own system, you're going to use what they have. And you can do the best you can within it but flexibility is not something you get necessarily in those environments. You get the security of working for a larger system. The large system is going to pay your salary, whereas if you have your own practice, you've got to get a bookkeeper and make sure you get your bills sent out to get paid usually from the insurance companies, otherwise you don't necessarily have an income.

Having a more explicit understanding of that kind of trade off, I think after four years it became a little more clear just in the sense that you have to find a niche, I guess. And I do very much say that when you're out of training, finding what you want to do can be tricky. Definitely I wanted to point out systems and technology and how we use it to be more efficient, but also realizing doing that in a large system, I think change is never easy. And I think change in a large hospital system or any healthcare system is challenging. If we look at how our hospital systems have changed over the years, or even how they changed from COVID, we can kind of realize that kind of change is atypical. Usually it takes a crisis like COVID to get things to change. And that was maybe a big thing we'll talk about in a bit is how much telemedicine changed in that timeframe out of necessity. That it hadn't really changed a lot before that until there was like, okay, people need this care and we have to find a way to do it, and these are the places that are set up to provide that.

At any rate, all those things go on my mind and I realized that I did want to make a change and I had pursued some other opportunities and I found a job working more partly clinical, partly as an area medical director for an urgent care system. It was based out of Portland that had opened up some places in Seattle. I guess you could say it was my first official administrative role.

The funny thing is, and it's the other thing I learned the hard way, when you're a physician working in a clinic, whether you want to be management or not, you are one of the doctors there, you are a provider, which means that other staff will definitely notice when you say or do things. You have to be careful what you say, and you also have to realize that you might not necessarily... You want to just show up and take care of patients and go home, but I think it's rarely ever that simple.

I certainly learned that you have to be mindful of that when you're in your job. Now, I was in this new job and I was actually officially management in my title at least. I got to see patients also help oversee some nurse practitioners and some physician assistants to run the clinics and kind of keep things running smooth. And I was doing a lot of chart review and just being available for clinical support for the team, and practicing in a different way. Seeing how they figure out the account I think was a valuable insight that I hadn't had a chance to really experience before.

John: Now, was it at that location that you started getting into the telemedicine, or did that come later?

Dr. David Fieg: That actually came later. As much as I enjoyed the opportunities working in urgent care, I had this thought in my brain that launched the having relationship with your patients and having that longitudinal care was actually a good thing. And it is a good thing. Although, looking back on it, I think there are caveats you have to be mindful of too.

I wanted to get into a situation where there was more of a panel of patients that I'd be taking care of. Maybe shift from the acute stuff to more of the continuity of care that I enjoyed. I made one more shift to a startup that was doing more work in that field, more based out of employer healthcare model in which employers actually can have their own clinics that are managed generally, contracted by this third party, so that the patients, the employees can go thinking that they are not necessarily going to the company doctor. It's the company that the company hired to help provide some extra care.

And there are creative ways you can manage the finances such that you can provide services, the company can cover it. If it helps with utilization of your primary insurance spending, then it can often pay for itself. There's some interesting ways around it. I think the market has changed a bit over the years, but that was what it was when I came into that profession.

John: What was that situation like? Was it one or two of you in a pod or was it a large group? Was it centralized where employees were coming from all over?

Dr. David Fieg: It started out pretty small with only two locations. And over time it expanded to multiple locations around the Pacific Northwest. And then it kept expanding from there. The growth of the company was pretty huge. And it did go on to do some big things from what I understand. I learned a lot again. And I was hired to work there, as one of the docs. And there were some changes. And then I had the opportunity to get more involved in leadership again, which was nice. And I did do a lot more on the technical side, kind of working with the EMR system, got to see the nuts and bolts of it, and that was sort of exciting and also overwhelming.

The more you dive into it, the more you realize that it's pretty complicated. And it's sort of why hospital systems have entire departments of people trying to wrangle this because it oftentimes has that level of detail because humans are complicated, medicine is complicated. And to translate some of that stuff to the non-physician, but to the developer that's writing the program, these are complicated things that we don't often think about. I learned a lot from the other perspective about that. That was definitely a great experience and also very much overwhelming in the grand scheme of things.

John: Then what? You were about to segue either into another move or thinking about something else. What was the next step for you?

Dr. David Fieg: I think it was at a professional low point in terms of my health that I think the stress of keeping up with medicine is something that all physicians have to deal with. And actually almost anyone in a professional setting, whether it's a nurse, a lawyer, a doctor, a nurse practitioner, a physician assistant, I think you all experienced some level of burnout. And I think over the course of my career, I certainly had burnout several times. I should give it a little shout out to Dike Drummond who I did connect with at different points over my career. That was really one of the first people to talk about burnout amongst physicians and then other health professions in a really solid and very focused way that really tried to define it.

I had left that particular job and that's when I sort of did more telemedicine. I also started to do a lot more locums in the area. More opportunities came up where I had never really done locums before. The opportunity to leverage some connections I had, I built up over the years to help cover some clinics, to help cover some maternity leave for some larger hospital systems, but also still going back and then sometimes then doing a couple hour shift in telemedicine was an experience. And it went well enough that I kept doing the telemedicine for a while. And that's when I got to experience both, you can say, doing coverage physically in a clinic, and then also doing telemedicine from home.

And I learned a lot. This was actually still pre pandemic. It was just before the pandemic and that was where things got really crazy, I guess you could say. Only in the sense that I was doing a little bit of both. I was still sort of looking, experimenting, do I want to open my own practice? Should I open up my own telemedicine practice? How can I manage this? And that's sort of when I just focused a lot on telemedicine for a period of time. And that's sort of when my locums assignments had run out and I decided not to sign up for anymore for a while so I could run more with the telemedicine component. And then I was doing that for a while.

The one thing I learned is that when you're in primary care and you have a patient coming in for a visit, the first few minutes of the visit can be incredibly nerve wracking because you don't know how sick the patient really is. And then when you see them on the camera, if you can, that's when you get an idea, "Do I feel good about this? Do I not feel good about this?" And maybe the major thing I learned was if you have concerns that the patient maybe is too sick for telemedicine, you have to be very explicit about that. And no, they'll never be happy to hear that. But if you're firm and you communicate your concerns, vast majority of patients that I explained my concerns to were willing to go into an emergency room and get care, which was good. And I think you have to be very cognizant of that if you're doing telemedicine because it's not the same as in-person care.

And maybe that's the biggest difference. At least in-person care, you can see the EMS take the patient to the hospital, but in telemedicine, you have to trust that they're going to follow through. And that was always a point of concern.

John: People I've talked to, they seem to indicate that's the skill you need to know to recognize when they're sick, and then to be able to quickly and effectively communicate, okay, this is not a telemedicine visit. You need to see somebody and whether it's emergent or in the next six hours or what have you.

We're going to run out of time pretty soon. So I really want to hear about what you're doing now and how you feel that fits in with your long-term plans and do you enjoy it? I'd like to see what you think about it. I don't know that many people are doing the job that you're doing now.

Dr. David Fieg: Right. I'd say I'm from New York, so we talk a lot. It goes with the territory. As I was doing telemedicine, I did have some friends that were involved in doing more utilization management work. I was able to pick up some extra work on the side. I cut to halftime telemedicine, halftime doing utilization management. This is more the traditional nonclinical job in which you're usually reviewing advanced imaging and trying to make decisions about whether the MRI or the CAT scan should be approved. I did that for a while.

And that experience, particularly working with different insurances and how to interpret rules and regulations, did give me the skills to connect with where I'm working now, which is more about reviewing Medicare claims as a qualified independent contractor. Working from one of the companies that reviews claims, it's quite complicated, much more complicated than I ever realized.

But what it boils down to is that Medicare rules and regulations are quite complicated. And even though I've worked in big hospital systems, even though I've worked in small startups, even though I've worked in many places, I did take quite a few Medicare paying patients. The physician's knowledge of the intricacies of some of the regulations is maybe not what we thought. And then you kind of realize, well, everything's on the website, so if you really have a question about how to bill for X, Y, Z, you can go to their website and look up rules and regulations. And maybe that's sort of the takeaway for me was I learned a lot through practice, although I did mainly outpatient, so I was probably more in part B than inpatient part A.

But you learn a lot by practice, and since we have separate billers and coders, maybe you don't get into the same level of detail that you do when you're actually reviewing the cases. And you see how it was coded, you see how the documentation was, and then you compare what you have to, what the regulations for Medicare are, and you try to make sense of why it was denied, what the rationale is. You do an independent review. You basically start from scratch to sort of see what your concerns are. But it certainly makes you realize just that obviously billing and coding for medical care is very complicated. And know physicians really focus for obvious reasons on the clinical side.

But looking back on how Medicare does their guidelines, how they do national coverage determinations, how they do local coverage determinations, all that information is out there. And if you do have patients you're taking care of, it's really important to be aware of how you do your documentation. That's probably why clinical documentation improvement specialist or clinical documentation review is also becoming a hot field because if we all had time, we could probably document better. If our computer system was better, we would document better. But you have to be the most efficient and the tools you have at hand.

John: Now I have a question. The review of Medicare, was there much of an orientation or training? They just throw you some manuals? How did that work out?

Dr. David Fieg: Oh, no, I got some great doctors to work with. We actually did it virtually because I had started the job right when COVID hit for real in March of 2020. That was when Seattle had its first few cases right before. People finally realized that it finally had reached to the states. And certainly things changed a lot after that fact, changes in telemedicine and then changes with remote work. This was always a remote position interestingly enough. I was able to virtually sit, and of course, now we have the technology to do this. Sit and talk by phone, by video, by real time sharing screens, going over cases, going over the information, trying to read through the major case types, understanding the types of cases you'll see in different parts of Medicare, whether it's part A or part B. Understanding one's more inpatient, one's more outpatient. Certain drugs are considered the B of A, so they fall under more of the part A side. Getting a lot of minutiae of detail, and just understanding how the cases go.

But a lot of really good doctors that have been doing this for a while and have a lot of experience, were really helpful in getting me trained to pick up all these details. And then a lot of it, honestly, is also reading a lot of cases, reading the decisions and going back to the case and just looking through it back and forth and understanding seeing the patterns arise. Why was this denied? Well, they didn't document X, Y, Z. Well, why was this approved? Well, they did document X, Y, Z. Sometimes it can come down to that, sometimes it can be more of a judgment call. But document, document, document is what they say.

You want to be careful on what you put in the chart in the sense of just for certain conditions, you just need to be very explicit as to what you saw and document it. It also comes back maybe strangely to the systems that we use. And if your EMR, as you said, whether it's due to time, energy and money is more out of the box, maybe it's not as customized as it could be for your particular style or your clinic. And that could affect your reimbursement if it's not configured correctly to capture all the key things that you need.

It's funny how that's kind of a strange circle and that we don't have time so we run through with our computer systems to document what we need, but maybe we don't spend enough time making sure it's documenting enough of the things we need, whether it's private insurance or commercial insurance or is it Medicaid, Medicare. Because they do have requirements that are available for review. And we do want to be mindful of them because getting paid is important and not getting paid for even the large health system can be quite onerous.

John: Yeah. It catches up with you if there's too much of that going on. Well, we are going to be out of time here in about a minute. So, just looking back, maybe advice you have for other people that are at the beginning of the journey that you've made so far where you're trying to find the right clinical thing to do, or maybe they want to do two different things or maybe they don't want to do clinical. What advice would you have for people that just find themselves early in that process?

Dr. David Fieg: I think you do want to get at least some clinical basis. And when you're out of training, you want to practice for at least a few years. A lot of the best nonclinical work does often require anywhere from three to five years of actual practice experience. For a lot of people you might close some doors if you don't finish your residency, if you don't do some clinical practice for a few years.

But once you get through that point, that's a great time to reassess. And as I said, there's more and more opportunities, whether it's telemedicine, whether it's utilization management, whether it's clinical documentation improvement, whether it is doing case or claim review, whether it's legal consulting. There's a tremendous variety of things available. One of the struggles I think is just connecting to figure out what's out there because it seems to change all the time. A lot of people didn't know about the work I'm doing now in terms of review for Medicare claims. More were familiar with utilization management. I think more are getting familiar with certainly the legal consulting component, and also getting more familiar with the clinical documentation improvement.

That's maybe the flip side to what I do, is that they're working with the docs to make sure they understand if they're seeing case X all day long, that they know what the requirements are for documentation, if they're billing a lot of Medicare claims. So that everything is set up to set them up for success rather than confusion in a lot of physician queries. I see that they send a query to the physician, the coder sends a query to the physician. What was this? And I remember getting them when I was practicing more in a traditional practice and it's like, "What is this? Why am I filling this out?" It's like, no, fill it out and try to actually think about what you're going to write because it's really important and it may actually affect whether you get paid or not.

John: Yeah, absolutely. I think some people might have lingering questions, you've covered a lot of material here today. It's okay I assume maybe if they can just find you on LinkedIn?

Dr. David Fieg: Oh yeah, absolutely. I'm kind of an open book. David B. Fieg. There aren't too many Fiegs on LinkedIn. So, if you see the doctor, that probably is me.

John: Well, I will put that link in the show notes too. If anyone is really struggling to find you, they can go to the show notes for this episode.

Dr. David Fieg: Yeah. And if you see the one that went to Michigan for a residency, that's probably me. So go Blue. Hopefully, we'll bring home the big one for the playoffs this year.

John: All right. All of you out there, I hope you are Michigan fans. All right, David, this has been really good. I appreciate it. We might have to have you come back in a few years and see if you're still doing this or have done something else, but we have a lot to think about. I really enjoyed hearing your story today.

Dr. David Fieg: Sure.

John: With that, I will say goodbye.

Scroll back to top

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

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

powered by

Disclaimers:

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

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

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

The post How to Find Fulfillment and Flexibility in Your Nontraditional Job appeared first on NonClinical Physicians.

Interview with Dr. Christian Zouain – 330

In today's episode, John revisits the hospital CDI career with Dr. Christian Zouain. He was first interviewed in March of 2019.

We explore the fascinating world of Clinical Documentation Integrity (CDI) through the lens of Dr. Zouain, a seasoned professional in the field. Whether you are a seasoned CDI professional or someone considering a career shift, Dr. Zouain's experiences serve as a valuable resource. His journey reflects the changing face of CDI, and the diverse career pathways available within this field.

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.

Dr. Christian Zouain's Journey into Clinical Documentation Integrity (CDI)

Dr. Christian Zouain reflects on his transition from medical school in the Dominican Republic to his involvement in CDI in the United States. He shares insights into the significance of CDI in healthcare, his initial encounters with physicians, and the evolving role of clinical documentation.

Significance of CDI in Healthcare

Clinical Documentation Improvement (CDI) significantly enhances healthcare quality by ensuring accurate and detailed medical documentation. It thereby improves patient safety, reduces errors, and promotes effective communication among healthcare providers enhancing care coordination.

Evolving Role of Clinical Documentation

In Christian's encounters with physicians, he discovered the evolving role of clinical documentation. What started as expertise needed to optimize payments, later became a critical understanding of how to demonstrate the quality of care. With annual updates published by CMS, the CDI expert must continually update their knowledge base.

From Clinical Documentation Improvement to Denials and Appeals

Dr. Zouain sheds light on the transformation of CDI from Clinical Documentation Improvement to Clinical Documentation Integrity. He explains the crucial role CDI professionals play in ensuring accurate and complete clinical records. Additionally, he explains how his knowledge of CDI enabled his professional growth in the area of denials and appeals.

Summary

Dr. Christian Zouain can be contacted through his LinkedIn profile. For information about job openings and updates, Acuity Healthcare's official website is a valuable resource. Dr. Zouain also recommends following Acuity on LinkedIn for the latest job postings. If you pursue a job, please be sure to mention Dr. Zouain to the recruiter.

If you have additional questions about this career or pursuing your first position, he encourages you to reach out directly to him. 

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. Christian Zouain's LinkedIn profile
• Acuity Healthcare
• Why CDI Medical Director Is a Great Nonclinical Job – 224
• PNC Podcast Blast from the Past: Clinical Documentation Improvement – 206
• Top Reasons to Become a CDI Expert with Dr. Christian Zouain – 077
• NewScr!pt

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

Email Download New Tab

Transcription PNC Podcast Episode 330

Follow This Plan to Establish a Solid Hospital CDI Career

- Interview with Dr. Christian Zouain

John: I wanted to bring back today's guest for several reasons. First of all, his story is very fascinating. Now, he was here in a previous episode in March of 2019. You can learn more about that at that episode, and I'll put a link to that. But he has a really fascinating story about how he became a hospital CDI expert.

I wanted him to come back because I personally think that a CDI specialist is really critical to hospitals functioning. I don't know how any hospital cannot do what they do and get paid appropriately and so forth without using a CDI specialist in some way. And I think it's a position that's often underappreciated and some of you should really consider that. So, welcome back to the show, Dr. Christian Zouain.

Dr. Christian Zouain: Thank you for having me again. It's great to be here.

John: I just remember our session back, those whatever, four or five years ago. I always loved CDI when I was working in the hospital environment, number one. And number two, it was so interesting to hear how you had gotten involved with CDI. And we'll define what CDI is in a minute. Why don't you, for our listeners, just give us the thumbnail sketch about your background and how you first got into the CDI business.

Dr. Christian Zouain: Yeah. The resumed version would be, I graduated from medical school back in the Dominican Republic in 2010. Initially, my plans as every other doctor, especially foreign doctors, who has a vision to come into the US is taking the USMLE. I practiced for a few years while I studied for the boards, and then I moved to New York, and I started getting into roles in the healthcare system. While I studied that way, I could also meet some people, network and all that to get my way through the residency process.

While I did that, I started finding out about these opportunities that were available. And it wasn't after I would say two or three years in that I found out about coding, clinical documentation improvement, the value it brought to healthcare, the importance is has for our health systems, and the well of our whole community.

I said, "You know what? There's something here. This is something that I can see myself doing. This is something that has value and that it will eventually continue to grow." And it's been already eight years. I've been doing this seven, eight years. So it's been great. It's been just as my original mentors had originally told me, listen, if you get into this, if you get the basics, there's so much you can do. There's so many pathways you can take. There's so many ways you can help within the industry to make things better, help the doctors, help the facilities, and eventually help the patients, which is the main reasons why we came into medicine, is to help our patients. That's one of the other good things that we are helping our patients in a good way by doing this work.

John: Yeah, it seems like a lot of these things that we do, whether it's utilization management or informatics or quality or CDI. Ultimately, the bottom line is to get the patient's care taken care of, pay for it, approve it, allow them to stay in the hospital or not stay in the hospital. There's lots of these things that we have to do to make sure they get the care that they need.

Tell us the technical, what does CDI mean now. When I was back in the hospital whatever, nine, 10 years ago is always called clinical documentation improvement. But I think you've kind of evolved that to a different definition now.

Dr. Christian Zouain: Yeah. It has evolved. They changed the last part, which now it's considered, they want to call it clinical documentation integrity, which we just want to make sure that we get the actual most complete accurate picture of that clinical scenario that happened in the hospital for that patient, translated into the record so the hospital, the physicians, and the entire health system gets reimbursed the proper amount of what went on that particular visit.

That's what the basics of CDI is. We're just trying to be of help, be that middleman between the physician and the coding expert, which is something that we don't really learn when we're in school. We tend to learn about this where when you're in residency or you start working in the hospital. Obviously like 10 years ago, I remember when I started something that physicians, they found a bit irritating. Someone's coming up to you, asking you all these, I would say dumb questions.

I even remember taking that as one of my approaches, when going to talk to one of the physicians saying, "Hey, doc. This is a really stupid question that I'm going to ask you, but I need to know this." That way I would be able to get that closeness and that reaction from that physician and I would get the information I needed.

But yeah, it has evolved. Gratefully, a lot of physicians have understood the importance, that this is not something that we're trying to question them or something that we're just trying to mess around. Sometimes I explain to someone that it's not the industry, like it's a game because it's something that it's a process that the insurance has, coding has, and then the hospital has its own process.

We're trying to manage on a day by day basis how to get everyone along. It's like getting all these rules together, getting everyone to understand each other. It's not like something that's going to be clear cut eventually that it's going to be fixed. No, it's something that it's still taking time. It's a process. And rules change every day.

John: I've heard in the past a metaphor where somebody was trying to describe this to me, and they talked about Michael Jordan and basketball or whatever. It could be anybody. But the thing is, games have rules. And you got to know where you can go in terms within the rules and do it right. But even in basketball, should you fouled out, should you not? That's a strategic decision. And you have to know the rules when you're playing a game or you're never going to win at the games. This is another one of those examples.

Now, one of the things that they used to tell me back in the day when we first heard about CDI and the importance of documenting and getting everything down to the last issue in terms of someone's preexisting conditions or president of admission. I don't even know if they call that anymore. But because most of the quality measurement of hospitals is based on billing data, then again, this is another reason why CDI is so important because there's a risk adjustment. And so, tell us about that. Is that still true?

Dr. Christian Zouain: Yeah, absolutely. Every day, again, it still holds true. That was the main reason why the billing process was shifted towards from pay for service, pay for performance. We're paying for the quality of service, the patient experience. How well was that patient treated, not based on the amount of procedures that the patient had. That's why we have the different billing systems, the MS DRG, the APR DRG. We have those in place. And that's the main focus of those. It's shifting that process of payment towards that, because eventually the quality, it's what's going to drive that payment factor.

We just want to make sure that the patient's reflected correctly, that we don't bill for things that happened in the hospital present on admission, of course, that's still something that holds true today. If you came in with something, everything has to be specified as being, okay, did the patient come in with this? Because if the patient had a fall and had a fracture eventually in the hospital, that code by itself can actually shift towards something that increases the bill. And you want to say, okay, if just by shifting that POA code present on admission indicator, shifting it from "yes" to "no" can make a huge difference on the payment.

Something I didn't mention to you earlier, which is now I'm not doing the actual clinical documentation improvement part. I'm working more in the denials and appeals part. I did a lateral shift, and I've been able to see a lot of these things that I would query initially, like coming back. That's one of the main reasons why I wanted to do that, to make that change. Because I wanted to see eventually, okay, is the insurance company really accepting what I'm having these doctors, that document in these records? How are they internalizing it? How are they fighting it back?

I do remember the other day, there was something that I didn't know, it was something about a procedure that the patient had a complication, and they said the doctor clearly said that this was a complication, and it wasn't coded as a complication, and it made a huge difference on the payment. And I said, you know what? They're right. I don't usually agree with what they said, but this is one of those instances where I say, you know what? I didn't know this, but it's interesting how these small factors come into play, the present on admission, quality indicators, anything that happens in the hospital, that make a difference in that payment, how it changes.

John: Yeah. That's why when I think back about my days in the hospital, we probably had at least every two or three years another consulting firm come in. And I don't know that there were these big companies, maybe Acuity was around and some others, but usually just people come in to help us bolster, improve our CDI program. It just amazed me that there were hospitals that still didn't have really even a dedicated nurse or physician even focusing on that. So, it kind of blew my mind. Although I have a question I have for you. Does it seem like the physicians coming out of training, residency and fellowship, do they have a better understanding of this now than they did five or 10 years ago?

Dr. Christian Zouain: Yes, I believe so. Yeah. I definitely think so, especially because just like you said, with let's say the rise of having these consulting companies, like Acuity, the one I work for is something of so much importance because when you have it on site, it is important. You have that person that the doctor can relate to. They know which doctor to go to.

But sometimes even if you're part of a big health system, because I worked in different hospitals, large health systems, small hospitals, and it's hard when you don't have that I would say that support, because you don't know it all. All these rules are very complex. You have the clinical part, but you also are continuing to learn the coding part. So you're trying to do your best.

Now, the doctors, when they see this, it's like, okay, sometimes you might make a mistake or they might think you're a little bit obnoxious. They don't want to really sit down with you and answer to all these nonsense questions. But with these companies now you have these group of professionals that they're all in tune. Even if you're not sure, for example, the model of acuity is you have a physician, which is a medical director position with an expert coder going into the case firsthand reviewing the entire case. So, you have an expert in clinical and an expert in coding reviewing that case.

Next part is they capture the opportunity, they send it over to someone like me, that was my position initially when I started in Acuity, which is the query writer. I would write the query based on the information they provided.

Now, when you have a more effective system, I would say it works better. I think physicians are able to accept it more with more ease. When they have a solid professional asking them questions and explaining to them in the right way, why are they asking the questions? This is the reason why we're doing this. We can show you in the code book. Or you also have administration behind supporting the consulting company.

And they're not just saying we're doing this for the money. No. These are companies like Acuity, and I don't know other consulting companies, but we go on site and we provide education to the physicians on how our process works. And we also give them education on them based on whatever issues we find recurring in their facility, why we are asking these questions, and how it translate into the coding and it translate into the payment and the quality metrics. That's been a huge part in answering your question. I know it's been a little bit lengthy, but yeah, I think that the physicians in these years have adapted more to the role because of the search of these consulting positions definitely.

John: Well, that's a good segue to talk about not so much CDI itself as an entity, as a domain to learn about, but what are the jobs in the CDI? Because I think you've held a number, and I don't remember exactly what you were doing before within CDI, but I know there are remote positions now a lot more probably since the pandemic, but then you have to go on site sometimes. Sometimes you're employed by a hospital system directly. Sometimes you're employed by a company that does the outsourcing. So, what's kind of the range of jobs out there that listeners might say, "Oh, this does sound interesting, this one's got the flexibility I might need?" Maybe give us an overview of that.

Dr. Christian Zouain: Yeah. It all starts with the coding. When I started, again, you have the clinical part and then you need to learn about the coding. And with that, basically, you can go into CDI. Again, I did a lateral move into appeals and denials, but as far as I know, it's coding, CDI, you can do inpatient, you can do outpatient within the realm of CDI. Then you have the different ramifications, which is you can focus more on a specific aspect. You can go more into education. You can be a director in a hospital. You can become a physician advisor. Going by what we have in Acuity, from what I know, just like I said, we have the medical director positions. But then we have educators, we have the people that go on site. We have query closers, we have query writers, we have appeal writers. The coding world is very, very, very, diverse. Just in the inpatient setting, there's a lot of ways you can go.

I remember about three or four years ago, the outpatient, CDI, was coming up and I said, "You know what? I think this is going to be like the future of this because I know a lot of procedures are being done like outpatient, eventually inpatient is going to be." And that was about for a year, two years. That was something that was really booming. But eventually, it has grown, but I've stayed in the inpatient setting. As far as I know, in Acuity we do mostly inpatient. And again, I went into doing appeals now, which I like even more because I get to see, I feel like I am using that knowledge again, and justifying why that service has to be covered or that diagnosis is valid using my knowledge and my expertise in coding in clinical and CDI.

John: Let me ask you this. Talking about specifically your role now in the denials and the appeals and so forth, are they looking at making an alteration in the principle diagnosis? Are they looking at whether the MS-DRG comes in three levels for most diagnoses? Is it that? What are the kind of things that actually get appealed in which you have to provide clarity when you can?

Dr. Christian Zouain: Yeah. In Acuity so far we only do clinical validation and MS-DRG appeals and denials. We receive changes in principal diagnosis, whether it is clinically valid or not. We receive request to change coding based on coding rules. Coding rules, which are sometimes more complex. Like this diagnosis were based on this guideline, it's supposed to be the correct principle diagnosis instead of this one.

And present on admission indicators, but mostly it's clinical validation. Clinical validation denounce is what we get the most. Sepsis. They use a lot of the argument now that sepsis three to one that has to be used, but the facility hasn't placed the rule, the guideline that still used the sepsis two. So we have to argue that okay, although sepsis three was put into place, they don't use that. So, we have to defend it on that end. Or the patient didn't really have an increase in creatinine of more than 0.3 to be considered AKI, but the doctor wrote it consistently throughout the record. Those things are the ones we fight every day mostly. It's mostly that validation of diagnosis that they feel like the diagnosis are not clinically valid.

John: Now, when you say appeals and denials and fighting these things, I have a friend that works at a local hospital. And on the UM side, he's getting on a conference call with an administrative law judge and other people on their side and Medicare side and their people on the hospital side. Is it like that? How do you do these appeals? Who are you appealing to?

Dr. Christian Zouain: No. We received the letters directly from the auditor or the insurance company. We receive letters and the letters have their own rationale. We provide the information, we make a document and we just send it back to the hospital.

John: So, it's a written appeal.

Dr. Christian Zouain: Right. It's a written appeal. We send back to the facility. The facility is in charge. I put my signature on it with Acuity's name, and then they send it over to the corresponding auditor. But then after, we might have several levels, but after it's exhausted how we call it, that's up to the hospital to decide if they want to escalate on their own part. If they want to have a peer-to-peer with their doctor and discuss that at that point. The hospital takes care of that. We are only part of I would say three levels of written appeals. We only do it in writing.

John: Got it. Got it. Yeah. This gets all very confusing because we can throw out a term and say there's always different jobs available, but Acuity does things one way, and there's probably 10 other firms that do other things and the hospital is doing its thing. But just to give us a glimpse in the time you've been doing this, both as in the denials and even before, are these the kind of jobs that are pretty much done remotely? Does it require checking into the office and showing up in person? Is it something you can do on your own time? Is it 9:00 to 05:00? Just give us some of the constraints on these kind of positions in terms of the time and the travel and so forth.

Dr. Christian Zouain: Yeah. When we first did the first interview a few years ago, I had just started with Acuity. And at that time, I do remember that I knew when I found them, I was like, "Wow, this is amazing." Because it was actually the first company I knew that it was 100% remote, and they were hiring foreign medical graduates. Other companies would require you to have an RN license, or some sort of license to work, which I found a bit strange because I was like, really? I'm doing work from home and it's documentation. I'm not really writing a script or anything like that.

But I do believe, especially when COVID hit, when the pandemic hit, a lot of other industries they had to go into fully remote or part-time remote. Then they just basically realized that it was doable.

This work can be done 100% remote. My company Acuity, it's been 100% remote. When I started, the only thing that I had to be present for was the training, which I had to go to the main office in New York to meet with, we had to get all the access and do everything. But during the pandemic that switched. So, the training is now being done just the same way, like any other presentation that's done in the company. It's done via Zoom or Teams. It's done remotely. It's 100% remote.

Now, I do know there are probably other facilities when you have your onsite DDI program, they probably still have it. I know some of them are maybe half and half. You would go several days to the hospital so they can see you and the other days you can work from home because you have access to the electronic health record through your computer at home.

But yeah, eventually I think mostly the ones that are still in the hospital, they are still require some sort of presence. And that's good because I think that's one of the benefits of doing the onsite. I had that I would say that privilege of doing that initially when I started, which it was 100% on site, and the hospital I used to work for was hybrid. They still had part of the records in paper charts.

So, it wasn't something that we could even argue like, "Hey, listen, can we do one day from home?" No, that was out of the question because they were still on paper and we had to go to the floor. But that helps you a lot to build that, to break out of that shell, I would say, to get close to the physicians, have a conversation, get to understand what's really going on with the patient, get their view. And also they learn from you in terms of, "Hey, listen, this is why I'm asking you because this documentation translates into this." Now with being 100% remote, you can't do that. After I started working with Acuity, my contact, when I was writing queries, I would talk to a doctor maybe once every two months. And it was because they would call me, they would see my name on the query, but they weren't really supposed to. They were someone else in a different department who would take care of that. Whereas when I was in the hospital, it was constantly, for every single query I sent, I had to talk to the physicians.

John: Yeah. Interesting. It has evolved quite a bit. I was talking to someone who does UM. He is relatively new, but it was kind of the same thing. He's in a system and they didn't really have a pretty robust UM program. He was assigned and he took a job as a medical director, and there were multiple sites, but he was doing half of it remote because he couldn't drive hundred miles in a day to hit every hospital. He'd do some of it remote, and then sometimes he had to show up and meet the physicians, and he really thought that helped. But I could see him migrating at some point to a 100% remote job with a big company because the lifestyle is so much better.

And so, would you say in general that most physicians are going to be very happy with working in CDI at one of these companies in terms of the lifestyle, the pay and vacation and opportunities for advancement?

Dr. Christian Zouain: Yeah, absolutely. Absolutely. The shift that I've seen and the opportunities just like I've seen in my own work environment, even though I don't interact as much. The company right now from the last town hall, they said we had about 600 employees nationwide. They did implement some sort of activity that we would do. Everyone that lives in the same state or close by, like in the same city, they would get together. I was able to meet a few of the doctors that work for the company as well and other coders. One of them was head of IT education portion of Acuity.

The others, they were directors of coding. There's a lot of opportunities still out there. I think much more that than what I know of, but definitely, again, just like I said, knowing the craft can get you towards getting a lot of opportunities in the field. And I've seen that. I would continue to encourage everyone that likes it and finds the value in it. It's really a good career. And all the companies, just like the one I work for, they're doing a great job and they're growing, expanding, and they're doing a lot of great things.

John: Excellent. That's good to hear. We want to have as many opportunities for our physicians as possible as they decide to transition to something maybe out of clinical that they're doing now or something like that.

We are going to run out of time. We're probably getting close to the end here. Real quickly, if someone is currently in practice, maybe they're doing some inpatient so they have exposure to that part of it, what would you advise them is how to start to look at making that transition? They just start looking up jobs, or is there something they can do in the meantime to set them up to succeed if they decide to apply for a job like this with one of the companies that does the remote CDI activities?

Dr. Christian Zouain: Yeah, I would say it would be the same advice I gave on the first part podcast. Again, you basically have the clinical knowledge part. Just get into knowing more about the coding aspect, how it works. Maybe do a coding course geared toward maybe a certification like a CCS. That's one I would say. For example, there's several coding certifications, but the CCS, it's like the more expert one. But for us physicians, to be honest, it's something that it's not that hard to acquire because we already handle all the terms, all the clinical terms. We just have to know all the coding rules and games, again, like we mentioned earlier.

After that, again, I know that Acuity has that particularly that the medical director position, the doctors they hire, they do have some coding, clinical background, but they don't need to be really like coding experts per se because they're looking more toward the clinical part and having a basic understanding of the coding part. And along with the coding director and with the company itself, you're going to be able to start learning everything and grasping. Because again, every company does everything on their own way.

There's not a specific way. Just like every hospital, CDI program does things a certain way. I know this because since I've worked for different facilities, one might think, "Oh, well, maybe when I go to this next job or this next facility, they might think I don't know how to do it because we did it differently."No, everyone in the industry is very aware that every facility has their own ways of doing things, but the core of everything is knowing the basics of medical coding and how it works. Other than that, it's just a matter of time and experience. Even till this day, I don't know everything, I don't think I'll ever know everything because again, there's a lot out there and everything changes from time to time, but it's a constant process.

There are certain things that are the main focus. There's always opportunities for sepsis, for acute kidney injury. There's diagnoses that are pretty common, for example. There's commonalities on every industry. But that would be my advice. Getting to coding and reach out to other colleagues that are doing the same thing, either in your hospital or through LinkedIn.

Right now, I do remember someone that reached out to me. I think it was who listened to your podcast about a year ago. I do remember she told me. I'm glad she listened to the episode. And a year later she messaged me again, and she told me, I just wanted to let you know that I was just hired in your company. And I didn't know. She actually went on her way. I think she got a coding certification, and she met someone else from the company through LinkedIn. And I think they established a friendship. And she was able to get hired for her first job in CDI 100% remote, which was something that if you would've asked me, probably like five years ago, I would've said no. You have to start maybe on a hospital, that they give you an opportunity on onsite. But now, it's possible. There's a lot of opportunity out there. There's a lot of facilities. You can reach to a lot of people.

John: Plus the power of networking.

Dr. Christian Zouain: Yeah.

John: It's like meeting people, getting advice, getting mentors and talking about their company. Who do I apply to? Is there someone I can talk to? There's so many little tricks you can do too along the way.

First I want to say that you're on LinkedIn, obviously, as you mentioned. Just look Christian Zouain up, or if you want to use the URL, I think it's linkedin.com/in/christianzouain. It's hard to miss you really. There aren't that many other Christian Zouains around. I don't think. I do see though on your LinkedIn frequently you'll post that your company has openings. I could put you on the spot now and say, are there openings there? And if someone has a question about an opening, they can just go ahead and apply, but I suppose it'd be okay to contact you and ask you a little bit more about it.

Dr. Christian Zouain: Yeah, definitely, if anyone is interested. As soon as I see any posts from HR or anything, I would do a repost just so anyone can see. If anyone has any questions, again, just like you mentioned earlier, I want to emphasize just like we did. I know we did on the first podcast interview, like networking that is very important, not just for this industry, for anything that anyone would want to do or pursue. The power of networking, it's very powerful. I would say reach out. Don't be afraid to reach out to anyone for advice. If you don't get a response from someone just move to the next one. There's a bunch of people. Look for someone that works in the company you want to work for and try to establish a connection with them. But if you see me reposting or you can go to Acuity's website, acuityhealthcare.com, or follow them on LinkedIn, they usually post the open positions there. If you have any questions on that, you can reach out to me. Just to throw it in there, we have a referral program. If you want to mention my name, just to put it out there, you can also do so.

But yeah, I'm available for any questions that you might have, any orientation that I can provide. By doing this, what I'm trying to do is be the person that I wish I could have found when I first started, because there was not a lot of people out there. Yesterday I spoke to, there was someone that came to my house. He's a nurse. He works as a nurse in the hospital, but then he's a doctor back in Brazil. And he was telling me. He came in, he did the process of getting his RN license and all of that. I was telling him what I did, and he was impressed because he said, "You know what? I've been doing this. I've been working here 15 years and I've never heard of what you do." And I said, "Really?" And he was like, yeah.

We talked for a while and I said write down my phone number. I send him the presentation I've had that I did back to do the Medical Association to that group of doctors. Because still, sometimes I'm impressed by the fact that these opportunities are really not out there so people can see them. Even if they're in the hospital, if they don't find the right person, some people maybe they keep more to themselves and all that, but whenever I find a colleague and they tell me they're a foreign doctor or a doctor that is trying to do residency, I tell them what I do, because you never know. And also I'm always open to give advice or even not just give advice, also learn, because I can learn from the other person as well.

John: I know there's at least a thousand physicians and other clinicians who eventually will listen to this episode. And so, I'm going to tell you that if you have any linkage whatsoever with a hospital or with documentation, coding, patient care, and if you're actually practicing, of course, you're exposed every day, then this is an opportunity. There's a huge need. It's a good lifestyle, and you're applying your medical background. And so, what could be better?

And the other thing is I don't apologize about maybe having someone mention that you referred them to your employer, because guess what people? I'm talking to my listeners now. All my guests come on for free. They take their time, they share because they're professionals or physicians, most of them, and they want other physicians to prosper and succeed and be happy in their careers, not be miserable doing corporate style healthcare seeing 50 patients a day and working all weekend. The least you can do is if you contact Acuity that you mentioned Dr. Zouain's name just as a little bit of a bonus for taking the time to share his information with us. So I do appreciate that, Christian.

Dr. Christian Zouain: No, thank you. Thank you for allowing me to be on your platform.

John: Basically Christian is agreeing to be your informal mentor. And by the way, if you need a mentor in the future, I always remind my listeners too. A mentor is not someone you're going to sit down for three hours with and take up all their time. A mentor is someone you just go to, you send them a note, or you have a brief conversation, ask them a question, and boom, you just take their advice and move on. And then maybe reconnect again three or six months later. We're not talking about intense coaching here. We're talking about just networking and communicating and getting a little bit of free advice.

Dr. Christian Zouain: Absolutely.

John: All right, Christian. I guess it's time to go. I really appreciate you being here today. It's been fun. I've enjoyed catching up and learning from you, again, more about CDI since I was involved with it over 10 years ago. I'm sure we can reconnect again down the road. Again, thanks for being here today.

Dr. Christian Zouain: Definitely. Thanks a lot, Dr. Jurica.

John: All right. With that, I will say goodbye.

Dr. Christian Zouain: All right. Take care. Bye.

Scroll back to top

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

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

powered by

Disclaimers:

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

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

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

The post Follow This Plan to Establish a Solid Hospital CDI Career appeared first on NonClinical Physicians.

In today's episode,  John learns how a visually impaired physician overcame challenges during his training and career. Dr. Jeffrey Gazzara describes the difficulties he encountered and what he did to surmount them.

For the past five and a half years, Dr. Gazzara has been a general practitioner working in telemedicine. During this period, he has advanced to several managerial positions, such as Medical Director and Supervising Physician Leader.

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.

How This Physician Overcame Challenges

At the age of 12, Dr. Gazzara was diagnosed with retinitis pigmentosa, which ultimately resulted in the loss of his vision. His initial career plan was to specialize in neuromusculoskeletal medicine. However, during his residency, he faced several obstacles that made it impossible to continue, and was forced to leave the program.

However, Dr. Gazzara eventually found his way into telemedicine, which enabled him to apply his medical expertise.

Advice from Dr. Jeffrey Gazzara

When faced with a significant physical impairment such as his, he recommends that such physicians consider this advice:

1. Be honest with yourself;
2. Surround yourself with support;
3. Find a medical school and a residency who are on your side, and
4. Don't forget about nonclinical jobs.

Summary and Next Steps

Dr. Gazzara is focusing on exploring remote opportunities in the Pharma industry and other nonclinical positions that leverage his medical background. Many remote jobs already leverage technology and are potential options for visually impaired physicians such as him.

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:

• How to Overcome Adversity and Find Success in a Nontraditional Career – 253
• How to Overcome the Inertia in Your Career Search – 042
• NewScr!pt

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

Email Download New Tab

Transcription PNC Podcast Episode 298

How This Visually Impaired Physician Overcame Challenges to Achieve Success

- Interview with Dr. Jeffrey Gazzara

John: I was recently introduced to today's guest by a colleague, and I thought his story would be instructive. He's faced some unique challenges in his education and his career, and I think we can learn from them. So welcome to the show, Dr. Jeffrey Gazzara.

Dr. Jeffrey Gazzara: Thank you very much for having me, John. I'm excited.

John: Good. I'm glad you're here and we can connect today. I guess the easiest thing is to just get right into your story. So tell us about your medical education and your clinical work that you've done to this point and we'll just take it from there.

Dr. Jeffrey Gazzara: Yeah. I attended the Philadelphia College of Osteopathic Medicine in obviously Philadelphia, Pennsylvania. Graduated in 2016. After that I went to Michigan Mercy Health Muskegon in Michigan. It's part of the Michigan State University College of Osteopathic Medicine. I completed my internship there. Now the goal was to complete a residency in neuro musculoskeletal medicine. I am visually impaired. So, I did not complete my residency.

I came home to South Jersey in 2017 and found work in telemedicine. I've been working in telemedicine as a general practitioner for five and a half years. I offer acute services, urgent care services, mental health, prescription refills, some primary care services.

I've also been promoted to a number of administrative roles. So, currently I serve as the medical director for Axiva Infusion Centers in Philadelphia. I was also the medical director for a nationwide telemedicine company, and I've also been promoted to supervising physician leader for a nationwide telemedicine company.

John: Okay, very good. I'm hearing some success there. A lot of success in terms of working and taking care of patients and managing some things and being a medical director. But you mentioned that you didn't complete the residency. So, apparently there was a glitch there which I guess the question we would all have is, "Okay, you went into that and they knew who you were and what was going on. So what happened? Why did that not get completed?"

Dr. Jeffrey Gazzara: Yeah. And you mentioned earlier that I have a unique story and this is where it kind of comes into place. Again, I am visually impaired. I was diagnosed with retinitis pigmentosa at the age of 12. My biggest difficulties, I have lost a lot of my acuity, a lot of my peripheral vision. I just don't see images very well.

My plan was to go into neuromusculoskeletal medicine. It is the residency for osteopathic manipulative therapy. What we do in osteopathic manipulative therapy is we use our hands to diagnose musculoskeletal dysfunctions, to diagnose back pain, neck pain, chronic pain, and then you use your hands to treat those conditions. I thought that this was perfect for me.

When you're in residency, certain residencies require a rotating internship. I was still being asked to go through OB-GYN, surgery, emergency medicine, and obviously there's just things that I was not able to do as a visually impaired person. The program flagged it and said "We're not so sure you can continue." I immediately fought back. I reached out to a number of blind or visually impaired doctors around the country and it just seemed like they did not face what I faced. It seems like their programs worked with them. They knew their end goal was to be a psychiatrist, for example. That's just an example. And they were willing to help them to get to their end goal. For some reason, that was not the case with me. They let me finish my internship, but I did not continue the residency.

John: Got it. So did you then immediately proceed looking for work? Is that what happened after that?

Dr. Jeffrey Gazzara: Correct, yes. When I came home from Michigan, again, back in South Jersey, I completed my internship, which means I could get licenses, state licenses. Unfortunately, when you don't complete a residency, you can't become board certified. So yes, I came home, started looking at, "Okay, what can I do?" And that is how I found work in telemedicine.

John: Okay. Tell us a little bit more about the telemedicine work that you've done. It sounds like it'd be pretty straightforward, but apparently, you experienced some challenges along the way in that as well. So, let's hear more about that.

Dr. Jeffrey Gazzara: Sure. When you're not board certified, it is very hard to get jobs as a doctor. Plain and simple. I can't work for a hospital. I can't work for a large private practice. And it was news to me that even some of these large telemedicine companies, Teladoc, Doctor on Demand, Roman, Hims; they will not hire me. They don't even look at me.

Over the past five and a half years, the jobs that I have gotten are with startup companies. I've worked with a lot of clients. Again, I've had a lot of success. I received a lot of promotions with these companies, and in four separate cases really felt like, okay, this is my full-time job. This is going well. I want to be here for years. And in those four separate cases, they all collapsed. They all went under, and I was left pretty much unemployed. I always have little stipends here and there, little supervising jobs. And it got to the point, the last one that happened was earlier this year, 2023, and I just said, "You know what? I need more stability. I can't keep going through this vicious cycle."

John: Yeah, it sounds pretty frustrating. We were talking in preparation for this, and I've heard and didn't really understand that it's kind of hard to know with some of the telemed companies how stable they are. And lo and behold, either they stop paying you or they're no longer in business because there are just so many different startups. So it sounds like you have experienced that firsthand.

Dr. Jeffrey Gazzara: And the other thing is, yes, what you just said is correct. They're just professional like marketers and advertisers. I can't tell you how many times I'll get emails saying, "A high volume client, this is expected to be high volume, thousands of patients." And it just doesn't happen. This is like hundreds of times to the point where I'm just numb to it. It's like you don't believe it. Like I said, four times in the past five and a half years where I really started to pick up work with a very good client, but I've worked with over 26 clients in this time that just didn't pan out, never got going, collapsed. It's very frustrating.

John: Now, one of the things we were going to talk about today is sort of looking back and like you said, I think you've talked to other visually impaired physicians and so forth. Based on what you've gone through so far, do you have advice for, let's say, the pre-med student or even people in medical school in terms of what to expect, what to watch out for, how to be a little judicious maybe in selecting a field to pursue?

Dr. Jeffrey Gazzara: Yes. I thought about this a lot and a lot of it is really internal reflection. What could I have done differently? How could I have made this work a little bit better? I think there are four things that I want to highlight, and I could honestly talk about this all day and really have discussions with somebody. But the first thing was to be honest with yourself.

When we use the word visually impaired, that can be anything from blind to simply having poor acuity or poor peripheral vision. So, you have to be very honest with yourself in what can you do, what can't you do? And choose a medical specialty or profession based on that. And again, I really think I did that, but may have been a little stubborn in not just simply going into psychiatry because I wanted to pursue musculoskeletal medicine and I wanted to be kind of cavalier about it.

The second thing is to really surround yourself with support. And when I say support, I mean emotional support, but also support in people who are going to help you get accommodations and help you set up accommodations. So that's very important.

Third, now this is hard because again, I tried to do this and I thought the residency was on my side, but third would be to really find a medical school and a residency that are on your side. They know about your condition, they understand your end goals, and they're your advocate. They're your partner in this, they're going to help you get through this. Again, that's kind of easier said than done, but I think that is huge and it appears to me that that's how other blind and visually impaired doctors have navigated this.

And then last but not least, don't forget about nonclinical jobs. I have and still am considering a master's in public health. There's a lot of really cool stuff you can do with that. A lot of things that are very amenable to a blind or visually impaired person. There are jobs with pharmaceutical industry teaching roles. You can get into medical legal work, quality improvement, medical writing. So, definitely don't be afraid to consider those things as well.

John: Good points actually. Yeah. Because the important thing, at least the way we look at it on the podcast, the way I look at it, is you've gone through all that training and whether you're leaving because of circumstances like you or just fed up or burned out, whatever it might be, it's really helpful if you can just leverage your medical background. And there are different situations where you can do that and you're likely to get paid more that way. And you feel some satisfaction that you're still building a business or a career based on your training.

I'm going to go back to some of the four things that you mentioned. Just some things that occurred to me. I always think about the ADA and there are people that think, "Well man, that puts a lot of pressure on the employer", but it's led to a lot of more opportunity, obviously. And so, do you feel like the school or the residency was really complying with what the ADA required? I know I've heard recently that maybe there's limits on what it requires, of course, it's overly tough, but what do you think?

Dr. Jeffrey Gazzara: That's really interesting that you bring this up. Literally, yesterday, as I make my transition from clinical work, I was at a meeting yesterday, just networking and it was a group of blind and visually impaired people. And this was very, very helpful to me to have that camaraderie and to talk to other people who get it. And the idea of the ADA came up.

So what it gets down to is "reasonable" accommodations. When I was in med school, when I was in residency, I can honestly say they gave me accommodations. They did, but there's only so much you can do when somebody just can't see something, they can't see something. And so, that's where the reasonable comes in. And to get a little deeper into it, I reached out to attorneys. I wanted to fight for my career. And I never got the feel that these attorneys were like, "Oh, this is a slam dunk." Because it's so blurred. It's so he said, she said.

I hope that answers your question. It's very tough. The ADA stuff is very tough because of that "What is reasonable? How far do you help somebody like me in my situation when there's just things that they're not going to be able to do?" To be honest, I think that "human thing" to have done was, Jeff wants to go into neuromuscular skeletal medicine. He's not performing surgery, he's not delivering babies, he's not putting anybody at risk by using his hands and treating somebody. But that's just not what was done for me.

John: Yeah. Like you said, the ADA it's talking about maybe some concrete things that can be done within a reasonable price. To me, I might think, yeah, well, the accommodation might also be in the curriculum. That's not really physically trying to overcome some kind of impairment, but to change the curriculum sufficiently or to make some kind of accommodation in the curriculum, be knowing that like you said down the line you're not going to be doing that, you're not going to be applying for residency and neurosurgery or something.

Dr. Jeffrey Gazzara: Yeah. And what you just said, you hit the nail in the head. Because that's it, it was the curriculum and in each clinical rotation, there's a checklist of things. But then you're really getting into the AMA or the AOA and kind of adjusting it on their behalf. But I agree with you. That would've solved a lot of issues.

John: There's another thing that brings to my mind, which we've seen a lot of recently. And as far as I know, these positions that I'm going to reference weren't created because of necessarily physical ability or disability. We know we have hospitals and training centers, training institutions that have chief equity officers, and those are mostly out of race and gender and whatever to try and make sure that everybody has a chance.

But to me that would be conceptually the next step beyond sort of something like the ADA. It's like making these opportunities available to perhaps in the past, people that wouldn't have access. Now I know they're focused primarily on patient care, but I believe those chief equity officers and some of whom are physicians actually have to also consider the employees and make sure the employment is equitable and whatever that means. I just wonder if over the next five to 10 years as they start actually putting professionals in these positions of ensuring equity, if that might be something that someone with an impairment of their vision or other situations could benefit.

Dr. Jeffrey Gazzara: One thing I say, and when I was going through this whole process, I spoke to another man who's visually impaired. He's kind of said this as well. We're not back in the early 1900s where one doctor is serving a rural community and delivering babies, treating your sinus infection, removing your gallbladder. It's not like that anymore. Now, I'm not ignorant. There are still rural doctors, rural medicine doctors. But largely, they're not practicing everything. We now have specialists, and if you were to talk to your heart surgeon, I guarantee you they wouldn't remember the guidelines on pap smears and screenings and all that stuff. I argue that it's just kind of antiquated to discriminate against somebody because they can't do everything. I kind of look at it as absurd. Maybe in the next five to 10 years that will come to light. So we'll see.

John: All right. Getting back to you and what you kind of been focusing on, have you come to a point where you feel like you mentioned the MPH, do you have this thing narrowed down? You're still doing a lot of investigating or exploring in terms of what might be possible with the nonclinical side?

Dr. Jeffrey Gazzara: It's coming along. Still kind of looking at everything. Looking at pharmaceutical companies, and that has really opened my eyes to the different positions that are available. I'm still very interested in the master's in public health. But of course that will come with education costs. I've also, again, from networking with this blind and visually impaired group, there's a lot of opportunity in technology that's very doable for a visually impaired person. Unfortunately, it wouldn't be very related to medicine. And I'd hate to just put my medical degree aside, but it kind of gives me a sense of stability and gives me that peace of mind. So, I'm also considering that as well.

John: Okay. Well, it's definitely going to be a challenge, but of course, many of us have made that shift from clinical to nonclinical and found the right sort of niche that fit best with our skills, our abilities, and our interests. So, definitely we wish you the best of luck and in the next few years, we will be interesting maybe to follow along and get back together and talk about what you've accomplished in two or three years down the road.

Dr. Jeffrey Gazzara: Well, I appreciate that, and I would be happy to check back in and hopefully things are a little more stable and I'm working towards another goal.

John: Well, one thing that myself and the other basically career coaches that help physicians and mentors and even faculty at courses and so forth, what we all agree is that a medical degree is extremely valuable. So, there's got to be a way to really leverage that over time, because you just have certain knowledge and skills that those without that degree just don't have. So, if you can just find the right fit for you, I think you'll be very successful.

Dr. Jeffrey Gazzara: I'm learning that. You've told me that before. I've read some books. Just as an example, looking at these jobs within pharmaceutical companies, I don't have the correct, relevant experience. Maybe relevant, but not direct experience. However the organizational skills, the ability to triage, the knowledge of science, and pharmacology, the ability to just take on a lot of work. Those are things that I am going to leverage when I apply for these.

John: Excellent. Any last comments or just advice for just anyone who's starting their medical career that might have this or similar challenges?

Dr. Jeffrey Gazzara: No. Actually, I think I was able to get my thoughts out there. And again, I thank you for this opportunity because I'm always happy to talk about it and express my feelings and advocate for people. So thank you very much.

John: No, thank you. It's been a wonderful conversation. I appreciate the time that you took today to share this with us.

Dr. Jeffrey Gazzara: Thank you. Have a nice day.

John: Bye-Bye.

Scroll back to top

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

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

powered by

Disclaimers:

Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. 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 How This Visually Impaired Physician Overcame Challenges to Achieve Success – 298 appeared first on NonClinical Physicians.

Today's podcast guests are two physician entrepreneurs who enable doctors to earn income working as a remote medical director. 

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.

Find a Need and Fill It

Lev and Dan realized that the non-physician providers looking to start their own practices often need collaborating physicians. Even when not required by state regulations, such midlevel providers may need the relationship to meet health insurance requirements, or for easy access to advice about unusual medical presentations.

This relatively new company worked diligently during its first year to develop a database of close to 1,000 physician remote medical directors. And it has developed its model to reduce the risk to collaborators and providers.

The process of connecting the two includes collecting pertinent information from each party. Then Doctors for Providers develops a contract that spells out the services to be provided by the remote physician. The latter must be licensed in the state in which healthcare services are being provided.

Become a Remote Medical Director or Collaborating Physician

Lev and Daniel described why this remote, part-time position can be an excellent way to generate additional income for physicians:

1. It does not involve a heavy time commitment. 

2. It's a remote job, similar to practicing telemedicine.

3. Being a remote medical director generally presents a lower risk of being sued. 

4. Doctors for Providers makes monthly payments, so there is no billing involved for the remote medical director. And the business relationship usually runs for a year at a time. 

Summary

This is an interesting new way for physicians to earn extra income doing a straightforward job. It is convenient, involves no travel, and poses a lower liability risk. And serving as a remote medical director in this way is a way to gain experience that will open doors to other jobs.

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

Links for Today's Episode:

• Doctors for Providers Website
• Email for D4P: admin@doctors4providers.com
• The telephone number for D4P: 1-855-DOC-4-PRO (1-855-606-1686)
• How to Secure a Rewarding Medical Director Position – 088
• How to Find a Top Remote Nonclinical Career – 188
• NewScr!pt

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

Email Download New Tab

Transcription PNC Podcast Episode 240

Why Part Time Collaborating Physician Is a Great Job - Interview with Drs. Lev Grinman and Daniel Cousin

John: By now most of you know that I enjoy interviewing physician entrepreneurs, especially when it involves creating an opportunity for you to generate income in some new way. And that's why today's guests are here. Hello Dr. Lev Grinman and Dr. Daniel Cousin.

Dr. Lev Grinman: Hello, John.

Dr. Daniel Cousin: Good afternoon.

Dr. Lev Grinman: I'm happy to be here.

John: Awesome. I'm glad you're both here. I've done maybe three interviews with partners or people that are doing something together, but it'll be fun. We're going to learn a lot. My audience is a lot of physicians looking for side gigs, full-time jobs, different things, and a lot of them are entrepreneurs too. I think they can learn from you both. Lev, we'll start with you. Give us a little bit about your background and then we'll go over to Dan.

Dr. Lev Grinman: Sure. I am a board-certified neurologist and sleep specialist. I live in the state of New York. I am entrepreneurial, I guess by spirit. I have started a couple of different companies. I have a home sleep testing company that's based out of New Jersey. I am also part of a couple of different ventures related to intraoperative monitoring, which involves monitoring of the brain and spine during surgeries. My latest venture is what we're going to be talking about today is Doctors for Providers. And that's a company that matches collaborating physicians with advanced level providers, such as nurse practitioners and physician assistants. And we do this in all 50 states.

John: Okay. Dan?

Dr. Daniel Cousin: Sure. Tough act to follow that one though, I have to say. I am a radiologist by trade and I'm also somewhat entrepreneurial spirit. I started trying to get involved with various nonclinical consulting opportunities. And then I started teaching some of my colleagues about these opportunities and getting them involved to ranging anywhere from medical legal work, plaintiff defence work, acts reconstruction, determinations and authorization work, and gatekeeper work. The list goes on. There's so much that doctors can do outside of their day-to-day clinical practice to really give them a large breadth of fun. And Doctors for Providers is one of those things.

John: Awesome. Yeah. I'm pretty much intrigued by this. Like any new business, it's solving a problem and it seems like it's a problem that needs to be solved. So that's a good thing and it makes it likely to succeed, I guess, if you guys do everything right. Maybe I'll go back to you Lev, and tell me exactly what prompted you and Dan to start this?

Dr. Lev Grinman: Yeah. What we realized is that there are a lot of providers out there who are looking to start their own practices or businesses in healthcare. And many of them are very well qualified, but they still need physicians to be their collaborators, to oversee what they're doing, to review some portion of their charts, to consult with during the month to make sure that they're providing optimal care.

And personally, I've had nurse practitioners come to me and say, "Hey, I'm doing so and so. I'm doing televised visits with patients and for a company. And I need a collaborating physician." I've had nurses come to me or NPs come to me and say, "I'm doing visits to patients' home on behalf of a company. And for this, I also require a collaborating physician and I just don't know where to find one." And I had this light bulb moment where I said, "You know what? We got to help these folks. We got to help find collaborating physicians." Doctors may not be aware that this need exists and doctors may not be educated to know what to do if they want to be a collaborating physician. And that's where we started.

John: I guess I'd like to hear what steps you took once you saw that there was a need, what was the process you followed it. There's this chicken-egg thing of where do you start? How did you put it together? So, I'd be interested in hearing that.

Dr. Lev Grinman: We started slowly, we started putting out little advertisements for actually on both ends. We started looking for providers online who were interested in finding a physician, and we saw that there was a big need online as well. People were looking on search engines. People were looking on Google. People were looking on Indeed as well and other job search engines. Then we reached out to physicians through our own personal connections. And in other ways we started telling doctors, "Hey, if you're interested in being a collaborating physician, talk to us, become part of our database. Let's do this together."

And so, gradually we started accumulating names of doctors who have become collaborators with us. And now we have a database of probably close to 1,000 people. We vet our doctors in the sense that before any collaboration is to start for the first time, we talk to them on the phone. We make sure that we look at their credentials. We even have introduction with the provider, with the physician on. That's how we grew our line of business as far as the physicians are concerned. And gradually we started doing more advertising on the provider side and that's how businesses grow and there's a lot of demand. And so, we're trying to meet that demand.

John: All right. There's some kind of marketing to try and get interest and get the physicians lined up. It sounds to me a little bit like the initial need came from the nurse practitioners and the PAs saying "I don't know where to find a doctor." There's probably doctors out there. So, was that maybe a little bit easier piece getting the physicians lined up first?

Dr. Lev Grinman: I think we wanted to line up both sides first to make sure that there wasn't a rate-limiting step. We didn't want to have a lot of demand and then not have the doctors to provide and vice versa, we don't want to have doctors sitting around promising them that they're going to be making all this money and not having actual customers.

I think we went at it sort of equally on both sides and started building it independently from each other, but really in parallel, so to speak. I think that's why we've become so successful is because we were able to grow, with the demand that we've seen by being able to provide the right physicians at the right time and figuring out how to get to these physicians, where to find them, how to talk to them, how to get them interested, et cetera.

John: Now, how did the two of you get together to work on this project? You're in different specialties. I think you're in different cities. But what brought you guys together?

Dr. Lev Grinman: Dan, do you want to answer that question?

Dr. Daniel Cousin: Yeah. Well, we're both very handsome dudes and we just naturally gravitate toward each other. No, we both were in several companies before this and we were doing nonclinical consulting together. This was Lev's brainchild, and he graciously invited me to join based on my experience in recruiting doctors and trying to convince them why they need to do these fun things and not just day to day. But it's been great. We're very good business partners and we compliment the other person. For example, that's a very nice shirt, Lev.

Dr. Lev Grinman: Thank you.

John: Well, it's good when you complement one another, because partnerships can go sideways if the personalities and the thought process is not in parallel and aligned. So that's good. So, where are you finding these doctors? I'm obviously well aware that there's physicians out there thinking, "Oh gosh, I need to find something else to do part-time to supplement while I look for another job or get the heck out of clinical medicine, ultimately. So, how do you find these docs?

Dr. Lev Grinman: There's a couple of different ways. One of the things that we've done as we've grown, we've obviously added a lot of different staff members and people have now specialized in doing different things inside the company. And we have folks who are basically committed to recruiting physicians for us almost full-time. And that is important if there's a project that requires our collaboration for which there's an immediate need, and if we may not have the perfect physician, we'll go out and we'll actually look for physicians, we'll call their offices. We'll basically stalk them. We'll find them and we'll kill them. We'll get them to talk to us, we'll explain what's going on and why we want to talk to them.

Sometimes we actually go out and try to find specific physicians. For example, we have a lot of need for psychiatrists in the state of Texas. It's a big state. There are limitations as to how many providers one physician can supervise at once. And so sometimes our physicians max out, we want to go out and find other qualified people. We'll be calling and we'll be Googling and going on different search engines trying to find doctors that way. We also have running ads on the internet to actually recruit doctors basically saying, "Hey, are you interested in an opportunity outside of your general practice? If you may want to talk to us, go on our website, check us out, and register with us."

It's just general advertising and actually specifically recruiting doctors. And sometimes we will also use our personal connections, talk to people that we know in healthcare, talk to people in our sister company, stands IME company. We will sometimes talk to somebody and say, "Hey, I know you're already doing IMEs or expert witness work. Would you also be interested in registering for Doctors for Providers?"

John: Makes good sense. When you have this kind of thing where you're matching people, I've seen it in others that have tried to start locums' companies, or they've tried to, I don't know, match up people doing different things. It can be tough because one side of the other might be really dominating and you can't fill a gap. And then like you said, you lose your clients.

I guess I do like to talk a little bit about just being an entrepreneur and starting a business. Maybe we can take it at a level higher in general. Just basic things that physicians should know if they're going to start a business. What are the basic steps? Should everyone have an LLC? Should everyone have an attorney? Just a little bit of advice for physicians who are thinking of trying something.

Dr. Lev Grinman: It depends. I guess it depends. If this is a business that's not a true medical practice, some people do prefer LLCs because they're more protected in case of a lawsuit. Our company is an LLC. I think one of the biggest pieces of advice that I would give is just don't be afraid to try something, don't be afraid to fail.

I think the big mistake that a lot of people make that want to go into business, but never do is the fear of doing something wrong. Business just as everyday life is based on a lot of little decisions and not necessarily one big decision that will change your life forever. You have to be able to be ready to make a lot of little decisions every single day. And that's very true when you're first starting a business. There's going to be a lot of decisions that you make that you've never made before, but you should not be afraid to make those decisions.

And then realize that if one decision that you made wasn't the right one, you can always go back and say, "You know what? Let's start over and go in a different direction." I think that's the most important thing is to be able to move some of the needle forward and say, "Let's start something. Let's try it this way." And if it doesn't work, you fail quickly, you move it in another direction.

John: Now, the businesses that both of you have done, whether together or individually have they generally been kind of bootstrapped? Occasionally I'll interview someone who's gone through some private equity firm and had to borrow half a million dollars or something to get the business started. But most of the people I interview are really just building it themselves.

Dr. Lev Grinman: Well, I've been in a couple of businesses. One was a big company into which I sort of joined in and then grew within that company. And that was a private equity back company. Another company that I was in also started out with investors initially, and then could only grow because there were investors, the company wasn't profitable initially. I do find that that's certainly the way to go in some instances, but you always have to remember that you have less control and less ability to make certain decisions when there's people watching over you.

I think if you are able to finance the company yourself, if it's not a huge financial commitment, then I think you should, because then you don't have to answer to anybody. You're also not getting financially diluted or paying back loans for many years to your investors before you're able to take home some money.

With Doctors for Providers, we were fortunate enough knowing how to start companies previously, we were able to finance it ourselves and we were able to grow it organically. Fortunately, it's been successful, we're at a point where we're actually a profitable company. And so, I think we're very proud of that.

John: Dan, how about you? Same experience mostly starting from scratch and just kind of bootstrapping as you go?

Dr. Daniel Cousin: Yeah. I think any good idea that is going to have proof of concept on a small scale that may not require a huge financial overhead, until you're ready to do so once there's proof of concept. But I think also a lot of people, like what Lev was saying, maybe expect everything to work the first time.

I think part of the fun of starting a company is actually the troubleshooting. I heard Gary V say that once. Anyone can come with an idea, anyone could do all these things, but what really is the important part is the trial and error, troubleshooting day-to-day. That's the fun of building a company. There are so many people in life who just didn't have the recorded skills, like who started McDonald's? The Kroc guy, I think his name was. It just happened to all work out and he was ready to capture it. All your life experiences, no matter how many great ideas or whatever come together sort of at the same time cohesively at that moment.

Dr. Lev Grinman: I just want to add onto something that Dan was saying. I think that it's important to do a little bit of early trial of your idea. I think that's a great concept. I read recently that the most important thing that determines whether or not your company's going to succeed in the short term and sometimes long term is whether it's the right time and whether the demand is there and whether the product is applicable to what's going on with your consumers.

You don't have to commit all of your capital, all of your time to something. But what we realized with Doctors for Providers, we started doing it on a small scale initially, but we realized that the demand was there and that the process works. And that's when we really started to really dig in and invest more money and resources into the company because we knew that the concept works.

John: All right. Well, I'd like for the next 10 or 15 minutes to get into the actual nitty-gritty of Doctors for Providers with the idea to imagine that there's just physicians listening to us right now. They're like, "Okay, I've got some spare time or I need some income" or that kind of thing. Maybe we could start with why this would be a good idea for a physician to consider, because they can do locums or they can do telemedicine or they can do some other things. Why do this?

Dr. Lev Grinman: There's a couple of different reasons. Number one is, it usually is not a very large time commitment. Most of collaborations will be simple chart reviews, perhaps as I said earlier, something like 10% of chart reviews for the practice. There may be occasional questions, but they're usually far and few in between. And usually, if the provider does require more assistance, they should let us know ahead of time. And then the doctor's compensation can certainly go up because of that.

It's something that a lot of times could be done during your free time or off hours or on the weekends. It can also be done from the comfort of your home or your office. It can be done from anywhere. It's a remote job. It's very similar to just practicing telemedicine. And so, in addition to that, most doctors are able, the ones that like doing it, usually do a few collaborations at the same time. And so, the income potential goes up as you do more of the collaborations at the same time. And some doctors, especially those who are licensed in multiple states, the opportunity to do more collaborations goes up significantly.

John: Of course, for the collaboration you have to be licensed in the state with whoever you are collaborating with, I'm assuming.

Dr. Lev Grinman: Because even though you are technically not seeing the patient as their physician and you're not establishing a direct doctor-patient relationship, when you're reviewing the patient's chart, you are practicing medicine, you are viewing confidential information. You are in some ways potentially establishing a doctor-patient relationship because you may have comments that influence that patient's care. So, you have to be licensed in the state where you're doing this.

Dr. Daniel Cousin: Yeah. And I just wanted to add to that. We have some doctors who just see how amazing this is and just keep asking us, "Do you have any more collaborations?" They want to get licensed in other states so they can max out those collaborations that you can do because each state has a limit. It's really just recurrent passive income. Like Amazon Prime, compared to how much you have to work per dollar in your daily job, this is much less than that.

John: Well, I'm sure people are going to say, "Okay, well, what about the malpractice and the liability?" Who covers that? That's a potential expense.

Dr. Lev Grinman: Right. We always ask the providers to add the physician to their malpractice policy, which I think is the right thing to do. I think it minimizes issues if God forbid there was a lawsuit, if you're on the same team as the provider. All our research has so far shown that the risk of getting sued is actually quite low compared to what you're doing day-to-day as a physician, meaning being a collaborator puts you at much lower risk for being sued. But again, having said that, the malpractice should always be provided by the provider's malpractice carrier.

John: Got it.

Dr. Lev Grinman: There's no added expense to the doctor. We do have a couple of doctors who have decided on their own to get malpractice policy add-ons that will cover them as either a medical director or collaborating physician. And that's fine. But most of our doctors do not have that.

Dr. Daniel Cousin: And I would just add and say that in this country, of course, anyone can get sued for anything, but the risk is so much less than every one of the patients that doctors see every day in their actual practice. And if you go to a hospital as a patient, for example, if something goes wrong, you're probably not going to sue the medical director or whoever it was that credentialed with the insurance companies because you never really saw that person. You could. So that's what we're doing here. The collaboration, it would be a paper-thin lawsuit.

John: All right. I'm going to pause here because I have a couple more questions, but I want to make sure to inject how they get a hold of you right here, because some people don't to the end.

Dr. Lev Grinman: Sure. The website is doctorsforproviders.com, or you could even use the number four, doctors4providers.com. That'll work also.

John: And then there's some answers to certain questions there or at least an overview. And then they basically at that point, contact you through that website.

Dr. Lev Grinman: Register directly on the website. There's a registration button, if they click on that, it'll bring them to a link that will allow them to register with us. It'll answer certain basic demographic questions, licensing questions, and then they would automatically enter our database. They will then receive a welcome email from us, acknowledging that we have received their registration. And if they have any further questions, if they want to speak to us, our phone number is on the website where they can email us at admin@doctorsforproviders.com and somebody will call them and walk them through the process.

John: Excellent. Okay. Now, back to my questions. We'll reiterate that at the end as well and I'll put it in my show notes. So, nobody should worry that they won't have access to that information. I'm just trying to think how this works. Do I have to make a commitment to be available seven days a week for a month at a time? Or can I do a week on - a week off? What are the constraints on what I can do?

Dr. Lev Grinman: Essentially the way the collaborations work is it's a continuous collaboration, meaning that the doctors will be paid every single month that the collaboration is active. So, it's a recurrent source of revenue for the doctor. They will be paid typically at the very end of the month when they complete their first collaboration. And so forth, it'll be every 30 days.

There's really no reason why anybody should start and stop. It's a continuous process, but it's having said that, again, the doctors most of the time don't have to do this during their regular work hours. They can do this on weekends. They can do it on after hours, in the evenings, et cetera. So, it's going to be a continuous thing, but again, it can be easily fit into somebody's schedule.

John: I take it then most of the people that might be doing this, maybe they have a practice, might be using a service that has a practice. They're there during the day. Maybe they have a PA or NP working evenings or weekends when you're not there. So, you need someone to cover those periods of time or is it for the independent PAs and NPs, they're working solo.

Dr. Lev Grinman: Actually, it's mostly for the independent PAs and NPs. Say you're an NP and you open up your own practice and you don't have a physician on-site. The doctors that we're recruiting, the doctors who are going to be the collaborators are going to be collaborating with the nurse practitioner remotely. The nurse practitioners in many states don't even need a physician, they can practice independently, but in about half the states, they still need a collaborator or the doctor to review their chart notes and things like that. So, it's mostly for providers who are doing it full-time. And the doctor is technically overseeing them full-time, but again, at a much-reduced capacity.

John: And I know the other question that might come up until they've had a chance to look through your website is, "Well, let's see what is my relationship to you and to them? Am I getting paid by you, by them? Am I signing a contract?" How does it actually get set up?

Dr. Lev Grinman: The doctors do sign a contract with us. We sort of serve as their agents, and we will collect payments from the providers on their behalf. Therefore, this is good for the doctors because it ensures that they will be paid every single month. There's never a break for getting paid. And we have to make sure on our end that we get paid from the providers. The relationship is we are serving as the matchmakers but also their agent in the sense that we introduce them to the providers and we collect the monthly fees from the providers on their behalf.

John: It seems like a pretty straightforward process.

Dr. Lev Grinman: It is. And there's no fees for the doctors to join us. You're only going to get paid by us.

Dr. Daniel Cousin: Yeah. And they get the benefits of being a contractor, which is another perk actually, if you're otherwise an employee only, and you can can't deduct anything. But I'm not a tax financial professional.

John: Yes. But that's true though. It's pretty much general knowledge that if you're doing some independent work, then that gives you a little more opportunity to do those write-offs. You have to talk to your own accountant, of course, as you said. This has been good. Anything else you think would be helpful for us to know, for my listeners to know if they're thinking about reaching out and doing something like this with you?

Dr. Lev Grinman: Definitely just go ahead. If you have any questions, even if you're not sure that this is something you want to do, go ahead and reach out, email us, call us. We'll talk to you. You can talk to Dan and I also, and we'll answer any questions or any concerns that you may have. This might be a good opportunity for you if you're considering it.

Dr. Daniel Cousin: Yeah. And I would also add that, I think it's great professional development as well, because you're immediately a medical director. You can put that on your CV or whatnot. It's also very rewarding because just like in academics, whereas physicians like the self-fulfilling experience of teaching a resident or someone to become a full-fledged successful professional, it's similar in that. You're helping to spread care through these entrepreneurial advanced practice provider businesses. It's really the trend in medicine, there's not enough doctors to go around and provide care to everywhere that needs it in this country. So, this is something that's really fostered by governmental policies, and you're helping to contribute to spreading more care than there otherwise would be.

John: Yeah. Every place I've ever worked there's a shortage of physicians for sure. In Illinois, I'm not sure it's as easy for an NP or PA to start out on their own, although I know of some clinics, but in other places, it's pretty common. They definitely need those collaborators. All right. Well, this has been fun. I've learned a lot. I think our listeners will have something to think about and if they're interested, they obviously should go to doctorsforproviders.com and check it out. I'll have links in the show notes. I just want to thank you both for being here today and sharing this interesting venture.

Dr. Lev Grinman: Thank you so much, John. It was our pleasure.

Dr. Daniel Cousin: Thanks for having us. Good time.

John: You're welcome. It's been my pleasure. Take care. Bye-bye.

Scroll back to top

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

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

powered by

Disclaimers:

Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. 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 Why Part Time Remote Medical Director Is a Great Job – 240 appeared first on NonClinical Physicians.

Dr. Nkeiruka Duze achieved balance in her professional life by balancing her roles as medical director and concierge physician.

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.

Medical Director and Concierge Medicine

Dr. Duze splits her time equally between clinical and non-clinical work. She is a physician advisor to the revenue cycle team and the medical director of value-based arrangements and risk adjustment coding at a large medical center.

Her primary responsibilities include coding education, liaison to payer teams who oversee value-based arrangements, appealing outpatient denials, and physician coder consultant. 

In her clinical practice, she recently transitioned from traditional outpatient practice to concierge medicine. As a result, instead of managing over 1500 patients, she is now responsible for 180.

Here visits are now twice as long, and it is much easier to get to know each patient very well. She is beginning to share patient coverage with another part-time concierge physician in her group.

Satisfying Balance

Dr. Duze enjoys her work as a medical director and concierge physician. She is helping her practice run more efficiently, document care better, and bill more accurately. She also continues to provide high-quality medical care to her panel of patients.

Summary

Nkeiruka was beginning to feel the effects of a high-volume practice. However, by replacing some of her clinical duties with nonclinical management work, and the remainder of her practice to the concierge model, she is much more fulfilled in her job. The feelings of burnout have resolved. And she is caring for patients in more rewarding ways.

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

Links for Today's Episode:

• Dr. Duze's LinkedIn Profile
• American Academy of Professional Coders
• Dr. Duze's Email Address:ncnwoko@gmail.com
• NewScr!pt

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

Email Download New Tab

Transcription PNC Podcast Episode 234

Achieve Beautiful Balance as Medical Director and Concierge Physician

John: Like others before her, today's guest sought to overcome burnout and find more balance by splitting her time between nonclinical work and her outpatient practice. But what I find so fascinating is her practice itself transformed from traditional to concierge medicine at the same time. I think that's super unique. Hello, Dr. Nkeiruka Duze.

Dr. Nkeiruka Duze: Hi, John. Thank you so much for having me on today.

John: I'm glad you're here because I think your story on the one side, it's like a lot of other people's stories in terms of trying to fight burnout and move forward in your career, but there are just some parts to it that I think are quite unique. Listeners, you're going to learn a lot today.

Dr. Nkeiruka Duze: I hope so. And thank you again for having me.

John: Oh, you are welcome. Like we usually do on the podcast here, tell us a little bit about your background, your education, the clinical background, and then I want you to end with what you're doing at this moment, but then we'll fill in the gaps later as I get into some more questions.

Dr. Nkeiruka Duze: Absolutely. In terms of my education and clinical background, I have a first degree in biology, which I got at Texas Southern University in Houston, Texas. And from then I moved on to Indiana University School of Medicine, where I got my medical degree, and subsequently to Virginia Mason Medical Center in Seattle, Washington, where I did my internal medicine residency.

In terms of what I'm doing now, post all my training, I really have two jobs. I have my clinical and my nonclinical roles. And my clinical role is as an outpatient primary care doctor. I still see patients in the clinic. And then my nonclinical role is as the physician advisor, as well as a medical director for value-based arrangements and risk adjustment coding at a large medical center in the Seattle area.

John: Very nice. Now, a couple of things, I'm going to just jump in here as we go through, because when I hear someone like yourself tell me what you're doing as an internist, then I automatically assume you're a hospitalist. Because just so many of the internists that I know they either do one or the other, of course, but your practice really has been mostly outpatient, right?

Dr. Nkeiruka Duze: Exclusively outpatient since finishing my residency training.

John: See, I could tell from the very beginning that you're always going in a slightly different direction than the majority of people.

Dr. Nkeiruka Duze: Well, I guess I don't like to follow the crowd.

John: Now you were doing just practice for a while, correct?

Dr. Nkeiruka Duze: That is correct. My transition into including the nonclinical job into my role or my practice started a few years ago, actually. As you mentioned, I was experiencing burnout and I started to explore what are some nonclinical opportunities out there that I could do while still practicing medicine, but then just kind of cut down my clinical practice. That is when I started to look into the possibility of becoming a physician advisor.

John: Yeah. It was very similar to what I did a long time ago. I thought, well if I can work an hour or two doing something else and use that to cover the cost of working less in the clinic that would be a good exchange. Because when you're doing the nonclinical, there's really no liability, there's no call. You're going to just put your hours in. It's a good way to segue and see if you like it.

Dr. Nkeiruka Duze: Absolutely. And I can tell you that comparing what my life was like when I was a 100% clinical practice compared to now, which is where I do 60% clinical practice, 40% nonclinical, the difference is night and day for me in terms of just overall wellness and quality of life.

John: Now, apparently, do you like doing the physician advisor work when you first started that? Was it enjoyable?

Dr. Nkeiruka Duze: Oh, absolutely. When I was exploring nonclinical positions to help combat burnout, the reason that I was drawn to the physician advisor role is that I've always had an interest and fascination with billing and coding. That was kind of what drew me to that particular nonclinical role.

John: Most of us think when we think of a physician advisor, or thinking like making sure that the procedure was done, was legitimate or it was a good indication for like utilization management, I guess I would call it. Sometimes you call it benefits management, but there are others. You mentioned the coding piece. Were you actually helping people with coding at the same time?

Dr. Nkeiruka Duze: Great question. Not until I actually got the role as a physician advisor. I think my journey has been somewhat unique in that when I was looking into the physician advisor role, certainly, I say it was mostly kind of a utilization review type position. But I learned though that the job of a physician advisor, it's actually more robust than that. There are so many things that you can do. Not only the utilization review but quality and performance improvement, appeals and denials management, and then suddenly with the coding and documentation support and education. I latched onto the coding support and education piece.

I think it was easy for me to do that because the medical center where I work already had an established physician advisor program. And I guess more accurately, I would define it as a clinician advisor program because it has physician advisors, but also has a pharmacist. And that particular program also had an outpatient physician advisor as well.

John: Now, when you were talking there about the way that these things overlap, it really is a good point because the core thing about that is for whatever reason, you're doing a review of a case.

Dr. Nkeiruka Duze: Correct.

John: And like you said, it could be a quality review. It could be just strictly a documentation and coding review, especially on the inside inpatient too, but the outputs the same thing, or it's utilization and they all overlap. And the coding effects, utilization because if you don't have the right documentation, you don't have the right code. Well, you're not going to order the right test, at least in the eyes of a reviewer. It's just interesting. And then you can kind of figure out which of those three and maybe there are other aspects that are the most interesting.

Dr. Nkeiruka Duze: Yeah. And even though I studied mostly with the coding support and education piece, I've been able to expand my responsibilities or roles since then. And that's the other beauty of a physician advisor role is that you can do as much as you want. And you can go as broad as you want. It just depends on what your vision is.

John: I suppose it depends on the organization and the size of it. And like you said, it had a well-established program already. So that helped.

Dr. Nkeiruka Duze: That helps a lot.

John: I've talked to physicians and I find this remarkable, someone recently said, "Yeah, I was the first physician advisor at this large hospital or this large system". I thought PAs have been around for 40 years. You're the first, it's kind of crazy.

Dr. Nkeiruka Duze: Absolutely. Well, in my case, I wasn't the first. Our institution was not.

John: Now, has that role evolved since you started? How long have you been doing that now?

Dr. Nkeiruka Duze: I've been doing the physician advisor role for two years. I actually started the role on January 1st, 2020. But prior to that, I already spent a lot of time looking up the coding certifications, preparing, just basically trying to get the knowledge to help myself in practice until a position opened up where I could actually be a physician advisor.

John: Now, at least in the past some systems have trouble finding part-time physician advisors, they usually look into their medical staff or the physicians that are already aligned with them, unless they're doing something where they're getting something that's a freelance or a third party to come in. But at the same time, it doesn't mean we shouldn't prepare for it. You did some things, I think to kind of say to you up for success. I know you got some additional certifications. Where did that come in?

Dr. Nkeiruka Duze: Great question. As I was looking into this nonclinical space and wanting and setting my sites on a physician advisor role, like most people, when you want to do something, you don't know where to start, you go to Google. So, I started off with Google and I basically came across through my search, and when I was thinking about coding and billing the American Academy of Professional Coders, AAPC. And it's from that organization that I earned my certified professional coder, which is the CPC certification. And then subsequently more recently my Certified Risk Adjustment Coder Certification.

John: Did you get the certifications after you had already started as a physician advisor or one before, one after? How did that timing go?

Dr. Nkeiruka Duze: Great question. With the CPC, I had already started preparing for it before I got the job. And then with the CRC, I did that while I already got the job.

John: I'm not sure I've ever heard of the AAPC. It would be odd that I hadn't, considering how many people I talked to that do revenue cycle and utilization management and so forth. I had talked to people from the ACDIS. Now that's more for coding. I'm sure the nurses that worked at my hospital were very familiar with the AAPC. Were there many physicians that have gotten that certification to your knowledge?

Dr. Nkeiruka Duze: Great question. I personally only know two-physician coders, but I suspect there are many more that I just don't know. And the two that I know were within our system. Even when I was already thinking about it, and at the time I got the job, I learned at the time that both of the outpatient physicians in the program also had a CPC certification.

John: Okay. It's funny because when we had consultants to our hospital to do utilization, that was mostly inpatient, but they were involved and they were certified whether by the AAPC or some other organization.

Dr. Nkeiruka Duze: Yeah. I do know, John, that the AAPC also has a CIC certification, which is a Certified Inpatient Coder certification.

John: That's probably what I had come across. All right. So you did that extra, you're working hard. Did that completely resolve everything you were looking to do as far as your burnout, your transition, your balance in life?

Dr. Nkeiruka Duze: Absolutely. I would say though that when I took on a nonclinical role it made a huge difference in terms of balance and quality of life. But then when I also made the transition from the traditional practice of medicine to concierge medicine, that took it again to another level where I really feel, and I'm fortunate to be at this sweet spot where I feel like this is really what I've been waiting for, for a long time to have this type of balance.

To give you, and your audience a little bit of a clearer picture of what I mean, when I was in the traditional practice of medicine, I had about 1,700 patients in my panel. And then with concierge medicine, which I'll expand on a little bit later in the show, I imagine, if I were still a 1.0 clinician, the maximum number of patients I could have would be 300, but I'm a 0.6 FTE. So the maximum number of patients I can have in the practice is 180 patients. It's a huge difference between 1,700 patients to 180 when you think about whether it be the MyChat messages or the phone calls or the lab results, or the notes you have to dictate, or the number of patients you have to see in a day to keep your practice healthy.

So, it's a very, very vast difference. Making the change to a nonclinical role, and then also making the change in the same year to concierge medicine, I think was really what made me get to this point where I can say, "You know what? This is what I've been hoping for and wanting for a long time."

John: I have a couple more questions about that whole thing, that whole transition. Now you said 1,700 in the basic panel before the concierge, right?

Dr. Nkeiruka Duze: Correct.

John: Now, was that the full time or the 0.6?

Dr. Nkeiruka Duze: 1.0 is 1,700. When I was in traditional practice, but if I had remained 1.0 when I made the switch to concierge medicine, then my maximum would've been 300 patients. But I'm a 0.6 so my maximum number of patients is 180 because 1.0 is 300 patients in our concierge world.

John: And I think you have, I don't know if it's completely unique, but when someone tells me, well, I'm going to do concierge medicine. I'm like, oh, wow, you're going to have a big transition because you're going to have to tell all your patients, and they're going to have to decide if they want to pay you that way. And you're going to have to start your own business. But you're talking about doing concierge medicine within a system that supports doing concierge medicine. You have to tell us how that works and why that even exists?

Dr. Nkeiruka Duze: Well, very great question. I would say it may be unusual now. Maybe then it was unusual. I don't know how unusual it is now, but I would say for sure that the medical center that I work for really pioneered concierge medicine in that kind of a setting, in that concierge medicine practice has been in existence for over 20 years. I believe it started in 1999.

But I do know that at least one other medical center in the area now does concierge medicine. I believe the Mayo clinic does concierge medicine. I suspect that it's not as unusual now, but it must have been then when the medical center that I work for began this journey into concierge medicine in 1999.

John: Now, I think that's very forward-looking. I'm not an expert on concierge medicine, but when I think of it, when I was in practice and I started reading about it, it was really something entrepreneurial. Individual physicians, small groups were doing it and saying, "Look, we're going to get outta the rat race. We're going to have a core group of patients. They're going to pay us as we go. And that's it. We're done with Medicare and all that".

Then there were these franchises that started too, where okay, well, you can sign up and we'll do this turnkey, but I had never actually heard of a system, although it made sense because I think even at the hospital I was at, they thought, well, should we consider doing concierge medicine within our physician group? Now, they only had like a hundred physicians. This wasn't a massive group, so I don't think they really seriously thought about it. But yeah, it sounds like where you've worked has really been on the cutting edge of that, especially for a large system.

Dr. Nkeiruka Duze: Absolutely. If any of your listeners are part of a large medical center that does not have a concierge practice, this might be your opportunity to suggest settling with their support, because I can tell you that there is a huge desire or need. A lot of patients are really seeking out this type of service.

Because we have currently in our concierge practice a waitlist at all our locations. I know that this is something that patients want. Patients want more time with their doctor, they want easy access. They really want to be able to have a doctor that can spend a lot more time with them, get to know them, and not really just be feeling like they're in a factory churning out patients. A lot of people will pay for that service. I believe that if you don't have it in your medical center, it's your opportunity to maybe suggest it and be someone at the forefront to help your organization kind of tap into this model of practice.

John: Yeah. That would be great. If our listeners could get that expanded into other organizations. Now I'm going to quiz you. You went down to your 180 patients. This is the thing that really amazed me about concierge practice. Now if one of your 180 patients pages you, texts you, contacts you, there's a pretty good chance you're going to actually remember who they are. Is that true?

Dr. Nkeiruka Duze: Oh, without question. Without question. Yeah. Because you only have 180 people that you're taking care of. You'll know not only who they are, but you're also going to know the husband or a wife's name, you're going to know the kids' names. You're going to know their pets' names. You're going to know them so intimately because you're going to have a lot of time to spend with them.

I'll give you an example that when I was in the traditional practice of medicine, for a long time, the appointment slots were 15 minutes or 30 minutes. 30 minutes for an annual check-up, et cetera, or multiple concerns. Otherwise, a routine visit would be 15 minutes, but over time in the desire to address burnout, the schedules became 30/30. You have 30 minutes per patient. I thought that was really great when the organization did that.

To the concierge model, in our practice a regular appointment is an hour, whereas your annual check-up is an hour and a half. You really get to know people intimately. You really get to support them in a more well-rounded way. Because if you're busy, you may not have time to hone in on something that they said about what it's happening at home or in their family, which ultimately, will impact their overall health.

I had a few patients follow me when I made the transition and of course, I did pick up new patients. For those that followed me from the traditional to the concierge practice, they also comment on the difference being night and day. And then I personally, in terms of on the other end, I feel like this is really what I had envisioned when I thought about becoming a doctor. It's to really be there for my patients and have time to take care of them.

John: Okay. The bit of advice that I'm going to garner from that whole thing is when you're looking for your first clinical job, work for someone that has the possibility of a concierge program in it, even if you're not going into the concierge.

Dr. Nkeiruka Duze: Right.

John: Oh man, that sounds so good. And the thing is traditional medicine, you mentioned it before that patients did have these long waits and everything, and a visit under traditional terms is usually pretty unfulfilling for the patient because they're in a hurry. They feel like they haven't even told you anything. And you're like, I got to go. We'll deal with one thing today.

Dr. Nkeiruka Duze: Another patient is waiting.

John: And then, of course, the physician isn't willing to treat something on the phone or telemedicine because they're not getting paid.

Dr. Nkeiruka Duze: Correct.

John: Now you just flip the whole thing around. I'm assuming you take care of a lot of patients just by email and texting.

Dr. Nkeiruka Duze: Well, we certainly have the ability to do that, to just have the patient call on your cell phone and have a conversation but I really believe in the value of actually having people come into the clinic. So that way you can naturally just have the focus time to talk about things and then also examine them. I always encourage my patients that if something's going on, let's make an appointment, and then suddenly if you're not certain, we'll talk through what the right thing is to do.

But suddenly there's some mild symptoms, people might express over the phone that it doesn't really warrant them coming in, but I still try to encourage people to come in. Not that it is required, but that is just what I found as the way that I find medicine fulfilling is to have that either face-to-face or virtual connection time set aside on my schedule for me to focus solely on you and any concerns that you have.

John: Now, that makes good sense. I'm just thinking of the one that calls in and says, well, I have athlete's foot, can you call something in for it? Or I have conjunctivitis. Well, I need to have you come into the office for that because otherwise I can't get paid.

Dr. Nkeiruka Duze: Correct. Yes. Basically, as you already alluded to, with the concierge practice the members pay a fee monthly, so regardless of whether or not you call me or see me, every month you're paying a membership fee. And when I do see you in the clinic, I'm still billing your insurance for any services that I provide. That membership fee truly is for the access that you just described, where you can call me on the phone and say, "Hey, I have athletes' foot can you send me an anti-fungal medication?" I'm like, "Sure. Yeah." So, when it's other things or multiple things and I tend to just have people come in. That's just my style.

John: There are a couple of other little background things we need to know about how this happened. First of all, it wasn't the type of thing where you were getting burned out, you just turned to the owners of the system and said, "I would like to do concierge medicine. Is that okay? Can I switch it over tomorrow?" There are some constraints on it. I think from what we were talking about before, in terms of who can do that, when they can do that, all that.

Dr. Nkeiruka Duze: Absolutely. Yeah. In order to make the transition, first, there has to be availability. There's got to be a spot that is opened up either because maybe someone is retiring or because they're expanding the program. And then in being able to be part of the concierge program, you have to have a certain number of years of practice. You have to have high patient satisfaction scores, et cetera. They're looking for a particular quality of physicians to join the practice.

John: And then the other piece, which I thought maybe you're going to go into since you're doing it part-time, that presents a little bit of an issue, doesn't it?

Dr. Nkeiruka Duze: Great question. Temporarily yes. To give a picture of what my schedule is like, usually, I'm typically in the clinic Monday, Tuesday, and Friday, and then my nonclinical days are Wednesday and Thursday. In the meantime, if a patient needs something on a Wednesday or Thursday, they can suddenly call my cell phone or send me a message to the patient portal. And then I respond during my admin days or my nonclinical days. But that is slated to change in the future because we're going to have a practice partner join me and we will both be then the first two real part-time concierge medicine docs. And on my nonclinical days, she'll cover me and vice versa.

But I must tell you, John, even on my nonclinical days I probably like on a busy day maybe get three or four emails or between emails and calls, maybe four, because again, we're talking about 180 patients. It's a small pool of patients. I'm not really getting a lot of people reaching out on the days that I'm not in the clinic. And if my patients do have to be seen on the day I'm not in the clinic, one of the other concierge medicine doctors is able to see them.

John: Well, it sounds like it's almost like a job sharing, but then again, if you're available, even when you're not officially on, it's not that big of a deal to respond.

Dr. Nkeiruka Duze: Correct.

John: All right. Well, where are things going? Where are things going? Are you going to do this for a while? Are you looking at expanding your nonclinical or do you want to hold things as it is for a while?

Dr. Nkeiruka Duze: I'm looking to expand my nonclinical role. As I mentioned earlier with the physician advisor role, you can do as much or as little as you want. And I've been focused a lot primarily on the outpatient, whether I be with education or outpatient denials and things like that, but I'm now hoping to expand to do more in the inpatient setting. When I think about where I'm going, I'm really going to be expanding my nonclinical role. And because it's concierge medicine as opposed to traditional medicine, I actually see myself being able to keep my 180 patients, and then just expanding my nonclinical role without having to cut back any further on my clinical role.

John: Yeah. Nice. It'll be nice if that works out. I remind people they ask me, "Well, should I quit doing clinical completely or not?" You could do a lot of executive positions without doing any clinical, but I remind people that the CEO of the Cleveland Clinic was doing clinical, the CEO of Mayo, the CEO of a lot of massive, huge organizations still do an occasional clinic day, just to keep that going. And this is even a different version of that. We'll have to wait and see. I want to right circle back with you in a few years and see what's going on.

Dr. Nkeiruka Duze: Absolutely.

John: What advice do you have if someone that was in the position that you were in where you are kind of getting burned to out and just kind of frustrated. Any specific words of advice you'd have for my listeners?

Dr. Nkeiruka Duze: Absolutely. And thank you for asking. I think three things that I would encourage you to consider. The first is whether you are a hospitalist or an outpatient doc, I encourage you to explore nonclinical roles. And the reason for that encouragement is that the nonclinical roles not only add variety to your career and your life but also, I think it's the quickest way to actually get that work-life balance that most of us desire. Because with clinical practice, as you know, when you see a patient, whether it be for 15 minutes or 30 minutes, there's a lot of work that has to be done just for that one visit, whether it be the messages you're going to get from the patient about that, or the lab results that you're going to have to respond to.

Essentially, I feel like full-time clinical practice is challenging and it's hard to have work-life balance if you're in full-time clinical practice in my humble opinion. My first encouragement is that no matter what you're doing, inpatient, outpatient definitely explore nonclinical roles, even if you're going to do that as a 0.1 or 0.2. Just to kind of give you a little bit of a break. So that way you can have more work-life balance. Life is too short.

The second piece of advice I would give is to be flexible. What I mean by that is two things. Be ready to pivot if you need to, when opportunities arise. And then the second is if you already have an opportunity, be ready and flexible to expand if needed because when opportunities come up if you don't tap into them, guess what? Somebody else will. Even if you've set your sites on something, then you see something else that looks interesting, that becomes available, consider it. You just never know. You might like it. My second piece of advice is to be flexible.

And my final advice would be to seek out mentors that are doing either what you hope to do or something similar to what you hope to do. Because I think that we can really learn a lot from each other. I've learned a lot from people along the way, like reaching out cold calls to people and saying, "Hey, can I just have 30 minutes of your time just to ask questions about what you're doing or how you got there?" I encourage people to at least seek out somebody, at least a person that can hopefully mentor you, as you make that transition of hopefully adding a nonclinical role to your career. And I'm suddenly happy to support or answer questions to anyone that needs that support. And I'm certainly happy for any of your listeners, John, to email me if they had questions. And my address is ncnwoko@gmail.com.

John: I got that written down. I'll put that in the show notes. And you are on LinkedIn and they can just go to LinkedIn and look up your name and they should find you. That's how I found you on LinkedIn. I had already been referred to you, but I did find you there.

Dr. Nkeiruka Duze: Yes, I am on LinkedIn.

John: All right. Well, this has been very interesting. I could go on asking you more questions, but I think we're going to have to go here because we're running out of time. I thought there are many unique things about your story, the certifications are not totally unique, but you proactively pursued that. And I think we sometimes forget that there are those kinds of things out there and the opportunity to switch to concierge and how much that helped. And if anyone can emulate that in some fashion either to get it established or expand it at your organization, that's another great way to balance the two.

Dr. Nkeiruka Duze: Absolutely.

John: All right. Dr. Duze, thank you so much.

Dr. Nkeiruka Duze: Thank you so much for having me, John.

John: It's been my pleasure. And I hope to catch up with you again down the road. With that, I'll say bye-bye.

Dr. Nkeiruka Duze: Thank you, John. Thank you so much.

Scroll back to top

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

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

powered by

Disclaimers:

Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. 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 Achieve Beautiful Balance as Medical Director and Concierge Physician – 234 appeared first on NonClinical Physicians.