medical director Archives - NonClinical Physicians

To Be a Better Physician Leader

John Jurica — Tue, 03 Dec 2024 14:30:38 +0000

Thoughts on Physician Leadership – 381

In this podcast episode, John shares his transformative journey from clinical practice to becoming a Chief Medical Officer, offering valuable insights for physicians considering leadership roles in healthcare organizations.

His experience highlights how physicians can leverage their natural leadership qualities developed through medical training while acquiring essential new skills in management and organizational leadership.

The transition from clinical practice to executive roles requires strategic learning through professional organizations, advanced certifications, and continuous education in management principles. Most importantly, John emphasizes that successful physician executives must master three core attributes.

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The Art of Total Immersion in Healthcare Leadership

John's approach to leadership development centered on complete dedication to learning and growth. Like his earlier experiences in medical training, he found that total immersion was key to mastering healthcare administration. This meant joining professional organizations like the American Association for Physician Leadership, pursuing additional certifications, and continuously expanding his knowledge through various educational opportunities.

This commitment to learning helped him transition from a practicing physician to an effective healthcare executive while maintaining a better work-life balance than clinical practice often allows.

Building the Bridge from Clinical Excellence to Organizational Impact

The transition from clinical practice to leadership requires a fundamental shift in perspective and approach. John emphasizes how physicians must evolve from individual contributors to organizational leaders. This means developing new skills in strategic planning, team management, and organizational development.

The reward comes in the form of broader impact – while clinical practice allows physicians to help individual patients, leadership roles enable us to improve healthcare delivery systems that serve entire communities.

Core Attributes to Be a Better Physician Leader

Three essential qualities are key to succeed as a physician executive:

Accountability,
Optimism, and
Humility

John emphasizes that accountability means following through on commitments and addressing challenges directly. Optimism drives organizational change and inspires teams, while humility ensures leaders remain open to learning and value input from all levels of the organization. These attributes combined with physicians' natural leadership qualities create a foundation for effective healthcare leadership.

As healthcare continues to evolve, the need for physician leaders becomes increasingly important. John's journey demonstrates that while the transition from clinical practice to leadership presents challenges, it also offers remarkable opportunities for professional growth and a broader impact on healthcare delivery.

Summary

Physicians who are interested in transitioning to healthcare leadership roles can access the resources through the American Association for Physician Leadership (AAPL) and the American College of Healthcare Executives. These organizations provide essential certifications, educational opportunities, and networking opportunities for developing executive capabilities.

Success in this transition requires the same dedication that drives clinical excellence and a commitment to continuous learning and professional development.

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Podcast Editing & Production Services are provided by Oscar Hamilton

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 381

To Be a Better Physician Leader

John: Now I spent many years in management and leadership roles in the hospital setting, which culminated by working as a chief medical officer or CMO. And while moving from part-time physician advisor and medical director to chief medical officer, I took advantage of educational opportunities at the Medical College of Wisconsin, the American College of Healthcare Executives, the American Association for Physician Leadership.

And I'm a certified physician executive and a fellow of the AAPL, and I hold a master's in public health. So today I want to revisit the issue of physician leadership, encourage you to consider moving in that direction, and offer some advice about how to get started. So let's get to it. I think that I'm going to be talking about being a physician leader today, and I'm going to start by sharing my story about total immersion.

What do I mean by that? You know, this is something we do when we're trying to learn something new. So all of us have gone through medical school and residency for the most part. And of course that was pretty traditional type of education. And I found that once I got into practice, everything was going well. I was building my practice. I was working at the hospital to see my patients, nursing homes and in the office. And eventually I started to free up a little bit of my free time and became interested in learning other things that are important, like things like protecting your income, how to invest, maybe trying to find some ways to stay healthy, physically fit. What I've tended to do when I began to get interested in something like that was to just to totally go in a hundred percent and bury myself in information to help me learn about that. So that's what I did after about five years in practice. I realized that I did not have in my little three-man practice, we didn't have an IRA, we didn't have a 401k or anything like that. So my partners and I got together and we started talking about how we could set that up. And then I thought, well, I need to learn about how I'm going to invest because all these concepts were kind of new to me, you know, investing in the stock market, mutual funds, individual stocks, dividends, non-dividends, paying stocks, money market accounts, things like that.

And so I just went all in. I mean, I read everything I could possibly read. I listened to podcasts about the topic. I bought books. I subscribed to certain magazines. And so it was kind of a total immersion into the concept of investing and planning for the future financially. And I even ended up starting investment club with some friends I got so interested in. And in fact, still over 30 years later, I'm still involved in that investment club. Well, as I started dabbling in being a physician advisor and then a medical director, similarly, I didn't really know what I was doing. I mean, basically I had learned a little bit earlier in my life by being the chief in my residency and participating in a bunch of committees at the hospital and becoming the chair of a committee. And then I learned about how meetings worked and how minutes worked and all that kind of thing. But it was a pretty superficial exposure. So I thought, well, I've got to get involved in learning more about physician leadership and management. So that's when I started joining these organizations.

And reading about it, starting to subscribe to different podcasts, newsletters, magazines that told me a little bit about it. That's what I want to talk to you about today. Before getting into that, I would say that I really do promote the idea of getting into hospital management. If you're already in the hospital as a hospitalist or an ER doc or anesthesiologist or a surgeon or any of the other specialties that spend at least 20, 30% of their time or more in the hospital, I think it's a great place to work because you're providing very intense medical care. And in my opinion, we need more physician leaders in these settings. Most hospitals are run by people with an MBA or an MHA. They may have never done anything clinical.

There's some exceptions to that, like nurses who end up being in leadership positions. And they follow a path very similar to many physicians. In other words, they start out clinical and then they become a manager or they become a director. And actually there's a significant number of hospitals that are run by nurses, probably many more run by executive nurses than are run by executive physicians. And so again, I would encourage you to look at this path. The thing I like about it besides that it's intellectually stimulating and really it's something that any physician can do if they're interested is that it's a way to really help more patients. When I was seeing patients, I was dealing mostly with the healthy, worried well people came in with minor problems, really, that probably didn't really need a visit. Yes, you've got a lot of the screenings we're doing and health maintenance, but most things that come in are acute and they're relatively trivial, and then once in a while you see a really sick patient, get them admitted, and nowadays, if you're a family doctor, of course, you probably won't even be going to the hospital. The thing is, when I started getting into management, I found I was helping patients in new ways.

And at the same time, my lifestyle was better. The more I did in the hospital as a medical director and then ultimately as CMO, the less time I spent in the office, the less time I spent on call, and the more work-life balance I had. And it was something also where when you're in residency and early practice, you're challenged quite a bit because you're still learning and taking on new responsibilities, but then it becomes a little bit routine. And so when I started doing more and more in leadership, I really enjoyed learning more about how to manage, you know, learning about HR, learning about leadership and strategic planning and communication styles beyond those as a physician. And so there's a lot to it. And it is quite interesting. Let me talk a little bit about that. Is this right for you? Yeah, I don't think becoming a manager, director, or CMO in a hospital is necessary right for everybody. Because you have to be willing to take on some new skills, learn some new ways of doing things. I think there's some areas in particular that you really should try to strengthen and learn as you decide to do this. But let's think about how we should look at this and let's reflect in review some of the things that we should consider before making this move. So first of all, let's reflect about our motives.

You know, I have to admit that when I started getting into the physician advisory role, that was mainly to just make a little extra money. It was almost like moonlighting, but it was really non-clinical. But even as I became medical director, part of it was that I was really getting a little bit burnt out and I was trying to exchange hours of care as a medical director for hours of work as a primary care physician. So ultimately what that meant was I was getting paid on almost an equal basis for the medical director duties, but it didn't involve any call. And so over time I was cutting my call responsibilities back. And at some point later on, I actually hired my own hospitalist to start taking my in-house call. So if the motive is just because you're burnt out and fed up with medicine, that's probably not a good motive and it won't, you know, you'll end up a year or two later in the same situation, five years later, still burnt out and not happy. But if at least you have an interest in management and interest in learning new things, you have an interest in a specific area of management that might be fun, like when it's quality improvement or, um, CDI, clinical documentation integrity or informatics or, you know, one of the things we really normally get involved with as a medical director, then by all means, think about proceeding.

Reach out to your colleagues. If you've been out for a few years, you're bound to have some colleagues that are doing at least part-time work, and you may have even gone through residency and fellowship with someone who immediately went into a non-clinical role, although possibly related to their specialty.

Reach out and just talk to people, get their feedback and find out what it's like to make this transition, and also what it's like to be in a full-time management or leadership job. Read everything you can about it. Of course, when I say read, that includes online, that includes books. A lot of books written about this, a lot of articles written. When I say read, I also mean maybe listen to some podcasts like this one or others.

Go to websites and try and get a take on that. Then there are some formal places where you can go and you can register, meaning you should register or enroll with some of these professional societies. Of course, the one that I think is the best and probably most appropriate for those thinking about doing leadership roles and advanced management positions is the American Association for Physician Leadership. Now I've been a member of the APL for over 30 years, taking many of their courses. I've really been involved heavily in fact, that was the chair of the CCMM, which is a community that oversees the CPE designation and the requirements and the work that's done to apply for that recognition. So I've been heavily involved with it. I am not promoting it. I'm not paid, you know, but I got myself involved because I believe in what I did. It is always looking for new ways to expand and grow and provide more services to its physician members to become great leaders.

Now, I do believe that physicians are natural leaders and I don't say that they're born leaders because I think a lot of the leadership skills that they develop come as a result of their medical training. There's a lot of characteristics that we have that we're either born with, nurtured while we're young, and then are nurtured further as we go through our training. I'm going to talk a little bit about that in a minute.

These are the kind of, I guess, attributes that I see that physicians have. Obviously, the intellect is there, very focused. Most physicians I know are quite accountable. They've got the ability to handle complexity, so they can think through problems well. Their communication skills are usually pretty darn good and are usually improved while they're going through training. Now, a lot of that is with communicating with small teams and with patients and with patients' families and so forth. So sometimes you've got to learn a different type of communication as you get into leadership, but very good perseverance and patience and keeping on problems, not easily distracted. Decisive is another good attribute that physicians generally have that's encouraged and grown during their training. They don't tend to be wishy-washy or indecisive. So that's good. And a lot of people are prone to that indecisive nature because they're not confident. Commitment, altruism, and a people orientation, now, doesn't mean that we're not sometimes introverts. In fact, I think probably the majority of physicians or at least a little more than 50% are somewhat introverted. So it's not like they feel comfortable in a large group giving a presentation necessarily, although most of us practice that during our training. But we went into medicine because it's a combination of science and also the health professions helping others, that kind of thing.

So it makes for fairly natural leader. A thing is though, physicians do have to evolve. They have to add new skills and new attitudes to really be an effective leader at the level of, an executive in a hospital, which is what I'm really promoting here today. So we need to, if we tend to be a little reactive, because we're in the mix of things, if something happens, we respond immediately, that's fine. But when you're in a business setting, when you're in an organizational setting, a big organization, whether it's a hospital, large pharmaceutical company, health insurance company, anything like that, you really need to be more proactive. So you need to kind of migrate from reactive to proactive when looking at things. When you're managing large groups of people and people in big organizations, you need to be proactive. So that's something you have to develop. You need to stop.

Or I would say add to being a performer or a doer to being a planner. You know, we don't necessarily go into our office seeing patients planning what we're going to do for each patient before they show up. A lot of times we wait till they show up and then they, we assess them and then we make a plan, but to run an organization and have two, three, four, five, 10 people reporting to you, running a budget of 1 million, 5 million, 20 million, 50 million then you need to plan and you need to be proactive. You need to kind of move from tactical to strategic thinking. So this is, again, you know, we're talking about annual goals, maybe a two or three year strategic plan. These are fairly common to do when you get to the VP level or higher in a big organization.

And we need to go from being deciders to delegators. We have to feel comfortable. If you're like, I'll tell you, when I was, I don't know, I'd say, I wouldn't say at my peak, but there were times when I had six or seven directors reporting to me. And my main goal was to help them develop their goals every year and maintain some kind of tool that we could track their performance.

And then encourage them and push them to meet their goals and exceed their goals. But I really wasn't there to tell them how to do their job. I was really there more to keep them honest and to make sure they were pitching in and to also coordinate with other senior leaders to make sure that all of our directors and managers were working together collaboratively.

And working for the benefit of the whole organization, not for just their department. So when you delegate, that means you can't really look over the shoulder and everything they are doing. But you have to feel comfortable with tracking their performance and their progress and meeting their ongoing goals and performing according to your expectations. We have to migrate from being independent, working independently to being more participative. So working on a team, not a team that we're necessarily always leading, we might actually be just the co-members of a team. For example, for the first few years that I was working as chief medical officer, I always thought my team was the directors and myself, the directors that reported to me and myself, area they had the utilization management, the quality, the medical staff office. And then at times I also had always had the pharmacy and then sometimes radiology and lab. And it was more about, like I said, quality and performance. And we were still responsible for budgets, of course. I came to find out later, or I came to realize later, that my real team wasn't all those people reporting to me.

Like I was the coach and they were my team. My actual team were my co-VPs, the people on the senior management team. There were 10 of us, if you include the CEO, usually the CFO, the COO, the CMO, CMIO we had for a while. We had the VPs for HR, VP for lab, VP for maintenance and facility and so on and so forth.

And that was really our team, but we spent a lot of time bringing that team together as a cohesive unit. And where at that point, the way we looked at it was, we are there to make sure that our departments, that level of team are actually working together to achieve the organizational goals, not to just make sure that their particular department looked good or had good numbers. So that was an interesting evolution that I observed. And we're usually practice focused. And in a hospital, if you have several hundred or a thousand physicians, depending on the size of the organization, of course, we're all focused on our own practices, our own groups. And once you move into the executive level of hospital management, then you really have to have this organizational focus. And basically you're trying to get everybody on the bus, you might say, or everybody rowing in the same direction on the boat. And it's a little different than just running a small business like a practice or even a large business is a multi-specialty practice or single specialty practice. Or even if you run your own surgery center, that's even there, you start to get a little different feel than running just to practice. And then you need to really go from, you know, patient accountability, which is important in terms of you're accountable for the healthcare of the patient, which even in a hospital executive position you still are, but it's organizational accountability and it's different. You're no longer a lone wolf. You're working as a unit with others at your level.

And you have to learn to be accountable to one another and to the CEO. So let's focus on three of these aspects in a little more detail. So that accountability part is pretty darn important. And basically one way to define that is that you, you do what you said you would do when you said you would do it. And sometimes we'll add and the way you said you would do it. Now, in some things that you're saying you're going to do, you're gonna get done, you don't really care how it gets done. You know, if you're supervising some director, you say, look, you told me you're gonna do X, you're gonna meet this budget, and by six months from now, you're going to have this project halfway completed, fine. Just make sure you do what you said you would do when you said you would do it.

On occasion, you want to add the way you said you would do it. So sometimes the way you achieve something is important. Obviously, it has to be quite legitimate and honest and straightforward and not underhanded in any way. But as a leader, sometimes you don't want to worry so much about the way things are done. If they have a goal and the outcome is important, and as long as we're being authentic and we're being honest, then, you know, there are multiple ways to achieve the same goal. But again, if you want to quote this, do what you said you would do, when you said you would do it, the way you said you would do it, if you want to be accountable. And this could be to your team or to your boss. And when you don't achieve that, then you need to make amends.

So, the other thing that's really important is if you committed to something, if you promised to do something or just even agreed to some goal, you need to learn to apologize appropriately when it's not achieved. And that's what accountability is. And that means that, and this came up a lot in our senior management teams, we would meet and say, "Hey, you know, two weeks ago, this was what you said you were going to do. And you said it was going to be done by this meeting. So what have you got to show us?" And if one of us didn't have it, it meant that we had to say, "well, you know what I did, I committed to doing that two weeks ago. And I admit that I have not completed that. I don't have a reason or a good excuse was bad planning, timing and so forth on my part." So that's the first step is just admitting your mistake or your failure to comply with your own commitment, explain how you will rectify it. "I will get that done. In fact, I'll have that report that you needed by the end of the day tomorrow", commit to a deadline, which I did there.

That's basically it. Now, when you're being accountable and when you're stating that you did not meet the goal that you said you would meet, didn't complete what you said you would do, we never phrase it like this. Like, "I'm sorry" if, like, let's say that you were going to communicate with somebody and you ended up doing, you know, saying something that was not accurate.

You don't say, "well, I'm sorry if what I said bothered you. I didn't mean to bother you or to insult you." That's not really an apology because you're putting the if sentence in there, we're just putting it on them. Like if they took it the wrong way, you just say," I'm sorry, I offended you and I won't do that again," or in this case, to be accountable.

"Yes, I made a commitment. I did not meet that commitment. I'm sorry about that. And I make a recommit myself to completing this project by the end of the week. I will not fall behind in this project again." So you have to really commit to and not repeating your mistake. So accountability is a big thing. And a lot of physicians, I mean, we're accountable to our patients doing the right things and not doing something we're gonna get sued about or get reported about. That's one level of accountability. But when you're in a team for a large organization, you all have to make your commitments, stick to them and be ready to admit your mistake if you don't and move on. The other thing is it has to do with optimism. I think it's easy to become pessimistic and angry in healthcare.

You can, you know, you get, you feel like you're overwhelmed sometimes you're burnt out. And when you get that way, then you start to lash out, start to act negatively. You start to become resigned and that's not good for a leader. A leader cannot be depressed and resigned and feel like they have no control and they have to maintain a certain level of optimism that they and their team and the organization itself can solve important problems, can move forward successfully, and should not get that resigned feeling like nothing can change and we're not making any progress. Leaders with that attitude really don't last very long at all. So you have to avoid the negativity, defeatism, apathy, resignation, all those things I've mentioned.

You should embrace positivity, be kind of faithful, have faith, be inspired, be easy to encourage and encourage others. You know, always have hope and expectations that things will continue to get better because we're all working together to make things better and more successful and more responsive to our patients and to the community. So optimism is really important. If you can't...

If you can't be accountable and you cannot be optimistic, you really can't be a good leader. Then the other thing is humility in spite of all this. You're learning a lot, you're taking ever increasingly important levels of responsibility, working your way up to the C-suite, maybe even eventually become the COO or the CEO. But you have to have humility because again, you don't do anything by yourself. You should avoid being self-righteous if you'd fallen in that trap in the hospital and the operating room and the delivery room. If you become condescending, a part that goes back to being burned out or overwhelmed, but you have to stop that. You have to maintain some humility.

Continue to always be curious, meaning welcoming other people's opinion. When you're in a leadership role, it's not that you're making all the decisions without input from your peers and from the people that are reporting to you. You should focus on listening more than talking. You know, just because you're the chief medical officer doesn't mean when you're with your directors or with your teams, it's so-called that report up to you, they have the frontline observations. They have the frontline knowledge of what's actually going on day to day. You have to remain curious, you have to listen first. And then if there's a sort of a solution that's self-evident and a decision has to be made about, are we gonna invest money here? Are we gonna share personnel?

Are we going to try and find other ways to meet a goal? Then you might have to make that decision, but you need all the information first and that means being humble. I guess what I want you to just realize is that leading is a skill that builds on what you learned during your medical training, but it involves listening and inviting others to embrace your vision. And you know, you think about when you're a leader, you're always on stage and your patience, dedication, and integrity become a role model that are key to recruiting others to join your organizational journey as a leader. You're trying, like I said earlier, to get everybody on the bus that's going to debut. I mean, it's a metaphor, but it's one that one of my CEOs used all the time. It's like, we're all going to get on this bus and we're going together.

We're all going to hop in the boat and row in the same way, in the same direction. There's no sense us all being in the boat. We're all rowing in a different direction because then we're not going to move. And so really one of the core responsibilities for a leader is to inspire your team and to get them to want to join, not be forced to join.

Bottom line is if you are successful and you get 90, 95% of people to row in the same direction and hop on the bus that you're taking to debut, then if there's five or 10% that can't do it, won't do it for whatever reason, then they should be left behind. That means they should go find a job where they're going to be happier and more productive. So if those are the kinds of things when you're listening what I just talked about sound like fun. Well, then by all means, that's an indication that you should consider strongly to start your leadership journey. You've probably already been on it. If you're a physician and you're probably asked to do things and take on responsibilities where you're not just pitching in as a member of the team, but you're leading part of the team or leading the entire team.

Maybe you're working on temporary committees to solve a problem. Maybe you're chairing a committee that's really important. Or maybe you're on the board of a hospital or a public health organization, hospice, something like that. If you like that and what I've talked about today sounds like a fun, like I said, then go ahead and take off and continue your leadership journey.

I'll be coming back to talk about more issues related to management leadership in coming podcasts in addition to interviews with more that are also doing non-clinical jobs outside of leadership.

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Many of the links that I refer you to, and that you’ll find in the show notes, are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you, that I have personally used or am very familiar with.

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

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Health Insurance Medical Director Is Still A Popular Job

John Jurica — Tue, 19 Nov 2024 12:16:19 +0000

Interview with Dr. Neetu Sharma – 379

In this podcast episode, John sits down with Dr. Neetu Sharma, who recently transitioned from a demanding nephrology practice to a health insurance medical director while maintaining a virtual clinical presence.

In sharing her story, Dr. Sharma describes the challenges of managing patients at six hospitals, taking weekend “call” duty covering up to 120 inpatients, and the added stress of COVID-19 that led her to explore alternative career paths, ultimately finding fulfillment in utilization review.

John and Neetu discuss the realities of working as a medical director, debunking common misconceptions about insurance companies. And they explore how physicians can achieve improved work-life balance.

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.

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.

Inside the Role: What a Health Insurance Medical Director Does

The transition to medical director involved a structured 9-to-5 remote schedule, reviewing cases for compliance with CMS guidelines, and ensuring appropriate resource utilization. Dr. Sharma debunks the myth that insurance companies focus solely on denials, explaining how the role involves complex case reviews, peer-to-peer discussions, and collaboration with clinical teams.

Before starting her primary duties, the insurer provided comprehensive training. Neetu quickly developed the skills to handle cases from regular inpatient admissions to complex long-term acute care situations.

Creating Your Unique Path: Blending Tradition and Innovation

One of the most interesting aspects of Dr. Sharma's transition is how she's created a hybrid career model. While working as a medical director, she maintains clinical skills through virtual practice and weekend calls, launched an online wellness program, and is expanding into nationwide virtual care.

This approach enables Neetu to leverage her expertise while maintaining a better work-life balance.

Summary

Dr. Sharma's journey, which included certification by the American Board of Quality Assurance and Utilization Review Physicians and training with the Institute of Functional Medicine, offers a blueprint for physicians seeking similar career changes.

For those interested in learning more about utilization review or career transitions, Dr. Sharma welcomes connections through LinkedIn, email (staff@zealvitality.com), or her website, where you can schedule a call to discuss your career path.

Links for today's episode:

Podcast Editing & Production Services are provided by Oscar Hamilton

If you liked today’s episode, please tell your friends about it and SHARE it on Facebook, Twitter, and LinkedIn.

Right click here and “Save As” to download this podcast episode to your computer.

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 379

Health Insurance Medical Director Is Still A Popular Job

- Interview with Dr. Neetu Sharma

John: It's been a long time since I interviewed a physician who recently left traditional clinical medicine to start a career as a medical director for a health insurance company. But I recently connected with someone on LinkedIn who's doing just that. And she's also maintaining a clinical practice and mentoring physicians and doing some other things. Dr. Neetu Sharma, welcome to the podcast.

Dr. Neetu Sharma: Thank you, John, it's my pleasure to be here.

John: I'm really happy to hear your story. This is going to be interesting. I think it's good to have someone who's recently made a transition and because there's a lot of physicians listening who are thinking or have been thinking about it for a long time and haven't done it. They can get some good inspiration from you. So, yeah, just tell us a little bit about your background and your medical education and clinical practice and things that were going on before you made a shift.

Dr. Neetu Sharma: Yeah, thank you for having me here, John. I have been listening to your podcast and got a tremendous help with my career. So thank you for doing that. And I wanted to give back to your community. So that's why I'm here today. I did my residency in Detroit with internal medicine, then went to University of Cincinnati for my fellowship in nephrology.

And I have been Michigander, I've been in Michigan for a while. I returned here for my clinical practice after my training. And I was with a private practice for the past eight years, but I have been in clinical practice for about 15 years going. And I was, to be honest, getting to the point where I was getting burned out. As a nephrologist, you have to go from clinics to the hospitals, to dialysis clinics. So it's a lot. And I was on call every other weekend and when you're on call, you're seeing, pretty much I was covering six hospitals and seeing about 120 on average patients on that weekend call. And I wasn't getting any day off after that. And you come back on Monday tired.

And so, it took a while for me to look into different options. And last year I actually ran into somebody who was doing utilization review for insurance plan. And he kind of gave me an overview how happy he was, how he had a control on his life. Then I thought it's interesting to know, and I started digging more into it. And I happened to listen to a few of your other interviews about utilization review, got a tremendous help from that. And I became a member with the American Board of Quality Assurance and Utilization Review of Physicians, got certified with them last year. And then started my journey with interviews with the health insurance plans and ended up with a major health plan starting this year as a medical director.

John: Very good. Okay, I'm going to go back to the whole beginning of this. To some extent, how long was it that you were feeling kind of overwhelmed and kind of, I don't know, overworked before you decided, like in your mind, you said, "You know what? I'm definitely going to make a change." Obviously if you signed up to do the education, that was really concrete, but what was that timeframe like for you?

Dr. Neetu Sharma: John, COVID changed a lot of things and it was around 20 when the COVID hit. I got pay cut. I was working overtime. I was taking care of patients in the hospital. I was completely burnt out to the point that I started thinking there shouldn't be a better way of practicing medicine. Especially in nephrology, I can tell you that other nephrologists might relate to it that we deal with very complex patients who are having life-threatening disease.

And we lost a lot of patients during COVID and that was quite depressing. I felt like I wasn't making a difference in the lives of these patients and there was no job satisfaction. At that point, I started looking into other answers, functional medicine, and I became a fellow with the Institute of Functional Medicine, got some training in that. I decided that I want to transition and do a holistic approach to help my patients. And then at the same time, I started looking for utilization review jobs too.

John: The story that you're telling is not uncommon and there's a lot of physicians still where you were a year or two ago. Did you get a sense that the organization you were working for, like, had any sort of recognition that the physicians were getting burned out like yourself or were they putting in place any plans to try and address that? Or were they just saying you got to do what you got to do and that's just the way it is?

Dr. Neetu Sharma: The way things are, unfortunately it's all run around and seeing more patients and working hard, but not getting the reward for it or getting satisfaction of taking care of those patients. Because if you have five minutes to spend or 10 minutes to spend in the office with it, how much difference you can make in the lives of your patients? You are just giving out pills. And that did not set with my principles, with my goals of becoming a physician. And I wanted to do something more for my patients. And that's what led me here where I am today.

John: Just for background, about how big was the group that you were actually working in?

Dr. Neetu Sharma: We started with five physicians. When I joined, I was the third one. We grew the group to five. Then slowly, everybody left the group.

John: It sounds like that's kind of how it goes often, especially if you don't have a large group that can kind of absorb the ins and outs of employing physicians in a group or being partners. But okay, let's see. Let's get back to your new career now. Did you say someone had recommended this? You had talked to someone about it? Sounds like you zeroed in on that particular career pretty quickly. Was there other things you had considered?

Dr. Neetu Sharma: Yeah, I was looking into different things at that time. I was looking into pharmaceuticals. I was also looking with the FDA. I actually got offered from the FDA as well for the medical device position because they deal with a lot of the international investors who bring the medical devices to US and they have to make sure it's not a public hazard. So for public safety, they have engineers, they have physicians who are looking into those devices and other technology to make sure they are compliant. And that was the position I was offered. But then I ended up with this major health plan, which was local. So I thought it would be nice to see the team once in a while to have more collaboration and face-to-face interaction. And that would lead to the position.

John: Okay, you did, obviously you're in a big metropolitan area, fairly big. And so, the company that you chose had at least one office in that area. So that was one of the big draws for you?

Dr. Neetu Sharma: Yes.

John: Okay, but that leads me into this question about what's the job like? Because I have a feeling you probably don't spend nine to five at that office every day, do you? What's that like, the actual job? And is it remote and how remote and all that?

Dr. Neetu Sharma: Yeah, right now it is a remote job from nine to five, eight to five, I would say. My day starts at eight o'clock and I am in utilization review as a medical director. So my main job is reviewing all the cases and making sure they are in compliance with CMS published guidelines and with the medical policies in place and making sure the resources the institute utilize is appropriate for that particular member.

I deal with different appeals and also collaborate with the clinical team, pharmacy and other clinical providers. I do have peer to peer calls on a regular basis. And my day ends by five, if not like 5.30, depending on how busy we are. But it's interesting because you're always in, you're talking to your team over the team meet or you are in a queue where you are interacting with the other team members. And you are also encouraged to go to the office once a week. So if I choose to go there, I can. But mostly the team that I could work as remote, so you don't get to see many people. But we do have team meetings every month where we collaborate, we see each other and celebrate the organization. So that's really nice.

John: Now, what's the job like? Because this is what people always are interested in terms of not only exactly what are the duties, but in terms of, is it really rushed? Are you expected to go through so many cases on a given day? Does it feel like a little bit overwhelming or is it a pretty relaxed feeling where you get a chance to really get into the cases, determine what you need to make a decision and then have a conversation and peer to peer if necessary?

Dr. Neetu Sharma: Yeah, as a major corporation, they have set certain goals for the team members, including the medical directors. So we have certain goals to achieve, which also includes the number of cases you're doing every day. But in reality, many of these cases are complex cases.

They are high risk patients and it needs reaching out to the team, to the acute care hospitals, to other providers to get the feel of what the members have been going through. Always taught in a public view that insurance companies are there for denials, but that's not true because we really look into the utilization of resources and whether they are done appropriately. So we try to actually approve the cases if possible for the member and keeping members in mind, it is important to know what they're going through. Some of the complex cases take longer and it's not realistic to put those goals into that basket. Sometimes you meet those goals, sometimes not. But I think the leadership, they understand the complexity of this job.

And to be honest, I haven't, so far, like three months I have been with this health insurance plan. I haven't had any interaction where they're telling me that you haven't reached your goal today because they know that I am working hard to understand the utilization better, to help the members better. So our goal as an organization is mainly the member satisfaction.

John: Now, the medical side of what you're looking at and the records you're looking at and so forth, obviously is pretty straightforward for an experienced physician like you. But doing all the things you are doing with that information and then you've got reports to fill out and you're doing the communication, might be with nurses or other physicians or peers. How much training is involved and have you felt like that's gone pretty well in the first few months that you've been there?

Dr. Neetu Sharma: Yeah, so it's a dynamic role because I will be doing different kind of cases. Sometimes we have complex case reviews, sometimes we are dealing with LTACH patients. Sometimes we have regular inpatient admission reviews where we are seeing the utilization of resources or the length of stay.

Those cases, they may vary and we get trained for at least a couple of weeks to get used to review those kinds of cases effectively. So I would say two weeks to one month is needed for each kind of category of the review you're doing. And it's an ongoing process.

It's training on jobs. So once I was trained on one particular area, I've been doing that for a while to get more proficient in that area and then I will be moved to some other area where I'll be reviewing more complex cases.

John: Yeah, in most of the physicians I've talked to over the years, it hasn't been a lot, but it goes back about seven years now. They tell me that basically there's a set of criteria they probably changed over the years, but just getting used to how you have to demonstrate compliance with whatever, the Medicare if it's a Medicare and you have certain different formats for doing that. But in any way, they say you just have to learn the system basically.

And when you're a generalist and someone who's an internist and a nephrologist, you know so much medicine. I had a pediatric cardiologist that went in doing the exactly the same thing you're doing. And it took him a little longer to kind of get the feel for things because he hadn't taken care of adults for 10 years. So I think you're in a good position.

Dr. Neetu Sharma: Yeah, thank you. Yeah, my team is actually very diverse. We have pulmonologist, we have ER physician, we have pediatrician. So it's a very diverse team and we all are doing the same thing. And the learning process for everybody is different.

John: And it's new, something new. You're getting into it, but now that you're at this point is it kind of what you thought it would be? And are you so far, are you satisfied with the way the work is going and the support at the company and that kind of thing?

Dr. Neetu Sharma: Yes, absolutely. I have a great team. They're very supportive and they listen to you, they listen to the feedback and they always put an effort to improve things.

John: Now, what I've heard sometimes is you can definitely do this full time and not do anything else, I think, but some of the companies do like to have their clinicians continue to have some activity so that they can, makes it a little easier to be current and in the treatment of certain conditions. So, you are still doing some clinical. So, if you don't mind telling us about that so we can see how that kind of fits in.

Dr. Neetu Sharma: Yeah, these health insurance plans, they actually encourage you to do clinicals and get up to date with that because when you review the cases, you can relate to it better. So, I'm also doing some virtual practice and I also reached out to my previous practice to do some clinicals with them over the weekend, some weekend call, which I'm getting credentialed for. So, I don't want to lose touch with clinicals for sure, but I launched an online wellness program and some virtual care for nephrology patients as well.

John: Okay, now on the virtual side, were you doing any remote kind of virtual work before?

Dr. Neetu Sharma: No, this is all new for me. It's a learning curve.

John: Are you limiting the virtual care to the state you're licensed in now or are you licensed already in multiple states? How's that working? Because that can be a barrier sometimes.

Dr. Neetu Sharma: Yeah, that is in process. I'm getting licensed throughout the US so that I can see some virtual patients. But right now I'm just offering a group program which is more like a health coach program.

John: Ah, okay. That one doesn't really have all the risk and the other aspects of sort of a true virtual remote telehealth or telemedicine type practice and the need to get to have your DEA and your licenses and all those things wherever you might be interacting.

Dr. Neetu Sharma: Yeah, no, if you're seeing the patients and you're posing as a physician, then the risk is there, John. So, I would advise to take the full precaution. I have my malpractice insurance and I am doing my due diligence to be compliant with all the procedures involved with the virtual care. So, that is something we have to keep in mind.

John: Yeah, absolutely. You've got to know where you need those protections for sure or you'll end up in trouble. All right, well, thinking back your process seemed to go pretty well in terms of from the time you were burnt out and said something has to change to actually making the change. Do you have advice for others that might be in the situation you were in back a year or two ago?

Dr. Neetu Sharma: I would say that look for what you really want to do and get the feel of it. If you like utilization review, I would advise to start from your organization, from the hospital you are in or in a practice you are in to do some kind of utilization review, whether to join independent review organization and start reviewing those cases or participate in the hospital quality assurance, different committees to get the feel of the job. And if you really like to do that and then get serious about it and start applying.

John: Yeah, that makes sense. I have a friend who's... Well, now he's a CMO for a hospital, but that's what he started doing as a physician advisor for utilization management. He was reviewing charts, interacting with physicians. And then he took on more and more roles and he ended up staying in the hospital setting. But I think a lot of the people I've talked to started out just doing those kinds of things in the hospital setting. And then it makes it, I think, a little easier to transition to the payer side of things because you're not going into a blind.

Dr. Neetu Sharma: Yeah, I'm sure those roles are overlapping.

John: I think some of our listeners will have questions for you, I'm sure. So let's see, one way they could reach you, I think, from talking before is basically LinkedIn. That's probably a safe way to get in touch with people. And if you just look up Neetu Sharma, you'll find her pretty easily. That's how I found her on LinkedIn pretty simply. But what other ways can they get ahold of you if they want to follow up or have questions for you?

Dr. Neetu Sharma: Yeah, they can either email me directly at staffs@zealvitality.com or reach me on my website, zealvitality.com. But LinkedIn is a safe website and they can reach me. Neetu Sharma MD is my profile on LinkedIn.

John: The zealvitality.com is actually the website where you're doing some of this outreach and ongoing clinical or right now, I guess it's a group coaching type of thing.

Dr. Neetu Sharma: Yeah, it has a schedule call through that website and they can put in the notes that they just want my advice or whatever they want to know about utilization review, I'll be happy to touch base with them.

John: Okay, the way things are going so far, you feel like this is something you can do for a while and really expand your challenges and your practice and your knowledge of medicine and patient care. It sounds like that's the direction you're going.

Dr. Neetu Sharma: That is true. So, it's a learning curve. A lot of things to learn about in medical school, you don't get taught about these entrepreneurship and you learn on your own and in this world where we are living virtually on social media, it is even more important to learn all that.

John: Yes, yes, it is. I think it can be daunting. It can be a little bit scary, but if you can get to residency and fellowship and practice, and like you said, working a hundred hours a week and challenging all these life and death decisions, you can start a side job or pursue a career with some kind of industry, whether it's like you did or pharma or hospital or whatever. But yeah I think it's easy to get kind of bogged down and forget that it really is something that thousands of physicians have done. So I think you're a good example of that.

Dr. Neetu Sharma: Yeah, I think the challenges are definitely there, but I am a big believer in delegation. So if you don't like to do something, then you delegate your work. And I think that will make your life much more easier and you pursue what you like to do.

John: Neetu, thank you so much for being with us today. I think that's about it for today. We're kind of out of time. So let me say goodbye and hopefully we can maybe get together again down the road.

Dr. Neetu Sharma: Thank you, John. It was a pleasure.

John: Okay, bye-bye.

Dr. Neetu Sharma: Bye-bye.

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Become a CDI Expert – A PNC Classic from 2019

John Jurica — Tue, 12 Nov 2024 13:21:44 +0000

Interview with Dr. Christian Zouain – 378

In this podcast episode, we revisit our enlightening conversation with CDI Expert Dr. Christian Zouain. He shares his journey from foreign medical graduate to a Clinical Documentation Improvement (CDI) specialist.

Dr. Zouain reveals how his transition from pursuing a traditional residency path led him to discover CDI. There he found his calling in ensuring accurate medical documentation. This critical aspect of the medical record impacts patient care quality and hospital revenues, which creates excellent opportunities for CDI consultants and medical directors.

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The Daily Life of a CDI Specialist

Working as a CDI specialist involves reviewing patient records, collaborating with physicians, and ensuring accurate documentation for both quality care and appropriate reimbursement.

Dr. Zouain describes the evolution from traditional paper-based systems to modern electronic health records, emphasizing how technology has transformed the way CDI specialists interact with healthcare providers. The role offers regular working hours (typically 8-4 or 9-5) and provides opportunities for both on-site and remote work.

Growing Opportunities in the CDI Field

The CDI field continues to expand, offering various career paths from hospital-based positions to remote consulting roles. Dr. Zouain emphasizes the importance of starting with hands-on hospital experience before transitioning to remote work.

He recommends three helpful steps to consider when pursuing this career:

joining professional organizations like ACDIS and AHIMA,
pursuing certifications such as the CCDS (Certified Clinical Documentation Specialist) and CDIP (Certified Documentation Integrity Professional), and,
networking within the CDI community.

Summary

Whether you're a foreign medical graduate, practicing physician, or healthcare professional looking for a change, CDI provides a promising career alternative that leverages clinical knowledge in a new way.

Want to learn more about CDI? Connect with Dr. Zouain on LinkedIn or check out ACDIS's apprenticeship program. Your journey into healthcare documentation excellence awaits.

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 378

Become a CDI Expert

- A PNC Classic from 2019 with Dr. Christian Zouain

John: Hello, Dr. Christian Zouain, welcome to the PNC podcast. I'm happy that you're here with us today.

Dr. Christian Zouain: Oh, Dr. Jurica, thanks for having me. I'm a frequent listener, I really appreciate you having me today as a guest.

John: Awesome, one of my three listeners. I'm glad to hear. Hi, mom. No. Kidding. So, no, I really wanted to get you on here. I did listen to a recent podcast where you were a guest and it was really interesting. I personally have this interest in CDI, which we'll explain what that is in a minute, but I thought you'd be a good one because you've had some recent experience in different venues, and I thought, okay, let's get Christian on the podcast.

Dr. Christian Zouain: Great, thanks. Yeah, sure.

John: good, it'll be fun. All right. I'll have recorded a short intro. It gives a little background about you, but why don't you tell us just a little bit, if you want to give us the brief history and a little bit about what you're doing right now?

Dr. Christian Zouain: Yeah, sure. I am a foreign medical graduate, originally from the Dominican Republic. I moved to the United States in 2011 to pursue residency initially, and while I studied for the boards, I worked as a medical assistant, later as a medical scribe, later landed a job in case management, utilization review at a hospital, as a means to get closer to the hospital setting and make connections, meet the doctors and obtain a residency position.

This is when I started doing research and looking into other non-clinical options, which I've never, had never done before. To me, the only path was obviously coming from the Dominican Republic was going into clinical or that's it. I knew a few people that were doing research, but I started exploring the other options. I remember I attended the SEAK non-clinical careers conference in Chicago in 2015, which is the one you've mentioned in your podcast a couple of times already.

John: Let me break in here and clarify that the SEAK non-clinical careers conference is spelled S-E-A-K, and it's not an acronym for anything. There's a reason why it's spelled that way, but it really doesn't relate to the content of the conference. It is still running annually in the Chicago area as far as I know. They just had their most recent annual big non-clinical physicians conference this past October, a few weeks ago, and I believe they will continue to do this annually. It's held not too far from O'Hare airport. They say it's in Chicago.

It's really technically in a hotel at Rosemont, Illinois. Next year will be the 20th event. Most physicians find it really useful because it presents about 20 live lectures over two days, plus access to 40 mentors, more or less during those two days. And they also have, I think, one or two pre-conferences. there's a lot going on. And I thought I would just mention that, and let's get back to our conversation.

Dr. Christian Zouain: And it really helped me realize that I was not alone in my decision to pursue a non-clinical path. then I enrolled in a clinical documentation improvement and ICD-10 coding course at New York University through the advice of a friend. This was actually new because ICD-10 was coming up. It was 2015. It was a big change, October 1st. they were saying that CDI was a growing career that actually needed a lot of healthcare professionals to jump in.

And while taking this course, I learned a lot about the impact that a complete and accurate documentation had in all areas of healthcare. I became really interested in that, and I eventually just decided to jump all in into CDI as a career path. At that point, I also became more involved with the use of social media, LinkedIn. And through there, I was able to land my first position in CDI. right now, yeah.

John: That's great. Let me stop there because I want to check a couple of things with you because some of what you said resonates with me. My recollection when I was working in the hospital setting was, I was involved with UM and CDI both. And at least my recollection was anything having to do with utilization management and the cost of care and even quality, much of it depends on the documentation. it's a natural partner in that whole process of trying to at least improve how things look on paper in terms of the quality. Would you agree with that? Was that part of this thing that led you to the CDI?

Dr. Christian Zouain: Yeah, definitely. Everything, all aspects of that, I would say would fall into place after you would get that true clinical picture of that particular case with the documentation. It's not just about... Initially, I remember I was thinking, okay, it's about reimbursement. And that caught my attention. But then later I started to find that a lot of things besides the reimbursement had a huge say with documentation.

John: I remember when we had projects and we were working on some quality project or some UM project or whatever, we always had the director for, well, it was health information services or whatever it was, but basically it was the coding experts who were at every darn meeting.

Dr. Christian Zouain: Yeah, and that's a huge part of it. In my previous job as a CDI, I was the only CDI, and I was involved particularly with all the administration. I had to report directly to the CFO. And it was a new venture for me because I came from my first experience, which was a department of 12 CDI specialists. We were just there reviewing charts and closing our records, dealing with the coders. But now I would have to go to all these meetings with the administration. I had to interact with the doctors, with case management, with quality management. I would see how it all blended together. I had to be there. I had to be in those meetings. And it's actually also a good opportunity to let them know up front what things need to be done. When they discuss cases, I can just jump in and let them know, this is how we can better document this particular situation for next time, just we don't have to go through the query process. And that way you also work to educate the physicians.

John: Absolutely. The other factor that's heavily dependent on documentation and coding, and we're not talking a lot about it here today, maybe a little bit we're touching on it, but it's the perceived quality of your hospital. The risk-adjusted mortality, complications, and length of stay depend on the accuracy of coding and understanding of inclusion and exclusion criteria and risk adjustment related to preexisting conditions versus those that develop during a hospital stay.

So for all those top 100 hospitals and all those five-star hospitals and forth, they heavily depend on very complete and accurate documentation and coding to demonstrate the quality of care because of those factors I just mentioned. All right. Let's get back to our interview. we're going to go back and go through the detail of how you actually made that transition.

You started to tell us about that, but I want to put a plug in for myself right now, only because I did a podcast early on in one of my, I guess I'd call him a friend, although we don't keep in touch, but we were working together at the hospital I worked at, and that was Cesar Limjoco, who's sort of this icon in a sense of CDI. I think you've probably heard of him, and he's got this massive following on LinkedIn and everything.

Dr. Christian Zouain: Yeah, I do. I do follow him. I haven't been able to, probably this year at this conference, I think he usually presents every year. Probably I'll go ahead and meet up with him. I mean, I know him. I've seen his articles. I follow him on LinkedIn, and he has really good information.

John: Yeah. And the thing that it was, in doing that interview, I mean, I really liked it because he gave like his whole perspective, but the thing is he is unique in the sense that he's been doing this consulting for long, and now there's other companies that are doing it, and really the starting point for someone like you or I back years ago was not what he's doing because he's been doing this for long. So I've been wanting to get a hold of somebody like yourself who has been a more recent entry into this, and again, that's just another reason why I'm happy to have you here on the podcast today, but I will say that was episode number five for anyone that wants to listen to it.

Dr. Christian Zouain: Yeah, I do remember. That was actually, I think, that was the first episode I heard from your podcast when I heard his interview. Yeah, because I was, I really wanted to know more about his journey as well.

John: Well, now we're going to supplement with your journey because you're following in the footsteps.

Dr. Christian Zouain: Thank you.

John: you had been exposed to UM, you became interested in CDI, you actually took the ICD-10 course, but then what are the steps did you take to try and make that leap into basically was essentially a brand new career for you?

Dr. Christian Zouain: Well, I was doing case management and utilization review, and what really caught my attention again was the contribution that Accurate Documentation brought to the process of healthcare. And I mean, I just decided that at that point, clinical medicine wasn't for me. I think that I just saw value and importance of helping the hospitals, helping the physicians in this current profession. that's why I decided eventually to take it on as a career path. I don't know if I'm correctly answering your question. Just let me know.

John: Let me ask you this, and I'll ask you some leading questions. were the hospital, where you're doing the UM, did they have a formal CDI program and did you end up working for them or did you end up going somewhere else?

Dr. Christian Zouain: Oh, no, I ended up going somewhere else. I believe they did later. I would find out later. They have some sort of CDI program that was starting. But I, again, I started doing research. I started being more involved with LinkedIn. So I started following all these hospitals. I was back in New York. And I would follow their HR department and this particular opportunity came up where they said that they were looking for professionals in the healthcare arena to go into CDI.

It was actually a dinner conference. if you had some sort of exposure or knew a little bit about CDI in some formal way, you could attend that meeting. I, at the time I was doing, I was doing the course at NYU. that was my ticket to go, to get into that dinner conference. And that's where I met my future boss. And eventually I was hired as a CDS.

John: now this was part of their recruiting process for people.

Dr. Christian Zouain: Yes.

John: Okay. Where were they promoting that? Where did you see that?

Dr. Christian Zouain: On LinkedIn.

John: On LinkedIn, was it a company that you were following or did they reach out to you?

Dr. Christian Zouain: It was a company that I was following, a health system. And yeah, they posted the human resources recruiter, posted the ad on LinkedIn. And I contacted them, send them all the information. At first they were hesitant because the course at NYU was new. they didn't know, but they wanted to. But I sent them the curriculum and everything and they said, "Okay, you know a bit about CDI. You've been studying for a while on that. you're good to come in." And I remember I was expecting for it to be a big conference or at least a lot of people to join in because I got new at the moment. That's all I would hear about how the CDI profession was growing. I was thinking I don't have the experience.

I was told by a friend initially that you might have to take a pay cut from your case management position because you don't have experiences in CDI. But I was willing to do that because I knew there was a better path for me in CDI. I actually went and it turned out to be the opposite. I didn't end up taking the pay cut. It was actually more. Well, I didn't have the experience, but at that point, there weren't a lot of professionals that had experience.

So I remember I showed up to the dinner meeting conference and we were like five applicants only. we had, there was the health system, each director for CDI of each hospital, which were around five. There were only five people that showed up that were interested. Two of them I remember were also foreign medical graduates, but didn't live close by. And one of them was a nurse who worked on the floor still. I was the only one who, okay, I was already taking the class of CDI and I had good interactions with the other directors.

The little I knew at that time, I was able to discuss during the dinner because they had a presentation, but then we had a moment where we would sit down at the table and meet the other directors. each one of them, I was able to interact with at some point. And one of them actually caught interest in me and decided to interview me and I was in.

John: No, that sounds excellent. That is such a good example of networking, getting in front of somebody who is in a position to make a decision about recruiting and forth. Let me jump in again on this point. LinkedIn is extremely useful. And I would say a necessity if you're looking for a non-clinical job. There is a lot of recruiting and hiring done directly through LinkedIn for many of these non-clinical jobs and some clinical. Many recruiters use it as their number one way to find and contact eligible candidates.

So it behooves you to optimize your LinkedIn profile and understand how to use it. If you're not comfortable setting up your LinkedIn profile and how to use LinkedIn effectively, I recommend you purchase the course called LinkedIn for Physicians by Dr. Heather Fork. Now, this has been out for, I think, at least three years. And she does updates on it every often. It's quite comprehensive.

And you can go find her website at doctorscrossing.com or you can go to my link and check it out at nonclinicalphysicians.com/linkedincourse. That's all one word. nonclinicalphysicians.com/inkedincourse. And I do receive a small payment. If you purchase using my link, the cost is the same either way. But this is an affiliate link. Okay. Now, let's return to the conversation. Now, at that point, were you already a member of any kind of professional society or organization? I mean, is it the ACDIS or there's other organizations? How does that fit into this whole scenario?

Dr. Christian Zouain: No, not yet. At that point, I remember I was still deciding. I was still studying for my boards and et cetera. I wasn't fully in. I haven't decided yet. I was still thinking about CDI as an approach to continue to work with the doctors and acquire experience and make connections.

But then it was that my director at that point, when she was a nurse, but she'd been doing CDI for 15 years. And I remember her telling me, "If you know CDI, if you learn to do CDI well, if you know the basics and acquire experience over time, this experience will take you a long way. You can do a lot of things. You can jump into different areas of healthcare, not necessarily clinical." I think that was the last step for me when I decided, you know what? I think I'm sticking with CDI instead of going into clinical.

So when I made that decision, I started reading more. I started getting more involved with the associations with ACDIS. After two years, I was able to, I got my ACDIS certification and also obtained the one from AHIMA, the CDIP. The one for ACDIS is the CCDS, which you're allowed to obtain two years after, with two years of experience working in the field. at that point, yeah. they have a lot of resources. So I really jumped in. I purchased. They have books, they have guides. that was a good turning point right there because even if when I took the class, I wasn't really sure until you get your hands on in the actual work, you start realizing what it's really about. when you combine that with the resources that are available out there, it makes it much easier. it makes much more sense.

John: let me just clarify for the listeners. the ACDIS is one big organization of people that are involved in CDI are with. Now AHIMA is A-H-I-M-A, right? Is the acronym?

Dr. Christian Zouain: That's correct.

John: Yes. That's more about health information.

Dr. Christian Zouain: Yes, that covers a lot more. That covers HIM, medical records, coding. ACDIS is focused on, exclusively on clinical documentation.

John: Allow me to clarify here a little bit. There are two major organizations that Christian discusses here. The first one is the ACDIS, Association of Clinical Documentation Specialists. You'll hear later in the interview about their apprentice program. But what they're really known for is the CCDS certification, that Certified Clinical Documentation Specialist. And you can find that at acdis.org. So that's the first one. And then the other organization is AHIMA. That's A-H-I-M-A, AHIMA, American Health Information Management Association. And it has at least eight different certification programs. Usually, I think the CDIP is the one most applicable to physicians, which stands for Clinical Documentation Integrity Professional. And that's a CDIP certification, can be found there at ahima.org, A-H-I-M-A.org.

Okay. Now, let's get back to the interview. And I think this is my last interruption. Now here's a question I have because you brought up ICD-10. Which is kind of, that's on the, pretty much the diagnosis codes basically, right?

Dr. Christian Zouain: Correct.

John: How important is that? I mean, that's important in inpatient and outpatient. We're talking mostly inpatient right now in terms of where you were, is that right?

Dr. Christian Zouain: Yes, yes. ICD-10 works, you have on the inpatient side, you have ICD-10, and for clinical codes and for procedures, you have ICD-10 PCS. In the outpatient, for clinical codes, you have ICD-10 and for procedural codes, you have CPT. that's something different right there. there's a lot of, yeah.

John: Now, in my recollection, sort of the coding, the documentation, the risk adjustment was more or less based on the MS-DRGs, but the ICD-10 feeds into the MS-DRGs. Is that how it works?

Dr. Christian Zouain: Yes. It's a bit of a complicated subject, but you have the right path right there. You have ICD-10, which then bundles up the list of diagnosis and then you obtain an MS-DRG, which is then what you use to then bill and what reflects the severity of the patient's condition while he was treated. Or outpatient.

John: there's many different directions we could go, but let's focus on your career at this point. what were you doing in that first job? If I remember, that was a hospital-based job and you're basically helping them better demonstrate the documentation and you can maybe tell us how that day looked like for you and what were the benefits for the hospital as well when you're discussing that? Maybe you can address that.

Dr. Christian Zouain: Sure. my first experience is CDI. we would basically come in CDI, you work Monday through Friday, it's office hours, but it also depends on the hospital and the hospital needs. You might be working with a specific department. It could be surgery. You might want to come in a little bit earlier because surgery is rounding at 7:00 a.m., 6:00 a.m., but our hours were around 8:00 to 4:00, 9:00 to 5:00.

So we would come in, we would have a list of records that we would need to review, particularly at, let's say, at the two-day, three-day mark after the patients were admitted. Not just right away because we wanted to give time to the physicians they could document, we could have enough documentation. It wasn't just like, okay, we just have an HMP, let's go with that. No, we wanted to give the admitting physician and the consultants to take a look at what was going on with the patient and then review.

So we would have a set number of cases that we would do in the morning, my colleagues and I. And in this particular hospital, it was still hybrid. it wasn't completely in... the medical records weren't completely in the electronic medical system. the progress notes were still in paper. we would have to go to the floors and it was a good opportunity as well because there we would see the doctors from time to time they were around or their residents or the physician assistants if we needed to ask them right away.

But we would, this is how the process goes, we review the cases. We would leave a query if we needed clarification on a case. We will leave a paper query inside written document, inside the record. they would see and remember it was a green fluorescent color. they wouldn't miss it. And once they opened that, they would look at the query and they would respond on the next progress note accordingly. And that we will leave there. We would come back the next day and follow up if the cases were not to see if the cases were answered or not. If they didn't, then we would escalate if it had been a couple of days. But particularly most of the time they would ask or we would see them around in the hospital. we would ask them just like I told you earlier, right there and there. And they were either document, agree or disagree. Then we would bring it back, close the cases. And once the case was already sent to billing in this particular hospital, we were involved with coding and we knew at the end what the final DRG was. we were able to make sure to see if we had impact or not on that particular case. we would start with what's called a working DRG, which is the initial DRG that reflected that patient when we first reviewed that case.

Once we obtained the further clarification, the diagnosis with more specificity, then we would change to DRG. we would have a system that would compare both and would tell us the difference that we had achieved on that particular case. I know that that's one of the metrics that we were able to capture with our program and see how good we were doing. We would also get feedback from the coding department. They would receive their denials.

So we would know if a particular case that we had impact had been taken back and it was denied because it didn't meet criteria. we knew what action to take further next time if we needed to change the criteria we were asking the doctors and what to do forth.

John: Yeah, and I want to jump in here and try and for you listeners that are maybe not used to hearing about CDI, I mean, if you work in a hospital, you're pretty much aware of it because you're going to be having these conversations. But the thing is, I mean, it can make such a big difference in both the payment that might because it's DRG based and if you're in a low DRG versus a high DRG, but the quality, that was my big thing when I was chief medical officer is that your risk adjustment's going to look lousy if your documentation's not good and someone who really has renal failure as opposed to, let's say, mild renal injury or something or you name it.

I mean, it becomes important to capture this information and to have basically these consultants like yourself, Christian, walking around helping the physicians. Now, they don't necessarily always want the help. Some do. I guess that's my question for you. Were they already used to having CDI people around and did your relationship with the physicians, was it pretty good there?

Dr. Christian Zouain: Yeah, this particular hospital, it was a big hospital. It was a 900-bed hospital and I know the program had been there for a couple of years already, but being that they were still in some part in paper, it would make it a bit, let's say, annoying for them because now a lot of programs, they use either email or you can send the queries through the actual medical record. in this case, you would have to leave everything, leave something in the medical record.

You don't know if they probably missed it or they didn't really want to answer the query. And in this particular hospital, it was interesting. Some of them were okay because coming also from a clinician's background, being a doctor myself, I know what they go through, what they're going through. So they have tons of other people calling them all the time. They have nurses, they have discharges that they have to do, they have case management, they have people from that administration calling them. with us, if we needed to contact them, we had to page them.

John: Right.

Dr. Christian Zouain: I knew that they were for me when I first started I said, oh my God, but a page that's for emergencies. And sometimes when I would call when I would page them with my number. I would pick up the phone I said I would say, "Good afternoon, CDI clinical documentation. This is Christian." Let's say, is this an emergency? This is not an emergency. I mean, you're paging me. So from that point, it was a bit difficult. Some of the doctors they would just run away. Sometimes we had to be a bit inappropriate because we would see them maybe in the cafeteria or just walking into the hospital. We tried to be as polite as we could they just let them know, "Doc, you have a query in one of your records would you mind taking a look when you have the chance or where can I find you later?"

That's what we don't have to do it right here and there in the cafeteria. Maybe they're taking a break. But yeah, those particular hospitals if it's a big facility and I would say with the inconvenience that this system is not fully automated it could be a bit of a hassle. Later when I was in my second job as CDI where I was the only one, everything was electronic and it was a smaller hospital, but I didn't have a problem there with going meeting with the physicians because it was mostly internal medicine doctors and they were all pretty good. So it depends a lot on the exposure that they have and if you're working with different specialties that could also be something to take in consideration because going from a multi-specialty hospital to internal medicine, basic medicine institution it's a big difference. You're able to handle it better.

John: Let me ask you, Christian. based on those first two experiences. I mean, how were you feeling? Were you pretty happy with the way things were going? Were you pleased that you had made that transition? I just want to understand how you were feeling and whether you feel like it also was a fit like with your personality and what advice you would give to others in that regard?

Dr. Christian Zouain: Yeah. It was tough. At that first one, it was tough because I wanted to let the doctors know that I wasn't there to really bother them again. The majority if we could handle it with the residents or with the PAs up front we would do it. But if it was, say, a surgery attending someone that's really, really busy, sometimes I would think twice on it. Maybe should I go? Should I do it?

I had my ups and downs on that particular job. But I knew that it was different because I've in other places because I would talk to other colleagues. I knew that it could change, that it was just the part that it was starting ICD-10 and in the whole process of documentation on the day until doctors would actually get readjusted. And until they would find update upgrade the system. it would make it easier for them. Because the way it was, it wasn't particularly really convenient for them right now, until later once I started my second job it was particularly way much easier. Now I had control electronically, the doctors could just come in and see my notification there and answer right away. They wouldn't have to be bothered with a call or a page unless they didn't really answer I did have to call them. Yeah, just to answer your question it was, initially I had my ups and downs. But I knew it was going to get better because it was just a particular case of where I was at the time.

John: Okay. Let me ask you this, because this can be a big impact on the way someone in your position is working and feeling. Did you feel like both institutions they had the support of leadership? I mean, here's what I experience is that sometimes the CEO or the COO doesn't want to have that conversation with the medical staff to say hey guys and gals, this is important, and we want to do a good job for you, we want to pair a nurse as well. We want to get paid and the only way we can do it is if you document and we support what we're doing here. We ask you to support it. I mean, did you feel like you had that kind of support at the institutions generally?

Dr. Christian Zouain: Yes, yes, but especially at my second job, because now I was, like I said, I was more involved with the hospital's administration. I was there at every meeting. The doctors already knew me. I remember when I first came in, they actually, they introduced me to the whole staff at one of their monthly meetings, to all of the attending docs. And I felt like I was really important. They really paid attention. And that's a good point you're making when you have the support of your CFO, your CEO when they back you up and they see that importance, they see that it's really necessary.

And especially when you're working in conjunction with the other disciplines again when I worked with case management and quality altogether. Sometimes the case management department would call me, the nurses would call me and will tell me, "I just saw that this particular GRG for this patient it's only giving us three days. Can you take a look at the case?" And sometimes I would say, "Oh." Especially turns out that this case, I had a query for one of the doctors until he answers if he answers, I mean, in the way that I'm expecting, it might change.

So I would tell them, "It might change, it might not. I just have to clarify. Well, I'm thinking of something but I just have to clarify the information with the attending." they would help me, once they had that conversation with the doctor in the floor, they would tell them, "Listen, Christian told me that you had some pending documentation that you need to further clarify. can you please go ahead go down to the floor where he's at and work on that to see if we can move this patient around, if we can keep him or what's going on." at that point, I had good interaction with everyone. we were all working together with a common goal.

John: Excellent. that's good. Yeah, I think that when you're working on a team and you have the support of administration, it's great. maybe that's even something to look at when someone's looking for that second or third job, maybe the first one. Now, I don't want to get bogged down here. you've been involved in a big institution with lots of staff. You've been involved where you're like the solo person, the solo at least the physician CDI person. then you made another change, right? you're doing something different now within CDI. why don't you explain that to us?

Dr. Christian Zouain: yeah, right now I'm working for a company. The company works for, I work remotely. Exclusively remote. I work from home. I know it's a big change. And I decided to make that change because I wanted to experience something different than just being in the hospital. I know there's a lot of these companies out there that they help in some sort of way. They either take over a whole CDI department for a hospital just like they did in the first hospital I used to work, or they help at the back end with physician education, denials management, and CDI. I was looking for that because I saw a trend and that's why I wanted to experience that. And also, I wanted to get to work in an environment with a lot of professionals from different backgrounds. CDI is a field that you're constantly learning new things and you don't know everything. That's why you have to stay updated, continue to read, go to conferences.

I like to be in an environment when I have all these professionals interacting with one another where you can get help in a particular thing to see what can you do in this particular situation? Do you have experience on this? that's also what caught my attention. that's what I'm doing right now.

John: now with that, how does that compare in your mind? Do you feel like this remote CDI activities, do you think that's going to be something that grows? Is it difficult to do when you don't actually have let's say a face-to-face relationship with somebody? What's your opinion on that?

Dr. Christian Zouain: Well, in this particular situation, I feel like the doctors have already, physicians in the hospitals that we work for, they've had some previous experience with CDI in the past couple of years. Every time if I'd contact them through email most of the time. But if they do have any questions or anything, they can just contact me. They can call me. But I haven't seen the need in this particular case to have that face-to-face because I think as time has gone by, they're used to the whole process. they know what CDI is looking for. I rarely get here and there a doctor that's asking me, "Do I have to do this same thing for every case that I have?" And I say, "No." Obviously. But that's one in 100. I mean, I think they're getting used to it and the whole process. I mean, it's still the process that we follow still has their CDI on site, which they can go to. But I mean, they can basically reach out to us via phone or email.

John: Okay. Now, would you say that if you were giving advice to someone who's thinking of moving out of clinical into CDI would it be, is there a better way to go would they try to find one of these companies that are completely remote? Or would it be better to start on the ground with colleagues that you can consult with? What do you think about that?

Dr. Christian Zouain: Yeah. I think it would be better to start in the actual hospital and get familiarized with the whole CDI process as much as you can. See, if you're a practicing physician at the hospital you can visit their CDI department, get to meet everyone and express your interest in CDI. If you can shadow them or they can sit down with you while they review your cases it's even better because these discussions between the CDS and the physician, the treating physician are a great learning experience for both of them and it will save a lot of time in the front and in the future just they don't have to query that much that the doctor knows up front what they need on a particular case.

John: Okay. That makes sense. That's what I assume but no, much is being done remote nowadays. Most people, let's say physicians even practicing telehealth or telemedicine, of course, started with you know live face-to-face patients, but I wonder if there'll come a time when they'll skip that step. But I did want to circle back to something and you went through your process and the fact that when you finished med school and then moved here to the States, but I do want to get your opinion on this because you were able to make this transition.

You did not end up doing a residency and becoming board certified and all that, which is fantastic because I have a lot of listeners who are for whatever reason finished med school whether it's in the US or elsewhere. Didn't do a residency and they're really saying okay, what are my options and there's several things out there. This is the first time that I've talked to anybody that's done that in the CDI realm.

So I just want you to comment on that and maybe what would be the difference if any between someone who maybe did have some clinical experience residency training and they were working for a while versus someone in a similar situation to you. How would the approach be different if it would be in your opinion?

Dr. Christian Zouain: I think that just like I mentioned, if you're already working at a hospital if you have the clinical experience could be easier because you've been already been exposed to CDI. You've had to work with them. The difference would be I would say if you're non-clinical if you're working somewhere else, and if you're interested in CDI you could enroll in a basic coding course of ICD-10. Again, get familiarized with the concepts and the guidelines, get involved with ACDIS. They actually right now they have an apprenticeship program that teaches the principles of CDI.

Which is also a good start if you don't have the experience and it will be valuable to employers later on. ACDIS has local chapters in every state you can look them up on their website. They have meetings every month, some of them maybe more frequent. And just like we said earlier networking is very important they can, both parties, I would say, the ones that have clinical experience and the ones that don't, they can become part of the meetings and go and attend, join ACDIS and the coding classes.

John: Now, you mentioned an apprenticeship. How does one find those or who are those through?

Dr. Christian Zouain: That's in the ACDIS website. I think you can just Google ACDIS apprenticeship program.

John: Okay. I'll definitely put links in the show notes. I'll track down all the URLs for these and listeners can do that, but yeah, another tool, another tactic I guess to really get experience.

Dr. Christian Zouain: Right. Definitely. Yeah, that will help a lot.

John: Any other bits of advice for someone thinking to go into this career that we haven't touched on already?

Dr. Christian Zouain: I would say, don't be discouraged if, this happened to me, if at the beginning you just don't understand right away how all of this works, how the coding side of healthcare works just like we were talking earlier about DRGs and ICD-10 and ESMs and all that. I know for a lot of us, we were not trained in this particular field in school and yet when we start working on it, we feel like we should be able to figure it out right away. But it really takes time to adjust your thought process into the CDI and the coding mindset.

I remember when I started I used to work with a group of nurses that were also CDS's and one of them told me once you have to lower your clinical brain a little bit. You turn down your clinical brain a little bit because as physicians we're taught to look at a case and diagnose, make a diagnosis, make a decision for management. Here we are looking for the wording and how it relates to codes it's different. We might see exactly what the treating physician is trying to portray but we have to be mindful of the coding guidelines and how it's supposed to be written. So that's different and it can take a while to make that transition. for those interested, if you start, and you start feeling like you quite don't get it, believe me, with enough practice and time and studying you'll get there.

John: Well, you're serving almost like a translator in two different languages in a way because the coding language is not meant to be or didn't, I mean it just it's like a legalese in a sense as opposed to what we learn as clinicians, this is what we mean when we say heart failure. But it may not be exactly the same when you're talking in coding language. yeah, you're translating being [inaudible 00:47:40].

Dr. Christian Zouain: Definitely.

John: Well, I think we're getting near the end here. what would be a way to maybe we could reach out to you if somebody just wanted to touch base and maybe follow what you're doing should they go to your LinkedIn page or what do you think?

Dr. Christian Zouain: Sure. Sure. Yeah. LinkedIn, you can send me a message. I have my email there and also my phone number which surprisingly I don't think people realize that because they usually send me messages. But yeah, I mean, if anyone has any further questions...

John: Yeah, I think that's great.

Dr. Christian Zouain: I'm glad to help.

John: And just to have that LinkedIn, it gives them, it's like a little bit of a barrier there. You got to make a little effort you don't get swamped with questions, but I'm not going to put your phone number out on the show notes but it's pretty easy to get through on LinkedIn. And sometimes if there's an issue, sometimes if you're like a third degree connection, you can't always, it won't let you necessarily ask to connect people can go to my LinkedIn page because some of my listeners probably already linked to me and then I could password along or whatever.

Dr. Christian Zouain: Yeah, sure. Definitely.

John: That would work. All right. Well, Christian, anything else you can think of we need to talk about before I let you go?

Dr. Christian Zouain: No, that's it. I think we have covered a lot today. Thanks for having me. Yeah.

John: No, I really appreciate it. And I think those that have even the slightest thought of going into CDI, here's a comment I was going to make earlier, but I guess I'll throw it into my little cynicism is that we have these cottage industries, which are now big industries that have all grown up because CMS has put processes and barriers in the way in a sense whether it's our views for capturing what we do in the clinic or UM there's just tons of rules and now CDI and for what it's worth I think we need physicians like you, Christian, in there serving as experts to translate all those crazy rules for us physicians. So, thanks.

Dr. Christian Zouain: Yeah. Yeah, definitely. There's a huge opportunity for right now just like you're saying, with all these companies developing and they're in great need of good clinicians to work for them and eventually take those things forward.

John: It didn't sound like there's a lot of call involved. that's a good thing.

Dr. Christian Zouain: I'm sorry?

John: It didn't sound like there's a lot of on-call duties involved as many of our non-clinical careers.

Dr. Christian Zouain: Yeah.

John: If you take a slight hit on the income, boy, you're going to make it up in terms of time with your family and free time and giving up the pagers. that's another positive to keep in mind.

Dr. Christian Zouain: Yeah, definitely. Definitely. Absolutely.

John: All right. Well, thanks again for joining us today, and hopefully, I'll get a chance to catch up with you again in the future, Christian.

Dr. Christian Zouain: Okay. Thank you, Dr. Jurica. It's my pleasure.

John: Okay. You're welcome. Bye-bye.

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Update On Part-Time Remote Collaboration For Extra New Income

John Jurica — Tue, 24 Sep 2024 12:17:03 +0000

Find Opportunities Yourself or Use a Broker – 371

In this podcast episode, Dr. John Jurica dives into part-time remote collaboration for physicians seeking extra income.

He shares various ways to collaborate with mid-level providers (NPs and PAs), primarily through chart reviews and supervision, with a minimal daily workload. This episode offers practical advice for physicians looking to reduce burnout and earn income while transitioning away from full-time clinical work.

Our Episode Sponsor

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For more information, go to nonclinicalphysicians.com/mlconsulting or arminfeldman.com.

For Podcast Listeners

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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.

Exploring Part-Time Remote Collaboration Opportunities

John describes how physicians can leverage remote collaboration opportunities with mid-level providers (NPs, PAs, etc.). He discusses the increasing demand for collaborative agreements. Then he shares how physicians can provide support through chart reviews and supervision, which requires minimal work while providing a steady income.

Companies Offering Remote Collaboration Services

These collaborations can easily fit into a physician’s existing schedule, allowing them to earn a monthly stipend with minimal effort. Some telemedicine providers use this strategy to earn additional income, paying between cases to collaborate or review charts.

Key platforms include:

Collaborating Docs,
Zivian Health,
Moxie,
Doctors for Providers, and,
IBA Nurses.

Each company has unique requirements and services, making it easier for physicians to find the best fit based on their specialties and licenses.

Balancing Liability and Income

John addresses concerns about malpractice liability. Physicians must be aware of the legal implications when collaborating remotely. And it must be crystal clear which party is purchasing malpractice insurance for the physician. Some companies provide the necessary malpractice coverage as part of their arrangement, making it an appealing side income for physicians easing out of clinical work.

Summary

John shares insights into remote collaboration opportunities for physicians, collaborating with nurse practitioners, physician assistants, and nurses providing infusion services. He highlights several platforms where physicians can connect with these opportunities, such as Collaborating Docs, Zivian Health, Moxie, Doctors for Providers, and IBA Nurses. These platforms enable physicians to earn extra income through chart reviews and providing oversight, often requiring minimal time commitment.

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Transcription PNC Podcast Episode 371

Update On Part-Time Remote Collaboration For Extra New Income

John: Hello, I'm John Jurica, and I'm back to do the weekly Q&A on behalf of the NonClinical Career Academy. For those of you that are not members of the NCA, it's a collection of basically about 30 different lectures. Some are multi-lecture courses, all about nonclinical jobs, non-traditional work, and that kind of thing. I want to get into today's topic real quick here. I'm trying to be more efficient on these calls. I look back and some of these calls lasted like 45 minutes.

So let's see, if I see a question here in the chat, I will definitely address that, but I came prepared to address a topic which should probably only take 10 or 15 minutes, but let me give the potential question. Is it true that I can make a significant amount of extra money by working for a company to collaborate with, I guess I'll call it mid-level providers, okay? So, or how can I do that?

And this actually came up when I was doing a presentation for Dr. Cherisa Sandrow and Alex Sandrow's course that they teach, which is a telemedicine, telehealth how to create your own telemedicine practice, and it walks you all through it. I think it's a 10 week process. And then we ended up talking a little bit about the issue of using some of that time efficiently by being a collaborator.

And there are obviously NPs and PAs in some states that require collaboration. There's many institutions and many of those, particularly the NPs, of course, who can be licensed without collaboration, but they still like to have the collaboration. And so it just varies, but bottom line is you can be available for different responsibilities related to that, and you can get paid for that.

And I first ran into this more or less, I've known about it for a long time because I employ a number of PAs and NPs and I'm their supervising or, quote, collaborating physician. In Illinois, the NPs don't necessarily have to have a collaborating physician, although again, I think most of them do because they feel like they can maybe do a little bit more in their practice if they have the background and ready availability of a physician. But let's just step back and talk about it in non-specific terms.

So what does this mean? This means that there are NPs and PAs that, and sometimes just nurses, that require physicians relationships to allow them to do either all of their job, like PAs generally can't work without that collaboration, or part of their job, or some things that normally they can do in a hospital setting sort of indirectly. So for example, infusion services.

I think there's some states where nurses can do infusions and they don't have to be an NP or an advanced practice nurse, but they do need to have a physician review things before they do the infusion. So this came up in the telemedicine course because when you're doing telemedicine, you can oftentimes have several sites open and take patients from different sites, wherever you may be licensed. And so you'll be taking, as a freelancer, you'll be taking these patients in as they sign in, and sometimes there's gaps, and so some people will do more than one cue at a time to optimize their time.

But the other thing that you can do while you're doing those things is some collaborative activities. And this doesn't mean that you're also taking calls directly from the provider, the non-medical provider, I'll call them, but that you're doing things like chart reviews because a lot of these collaborative agreements require, and again, it's state-specific, require that a certain percentage of charts be reviewed each month as a, I guess, a quality measure in a way to make sure that there's some oversight. So some might be working full-time as an NP, running her own clinic, doing whatever she does, and one way you may get a call from that person. You get paid for being available whether you get a call or not.

And so there's lots of situations where that might be a good thing. So let's say you're just starting your practice. You've only been out for six months to a year, and you don't necessarily have a full practice, and you're not super busy.

Well, you could sign up for several of these companies and be their collaborating physician. You might be doing telemedicine and telehealth, as I mentioned. Another is you might be in more of an administrative role.

Let's say that you're the owner and operator of a practice, and you happen to supervise several NPs or PAs. Maybe you have a small clinic. You can only see so many patients in a day or at a time.

Maybe you've got six exam rooms, but you employ two non-medical or mid-level providers. So sometimes you're just doing your business part of your job of managing. Maybe you're doing payroll. Maybe you're doing some research or you're doing some paperwork. You're in your office. You're available to collaborate with the other providers.

Well, you could also be available online and collaborate. And again, you get paid for just being available, and you might get an occasional call, but by no means do you get necessarily if you have one collaborative agreement more than one or two calls on any given day. At least that's my experience with if you recruit and employ very experienced medical providers.

If you think about it, this is just one way to look at it. Someone was doing some calculation, and I'm going to go through the actual names of some of the companies that do this, but it was an example from one of the companies, and they said, well, you can make easily, let's say 500 to $1,000 a month being a collaborating physician. And probably in that situation, the most of the time you're going to spend is going to be in reviewing charts, and those can be done at any time.

So you can find the slowest part of your day, and let's say you're taking a one-hour break for lunch and you only need 20 minutes to eat, you could be reviewing charts for the other 30 to 40 minutes. But anyway, you're going to make $6,000 to $12,000 per year just to be available for that person to whom you're assigned to collaborate with. Well, you could have four of those was the example I read, and you could easily make up to somewhere between $24,000 and $48,000 a year just being a supervising and collaborating physician with probably minimal work.

There's obviously if you're supervising four different medical providers, then you're going to have a number of charts to read and review. So, all right, so I want to get back into this, the rest of this by saying there's a couple of things I want to talk about here. And let me first of all say that I put the names of the companies that I'm aware of, and they're in the chat.

Now, because not everyone who will be watching this in the future has access to the chat, I'm going to go ahead and give those URLs right now. And they're in no particular order, but I'll mention some specifics about them as I go along here. So, first of all, we have collaborating docs, which is at www.collaboratingdocs.com.

And the thing that's unique about this one is it only does collaborative services for NPs. So, if you want to make some extra money supervising, collaborating with NPs, then that would be a good one. The next one, and I'll get to the questions that are coming in in a minute, Zivian Health is another one, zivianhealth.com.

And then we have joinmoxie.com. Now, that one is called Moxie, but the URL just happens to be joinmoxie.com. And then we've got doctors4providers.com. I think you can get at it by going to doctors4providers.com or doctors4providers.com. I'm pretty familiar with that because the owners have been on my podcast, and I've actually worked with them to consider getting coverage for our NPs and PAs and my urgent care centers. But we did not consummate that.

And then we've got this kind of screwy one, IBAnurses.com/joinus because there's an organization that is run by the International Business Association for Nurses, and it has a lot of APNs. And so it has put together a service for connecting these physicians to the APNs. And then the last one I have is guardianmedicaldirection.com, just the way it sounds. And I don't know too much. They do NPs and PAs. I think the only one that only does NPs would be actually collaborating docs.

And it's funny because I think even the IBA one, which is a nursing organization, does provide collaboration for NPs, PAs, and let's say BSNs or RNs who are doing infusion services on their own. So those are the links. Let me answer this question real quick.

Would it be this type of work would increase your medical liability? Well, by definition, it increases it. Anytime you're extending the scope of your practice, even if it's an indirect way, you're going to be liable.

It needs to be covered. I'm not an expert on this, but I know that some of these companies include the malpractice coverage with their contract. In others, the physician has the onus of having the coverage and in others, it might even be that the practice would have to.

So I know for the collaborating docs, it's built in, and I haven't really done the research on the others. And then, so the next question is, what are the malpractice implications of this work? So I've kind of alluded to that.

In general, in the past, in my recollection, overall, NPs and PAs tend to be sued much less often than physicians. But having said that, I would say that I've been doing urgent care in my current setting where I'm a co-owner, a medical director, and we have had one lawsuit and it was a result of an interaction of a patient with a physician assistant. So I would say as time goes on and we are doing more and more with, in general, with non-physician providers, you're going to see more of those providers sued.

If you're concerned about doing a nonclinical or non-traditional job to earn money is to avoid liability, then you need to basically step away from all patient care, because as long as you're working as a licensed physician, at least as far as I know, whether it's directly seeing patients or supervising other people doing things with and to patients, your liability will continue and sometimes will expand in direct correlation with the number of patients you're interacting with, whether it's directly or indirectly.

When I decided to leave clinical medicine the first time, that was a big driving force for me. When I became chief medical officer, I really could put my malpractice into suspension, at least for once I stopped seeing patients, I still had to have the coverage for those that I had seen in the past. So some type of tail to cover that, but yeah, that's an issue. Let's see, now there are things you should look for and I just want to spend another two minutes here addressing this question, but there are things you should look for when you're working with one of these companies.

Think about it, if you're doing chart reviews, you have to get into an EMR. So do you already have access to that EMR? Do they have a platform that integrates the EMRs from anybody so that you can do the chart reviews easily? Obviously this is all going to be done electronically.

They're not going to be sending you copies of the charts or anything. So look at the platform they use, look at the EMR integration, how easy it is to handle that. Of course you have to be licensed in any state where you're doing this kind of work. That has to be addressed and how able, can they help you get the new license if you need it? Do you already have licenses? Can you limit? I think all these companies will limit it to whatever existing license you might have. Of course, the more licenses you have, the easier it is to get a contract or a relationship to do this service. Some of them have specialty needs. So depending on your specialty, it may or may not be as easy to pick up some work for others. And the malpractice coverage we've also talked about.

And then the responsibilities. Most of them are fairly explicit in saying they're going to have you do whatever it is that that state requires. There are states that do not require chart reviews, although at least one of the companies said they're going to always have you do a 10% chart review. It's just their policy just to maintain a healthy relationship and a good quality monitoring.

But if you were working in Illinois, for example, you wouldn't necessarily have to do that if you're contracting medical clinic or whatever, didn't feel that was necessary. They might have somebody else doing that who's live or on site. But all the different things that in the malpractice, the number, the minimums, the maximums, the platform, and the responsibilities should be considered when choosing these.

Again, let me just give you the names real quickly here. Collaborating Doctors. Zivian Health begins with a Z. Moxie, you can look up Moxie or joinmoxie.com. Doctors for Providers, ibanurses.com. You can find a link there and guardianmedicaldirection.com.

Like I said, I want to keep these short, but if you have any interest in doing that, check out those sites and maybe you'll find some others that I haven't been able to find and see if you can earn a little extra money, maybe while you're preparing to leave clinical medicine or as you go part-time, maybe one of the things people do, they get burnt out, well, may they slow down, but then they can do more leisurely chart reviews and take the occasional phone call from a mid-level provider.

All right, that's all I have for today and I'll see you next week. Send me your questions through the emails you've been getting and we'll address something new next time. Thank you.

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The post Update On Part-Time Remote Collaboration For Extra New Income appeared first on NonClinical Physicians.

First Consider The Most Popular Full-Time Careers

John Jurica — Tue, 03 Sep 2024 13:06:03 +0000

Proven Options for Leveling Up – 368

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.

For Podcast Listeners

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

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

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

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

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

Summary

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

Links for Today's Episode:

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

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 368

First Consider the Most Popular Full-Time Careers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The Amazing Field of Life Insurance Medicine – A PNC Classic from 2018

John Jurica — Tue, 13 Aug 2024 11:32:48 +0000

Interview with Dr. Judy Finney – 365

In this podcast episode replay, I'm speaking with Dr. Judy Finney, an interventional cardiologist who transitioned to the amazing field of life insurance medicine in 2012. She describes her career journey and provides insights for those considering this unique career.

At the time of the interview, she was serving as an Associate Medical Director. Since then, she worked for 2 years as Medical Director and moved to Vice President for a major mutual insurance company earlier this year.

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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.
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[From the original post in 2018:]

Today I present my interview with Dr. Judy Finney. I've been hoping to get an expert in Life Insurance Medicine on the show for many months. I was able to link up with Dr. Finney after seeing her quoted in a blog post by Heather Fork at Doctors Crossing.

Judy completed undergraduate studies in zoology, and medical school, at Michigan State. She completed an internal medicine residency and fellowships in cardiology and interventional cardiology and became board-certified in all three disciplines. She built a private cardiology practice, then opted to work for a large group for the final 3 1/2 years of her clinical career.

Six years before our interview she moved into life insurance medicine. She works full-time in the amazing field of life insurance medicine. However, she also finds time to work as a speaker and mentor at the annual SEAK Nonclinical Careers for Physicians Conference each October.

Pursuing a Career in the Amazing Field of Life Insurance Medicine

Judy does a great job during our discussion addressing several issues:

Her career path from interventional cardiologist to full-time Associate Medical Director;
Her advice on how to increase your odds of getting a job in life insurance medicine;
The personality traits that are most compatible with such a career;
Some of the adjustments that will need to be made when pivoting to this type of position;
Resources that can be helpful for the prospective life insurance medical director, such as:

Summary

By following Judy's advice, you can accelerate your pursuit of a career in the amazing field of life insurance medicine. I hope you found this episode helpful. If so, please subscribe to the podcast on your favorite smartphone app or iTunes. Join me next week for another episode of Physician Nonclinical Careers.

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 365

The Amazing Field of Life Insurance Medicine - A PNC Classic from 2018

- Interview with Dr. Judy Finney

Jurica: It's my pleasure to welcome Dr. Judy Finney to the PNC podcast. Hello, Dr. Finney.

Finney: Hello.

Jurica: Thanks for joining me today. This is going to be great because I've been trying to find someone to talk to about the life insurance industry and the physician positions in that industry since I heard about it about a year ago. And I came across an article by Heather Fork and I think she was quoting you in the article.

So I thought you would be perfect, a perfect person to answer the questions for our audience today.

Finney: Well, that sounds great. I met Heather at a conference for physicians who are contemplating career change called SEEK and so I have really run into her the last several years annually and we talk all the time about positions including in my field.

Jurica: That is just perfect because my audience is pretty much the same as the people that would tend to come to the SEEK conference. So let's just get into this then. Why don't you tell us first about what it is that you do in your position as a life insurance physician, if that's what I would call it, but you can explain that to us if you would.

Finney: Okay. Well, I'm employed by Allstate, which is actually a combined insurance company and it really does a lot of property and casualty, home and auto, but they always have had a certain portion of their business in life insurance. And in fact that end of the business is actually growing for Allstate.

So my boss was actually in his position, I think for about five or six years before he hired me as the second physician and we're now up to four physicians who work in the life insurance medical department at Allstate. And primarily what we do is in underwriting, which is basically a risk assessment of potential mortality for people that are applying for life insurance policies. There's other physician positions at other organizations that sometimes do a little more than that.

They might work in claims, which are things that need to be assessed after the fact of a death, or they might work in underwriting research and policy or writing reinsurance manuals, but at Allstate we don't necessarily do those functions. We are very concentrated in underwriting. So as my job basically involves a lot of communication with underwriters who are a professional group of people.

In Allstate, they usually number around 90 to 100 people scattered across the country who are doing sort of preliminary review of life insurance applications. And that review would actually include some non-medical things, but it also includes medical things. And so I serve, as do my fellow physicians, as resources for those underwriters.

They would tend to send us cases which are more difficult or more complex or have more medical problems instead of being very simple. They're pretty experienced, so they tend to be able to handle the simple ones themselves. But the more complex things get, the more they might need some medical review.

And especially if something was rare or unusual, or it took a lot of what I guess what I would call weighing and measuring, that would be the kind of case that would come to the medical director in the life insurance underwriting department at Allstate. And that case would involve their review. So they make an assessment of the medical records and send me their thought process plus the actual medical records themselves.

My job would be to review all of that and then I have various resources I can use in order to help judge mortality risk and I would send back an answer to that underwriter. So I would assess the risk, but I would also assess their evaluation. And thereby, case by case, I'm literally doing one-on-one education and training.

So I would say that portion of my job takes up about 50 to 60 percent of my time on a day-to-day basis. And about, I would say, 20 to 30 percent of my time is spent doing other things that are also educational, but they're not based on a single case. So for instance, I might give a webinar over the computer or through Skype or other sources in which I would teach about a specific topic.

Now, I happen to be a cardiologist, so I will tell you that they very often ask me to speak about cardiology topics, you know, and this might be hypertension or coronary disease or coronary calcium scores or the tiny important details in echocardiograms, but many times it's often in non-cardiology topics. For instance, multiple sclerosis or anemia or adult survivors of childhood cancer. Those are all topics that I've given various talks on in the past.

And then the smaller fraction of the rest of my day or my week would be to serve as a resource to other departments in the corporation. It might be the legal department or it might be the underwriting research and policy department or perhaps one of the executives in the c-suite who has a particular interest because they've read something in the Wall Street Journal or the New York Times and they want a medical assessment as to how this impacts our industry and specifically our corporation. So my job involves a lot of reading, answering, communicating, educating, that kind of thing, but it might differ as to who I'm doing it to and for and at what level of detail.

Jurica: Of those things that you're doing, are there certain parts that you find particularly satisfying or interesting?

Finney: Well, I actually like this job quite a bit. And what I would say is I always did like teaching, including when I was a clinician. So it didn't surprise me to have the teaching parts of this be very satisfying.

But I think I also was a person who really, a physician who really liked the puzzle, figuring out the puzzle. So to have cases that I'm thinking about, reviewing, and then doing what I mentioned before, the weighing and the measuring, in a lot of ways that whole function is part of being a clinician all the time. All the time you're taking in information and you're weighing risks and benefits and applying it to your own personal experience and your knowledge of the medical literature and trying to come to some conclusion.

So those are really transferable skill sets and that kind of thing is the same kind of function that you do. It's just that you do it from the lens of mortality risk assessment in various medical impairments.

Jurica: Very interesting. So it's clearly a non-clinical job, but like a lot of our non-clinical jobs that really, there's a lot of overlap with what you learn during your education and training as a cardiologist and interventional cardiologist and so forth. So that's good to know.

But maybe we can step back for a minute and you can explain sort of how did you make that transition and why from a practicing cardiologist?

Finney: Well, I'm not sure everybody should do it my way. Maybe that's one thing I should say from the start. I sort of did my transition in a more desperation mode and a setup to here mode and I don't always think that's really a really great way to make decisions.

It's just that it worked out for me. But you know trusting to luck may not be really the right way to handle it. I was actually one of those people that really truly loved my job, loved my field and if you really had asked either myself or anybody that knew me during all the years that I was in cardiology, which were quite a few, they would have told you that I probably would be one of those people that would die with my boots on still practicing.

And I would have told you that also. It's just that the last few years that I was in practice and I basically stopped doing clinical practice in September of 2012. I found like many physicians find is that they're really not in control of their destiny anymore and they also what they signed up for is not exactly what was happening.

And so it was I think a gradual transition over time and I did try to solve it in other ways. I had my own practice. I was in private practice and I created a group and I grew the group to a pretty good size and my first assessment of this was that I was simply burnt out from being both very administrative in my practice as well as clinically involved.

And I was just burning the candle at both ends. And so I thought I would solve it by getting out of my own practice and moving to another actually larger cardiology practice where I could devote myself to just being clinical. And I lasted in that for about three and a half years, but it sort of became clear to me that the same challenges that I faced in my practice, many of which I think were external to the practice, they were still affecting this other larger practice as well.

And so I sort of gradually came to the conclusion that it wasn't just me or just my circumstance, but it was a larger issue. And yet I felt that I didn't really want to just retire. I felt like I still had more to give and I really enjoyed using my brain and I just didn't want to work 100 to 110 or 20 hours a week.

I just felt like it was sort of unfair to ask me to do that. But I couldn't really find a good way in cardiology, in the city I was in with the circumstances that existed, to downsize. So that's when I became more open-minded to looking around to other things.

And I was still working at the time and I kept looking and looking and, you know, to be honest, feeling more and more desperate. So one of the ways that I looked is I actually asked a couple of friends that went all the way back to medical school who had made the transition to life insurance medicine years before. I asked both of them if they thought I could do that job and would I be good at it and would it be good for me?

And of course because they knew me, they could give me good honest assessments and they said, yes, this would be great. It would be great for the field and great for you, etc. And I had had one helpful experience, which was some five years before that I was asked to be a guest speaker on a cardiology topic at one of their regional meetings.

So I had met a whole bunch of people in life insurance medicine already and I didn't just stay for my own talk. I stayed for the entire meeting and I got a chance to meet, you know, 40, 50 people who were in the field and they were singularly happy. so it impressed me and I think it just kind of sat in the back of my brain.

I kept thinking, when's the last time I've been in a room full of happy doctors? And that's really why the idea of insurance medicine came. And then when it did, I contacted my friends and tried to sort it out.

Now I will tell you that I didn't, you know, despite making the decision that this was a good place to go into or to transition into, I still didn't get any interviews for probably six to eight months. And so I put my resume out. They tried to help me a little.

They told me some things I could do to prepare myself a little better and become sort of a better candidate. But because the people in the field are pretty happy, it's not like there is enormous turnover in the field. I think there will be some and I have spoken about this and written about it before.

It's because a lot of the people in the field are now in the age group where one would expect retirement. But there's also some changes that are happening in the field. Some companies are buying other companies.

So there's some contraction. And there is some automation of processes. So because of that, I'm not totally sure that what I anticipated five years ago about the number of retirements.

I'm not sure that that will really be exactly the same. It might be less.

Jurica: Okay.

Finney: I will tell you my experience is that most people who go into this enjoy it a lot. And so they don't really leave. And they don't necessarily leave voluntarily.

Or if they do, they just leave to go to another company and do the same thing. So that's one key sign that people are generally happy with the field, you know.

Jurica: Yeah, in my conversations with a few people I have spoken with, there's been a pretty much a consensus that most physicians in this field are happy with their careers and glad they made that choice. I want to go back for one second. You know, you're talking about how your colleagues or friends said, well, hey, you know, you'd probably be good at what we're doing.

Do you feel like there's certain traits that would be either favorable towards working in that sort of position or traits that would say, no, maybe something else would be better? Any ideas on that?

Finney: Yes, I think so. I mean, I get asked this question sometimes by physicians who come to me just like I went to my friends. And what I would say is that you have to understand that a great deal of this work involves reading and then typing back answers and communicating one-on-one with people.

So it's a production-oriented environment. And also in general, I would say the person who does this as a physician needs to understand that they are in a whole new environment, a corporate environment, in which the physician is not the so-called buck stops here final arbiter of many things, including individual case decisions. And that transition, I think, would be hard for some people.

When I first made the transition and I was working for a while in life insurance medicine, I kind of wondered to myself, out of all the cardiologists I knew, and maybe especially interventional cardiologists, how many did I know that I thought would actually be able to make a successful transition where they weren't the king of the ship anymore? And I think the number might be small. So I think it helps to be able to have a mindset that you're part of a team and you're a smaller cog in the really large wheel.

So what I would say is that's a quality that you would either have to have or develop. I think that you also should understand that you're only one piece of the puzzle. You are the medical piece.

You are the medical expert that people are consulting for your medical knowledge. But you are not the only person that is participating in this decision. Because this is a business and the business is to sell insurance policies.

So there always has to be some give and take on a lot of the non-medical factors that go into the decision of whether to extend an offer. So that's one thing. I would also say that most people don't understand that although they may know a lot about medicine, they probably don't know much about actuarial science.

And although you don't have to become an actuary, I think you have to. This is a very difficult field to make a sudden leap into from one day doing your clinician job to the next day suddenly going into this field and being able to do the kind of work you need to do and communicate with the people you need to communicate with if you don't have some background knowledge about insurance and actuaries and their vocabulary and how they do their calculations, etc. So I did not find that I had to become an actuary, but I had to learn how to think like one and I had to learn how they come up with some of the things that they come up with, etc.

So you can't do that in a day. And what I would say is because the jobs are fewer and because the competition is growing because the field is so pleasant, it's helpful to distinguish yourself by making some moves to get yourself a little bit more trained or familiar.

Jurica: Okay, so great segue. So your story is unique like everybody's, but now that you have this experience and you're looking back and people are coming to you, so what would be sort of the ideal way to prepare oneself and position oneself to be attractive to an employer?

Finney: Well, I think I will talk about some specific background for life insurance. But one thing I would say which people should understand is that it's very difficult to find a part-time job in this field. They almost all are full-time jobs.

But what you can do, I think, is develop what I call transferable skills. So there are many jobs that are in similar fields that have transferable skills and many more of those can be part-time. So that's one way somebody who's working as a clinician but wants to make a transition could kind of dip their toe in the water and just make absolutely certain they like what they're doing, they can perform, they can live within the parameters, that kind of thing.

For instance, people who do utilization review or quality assurance review in which you are given cases, you have to make assessments, you have to give written responses, you have to perform your duties within certain project time frames or turnaround time frames. Those are all things where you can demonstrate very similar skills and performance and see if you like how that goes, how that day goes, and see if it suits you. Those are fields that have many more part-time and project limited opportunities.

So you literally could sort of demonstrate your skills. So I often advise people to try to do something like that and put that right near the top of their resume when they're looking into life insurance because that's the kind of thing where people will sit up and pay attention and realize that you've gone the extra mile to try to train in the skill set. In terms of education, there is sort of a bible of life insurance medicine and although it's expensive, I think it's really worth purchasing if you're serious.

I got my bible through Amazon and so it's available. It's called Brackenridge's Medical Selection of Life Risks. It's this enormous textbook and the whole first half of the textbook is really demonstrating life insurance as a history, how it came about, and how people did the calculations and some real basic things about mortality and morbidity calculations, how actuaries think, terminology, and then the whole back half of the textbook is very disease and impairment specific.

So once you get the basics, how do you apply them to various disease states that we see? When we read medical records, so that's one thing. Another thing is there's a whole formal organization for medical directors, which is national, which is called AIM, A-A-I-M, American Academy of Insurance Medicine, and it is national.

There are some international people that come to it, but it is mainly intended for physicians in the United States who work for various insurance companies, primarily life insurance, but some disability insurance and some critical illness insurance. And so we have an annual meeting for AIM that happens every year. Most years are two and a half days long.

CME credits can be earned and then every third year is what we call our triennial meeting and that meeting is five days long. And once again, you can earn CME credits. There's a whole lot of people in the field from many, many companies who come to that so you can make contacts.

It is not limited to people that are already in the field. And usually at least 50 percent or more of our speakers are actual clinicians who practice at universities and come and give us updates in various medical fields. Because one of the things is you have to keep yourself updated in what's going on in clinical medicine in order to be able to read medical records and tell the importance of various things that you're reading.

So going to one of these national meetings, I think is very useful both for contacts and for information. We also have regional meetings that take place. For instance, this particular year, I'm the president of the Midwestern Medical Directors Association or MMDA.

And that is a regional association for life insurance companies that are generally in the Midwestern state. And we have a meeting every May and so there are probably 40 plus people who attend our meeting who are medical directors, but we also are open to people who aren't in the industry yet. And we usually have, I would say, anywhere from two to five people that are coming to our regional meeting and making contacts and seeing what kinds of educational opportunities we have, etc.

There's also a national underwriting association, which is you know really meant for underwriters, but they do an enormous amount of very basic training both online and with textbooks, etc. And they're called LOMA, L-O-M-A. And Life Office Management Association is what that stands for.

And they have a website www.loma.org So they also provide underwriting type training and if you're totally green and don't know anything about underwriting, they have some very basic courses that would be able to bring you up to speed and they're not terribly expensive, etc. Another very useful thing for people that are truly serious is that AIM has a specific basic mortality course that they advertise. And the course is very interesting and it pairs you with a mentor and takes you through some mortality calculations with homework over about a six-month period with feedback back and forth between you and the mentor.

And then it culminates in a one to two-day meeting, which is piggybacked on to one of the national or regional meetings where you can have a review and then take a test and get a certificate. So doing things like this in terms of reading, courses, meetings, and especially that basic mortality course, those are all ways that people could prepare themselves so that they look appealing to a hiring manager who is looking to hire somebody who's never been in the field before.

Jurica: Well, that's a lot of really good information and it would take someone hours and hours just to start looking into some of those things. I will provide show notes, links to the various organizations and so forth that you've mentioned. So that'll be fantastic.

I know the listeners are going to appreciate that. Sounds good. Now, let's see.

Any other thoughts or I guess one of the questions I had is whether there's some kind of newsletter or any kind of journal that is produced either from one of those organizations or just in general that addresses this topic?

Finney: We used to actually have a journal that was literally published, but now it is published electronically on the AIM website. So it's called JIM, J-I-M, Journal of Insurance Medicine, and comes out quarterly. And you can get at it through the AIM website and I'm sure I'll provide these things to you so that you can have links.

In general, you know, you have to be an AIM member, but people who are not yet in the insurance medicine industry can in fact become an AIM member just like they can through the MMDA that I mentioned.

Jurica: Awesome. That's great. Well, let's see.

We're getting close to the end here. I did want to circle back a little bit because you mentioned the SEEK meeting and I believe you're scheduled to speak again this year. I didn't know if you want to talk a little bit about that.

Finney: Sure. I think SEEK is a very useful thing for physicians considering transition to go to. I will tell you that I was unaware that they existed before I made my transition, but I wish I had known about them.

Because one of the things that astonished me the most the first time I went was how many fields are out there and how many non-clinical opportunities there are for physicians. It just was astonishing to me. So I really got invited to go there because a hospitalist that I knew provided my name to them as somebody in life insurance that he thought would be a good speaker for them.

So they called me. So that very first year I basically gave a 45-minute talk kind of like this all about life insurance medicine with some slides and talked about, you know, making the transition and what did it take and what was involved that kind of thing. So they have those kind of opportunities at SEEK where people in particular fields already come and talk about how they made their transition and what's involved in their field.

And usually attendees can pick and choose which one of these various talks they would like to go to according to their level of interest. But they also have an opportunity which I've also participated in now which is kind of called mentorship in which you sit at a table in a large ballroom and you do almost like a speed dating kind of experience in which people sign up to have little individual 15-minute visits with a person in a particular field and they talk back and forth about their own personal experience. They get to ask questions.

So you kind of have a one-on-one interview with people who are interested in your field. So I've done both the talks and the mentorship. I tend to create a handout for mine because it's really hard to cover everything in 15 minutes and because I think it's useful for people to have something they can walk away with.

Jurica: Very nice. No, I bet they really appreciate that and I have been to one of the meetings and it is an eye-opener the first time you go just to see so many people interested in change and so many different careers out there that you maybe hadn't even imagined. So I bet they're very happy to have someone such as yourself to be able to talk to the insurance industry because I know they like to have people that are pretty experienced and knowledgeable and can give some practical advice.

So that's very helpful. All right. Well, I think we're going to wrap it up then here. There might be some questions. Would there be any way that a listener could contact you or track you down?

Finney: Sometimes they will come to me through our national organization, AAIM. We actually have a kind of a mechanism at the national organization in which the secretary for it maintains a file of members like myself who are willing to have a one on one phone conversation with people about life insurance medicine. And what they try to do is they try to match the caller with the person already in the field. So, for instance, if somebody is a sub specialist. you know, I might take them on. Whereas other people who are in the field who are more in primary care originally, they might try to match them with that. Or sometimes they'll match them with people geographically or whatever. So these really aren't people that are designed to find you a job, but more somebody that you can relate to, you know, who has agreed to be a participant.

Jurica: Okay, so if they were to go to the website for AIM. they'd be able to find a contact form of some sort or trying to get linked up with someone who could answer some questions or mentor them.

Finney: Right. There's a secretariat who does all of our administrative work and she is well familiar with this program.

Jurica: Okay, good. Alright, well, I thank you again very much for joining us today. You've answered a lot of questions and given us a lot to think about if we're interested in this area. You did a great job and I'm going to be following up on some of this myself and mentioning it to some of my colleagues who might be interested

Finney: Sounds great.

Jurica: All right, Judy, thank you very much again and I guess then I'll just say goodbye for now.

Finney: Okay, goodbye John.

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Priceless Advice From an Expert in The BioPharma Industry

John Jurica — Tue, 06 Aug 2024 12:18:05 +0000

Interview with Dr. Michelle Mudge-Riley – 364

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.

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.

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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.

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Land a Pharma Clinical Development Job: A PNC Classic from 2021

John Jurica — Tue, 25 Jun 2024 11:02:17 +0000

Interview with Dr. Laura McKain – 358

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

Our guest, Dr. Laura McKain, is a board-certified physician with more than 10 years of pharmaceutical industry experience. She has managed clinical-regulatory strategy, study design, protocol writing, Phase 2, 3, and 4 clinical trials, medical monitoring, safety surveillance, data analysis, and report writing.

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We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast. The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career 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.
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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.

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Today's PNC Podcast Transcript

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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.

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The Truth About Medical Specialists and UM Jobs

John Jurica — Tue, 20 Feb 2024 12:56:18 +0000

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.

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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.

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

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

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

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.

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Today's PNC Podcast Transcript

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The Truth About Medical Specialists and UM Jobs

Interview from the Archives with Dr. Rich Berning - 340

Released originally on May 8, 2019

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

John Jurica: Okay, good.

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

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

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

John Jurica: Oh, okay.

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

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

John Jurica: Got it.

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

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

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

John Jurica: Okay, good.

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

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

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

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

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

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

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

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

John Jurica: Nice.

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

John Jurica: That was good.

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

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

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

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

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

John Jurica: Yes.

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

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

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

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

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

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

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

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

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

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

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

John Jurica: That didn't work.

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

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

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

John Jurica: Right.

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

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

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

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

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

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

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

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

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

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

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

John Jurica: Sure, no problem.

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

John Jurica: Yes, the APL.

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

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

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

John Jurica: That's good to hear.

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

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

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

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

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

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

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

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

Rich Berning: Absolutely.

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

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

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

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

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

Rich Berning: Right, absolutely.

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

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

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

Rich Berning: and persistence.

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

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

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How to Find Fulfillment and Flexibility in Your Nontraditional Job

John Jurica — Wed, 27 Dec 2023 15:35:21 +0000

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.

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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.

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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.

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