Transcription PNC Podcast Episode 405

Opportunities With First Class Consulting Firms Are Fantastic

Interview with Dr. Jonathan Jaffin

John: You know, I'm very familiar with consultants for my job as a CMO at a hospital. We used to have consultants in there all the time. And so it's kind of weird that after, you know, 400 episodes, I've never interviewed a consultant from a large consulting firm like we're going to do today. So I'm really happy to be able to introduce you to today's guest, Dr. Jonathan Jaffin. Welcome to the show.

Dr. Jonathan Jaffin: Thanks, John. It's great to be here with you and sort of excited to tell my story.

John: Excellent. That's fantastic. So I've done a little intro, you know, that kind of I recorded separate from this. But why don't you start by just telling us about your background. You have a long background and in practicing and then not practicing. So tell us a little bit about what you did as a physician.

Dr. Jonathan Jaffin: So as a physician, I did my internship and residency in general surgery and did that at Walter Reed because I was in the army, stayed in the army 31 years, so long army career. I then went and went to Honduras as a general surgeon, came back to Walter Reed as a general surgeon, went and was a group surgeon for Fifth Special Forces Group when I was a lot younger and a lot better shaped than I am now. And then went and went to Command and General Staff College with the Army. So have always done some nonclinical stuff. At Command and General Staff College, spent a year there and then went and did a fellowship in trauma surgery and critical care medicine. So went back into clinical medicine, was chief of trauma at Brooke Army Medical Center for my next job.

Then went and was the division surgeon for 4th Infantry Division up at Fort Hood, Texas. Went back, did some stuff with combat developments, took command of a hospital, a small hospital at Fort Eustis, Virginia. Then did my war college equivalent instead of going to the War College, I worked with Health and Human Services for a year. And that was supposed to be an easy year, but turned out to be 2001, 2002, if you can imagine with the anthrax attacks and everything else, we were busy. And so we had to set up the Secretary's Command Center. We spent long hours working and making ourselves helpful to the nation as a whole while we set up DHS, while we answered the anthrax attacks and everything else.

Following that, I took command at Walter Reed and that was when the war in Iraq broke out. So we got quite a few soldiers back. Fortunately, it was before all the scandals at Walter Reed, but it's still, my boss ended up getting fired as Surgeon General. And so that was not a good thing for my career progress.

John: Oh boy.

Dr. Jonathan Jaffin: But, then went and did the assignments for the medical corps. So I was the branch chief for the medical corps. Then did, was deputy commander and for nine months the acting commander up at the medical research command that the army runs. Then went back to the surgeon general's office where I served for the warrior transition units as chief of staff. And then for the Surgeon General, basically his CMO, they called it Director of Health Policy and Services, but it was the equivalent of a CMO, Army Surgeon General. And then, then retired from the Army.

When I retired from the Army, got a phone call from a friend of mine, and I had applied to a number of places, including CMO jobs. And he said, hey, have you ever thought about consulting? And since he outranked me, I said, no, sir, I haven't. And he said, come see me. So I did. And we talked. And he said, well, Deloitte would be very interested in somebody like you. We actually have 20 or 30 docs who work for Deloitte. And you can open doors and use your clinical expertise because they want to see somebody who's been in the trenches the same as they have.

And so that was always important was the ability to translate my experiences to what they were facing or what we were trying to teach them or help them solve whatever problems they were having. Now, the interesting thing with consulting is you have to be willing that they won't take your recommendations or that they may ask you for help with one problem. And you may see that problem is really something completely different. And so you have to be willing, one, to not have your recommendations taken, two, be willing to say, you know, I think we'd be better off solving this problem than that problem. And you have to be always looking for the next opportunity.

Now, what I liked about consulting was that I always was doing something different. So whether it was working with the military health system or their legacy EHR systems, whether it was helping a VA with coaching their directors at a medical center, whether it was helping physicians learn about clinical documentation and its importance, had a wide variety of jobs at Deloitte. And so never got bored, which was one of the things. Was I well rewarded? Yes, I would say I was well rewarded. Was it as much as a trauma surgeon makes? Probably not. But the hours were much, much better.

As a consultant, you spend a good bit of time, unless you're a government consultant, on the road. So you have to be willing to travel. So that's an important consideration in your consideration. You have to have some clinical expertise. And that's very important because people will ask you, why should I listen to you? And if all you've done is gone to medical school, they probably won't pay much attention to you, even if you're giving great advice. So you want to make sure that you've got some clinical chops under your belt, that they will respect what you've done clinically as well as what you've done beyond that. And so that's why I say it's important to be a good doctor first, then you can be a good consultant.

People ask often whether or not you need an MBA. I never got an MBA. So I didn't, obviously you don't need one. There are people who have them. There are people who have an MPH and other degrees. I have none of those. But what was most important was knowing people. Helping them, knowing that they can call me with their problems and building that relationship of trust with them either from previously, and those were some of the strongest relationships to the ones where we had to develop relationships, but we still developed the relationships because it was still important to have that.

John: Now, just to give context to the listeners here, so you were doing this full time, I believe, for over 10 years, is that correct?

Dr. Jonathan Jaffin: Yes, I did. I did it for probably 11 years full time.

John: OK. And I'll comment too on your background, because what I've seen in a lot of these nonclinical jobs, first of all, they love someone from the military. I think you have a little bit of an advantage because they assume you have that understanding of leadership, you know, which you have a lot of, and you throw that in with the clinical, you know, if you've been a CMO or a CEO equivalent in military, I mean, you have got a lot of leadership experience. So

Dr. Jonathan Jaffin: Thank you.

John: Did you run into other physicians that were consultants, number one of any type? And how many, if any, were had a background in the military?

Dr. Jonathan Jaffin: So we had a mixture. We had a number who'd been either department chiefs or CMOs of civilian hospitals. We had a number who'd been military, including ones who'd been at the surgeon general level in the military. So we had, so there were, there were some who were very, very experienced with leadership and had spent a career at, a leadership position. And obviously it's important that you have a good Rolodex because they want you to, to be able to call people and to call on people and to help generate business and your reputation lives with you, so you don't want to burn bridges as you leave the door, because those are the people who you're going to be working with again.

John: What's it like working in a team and what's the schedule like? Are you constantly doing something? Is there any downtime? Are you leading the team? Are you just a member of the team?

Dr. Jonathan Jaffin: It would vary. So it varies depending on what the problem is that they're trying to solve. So one team that I would be a member of was a team that was looking at revenue. So clinical documentation is an important part of revenue. So I would be the one who would educate the physicians on the clinical documentation, but I wouldn't review the charts to see which charts were necessarily had room for improvement and things like that. At the same time, I would be... I might lead a team that that had a purely clinical or a more clinical background. So the quality assurance team or something like that. So it would vary depending on the team itself and what was needed within that.

John: Now, I think Deloitte is known as maybe even a global company. Were you basically based in the US?

Dr. Jonathan Jaffin: So I did all my work in the US, but we did have stuff who folks who worked with our English firm, our German firm or Japanese firm. South American and Central American and Mexican firms, Canadian firm. We had a physician call with physicians from all over the globe. And that was really interesting because they obviously had a very different perspective. Often they work in, you know, have to work with a socialized medicine system and things like that. And so it was very interesting just comparing notes with how their experiences were different than ours.

John: I'll get into the nitty gritty here as much as I can, but how much were you on the road traveling versus working at home remotely or on calls?

Dr. Jonathan Jaffin: I was probably on the road two weeks a month. So about half the time I was on the road, that was more my choice. I could have stayed home more and done a more government type consulting job because obviously that was an important part as well. But probably two weeks on the road. I got my frequent flight on Mars.

John: And was it regional in the sense that would they try, if they have dozens of physicians working for them, you, would they say, well, we're going to send this crew to the East coast and we're going to use Jonathan for the West coast?

Dr. Jonathan Jaffin: It was more, we had areas of expertise. So I was, I had the expertise with the military. I had the expertise with clinical documentation. There were others who had Cerner expertise or Epic expertise. And so we did an Epic or a Cerner implementation, may ask them instead.

John: Okay, yeah. So really kind of fit the best team together. And I assume you worked with lot of different people over the period that you were there.

Dr. Jonathan Jaffin: Quite. I mean, traveled all over the globe, or all over the country.

John: Yep.

Dr. Jonathan Jaffin: I had one week where I was in Bismarck, North Dakota, Des Moines, Iowa, and Little Rock, Arkansas, all in one week. So sometimes you went to places that you otherwise might not visit.

John: Yeah. So you gotta have a lot of flexibility. You gotta be able to, you're not tied to your home for whatever reason, you're raising 17 kids or something, you know.

Dr. Jonathan Jaffin: No, and luckily I'm a little bit older. My family's grown and things like that so that I was able to travel as much as I did and it wouldn't, the kids didn't worry where I was.

John: Right, right. Okay, now, you kind of, I mean, you hadn't planned this transition for, you know, 10 years or anything. It sort of all happened pretty quickly. Now, if you were advising someone else, let's say they're not in the military and, who knows, maybe they're just practicing, maybe dabbled a little bit in, you know, different leadership roles at the hospital or something. Any advice that you would give in terms of if you were really thinking about this?

Dr. Jonathan Jaffin: I think one thing that's really, really important is to get leadership roles, whether it's chief of your department, whether it's running your practice, if you're more an outpatient practice, whether it's being a CMO or things like that. First of all, you make connections, you meet people. And one thing with consulting, you're more likely to consult with somebody you trust, somebody you know, somebody that you're concerned with, than somebody de novo. So the credentials always help, but they also would rather work with somebody they know already. And so that was, I would say, meet as many people, go to meetings. If you can, get yourself involved with the leadership in various organizations, because that also will translate to connections and people knowing you and developing a reputation.

One of the things that very important is to develop personal eminence. And so you want to be somebody that people will come to with problems. You want to be an expert in something. And whether you get that from being on a society membership leadership position, whether you get that by being a leader in the hospital or things like that, or leader in your medical system, those are ways to develop expertise and eminence and leadership.

John: Now, did you get a sense of or ever meet others doing consulting for other big consulting firms? Any feedback on that?

Dr. Jonathan Jaffin: We would meet. And I think most people, the experience is going to be fairly similar. Lloyd's got a fairly good size health care practice. Any of the big four, I would say, does as well. But it's important that and there also are boutique firms that specialize in healthcare. And you may find that that's a better fit for you than a great big firm. I mean, we were one of thousands at Deloitte. And one thing I did enjoy doing that was unrelated to my medical profession was I helped with the Welcome to Deloitte consulting. So I helped with that class, taught that class multiple times and enjoyed that too because you'd see such a broad range of expertise and experience and you could really help people as they made that transition from say industry into consulting.

John: You know sometimes when physicians are thinking about shifting, let's say they're just burnt out or whatever, you know it's not necessarily a good reason to leave medicine but you know they may practice 20-30 years, thinking of doing something else. And one of the things that holds them back is that they feel like they're sort of abandoning patient care and abandoning patients. But do you have a recollection of like some project you worked on that really ultimately was gonna help so many patients? You know, it kind of gives you the sense, well, I am helping patients actually, but in a different way.

Dr. Jonathan Jaffin: Absolutely. So I spent a good bit of time working with the VA leadership, especially at one of the VA medical centers. And we were able to markedly increase one, their throughput. So they were able to see more patients. Two, I think we helped them be more responsive to the needs of their community. So that not only were they seeing more patients, but they were able to help them more. And so that was one of the things that we did that I would say, yes, you're not you miss visual touch and you aren't going to do that, but you're definitely going to do things that affect a large number of patients that affect how a hospital responds to patients.

You're going to help people see that the patients are people too and need to be treated as such, not just physicians who usually get that, but sometimes administrators don't and sometimes People view the patients as a burden. And so you're able to bring your clinical experience in and say, you know, we actually were able to do this because of this patient, because this patient had this issue and brought it to our attention.

John: Now, I think it'd probably be pretty common that someone who had had a fairly long career would end up, you know, jumping into this because just the... You know, they're freed up a little bit and they're trying to do something different. Do you think some of that was really early in their career? Let's say after 10 years or so, did you meet some that had been physicians that have been with Deloitte for a long time?

Dr. Jonathan Jaffin: Absolutely. And so often then I think it does make sense to get an MBA because you're going to be a longer time at the company. You're going to try and grow within the company. You're going to start at a lower level. And so that helps you get promoted within the company and things like that. So I think all of those play a role. Still have practiced medicine, so you still have that rapport with other doctors. And I think that's also important. And then it's important never to forget where you came from. So the clinical side of things still plays an important role. And you will get asked clinical questions. I still get asked clinical questions to this day.

John: Are there any particular roles that you ran into that other physicians were doing maybe that you didn't do, but that seemed pretty interesting. Well I didn't think they would hire someone for that.

Dr. Jonathan Jaffin: So a lot of physicians go work for insurance companies reviewing claims and things like that. A lot of physicians take leadership positions in the hospital, which, course, appealed to me. There were physicians who would do similarly to what you're doing. They would focus on helping promote other physicians into nonclinical jobs. And so I think that's a really fascinating field to make too.

John: Yeah, there's a lot out there that sometimes I'm just shocked by what physicians are doing, but it's still building on their expertise, their training, their experience, and finding a happy medium with their lifestyle, you know, that there's plenty of things out there.

Dr. Jonathan Jaffin: I think one thing is that it helps to be a good doctor first so that that gives you a steal of approval from other physicians so that they say, yes, you're not doing this clinically now, but he still, used to be a good doctor.

John: Yeah. And when you do leave someplace, leave on good terms.

Dr. Jonathan Jaffin: Oh yeah. Don't ever burn bridges.

John: Don't burn your bridges. Yes, exactly. So, you... we didn't talk about this at the beginning, but I want to mention it because, you know, I found you by basically looking back over the SEAK, you know, brochure in a way, because I had gone to seak a nonclinical conference, you know, several times and met a lot of physicians doing things like what you're doing, any anything about the meeting you want to share with the audience? Because you've been there, I think, at least twice and presenting.

Dr. Jonathan Jaffin: Yeah, one, it's... It brings together a good group of people who have done a variety of things after their clinical practice. So I think it helps reinforce that there, one, are a variety of roles out there that you can fill, and two, that not only can you fill those roles, but you can prosper in them and your medical background provide you an extra area of expertise that they otherwise wouldn't have.

John: Yeah, and they're not a sponsor, so I have no financial relationship to them. I'm always looking for resources, you know, and for my listeners. And when I have someone like you that's been part of that, they can explain it. So I think the people that do help and go to SEAK are, you know, have good intentions. And so, again, I'm not promoting it, but it's just another resource for people. Now, I'm sure my listeners still have more questions that I haven't even thought to ask you. Would they be able to go ahead and maybe reach out to you through LinkedIn, back in the best way?

Dr. Jonathan Jaffin: I check my LinkedIn. LinkedIn always notifies you when you've got a message and would love to hear from anybody things I've said correctly, things I've said incorrectly, things that their experiences and things like that. So feel free to reach out.

John: OK. You don't have any books coming out.

Dr. Jonathan Jaffin: No, nothing to promote.

John: OK. Well, any last advice for physicians who may be been practicing for a while, but they think, well, you know, I like medicine, OK. But you know, what happens is things get old and they want to try something different. So any advice in general or about consulting as an option?

Dr. Jonathan Jaffin: Two things. One, don't be shy about trying something new. Yes, you may not make as much money, but the rewards are there are other rewards that you can gain. And two, the thing I like about consulting is it didn't bore me. There were always something different coming up. Somebody had a new problem. And let's be honest. If you can solve it yourself, you don't hire a consultant. So we only got tough problems. And so it was good. They were challenging, made us think. And I think we helped out people, which is also a very rewarding thing.

John: A great advice. Yeah, it sounds very interesting. Little, you know, you to deal with the travel and what have you, but the problems you're helping to solve and apply your medical background at the same time and your leadership experiences. It's just like a, just a way to really use a bigger, you know, panel of skills and experience. So what are you doing these days? You're not with Deloitte anymore?

Dr. Jonathan Jaffin: I do a little bit of consulting with Optimum Health, which is actually a sub to Deloitte. So I do some stuff with Deloitte. I've got seven grandkids, so that keeps me running, and uh... And three stepchildren and one son of my own. So between that, all keeps me busy.

John: I can relate to that. Just had three grandkids born in the same year.

Dr. Jonathan Jaffin: Oh good, congratulations.

John: Zero to three, my wife is ecstatic.

Dr. Jonathan Jaffin: I'm sure. So am I.

John: All right, Jonathan, this has been great. So I thank you so much for sharing all this wisdom and experience with our listeners. I think they're really going to appreciate it. So with that, I'll say goodbye.

Dr. Jonathan Jaffin: Thank you so much. And thanks for having me on.

Transcription PNC Podcast Episode 404

Triumph With An Awesome Direct Primary Care Practice

Interview with Dr. Ati Hakimi

John: I've been following the DPC movement for several years. And I've spoken about it here in the podcast, but actually today's guest is the first physician to join me on the podcast to talk about her DPC practice and why it might be the salvation of independent physicians and their patients. So Dr. Ati Hakimi, welcome to the podcast.

Dr. Ati Hakimi: Thank you, John. I'm happy to be here.

John: I think this is going to be good because I have this feeling that, you know, the people that listen to me, they're trying to get out of clinical medicine. They're looking for these nonclinical jobs. But I don't think they've, a lot of them have really fully explored this DPC thing. They've heard of concierge and they feel like that's, you know, expensive for patients. So just tell us a little bit about your background and then maybe segue into, you know, why you decided to start this particular type of practice.

Dr. Ati Hakimi: Yeah, definitely. So. My name is Ati Hakimi. I am a family medicine physician because we are the real doctors with all due respect to everyone else. That's why I chose to go into family medicine. I really wanted to know everything about everybody and how I could take care of the whole family. So that was my trajectory. I trained at Northwestern and I also did a little extra training at Rush University Medical Center. I got a year of geriatrics under my belt because we all know that medicine is geriatrics. So that was my calling in life. And I went on to actually work with the VA, which would have been the perfect fit, right? Because I just came out of a geriatrics fellowship and what have you. Unfortunately, it was not a good fit. And from there, I went to get an MBA. I have an executive healthcare MBA from UC Irvine because it had already started to become medicine was a business. Yeah. So I needed to learn how to speak the language. And that was the reason why I decided to get an MBA.

And so a caveat for your listeners as well is that you don't have to have an MBA to go into direct primary care. It was something that I chose to do to kind of give me more of the knowledge when I was actually in the insurance model of care because that's the care that is the business model, not what we do in DPC. So that's just a little caveat there. And so I actually went on to do more of the geriatrics practice in terms of post-acute care, things of that avail, and the primary care aspect was kind of put on hold until I came into DPC, even though I was trained in doing that outpatient primary care in my training.

So my story was that I was living in San Diego and I was with the Department of Defense there. Once again, not a good fit for me. And after doing my MBA, seemed Nevada became my calling. There was a gentleman who had actually became the president of one of the major HMOs out here. And if anybody knows any statistics about Nevada, unfortunately, we are number 47 in the nation in healthcare. There are just not enough of us here, specifically physicians. So he reached out and was like, we need doctors. And so I came out, it was a time in my life where it was a time for change and change is good. A lot of things that were going on were not good for me, but change was good. And California is very expensive. I don't pay state income tax here. So that was one of my major reasons to come out here. Quality of life was a little bit better for me. So it could have been worse, I guess. I ended up in Las Vegas. And I started working for that large HMO company. And at one time, it was an OK fit because they were physician run and operated. And they were called, can I say names?

John: Sure.

Dr. Ati Hakimi: I think names are OK. Health care partners, right? So they were physician run and operated, so it was a good fit. And once they started to go into the M&A world of mergers and acquisitions and sold and became DaVita, as you know, DaVita is a dialysis company with primary care, it was just not a good fit. And I really started to think that this was not for me because metrics started to become a thing in our world. And the metrics, unfortunately, were not attainable. There was probably at least 200 of us in the practice and like three of us would meet the metrics to get our bonus. So that was not what I went into medicine for.

And I decided that I needed to start thinking outside of the box, really. I actually left the company on my own accord when the metrics started coming because it was really egregious stuff, really egregious stuff and they had no answers for me when I had questions about these things. And I thought, you know, I'm a pretty smart cookie. Maybe there's other things I can do, right? But I'm a family doc. I love medicine. I love socializing with my people. I love taking care of people. I love preventing things from happen to them because that's my calling, right? My calling is to make a difference in your life before I leave this earth. It was a void. There was a void.

So I actually joined a leadership group in our city and found a tribe of people that believed in me, supported me. And I started volunteering. And when I was volunteering and just not being a scribe, not billing, not coding, not those horrible words that have nothing to do with what I was trained to do, I realized I'm a pretty good damn doctor. I am a good damn physician, and I deserve to continue practicing. And so I started doing my own research and I was a little bit into the whole internet world and social media and things like that. And I ran across direct primary care. And I started following a group on Facebook, which was literally, I think it's called DPC docs. And I just started becoming a little bit of a troll and checking out what people were saying and their experiences. And it was just different, right? It was positive, people were helpful, people seemed happy themselves, and it just lit up all of my sensors. What the heck is DPC? What is direct primary care?

And I went online and I tried to find someone locally that was doing this. And I did find someone and he was an... He is an amazing person. I'll call him out Dr. Jimmy Hawks. He already had started his own DPC practice. He had about 400 or members at that time. And his story was he was a hospitalist. So he actually found there were so many people that had no one to follow up with. And so he created his practice from that source and was extremely successful, and the nicest guy in the world. I mean, you couldn't find a nicer person, I have to tell you. So he took me under his wings and he literally said, just come to the office, just come check out, follow, shadow, see what I do. And honestly, I was floored. I was floored. It was just good old fashioned medicine, right?

The model that he had constructed, and I think we all have that base of the same model that we have constructed. We all go off on our own in terms of what we think is fulfilling, not only for our members. I don't call my people patients because they're not sick. Right? I call people that are sick patients. My people are members. So we all create our own models when we start doing DPC. And his model was chronic disease management and it was amazing. And I really just started to finally believe in myself and think that there is a possibility of practicing for myself, not dealing with insurance, not dealing with all of that drama. And I am a solo female minority physician. And I would like to think I'm pretty successful. And I would think that if I could do it, anyone can do it.

But the moral of the story is it's nice to have a mentor because we can talk you through it. We can show you how it's done. And we are glad to do it. Listen, John, nobody in primary care should be working for anyone but themselves. We have found a way. And we, the rest of us are... We would love to help you get out a hundred percent, right? Because we deserve to do this for ourselves. You know, for every one of us that gets hired, they might give us like, you know, measly six figures somewhere, but they make two to three million off of each of us. Right. Seeing 40 or 50 people a day. That is not quality care. That stuff was killing me personally. Right. It wasn't just my members or my patients at that time, cause they were sick. It wasn't my patients that weren't getting the quality of care they deserved. I was struggling and hurting and it was hurting my soul. So to find direct primary care, it was very selfish. It was really about me. It was really about me. Yeah.

John: Let me ask a couple of questions just because when you first heard about it, maybe weren't aware of it at all, but just the beginning, it almost sounds too good to be true at the beginning, doesn't it?

Dr. Ati Hakimi: Yeah, for sure. Yeah. But it's all real. It's all real. And I think that, I mean, when I found out how much things really cost is where, you know, and having an MBA is where I was floored. I literally almost started crying when I found out how much things cost.

John: What were the surprises?

Dr. Ati Hakimi: The surprises for me, first of all, so let me just give you a quick spiel about direct primary care. This is the 32nd, you know, elevator speech.

John: Okay.

Dr. Ati Hakimi: So direct primary care is a flat fee healthcare membership. It is like the Netflix of healthcare, right? You pay us once and we are there for you. So for me, I am solo. So you call, me. You text, it's me. You email, it's me. When you see me, it's me. And I do a lot of telehealth still. So fun fact is that telehealth is going to be removed from that fee for service model again, because insurance just decided that's what they want to do, right? I don't work for insurance, I work for my members. So I get to do whatever I want. So that's fantastic.

So direct primary care has its benefits. And one of the benefits of course is access. You have your physician with you at all time. I pride myself on that being available, being accessible. Another part of that is labs. I can get an entire panel of labs from A to Z. I've actually got a relationship with LabCorp and it's something called client billing that we do. So basically LabCorp will give us prices that are pennies on the dollar, pennies on the dollar. The same labs that somebody would go in and say cash pay, if they do it through me because I pay LabCorp, so that prevents them from having to deal with billers and coders to run after everybody for all these ridiculous fees, they know that I'm going to be responsible for that bill.

So when I do that, it drops the prices significantly. My members compensate me afterwards, of course, but when they do it through me, it's probably a couple of hundred dollars, including all kinds of things, vitamin levels, not just your standard CBC, CMP, TSH. I can get all the vitamins in the world. I can get inflammatory markers. I can get it all, right? Pennies. Penny is on the dollar. That's one thing.

The second thing is imaging. I work with the local imaging center. So that's something that's city specific. You got to get out there and talk to your imaging centers, find out which ones are the ones willing to work with you. My people here, they'll give it to me for, I can get an x-ray for about $45. Walk in, I can, and that's with the read, that's with the radiologist read. There's not a separate fee that goes with that radiologist. So I can get that. I can get that x-ray. They will even do it for me for stat, same price. Same price. I can get a CT scan for probably three, $400. Those prices unfortunately just went up. It used to be less. And then I can get an MRI of any body part for maybe $500. Because nobody wants to deal with insurance. That third party model that we have in this country with everybody's hands in that pot is what is costing our healthcare system to be so egregious. There's too many hands in the pot. When you just go straight to the source, as with any business, everything drops tremendously, right?

And then the final one that I have for my membership, and this is specific to physicians as well as the state that they practice in, I actually order medications directly from the manufacturer. Every physician should know that they can do that for their people. You can create an account. I use Andameds. You can create an account if you have a DEA number and you can order medications directly to you. Right? So my blood pressure pills can be maybe $10, $15 for three months. My cholesterol pills, all my statins, they don't cost a lot anymore. They are all pretty much generic. I can get three months for $10, $15. Now I even put up a little markup there. That's with my little markup. So it's even cheaper than that. You understand? So that is another benefit. I have people that are in my practice that are making money off of me.

John: In what way?

Dr. Ati Hakimi: Because I'm saving them so much you're saving them.

John: Right. Yeah. Do you find that your patients are maybe on fewer meds? I see a lot of docs that basically every visit they come in, they're adding another med because of a side effect or something. So.

Dr. Ati Hakimi: Yeah, so that's an excellent question. I think once again, as a primary care or family medicine physician, also with that geriatrics training, right, that polypharmacy world is a nightmare. So when people do have access to their own physician and when they, what I like to do is check in on people once a month. That is my way of practice. My way of practice is about lifestyle medicine, which means I hold people accountable for how they sleep, what they eat, what they drink, how they move physically, what their mental health is, how their relationships are, because that is your base and foundation of healing.

So that's how I do my practice. But with direct primary care, you have the freedom to create it the way you want. There's nobody over your shoulder telling you to meet metrics, right? That's all gone. You create it. I have colleagues that literally have office spaces where they might have put a kitchen in there, classes about nutrition or yoga studios or have contracted with people to do such, right? It's what you want it to be. It doesn't just fulfill your patients' souls, it fulfills your soul, right?

So my onus, like I was saying before, that physicians, we are chosen. We're not made, we're chosen. And the current sick care model in our country has taken that away from us. And so people need to know that there is still a way to practice the art that you were chosen to do. And this is not just for primary care. I have specialists that have jumped on this as well. You know, we have direct specialty care now. It's a little more complicated when you have to do procedures, unfortunately. But there is a way for your members who don't have health insurance to actually bring on DPC in their worlds as well. And that's called a health share plan. I don't know if you've ever heard of that. Health share plans are perfect with direct primary care.

So the perfect health care model right now, I'll tell you, is a health share plan, which was started by the Christian faith once upon a time where people put money into a pot. So it's not faith-based anymore. There are several companies now that are doing this. And basically what they do is they take the onus of the catastrophes that happen, right? They work well with DPCs because they know we take the responsibility of preventing things from happening to them. So with the combination of a health share plan, a DPC and an HSA, which you can pay for your health share plan, which actually, you know, your money working for you, is honestly the ideal model of care in the United States when it comes to healthcare. Hands down.

John: Sounds awesome. Yeah, I think I did hear a podcast where someone was talking about like a crowd share kind of approach the pool for the big things. But I know one of the things my listeners are probably wondering about, like what is your day like practicing like this?

Dr. Ati Hakimi: So, I think for me, I am very, very outside the norm because what we have to do when we start a direct primary care practice or any type of business is you always have to first go back and evaluate what your needs are when it comes to your financial situation, your family, things of that avail. I have very, very, very, very, very little needs. So my overhead is non-existent. It's non-existent. I don't have a ginormous office space. Yeah, so I actually found one of my colleagues in a women physician medical society group that I'm a part of that when I approached this group and told them, hey guys, I'm done, I'm doing my own thing, one of my colleagues was amazing. She's like, I've got a huge office, like a huge office space, because she does infusions in a rheumatology clinic. So she has nothing but space. She's like, come rent one of my rooms. That's what I do.

So I literally pay her for a room. I don't need an office. I don't need front desk. I don't need any of that stuff. I can take my own blood pressures and weigh people myself for goodness sake. So I actually rent space from her. I go into the clinic once a week. My practice is very tiny. And that's because that's okay with me. That's what my needs are. So I have like a boutique practice is what I'd like to call it, right? I have about 150 people and I know them by name. I know their husband's name. I know their wife's name. I know their kid's name. Cause that's the kind of family medicine practice that I wanted to have.

So that's my practice. What my day looks like, it can vary. Honestly, I do a lot of telehealth because remember I told you that I like to hold people accountable. So we will jump online based on their needs or their times as to when they had that availability. I go into the office, like I said, once a week because I'm tiny. So I go into the office once a week and that's when I do the hands-on stuff that I need to do. The rest of it, honestly, this is my office. Is here.

John: I can imagine you see someone texting you or calling you. Well, you know in your head already who that person is. If they're on meds, probably. With that number, can, especially the people that have, maybe they got a chronic illness. And you said a lot of it's preventive as well. Do you feel like you're gonna stay at this about the way things are now? You gotta pretty much...

Dr. Ati Hakimi: Yeah, I think for me, my goal is just 200. That's my sweet spot. 200 is my sweet spot and then I'll tap out. And like I said, I have colleagues that have 400, 500 people. They've got this, you know, this whole beautiful office space they're paying $5,000 a month for, you know. But remember, our price point is also different for each practice, depending on what your needs are again, and how you actually construct that.

When I first started, I based it on age. Um, and now, um, and I also was doing a lot of house calls. Unfortunately, Nevada did something to us where our med mal practice, our legislation kind of messed us up. Um, they, they removed the cap on our med mal. So it's not, it's not for me anymore to, do the house calls thanks to the legislators. Uh, so anyway, um, I was doing that at one time too, because like I said, you can make it anything you want it to be. Now I've just had a flat fee. So I have a fee for my individuals, have a fee for my couples, and I have a fee for families. Listen, I charge $150 a month. That's it. I live in Las Vegas. If you go out onto the strip and have a couple of cocktails and a dinner.

John: Yeah, that's it. So what's the mix now then? I mean, is there a certain of the, you know, because you're talking about full spectrum from children all the way to seniors. Is there certain mix? Lot of women's health, lot of more middle healthy younger people.

Dr. Ati Hakimi: Yeah. So, that's an excellent question. I have everybody from the CEO to the Uber driver, right? The CEO, because their access is very important to them when they need something now, they have to have it now, and the Uber driver because they can't afford the nonsense that's out there. So there is no discrimination. It is affordable.

So the difference between us and Concierge is that Concierge was once upon a time created for that access too, but they charge a large sum upfront and then they still bill your insurance. It's a double dip. So I'm not sure how they get away with that because with Medicare and things you can't. That's the difference between direct primary care and concierge. And concierge, sometimes they don't do all the other stuff of offering the labs and all these other things because they're going to bill your insurance and go through that fee for service model. They don't have the other things that are, I think, beneficial or options. They don't give people options, I think. So that's the biggest difference between us and concierge.

There was a time when I was interviewed by a local TV station and she said something about, well, it's cost prohibitive. You know, we are only taking care of people that have money. And I will dispute that all day, every day, because once again, I live in Las Vegas. So my fees, I think, are very affordable, very fair. And It's not the right concept or the right argument to even have with anybody when it comes to that.

John: You know, when Like where I am, our deductibles are so high that if my wife needed an MRI or an x-ray, I would just go outside the system and go directly to the freestanding clinic and get it done anyway.

Dr. Ati Hakimi: Yeah, sure. Cash pay it. And that's the other point is that we have forgotten that cash is still king. Um, so if people have insurance, can they do direct primary care? That's a major question that I get. Absolutely. Absolutely. Insurance doesn't take care of you. We do.

John: Right.

Dr. Ati Hakimi: When is that conversation going to be had? They do not take care of you. If anything, we are fighting them. If people are not paying attention to the world, we are fighting them every day to get you what you have been paying for every month. And every year it goes up. My fee for service family, every year Medicare goes down. We are the only profession that our salaries get docked every year. Right? That's a whole different conversation. That's because we are not part of the government and legislation. More of us need to get into that world if we're going to have any kind of change. We absolutely have to be a part of the legislator's lives and, you know, We should be in it ourselves. We should try to be elected officials ourselves. That's the only way is that if we are not at the table, we are going to be on the table. That's what's been happening every single year, especially in our state. So, I mean, that's a different conversation to be had. But once again, direct primary care, you don't have to worry about that.

John: OK, let me ask you this. Many years ago, I started my own practice. And this was not DPC obviously. Yeah, and I had to hire a ton of people and I haven't heard you talk about any employees. So do you have anyone doing anything at this point?

Dr. Ati Hakimi: What would I need them to do?

John: I don't know- I know the memberships they pay monthly or you know, but somebody might have to remind them. I don't know.

Dr. Ati Hakimi: Yeah, like QuickBooks. QuickBooks does my recurring billing? Doximity sends my faxes for free. I prescribe, I pay a yearly fee for my prescriptions. I'm primary care. I'm primary care.

John: Do you remember with your colleague that you talked to initially, Jimmy Hawks, I guess it was, Hawks?

Dr. Ati Hakimi: Hawks, yeah.

John: Hawks, yeah. Now he has a different practice. He has some employees or minimal?

Dr. Ati Hakimi: Yes, because he's huge, right? So he actually had somebody answering the phones and he had. He had nurses to assist him he needed. And he's a male, so pap smears and things like that. He needed to have somebody of that avail. But yes, so if you grow, obviously you know what you can and can't handle. But come on, like I said, we're used to 1,000, 2,000. I can handle 150. And so that's another question that my colleagues will ask me. And then the other one is, you feel comfortable giving people your phone number? Yes. Absolutely.

John: Yeah because its doable.

Dr. Ati Hakimi: It's peace of mind. When they have peace of mind, they will respect your time even more. I am so close to some of my members that my father passed away and they even came to his funeral. That's what it was about. That's what it is about. That's what I pride myself on because that's what I've created. It's something that fulfills me too. You know, we are always giving, giving, giving, giving, and we need to take back.

John: Yeah. I'm going to have a couple more questions for you, but first, tell us what your website is and maybe your LinkedIn profile.

Dr. Ati Hakimi: So LinkedIn is just my name. A-T-I is my first name. My last name is H-A-K-I-M-I, Hakimi, M-D-M-B-A, and I'm on LinkedIn. And then my practice is called Vegas Direct Primary Care. The website is VegasDPC.com. And I'm also on Instagram. I'm trying to learn that world a little bit. I'm on Vegas Direct Primary Care on Instagram as well.

John: OK. I'll put that in the show notes too and the emails that I send out. Let's see, questions. So what if someone's listening now? Are my listeners, maybe they're looking for other things and they hear about this? What's kind of the first or second step they should take if they really want to learn more?

Dr. Ati Hakimi: So the first step you should take is get online and look up direct primary care in your city. Find one of us. Find one of us, reach out to us, make yourself known that you want to do this. They also have, we also have, you know, there are professional associations with direct primary care as well. There's something called DPC Alliance and there's a couple of OGs that have been doing it for a while, Dr. Paul Thomas, things of that avail, that are also very helpful. But if you get on Facebook and get on that DPC docs group, that is one of the places that I initially started going on and doing my own research. And you will find that we are a very supportive community.

I didn't find that in the fee for service model. I found it a little bit competitive and I don't know why because we have 2 million people in our city now. There's plenty to go around. So that was the other uncomfortable thing about fee for service. But I think that those docs are just so stressed, right? And so they weren't as receptive. I'll tell you something else. I did look into taking on insurance when I first started. They weren't going to deal with me. Insurance will not deal with you if you're a one person show. They want groups now to come on because they want to negotiate paying you crap. Yeah. So that's another reason that I had to go direct primary care. They weren't willing to even bring me on. So, you know, that was the other thing. And thank God they did not.

John: It's worked out great. Okay. Last question. You know, I have listeners and they are calling me sometimes and email me about, well, I'm miserable. I just can't stand it. I have this corporate medicine BS is from birds and I'm, should I retire early? Should I go look for a job in pharma? Why should I do what you're doing?

Dr. Ati Hakimi: Because it will save your soul and you deserve better. And you have worked so hard to be where you are. Stop working for others, work for yourself. Don't let the corporate systems, the private equities. They don't give a crap about us, you guys. And they will never. That is what they are made to do. We can't blame them. Their model is about the bottom line. Their model is about making money. Now, if you choose to work in that environment, you are going to be a slave to their model. That's all it is to it. And this is not disrespect to any of these things, to anybody or corporations. It's not disrespect. It's just how that model works. It's not made for any of us, honestly, I don't think.

It's not humanly possible for you to see 40 and 50 people. And I even have residents that are coming out saying that they're giving them two to 3000 and they're already thinking of looking for another career. We went to school for so many years. We jeopardized things and sacrificed our lives to be who we are. Don't let them take that away from you. Listen, I did clinical trials. I was a PI for things. I did all of those things. There is nothing as fulfilling as being a physician with all due respect to I don't know if you're still practicing, John, but I mean, once you're ready to retire, that's fine. But don't let anyone else take it away from you. This is the way to go.

It's not hard, you don't need an MBA. Please, I mean, my number is online. If you get online and see my number, call me, text me, I'm totally happy to help. We all are, honestly. I'm in Vegas, that's fine. You can emulate this model everywhere, right? It's absolutely reproducible. And it's not hard, you guys, it's not hard. I did a whole thing for the Small Business Association about how to start your own practice, but it's even easier with DPC because you don't have to deal with all those insurance things and having this number and that number and coding and billing and none of it doesn't matter. That's not what we were trained to do. We went to medical school. We didn't go to billing school. We didn't go to coding school. You don't need to do that. Just be a physician and make a difference. That's what you're meant to do and you can do it. Get out. DTFO.

John: All right, that was fantastic. I really appreciate you, you know, sharing your experiences with us. I think it's gonna be great to look at. I love this. All right. With that, I'll say bye.

Dr. Ati Hakimi: Okay. Thank you, John. And let me know how else I can help.

Transcription PNC Podcast Episode 396

Pursue One of These Part Time Nonclinical Hospital Jobs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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