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. 

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

For Podcast Listeners

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

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:

• Dr. Neetu Sharma's LinkedIn
• Zeal Vitality's Website
• American Board of Quality Assurance and Utilization Review Physicians
• Institute of Functional Medicine
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)
• The Nonclinical Career Academy

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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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The post Health Insurance Medical Director Is Still A Popular Job appeared first on NonClinical Physicians.

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

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

Our Sponsor

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

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

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

For Podcast Listeners

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

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

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

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

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

Summary

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

Links for Today's Episode:

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

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Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 368

First Consider the Most Popular Full-Time Careers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Interview with Dr. Jonathan Vitale – 345

In today's episode, we present Dr. Jonathan Vitale's inspirational masterclass on securing your first utilization management job from the 2023 Nonclinical Career Summit.

Dr. Vitale shares his journey, emphasizing the appeal of UM's remote nature, stable hours, and reduced stress compared to traditional clinical practice.

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

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

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

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

Our Episode Sponsor

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

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

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

Dr. Jonathan Vitale's First Utilization Management Job

Dr. Vitale shares his journey from traditional family medicine to becoming a manager of utilization management physicians, highlighting the pivotal moments in this nonclinical career path. He discusses how his early exposure to utilization management, driven by family experiences with insurance rejections, sparked his curiosity and ultimately guided his transition from clinical practice to a leadership role in UM.

Through anecdotes and reflections on his career trajectory, Dr. Vitale provides a compelling narrative that inspires physicians to explore alternative paths.

Navigating Utilization Management: Roles, Compensation, and Application Process

Delving into utilization management (UM) careers, Jonathan provides a comprehensive overview of its definition, functions, and significance within healthcare organizations. He lists the primary goals of UM, emphasizing its role in ensuring the appropriateness, efficiency, and cost-effectiveness of healthcare services while minimizing potential harm to patients.

By delineating the three main categories of UM companies and elucidating the key responsibilities associated with each, Dr. Vitale equips aspiring UM professionals with a foundational understanding essential for navigating this dynamic field.

Jonathan's Advice on Overcoming Fear of Rejection

Apply, apply, apply. The clients that I work with, one of the biggest hurdles we have to get over is they fear rejection so much. I say, ‘My gosh, I was rejected hundreds of times. I didn't even get to rejected status. I was just ghosted. My application would just go into the big dark oasis and nothing ever happened.' And I just got over it. And after a while I started celebrating rejections because every rejection is one step closer to an acceptance.

Summary

In his insightful discussion, Dr. Jonathan Vitale shared his journey from family medicine to managing UM physicians, highlighting the appeal of remote work, balanced hours, and reduced stress in UM roles. Dr. Vitale also offered practical advice on gaining UM experience, building CVs, and navigating the application process.

You can contact him through his email drjonathan@drjonathan.com, or check his website drjonathan.com. He also encouraged joining the supportive community of Remote Careers for Physicians on Facebook.

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

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

Links for Today's Episode:

• Dr. Jonathan Vitale's Website
• Remote Careers for Physicians on Facebook
• Reserve Your Free Spot at the 2024 Nonclinical Career Summit
• Dr. Debra Blaine's Coaching Services

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 345

How to Secure Your First Utilization Management Job

- Presentation by Dr. Jonathan Vitale

Dr. Jonathan Vitale: I'm going to talk about myself a little bit and how I got to what I do today, and then I'm going to talk about what is UM or utilization management. I'll talk about the types of UM, the day-to-day of a UM doctor, then the compensation, which everybody is very interested in, the application process, how to get experience so that you can apply, how to build your CV, how to get appropriate coaching if you need that. And then I'm happy to answer any questions.

Again, I'm Dr. Jonathan Vitale. I am a board certified family physician. I had a pretty traditional journey to being a family physician, and today I'm a manager of utilization management physicians at one of the top health insurance companies in the country.

I'll tell you a little bit about my journey and how I got there. I had a pretty typical path to becoming a family doctor, except I picked up a master's in counseling before medical school. And after medical school I did residency in Chicago and family medicine, and then I moved to New York City where I live now for my first attending job at kind of a concierge clinic that I thought I would enjoy because I really did not like the traditional doctor's schedule, the traditional working nights and weekends, working a lot.

And after doing that for really just a few years, I decided that I needed to transition. I was very fortunate and one of the very fortunate people to have heard about UM very early on. I actually knew about it when I was in high school because my brother has type one diabetes, and my parents would always be getting rejections from the insurance companies. And I always wondered why, and I would ask my mother, and she would tell me that they had doctors working at insurance companies making decisions.

I'm one of the very lucky people who knew about UM, and was intrigued by it very early on, although that's probably only about 1% of UM docs who knew what it was before they became burnt out.

But another thing I wanted to say is welcome to everybody to this amazing community. The community of nonclinical, or as I call us non-traditional physicians. It is a very, very warm community. It's a very welcoming community, and it's a community of people who really want to help you transition into a job that you love.

What I've kind of came to the realization of early in my medical career was that doctors in general, from day one of saying you're a pre-med, day one of deciding your pre-med, you are overworked, you are underappreciated, you are underpaid. And that continues for the 10 or 15 years it takes you from day one of pre-med to becoming an attending. And I think that what happens is a lot of people just become very used to being treated that way. That's why so many doctors do so much extra work for free. Name another profession where you work extra hours and aren't paid for it, or you're doing your charts at night, not paid for it, or on weekends not paid for it or taking call nights and weekends, not paid for it.

And I never understood that, and it always bothered me immensely because I think physicians are amazing. We have so much to offer and we should be fairly compensated and respected for that. And that was one of the things that got me into wanting to transition. And also my background as a counselor is really what got me interested in and after I got there coaching other physicians on how they too can get there.

What I do today in addition to my utilization management job is I also coach physicians. Specifically I help people get remote careers, mostly in UM, but I do know about other fields as well. You can always reach me at drjonathan.com or email me at drjonathan@drjonathan.com, or please, as John mentioned, join our Facebook group of Remote Careers for Physicians, which is a wonderful community of physicians helping out physicians who are interested in remote careers.

I always joke that I was into remote careers before being in a remote career was cool. I started that remote careers Facebook group in 2018, and since the pandemic, it's exploded. Nowadays everybody wants a remote career, it seems like, and I think it's as best of a time as any to transition into this field. But I'm especially going to be talking about tonight utilization management.

So, what is utilization management? It's also called utilization review. But for tonight, we're going to call it UM or utilization management. The best definition I could find is it's a systematic approach used by healthcare organizations, insurance companies, and other stakeholders to evaluate and manage the appropriateness, efficiency and cost effectiveness of healthcare services.

The primary goal of UM is to ensure that patients receive the right care at the right time in the right setting, while minimizing unnecessary treatment costs and potential harm. Another way I think about it is we reduce fraud, waste, and abuse. Probably mostly waste. Probably 80% of what we deal with are waste, wasteful orders, or wasteful requests, et cetera, which we'll talk more about later.

There's really three main buckets of UM companies, and I always like to be very general about how I describe this. And then we'll move down into some specifics. There's private UM companies. These are those third party companies that I always talk about, which are good companies to try to get experience with. Those are superfluous. Many of them are listed in nairo.org, which we'll talk about later. Then there's healthcare systems or hospital systems, which also hire UM nurses and UM doctors.

And then probably the most common for full-time docs would be insurance companies. Insurance companies also hire their own UM nurses, their own UM doctors, their own UM physical therapists, pharmacists, et cetera. And these are the big names you've all heard of. This is your Aetnas, your Humanas, your Uniteds, your Anthems, your Kaisers. They all hire their own UM clinicians to work for them.

And what you do in UM is usually one of three things. There's prior authorizations. Everybody has heard about a prior auth. Everybody knows what a prior auth is. There's certainly a lot of attention in the news nowadays around prior auths and reducing the paperwork associated with prior authorizations. But there's a lot of UM that goes along with that.

A physician orders a test, a study, a medication, a home health service, which I'm involved with. And the prior auth physician determines whether or not that meets certain criteria, and most importantly, whether or not it is medically necessary. That's prior auth. And there's also concurrent reviews. This is very common in the hospital setting. When we're talking about bed days and how long a patient can stay in a hospital, how is this patient doing day to day? They're checking in to see if they can extend and give them more days or if they're suitable to go home or go to rehab or go to a different level of care. That's called concurrent reviews.

And then the final one is probably the smallest, and those are retrospective reviews. Those are done when the service has already been provided, already been rendered, and now they're reviewing it on the backend to see if it was medically necessary and if it fit the guidelines.

The reason why a lot of people go into UM is really primarily I would say what attracts people is the lifestyle, meaning it's typically remote. It's typically 40 hours a week when you're in a full-time gig. It's a typically salaried position. Typically, not always. Also, you have very low liability. Basically, you're not practicing medicine. You don't need malpractice insurance, you carry errors in emissions insurance. It's interesting work. It's a very comfortable pace and you're not patient facing. It's a much lower, lower stress job. And you have typically, generally speaking, nights and weekends off and holidays off.

In terms of compensation, and this is a very hot topic. I'm asked this all the time. There's really not good national average data. I will tell you what I see because I look at hundreds of positions for UM all the time. And I would say there's a very big range. I'm sorry I can't be more specific, but generally if you're a full-time UM physician and you're in one of the primary care areas, you're typically talking about the lower to mid $200,000 range as a W2 base salary. I've seen it all the way up to $300,000, maybe a little bit more for people like an oncologist or people with very, very high demand skills.

But keep in mind, in addition to that, first of all, that's 40 hours a week, but in addition to that base salary, we're also talking about merit increases, which typically happen every year on the order of usually around 2% to 3%, but it can be more than that. In addition to that, you're talking about quarterly or annual bonuses, and you're also talking about usually a stock gift if you work at a large insurance company as I do.

There's a lot of additional compensation that's also very attractive. So, always keep that in mind. I always like people to keep that in mind when they're saying, "Hey, but I make all so much more money than that." I say, "Yeah, but you probably work 80 hours a week and are a hundred times more stressed." So, keep that in mind.

Some other things I wanted to talk about is basically the process of what your typical day looks like when you're doing most UM. And I'm going to talk about full-time jobs, and then we'll talk about the gigs. The full-time jobs, which are kind of the cream of the crop of UM, which are those very, very highly desired 40 hour a week full-time jobs, which are very competitive, is you typically have a set number of cases that you're reviewing per day. You're not chained to your desk. It's not like it is in most clinical practices where every second of your time is scheduled and monitored and you need to be patient facing in order to bill. No, you typically have a set number of cases that you're attempting to get through. Sometimes there's peer-to-peers involved as well. And sometimes you have a few meetings and things like that when you're at the basic medical director level. Medical director is entry level for utilization management.

And then there are also opportunities to grow, kind of like Marie was talking about at MSL. There's some opportunities to grow into more of a team lead and manage a team. And then there's opportunities for being a manager and managing a larger team, which that's what I do. I manage a large team of UM physicians and I also hire them and interview them.

And then there is also the opportunity to branch out into other fields in health insurance companies, which other people are talking about in their lectures tonight. I won't get too much into that.

Something I do want to talk about is some of the other gigs in utilization management. There are small companies, usually these third party companies that exist and they do certain reviews. They may be doing reviews for a certain procedure, they may be doing reviews for a certain medication. And what they'll do is they'll have a panel of doctors of 1099 or independent contractor physicians who they will reach out to and say, "Hey, we have this request for this medication. Can you review it for us? And we'll pay you X number of dollars." It's usually very low, by the way. It's usually like $20, $30. And those companies exist and they are superfluous.

And a lot of physicians look at that and say, "I'm not doing that." And I say, "You don't understand. You have to do that. You do that to get experience. You don't do that to make money. You do it as a side gig while you're still in your other clinical job so that you can get some experience under your belt in doing UM so that you can put that on your CV." And that's why you do those roles for six to 12 months so that you can actually have some experience to talk about when you apply for those big full-time positions.

Now, how do you get these gigs? It's pretty simple. I talk about it all the time on Remote Careers. You just go to nairo.org, the National Association of Independent Review Organization. You click on members, again, you don't become a member, you click on members and you scroll all the way down and it lists the logos of 20 or 30 of these companies.

You go to every one of those individual company websites and you navigate the website and you click on apply to be on the physician panel, and you submit your CV to every one of them. And I guarantee you, at least two or three of them will contact you within the week and put you on their panel. And that means you are now getting UM experience. That's a great way to get you UM experience. Yes, it does take a lot of time to sign up for all of them. I never said it would be easy. And it's a great way to get your first step in the door.

I always say this. My specialty is helping doctors who have no other experience, no outside experience. Normal, average doctors. I guess no doctor is average. We're all awesome. But I would say regular doctors into the world of UM who have no prior or outside experience. No connections, nothing else. That's what I help people to do because that's how I got involved.

After you have that, the next thing that you need to do after you've done that for six or 12 months, that's when you're able to actually apply to these full-time UM gigs that most people want. Like every other non-traditional job, especially nowadays, it is very competitive. However, what I can say, and I think this is really, really important, that it's not that it's super, super competitive, which it is, but it's more so the fact that doctors are used to it being ridiculously easy to get a job. If you're a regular traditional outpatient family doctor, been working at your clinic for 10 years, and now you want to move to a different city next week, and you want a job there, all you have to do is send out an email with your CV to a couple people, and you'll probably get a hundred job offers the same week.

That's how it is for clinical doctors. We're very spoiled. But that is not how it is when you make the transition. And that's something that you really have to psychologically get behind and understand that for many people it's going to take a year, sometimes two years, to actually make that transition to get enough applications in to get rejected enough. As you always hear me on Facebook, for those who follow me, I always say to people, you haven't been rejected enough yet. That's your main problem. It takes a lot of rejection, a lot of getting ghosted before you get your position. But you will get there. Don't worry, you will get there. It's just a process.

The thing that you also want to do is you want to work on your CV, and there's lots of coaches to help you with this. I'm one of them, but there's certainly many other coaches who can help you with this, many of whom you're hearing about these past three nights. And you also want to work very hard on your interview skills, and coaches can help you with that. I can certainly help as can all the other coaches.

And what you want to do is you want to make it your job to every day apply and send in your CV to openings for utilization management. These are typically listed. I like to keep things simple. They're typically listed on Indeed, on LinkedIn and also on the private insurance company's websites.

What I encourage people to do who are interested in a life of UM is every single day, it only probably takes about an hour out of your day, you want to be visiting every one of those websites, and you want to be searching, you want to save this in search, you want to be searching for medical director utilization review, utilization management, utilization review, physician, physician reviewer, MD reviewer. All those synonymous terms that a lot of companies use. And then you want to be looking for those positions and you want to be submitting your CV.

Yes, absolutely. Networking is great. If you can do that, if you have any contacts, if you network through LinkedIn, if you network through one of these conferences through a SEEK conference for anything like that, that's wonderful. But what I can tell you is that in the UM world, things move very quickly and that works both in your favor and against your favor.

Let me be more specific about timing. I always talk about when I first got into UM about how I applied for a year and got rejected probably over a thousand times. At least hundreds and hundreds of times I was rejected or ghosted. And what I've learned now that I'm a hiring manager for UM is that timing is everything.

Let me be more specific on that. Many times these UM companies, especially the insurance companies, which are the largest employer of UM docs, are always trying to get more business. They're always trying to get more contracts. They're always trying to expand their geography. They're always trying to do UM for another network, for another geographic location. They have business folks who that's all they do is try to broaden their business.

And as you guys know, anybody who's worked in business, business is a tough field. Things move very fast and sometimes very unexpected. You can literally be at a job or I can literally be in a position and I can literally hear one day, "Hey, you know what? We finally got that contract we've been after for eight months or 12 months. Now we have a need for five other doctors on your team, as we call them FTEs, full-time equivalents, five FTEs on your team. And you need to get them up and trained and ready to go as soon as humanly possible because we're going to start getting UM cases from that network in three months. And we got to be ready to go."

This is the kind of thing that happens. So, what am I doing? We're posting it on our website. And the first good CV I get who is board certified, who's got some decent experience, I am scheduling them for an interview. But let me tell you what though. That same candidate, if they applied two weeks before, they probably would've gotten either ghosted or rejected. Again, I don't write the rules, ladies and gentlemen, I'm just telling you what they are.

The HR oasis for these big companies is don't assume that they're going to put your CV on hold. Don't assume that every job listed currently is available. That's another one. Don't assume that you're going to even hear back. That's why my best advice is it's a numbers game. When the new positions come up, is why you have to be checking every single day. You need to be applying for that new position, because that happens all the time in UM. And which is good news for people like us, because it means there are definitely jobs that open up and that need good folks.

But the flip side of that though is let's say that you have 20 years of UM experience, 20 years of clinical experience, and you're the most competent UM doc in the world, and you reach out to me and send me your CV today. I'd say "I can't do anything with this but thank you." Because we don't have any openings, I'd say just keep monitoring our website. That's how it works at a lot of the large health insurance companies. Yes, there's other things that happen at smaller companies where they may keep things on hold, but I'm just telling you how it works at the large health insurance companies. That's why I always say to people, and you see me say this on Facebook and everywhere else. Apply, apply, apply.

The clients that I work with, one of the biggest hurdles we have to get over is they fear rejection so much. I say, "My gosh, I was rejected hundreds of times. I didn't even get to rejected status. I was just ghosted. My application would just go into the big dark oasis and nothing ever happened." And I just got over it. And after a while I started celebrating rejections because every rejection is one step closer to an acceptance. And these jobs, especially UM jobs, as Marie was talking about MSL jobs, they're very competitive. There's more docs than ever that are looking to make a transition. The other thing is doctors are looking to make a transition earlier and earlier in their careers.

My team, I would say on a whole, at this point, we have about 25 docs on my team. And we are all stages of our career. There's people who are in their early career, mid-career, late career. There's people who are post-retirement who just do this for fun. If that tells you anything about the job as well.

So, it is difficult to get a position, but it's definitely not impossible. It just takes persistence and there's so many people who are there to help you.

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Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so does not affect the price you are charged. I only promote products and services that I believe are of high quality and will be useful to you. As an Amazon Associate, I earn from qualifying purchases.

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

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

The post How To Secure Your First Utilization Management Job appeared first on NonClinical Physicians.

PNC Classic Episode with Dr. Rich Berning – 340

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

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

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

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

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

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

Our Episode Sponsor

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

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

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

Navigating a Non-Clinical Career Journey in Healthcare

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

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

Negotiating Salaries in Nonclinical Positions

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

Dr. Berning's Advice

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

Resources and Networking for Aspiring Medical Directors

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

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

Summary

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

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

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

Links for today's episode:

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

Disclaimers:

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

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

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

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

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

Our Sponsor

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

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

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

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

Unexpected Opportunity

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

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

A Great Hospital Job: Utilization Management Physician Advisor

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

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

Summary

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

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

Links for Today's Episode:

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

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

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 230

Why Utilization Management Physician Advisor Is a Great Hospital Job

John: Hello, Dr. Robert Craven.

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

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

Dr. Robert Craven: Excellent.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

John: Nice.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Robert Craven: That's right.

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

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

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

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

John: Anything you don't like about it?

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Robert Craven: Correct.

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

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

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

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

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

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

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

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

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

Dr. Robert Craven: Right.

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

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

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

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

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

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

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

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

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

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

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

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

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

In this week’s interview, Dr. Jonathan Vitale explains how he found his remote nonclinical career.

Our Sponsor

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

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

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

Finding a Remote Nonclinical Career on Facebook

Jonathan is the founder of Remote Careers for Physicians Facebook Group with over 8,000 physician members. He has helped dozens of physicians transition into utilization management, telemedicine, expert witness consulting, insurance work, pharma, executive leadership, freelance consulting, medical education, medical writing, and medical media.

His work focuses on the psychological, logistical, financial, professional, and personal aspects of physician career transition.

Life is meant to be awesome. – Dr. Jonathan Vitale 

His preferred remote nonclinical career is utilization management. During our conversation, he explains why he thinks it is such a good option. And he tells us who is most suited for this job.

Coaching 

With the growing demand for career coaching for physicians, I have noticed a new trend. And I think it is a good one: physician coaches who specialize in a career niche. I’ve interviewed three coaches who specialize in the pharma and medical device industry. And now we have been introduced to Jonathan Vitale who focuses on UM careers.

Physicians have such a vast skillset. – Dr. Jonathan Vitale

They can all coach in areas outside of their niche, including a different remote nonclinical career. But if you’re committed to quickly finding a utilization management job, a coach like Jonathan Vitale is the way to go.

Summary

As we noted during the interview, you can find him at www.drjonathan.com if you need a coach. Be sure to check out the Remote Careers for Physicians Facebook Group. And if you’d like to hear Jonathan’s musical side, go to TheRealDrJonathan on Instagram.

NOTE: Look below for a transcript of today's episode that you can download or read.

Links for Today's Episode:

• Dr. Jonathan Vitale's Website
• Dr. Jonathan Vitale on Instagram
• Remote Careers for Physicians Facebook Group
• Is One of These Popular Home-Based Careers for You – PNC Podcast Episode #142
• How to Secure a Rewarding Medical Director Position – PNC Podcast Episode #88

Download This Episode:

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

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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PNC Podcast Episode 188

How to Find a Top Remote Nonclinical Career - Interview with Dr. Jonathan Vitale

John: Okay, listeners. I know that many of you are anxious to find a nonclinical job in utilization management or another remote career. And if you're one of those, then today's guest is here just for you. So, Dr. Jonathan Vitale, welcome to the PNC podcast.

Dr. Jonathan Vitale: Hi. Well, thank you so much for having me, John. I really appreciate it. I've been a fan of your podcast for a while. It's good to be on.

John: I was looking around Facebook as I do, this is back a while ago and I noticed this new site. So, I was like, “Wow, there is a Remote Careers for Physicians Facebook group”. And it had a few thousand members and now it's over 8,000 members and I thought, “Okay, I've got to get this guy on the podcast”.

Dr. Jonathan Vitale: Yeah. Well, thank you so much. Yeah, it's funny. We started that group a little over two years ago well before the pandemic, Remote Careers for Physicians and it has really taken off since the pandemic as more and more people are looking for remote careers. So, it's a great group.

John: Yeah. I've been in there a few times and I would recommend it to everyone that's interested. And you've talked about all kinds of careers in there. Utilization Management comes up quite a bit and I know you're an expert in that, but why don't you go ahead and tell us briefly about your educational background and kind of segue into your clinical practice and then into what you're doing more recently?

Dr. Jonathan Vitale: Sure. My background in medicine is pretty traditional. I was a psychology major in college. I did all the pre-reqs during college. Then I went and got a two year master's degree in counseling. And immediately after that, I went to medical school. And then immediately after that, I went to a family medicine residency in Chicago. After residency, I spent about a year in Chicago doing locums work, a little bit of telemedicine work as well. And then I moved to New York City where I live today. And I got a job at a more concierge style, outpatient family medicine practice, where I worked for about a year and a half. And then after that is when I made the transition into utilization management where I've been working full-time for the past five years almost. So here I am today.

John: Okay. So, I have a question. What prompted you to make that transition? We get a lot of guests on here that either they got burnt out or they just realized I chose this career basically when I was a kid and it's not what I thought it was going to be. And so, let's look for something different.

Dr. Jonathan Vitale: That's a really great question. I think that Utilization Management draws physicians from a lot of different places in their life. For me, I was a little bit unique in that my entire life I've always wanted to be a doctor, but I've always also had other interests. I've had a lot of interest in business my entire life. I've had a lot of interest in politics, in policy. I've had interest in how health insurance worked and how health care dollars were spent in this country.

So, I actually got a little bit interested in UM as early as being a medical student where I started reading about it. And I never really pictured myself sitting in a clinic or sitting in a hospital for the rest of my career. I knew that would be something that would be a little bit boring for me and not really for me. And it wouldn't use every part of my interest. It wouldn't cover all of my interests.

So, that's really what drew me to utilization management, being able to use many different parts of my brain, whether it’d be the medical part, the ethical part, the business part, and also my part-time life as a musician. I knew I wanted a lot of flexibility in my day-to-day life. And I knew that utilization management was one of those ways that I would be able to get that flexibility. Then the more common thing that I went through was even when I worked at this more concierge style practice where I was only working four days a week, only seeing 14 or so patients a day, I still got very burned out from that.

As a family doctor, there's a lot that goes on in medicine today, where it's a very tough daily grind for really anybody in medicine, but especially primary care. And I just wasn't completely fulfilled by it. So, that's how I got to where I am today. And interestingly, I'm more fulfilled than ever.

John: Awesome. That's great. When you talk about that and think about even in med school, that is what you might do later with a little bit more multiple kinds of interests. I was in a conversation the other day with Dr. Heidi Moawad. She is one of my guests from the past and she's a writer and so forth. And we were talking about how most physicians don't think about anything after clinical practice. Like there nothing exists and yet there are thousands and thousands of jobs just open waiting for a physician to step in and they have to be a physician with experience to do those jobs.

Dr. Jonathan Vitale: Yeah. You know what's crazy about it? And I talk about this all the time. Physician Hood is one of those few careers where everybody assumes, you're going to be sitting in a clinic or a hospital for the rest of your career. People don't think that for lawyers. Probably half of lawyers don't practice law or a lot of other jobs too. Pharmacists, who a ton of them work for a big pharma work in business, or people who are even in the military and they just do the military for a few years and then they go off and do something else.

But for some reason, physicians are always assumed to have to do the daily grind of traditional medicine every day for the rest of their career. And it's really too bad because physicians have so much knowledge and so many skills that are really needed in so many other jobs. And that's why all these groups exist so that physicians A) understand that and B) can figure out how to get those jobs as well.

John: Yeah, that is a good point. Well, we're not going to let you get past the fact that you transitioned to UM without hearing a little bit more about how you personally made the transition. How did you find the job? How did you prepare for the job? Who did you reach out to? Did you use a recruiter? Tell us a little bit more about that.

Dr. Jonathan Vitale: Yeah. And this is what I like talking about the most, because for everybody listening, I'm just a regular doctor. I had no connections, none at all. And I didn't even have that much experience, in post residency medicine. But what I did is I basically went online and would apply every day on Indeed and on LinkedIn. And that was basically the two places I would look. And I did that for months and months and months, and I got more rejection emails or as I call them, I was ghosted more times that I can even count. And what happened though and this was probably a stroke of luck, was that having applied for months and months and months, probably over six months at this point, I got a gig 10 hours a week, doing Medicare reviews for a company based out of Florida.

And so, that allowed me to dip my toe into the water. So, I was working, doing this 10 hours a week while I was in a full-time clinical practice. And that was really just a stroke of luck. It was a newer company. They needed people. They knew I wasn't that experienced, but they took a risk.

Then after that, after doing that job for probably a year or so, I was like this is really interesting work. I kept applying on Indeed for a full-time role. I kept applying. And that gave me a little bit of credential because I was able to put that small gig on my CV, which is always the key. And I teach people how to do this, how to get those small gigs that give them experience in UM. And another flu guy called or another stroke of luck. I got an interview with a smaller company based out of Tennessee that was looking for physician reviewers. And I started with them, I think 20 hours a week. And then after about six months, they asked me to come on full time and I've been there ever since.

My journey was pretty traditional because I went through the whole application process, kept applying, kept applying, had no connections. I think what physicians forget, they always say, “Wow, it's so hard to get a job in a non-traditional career. It's so hard to get a job in UM”. My answer to that is it's not that it's hard, it's that it's not very easy. And physicians are used to getting a job in clinical medicine very easily. And in the non-traditional world, it's not like that. It takes a while, but you can still get those jobs, just takes persistence.

John: Now, I don't want to go into everything you teach your clients because we're going to talk about your coaching in a minute. But you probably don't advise people to just take your path, just start applying. So, what would be one, just one sort of thing that would accelerate their process, that you would share with us now? Like here's how you can prepare or maybe a place you'd look besides LinkedIn or Indeed. Any advice?

Dr. Jonathan Vitale: Yeah. So, my biggest advice for people who really want to do UM and they're really interested in it is to get experience doing it. And there's some really easy ways to do that. There's the NAIRO website, for instance, nairo.org. And if you go there and you click on members, it has a lot of companies that hire physicians to do PRN physician reviews of all sorts. And these are jobs that don't require any experience. So long as you are board certified, they'll put you on their panel. And after you're on that panel for a while, you'll get a handful of these cases that you'll be able to do just to put something on your CV. And after you do that, you're going to have a lot more likelihood of getting your foot in the door to these real UM gigs that are part-time or full-time. So that's always my biggest advice to people.

The other piece of advice I have is Facebook is an amazing resource nowadays, all the physician groups, of course, there's my group, there's your group. There's a lot of groups on Facebook where you can go in and ask doctors what they're doing, reach out to people who are doing work that you want to do. Try to make connections is the thing I say. And it's so easy to do nowadays on LinkedIn or Facebook. Make a connection. Don't do what I did, which is I didn't have any connections, I just blindly kept applying every day. You can do that, but it's going to be much easier if you can get a connection. That's what I would say.

John: Can you imagine doing this 20, 30 years ago? You had no internet, no applications. It'd be crazy. But I do want to ask you, what do you like about it so much? Why do you think it's a good option for physicians and what do you find that's compelling for you?

Dr. Jonathan Vitale: Well, I think it's a great job because it uses so many areas of your brain. As I said before, you're not just thinking like a doctor, but you're also thinking like a business person, you're also thinking like a financial person. But at the end of the day, you're always making the ethical decision. And so, I consider people in UM kind of physician advocates. We're working to make sure that patients get the care they need. And this is at a very high level and oftentimes these patients are very sick and need a lot of services, and we're trying to make sure that they can get the care they need while we're also reducing the fraud waste and abuse that happens in the system. So, if you're looking for that sort of satisfaction, I think it really gives you that.

The other thing is, I think that UM is a great job for people who are self-motivated, who don't mind working from home, but nowadays most of these jobs are from home, who are so good at self-policing and self-pacing because you're not really monitored that heavily and you have to usually get through a certain amount of volume.

And I think it's good for people who want more flexibility in their life, who want to maybe spend more time with their family, spend more time on hobbies, spend more time on other things in their life, maybe some business side things that they're doing. And I think it's also great for people who want a very stable schedule. They want to work 40 hours a week. They don't want call. They don't want nights. They don't want weekends. So, there are so many different people who do well in UM and I've worked with many of them over the years. And it's a really great profession for people who just aren't fully satisfied doing the daily grind of clinical medicine.

John: I just have to maybe jump in here about asking you a question. I assume the pay is decent compared to what you're doing as a physician and if you take into account the lack of call, the lack of late hours, the lack of all the weekends and all that. And once you're in it and you have experience, there's some upward mobility there in terms of your pay.

Dr. Jonathan Vitale: Yes. That's something I like to talk about because if you're a clinical physician and you're employed as most physicians are, you're probably not going to see too much opportunity for things like bonuses, unless you're working at a RVU system, but even then, as I always say, doctors are treated a lot better in the nonclinical world than they are in the clinical world.

In terms of pay, I always say that it's probably on average around a family physician, outpatient family physician salary, but you can easily get above that. And there are usually opportunities for bonuses, yearly bonuses. And also, usually there's a percentage increasing your salary every year, a small one, but still a notable one.

And you're exactly right. If you take into account the fact that you're never on call, that you have a corporate vacation, which is four weeks, you have time for all sorts of things. If you take all that into consideration, it's worth it. It's really worth it. I won't lie. If you're a super specialist and you're going into UM, you're probably going to take a bit of a pay cut, but it's going to be made up for in terms of your lifestyle, in my opinion.

John: Yeah, yeah. And it's funny because I know so many clinicians who have four weeks of vacation. They're lucky if they ever take it. It's like, “Oh, well, we can't get coverage”. Well, what is the point of having a contract? And the other thing about the contract is there's no pay raise in the contract. If it's a two-year contract, it's fixed. If it's a three-year contract, it's fixed. I've had people come back. I was a CMO at a hospital. It's like, “Well, don't I get a cost of living? - You're on a contract, man. That's not built in”. If you were an employee, you'd be in a much better position in the sense that if you have like what everybody else in the organization gets, which is a salary increase and all that.

Dr. Jonathan Vitale: Yeah, you are exactly right. So, if physicians have also a utilization management, I think it depends on the company you work for, of course, but there can be opportunity for vertical movement, to become the intro level position in utilization management as medical director, but then there's often opportunities to be a senior medical director, regional medical director, depending on how big the company is. And then of course receiving more executive roles, like CMO, things like that. And then of course the pay is different for each of those. So, there is opportunity for a lot of professional growth in most UM companies, not all.

John: And then if you keep looking, you go from one job and find the next one. But I'm going to segue now into your Facebook group, because you've got over 8,000 physicians in there looking for the right answer for themselves. So, I want to know, what have you learned in running the Facebook group and what other are the common remote or home-based careers that seem to crop up in there?

Dr. Jonathan Vitale: Well, I've learned a lot from running that group. I think the biggest thing I've learned is that what a big desire there is for remote careers and non-traditional careers for physicians. We have over 8,000 physicians in our group from all over the world. And most of them have never had a remote job. They're trying to get one, they're trying to learn more about it.

And so, that's really fantastic that there's such a desire, but also the best thing about the group is physicians helping each other. Everybody's trying to help each other, everybody's giving each other leads. And that makes me feel very good that physicians are so good to each other. Because for people like me who used not to be that happy in my job, I want to make sure that I can do what I can to make sure other physicians get to make the transition I made and get to become happy again. It's kind of important and it is great how physicians look out for each other. So, the group has been just a lot of fun and a real great place for anybody to join, to get information.

The jobs that we talk about the most in the group, certainly utilization management is the number one thing we talk about. I think it's a very common path for physicians interested in non-traditional careers to go into. But we also talk a lot about the industry jobs in pharma, which is big nowadays. So many opportunities there. And we have a lot of people in the group who talk a lot about that. Many of whom you've had on your podcast.

Also, I would say medical writing is something that a lot of people are interested in nowadays. Whether it's medical education writing or writing for various outlets or media, things like that, that's always a popular one.

And then interestingly, a lot of people are interested in telemedicine, which is of course still clinical. But the opportunities for telemedicine nowadays have just exploded because of the pandemic. So, a lot of our docs really enjoy doing a little bit of telemedicine as well. So those are the main ones in our group.

John: Yeah, I focus on nonclinical careers, but I always include locums and telemedicine because you get the flexibility, the telemedicine is home based. So even though it's still clinical, that is very attractive. I noticed in the group that I'm the admin for the PNC Hunters, that we get people in UM who will say, “Hey, my company is hiring”. So, do you get a lot of those posts?

Dr. Jonathan Vitale: We do. I wish my Facebook group existed when I was applying because it’s a great way to get leads. It's the Facebook group. The company I work for, we've hired doctors through my Facebook group as well. So, I make those postings too. So yes, definitely join and use it as part of your job search, those Facebook groups.

John: All right. So that's Remote Careers for Physicians. Just look it up on Facebook. Because I wanted to segue now into the last part to talk about what you're doing outside of that Facebook group, in the coaching with physicians who are looking for nonclinical careers. I'm assuming that a big chunk of that might be for those who are definitely interested in UM, but tell us more about the coaching that you're doing. And that's at drjonathan.com.

Dr. Jonathan Vitale: Correct. I started doing some coaching about two years ago. Again, I have a background in counseling. So, I saw that there was a big need for physicians who really need that one-on-one attention. And that's what I started doing.

So, what I do is I help physicians who are in a traditional job and they're just not happy for whatever reason. I help them figure out what they don't want to do with the rest of their life. Which is oftentimes more important than figuring out what you do want to do. And then I help them understand what all their options are. And then I help them to transition into that.

And yes, most of the people I work with are interested in UM, but there are so many aspects to making a career transition like this that I help out with. There are psychological aspects, there's financial aspects, family aspects, geographic, legal, licensure aspects. All those things that doctors have to think about. And that's what I work with people on. So, reach out to me at drjonathan.com. If you want to make an appointment, I'd love to speak with everybody.

John: You make a good point because it's not a matter of just saying, “Well, let's see, what's my passion? I can figure that out”. But you also have, “Well, do you have any money saved up and what's it going to do to the paying back your student loans?” And psychologically, what's going to be the impact when your family looks at you like you're crazy.

Dr. Jonathan Vitale: That's right. Yeah. These are all extremely important. These are more important even than figuring out what you don't want to do and what you do want to do. Yeah, because I always say to people, look how long can you go without having an income. Because you have to be prepared for this to take six months, for this to take even a year, sometimes longer in some cases. And unfortunately, physicians are notorious for not being great with money. But there are a lot of great physician finance groups.

John: There are plenty of those.

Dr. Jonathan Vitale: Plenty of those. So, we're getting a lot better at it, but it's something I help physicians with as well to make that transition.

John: That's awesome. That's cool. So, we'll put links to everything in there and actually, I'll put a link to NAIRO, which you mentioned earlier and whatever else came up during our conversation.

Dr. Jonathan Vitale: Yes. It’s a great site.

John: No, this is good because as far as I can tell, it's the most popular nonclinical, that's an informal observation job. And to know that there's someone out there that has expertise specifically in how to transition in that is very helpful.

Well, Jonathan, we're going to run out of time pretty soon here. So, anything else that you haven't told us that you want to tell us or any words of advice for the listeners?

Dr. Jonathan Vitale: Well, my words of advice for everybody who's interested is, go on the Facebook groups and just learn more about all that's available. Even if you think you're happy in what you're doing now, just go and learn about it and see.

The other thing is it allows you to have a lot of time to do other things. So again, I'm a big musician. You can check out my work at therealdrjonathan on Instagram. I appreciate being here and I really hope people reach out to me or reach out to our Facebook groups if you're at all interested because I want to help and all the doctors in our group want to help you too, to make sure that you're in a career that you love.

John: It's going to be interesting to see where this goes 10 years from now.

Dr. Jonathan Vitale: It will be.

John: We're in a flux right now when people are scurrying around and trying to find out what they can do besides clinical, if that's what they're interested in. So, I really appreciate those words of wisdom and advice. That was awesome. I think this gives people hope because it sounds like there's a way to make that transition. There's help out there.

Dr. Jonathan Vitale: Yeah. There's always hope. And there's so many people willing to help you out there. A lot of physician coaches other than me and these Facebook groups. And don't forget, physicians have such a vast skill set. They just have to figure out how to best market themselves and how to apply it. Because really life is meant to be awesome. And you have to be in a job that you really enjoy going to, and that you feel that you're making a difference because that's what being a doctor is all about. Because at the end of the day, we're either directly or indirectly all working to make sure that patients get great care. And that's what all these jobs are about. So, don't be afraid to explore them.

John: Yeah. We're not talking about dropping everything and opening a hot dog stand. We're taking that medical knowledge, all that education, all that experience, the leadership, the management, and applying it in another way.

Dr. Jonathan Vitale: Yeah, absolutely. I would say there's a lot of parts to the moving wheels of medicine. It's not just sitting in a clinic or sitting in a hospital. There are so many other moving parts where we need good doctors to make sure that our patients are getting good care, that's affordable and accessible.

John: All right. Well, that sounds like a good note to end on. So, with that, Jonathan, thanks so much for being here today. And I will just say goodbye.

Dr. Jonathan Vitale: Well, thank you so much, John. Thanks for having me.

John: You're welcome. Take care.

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The post How to Find a Top Remote Nonclinical Career – 188 appeared first on NonClinical Physicians.