Five years into his career as a hospitalist, Ahmed Abuabdou, MD, MBA, found himself frustrated with America’s healthcare system. “There were too many challenges, too many struggles, and I wanted to be able to influence change,” he says. “In order to do that, you need to have a seat at the table.”
He drew up a personal strategic plan with a clear goal: Become the CEO of a hospital or healthcare system within 10 years. The identified action steps of the plan included pursuing a master’s degree in business administration. “I also needed to have a series of accomplishments and project completions at the hospital level, and that’s where physician advisory came in,” he says.
During the past seven years as the lead physician advisor for University of Arkansas for Medical Sciences (UAMS), Abuabdou has been offered more leadership responsibilities. In January 2023, keeping his 10-year plan well on track, he was named UAMS’ chief clinical officer.
The position of physician advisor — a liaison between physicians and a range of administrative functions — is a career endpoint for some physicians and the route to new leadership positions for others. “It is a really great conduit to go on to different physician leadership roles because physician advisors have a good understanding of the business of medicine,” says Clarissa Barnes, MD, president-elect of the American College of Physician Advisors (ACPA).
Barnes is a good example. A hospitalist at Avera McKennan Hospital, she was physician advisor for clinical documentation integrity and utilization review for the Avera Health system and lead physician advisor at Avera McKennan until last fall, when she became medical director for Medicaid in South Dakota.
During the past six years, she has seen the position of physician advisor move from “nobody wants to do it” to being highly sought-after. “The last time I had an opening for a .2 FTE [at Avera], I had nine people apply for that job,” Barnes says. “People want to do this work now.”
Juliet B. Ugarte Hopkins, MD, founder and CEO of Velvet Hammer Physician Advising, says physicians increasingly recognize the need to support their fellow physicians by taking on some of their administrative challenges.
“All of us who go into medicine choose medicine because we don’t like business stuff — we just want to take care of the patients,” says Ugarte Hopkins, formerly a pediatric hospitalist and the current ACPA president. “But in reality, that’s not a possibility anymore. When you have people who are business-minded and people who are medicine-minded, it is very difficult for the two to get together, so there is this need for a position that can bridge those two worlds to make sure everyone understands each other.”
What Physician Advisors Do
The job title “physician advisor” can encompass a wide range of responsibilities, which vary considerably from one job to the next. Serving as a physician liaison with the departments of case management, utilization management, and clinical documentation/coding are the “classical three parts of it,” says Ugarte Hopkins. “I think everybody who gets into this job finds out very quickly that your original job description can expand exponentially,” she says.
When insurance contracts allow it, physician advisors often handle peer-to-peer reviews with insurers’ medical directors, thus freeing up their physician colleagues to take care of their patients. This can be a winning strategy to get therapies approved.
“If you’re doing peer-to-peers over and over again, you get better at it,” Ugarte Hopkins says. “You learn what a certain medical director is looking for, so you can go into that conversation with the points that you need to get across.”
While physician advisors typically don’t have authority over physicians, they serve as a resource for their colleagues, who often do not know all the CMS regulations and documentation requirements for insurance claims — or even how to find out. “When you take that on and say, ‘I am your resource, and I am the person to come to with your questions,’ you start to become the authority and people start gravitating to you with their issues,” Ugarte Hopkins says.
As they work through patient-specific issues, physician advisors often find systemic problems that need to be addressed. “For example,” she explains, “you’ll start looking at a case on a specific floor and learn about a delay that’s happening on a routine basis and you’ll find an opportunity to improve the process or that there is some sort of misunderstanding that’s creating a holdup over and over again.”
That type of systemic change can bring tremendous benefits. For example, physician advisors at Avera Health spearheaded an initiative to analyze denials, facilitating targeted efforts to reduce them.
“In the last five years we’ve managed, with our computer friends, to build these dashboards so all denials are getting tracked,” Barnes says. “We can tell you what percentage of denials for a given diagnosis that we have won and how much money that has resulted in. I can tell which person writing the appeal letter had the most success. It’s been amazingly helpful — you can’t target denials for a diagnosis and see whether you can make a difference if you have no idea where you’re starting from.”
Some health systems employ full-time physician advisors while others prefer having several physicians working part-time in the role. UAMS is in the part-time camp. Its physician advisors are required to work as clinicians at least half-time. Even though he is chief clinical officer, Abuabdou still spends 20% of his time as a hospitalist.
“I need to know what’s actually happening on the ground because if a problem presents itself, then my knowledge will help me make a better-informed decision for the team and for the patients,” he says.
Scott Ceule, MD, an emergency physician at the University of Kansas Medical Center (KUMC), shares that perspective. “We really feel like if you become a full-time physician advisor, you’ve got a limited lifespan of being clinically relevant, and your ability to have the same collegial clinical conversations wanes a bit,” he says. “Working clinically in the hospital keeps you in the loop for the day-to-day issues and constraints that are faced by physicians.”
He was recruited to be KUMC’s first physician advisor nearly six years ago. The team has since grown to seven physicians, all of whom continue to practice medicine. Ceule works half-time as a physician advisor, while his teammates work in that capacity one or two days a week.
On their physician advisor days, the physicians are called into action in observation vs. inpatient decisions if a utilization-review nurse’s determination does not match a physician’s order. “We’re the ones that review the chart in a little more detail, make the determination, and notify that attending provider,” Ceule explains.
The physician advisors also field transfer-center calls to make sure transfer requests meet medical necessity to be at KUMC and that the patients’ insurance plans include the medical center as an in-network provider. And they work on patient throughput, expediting tests so that inpatients and observation patients can be discharged as soon as medically appropriate.
By contrast, CommonSpirit Health, which operates more than 1,000 care sites and 140 hospitals in 21 states, employs approximately 150 physician advisors as remote workers who work primarily on concurrent reviews.
Elizabeth Quinn, MD, system vice president-internal physician advisor services, is building a team of onsite and remote physician advisors. “In the hybrid model, whatever we can do efficiently and effectively while working remotely, we will do,” she says. “Additionally, there’s a need to have onsite physician advisors at every hospital.”
Some health systems prefer onsite physician advisors who dedicate all their time to the role. That was the case for Ugarte Hopkins, who spent almost nine years as a physician advisor at ProHealth Care in Waukesha, Wisconsin.
“I think the closer you are to full-time, the better because there is so much to be done,” she says. “If you have different individuals in the position, depending on the day, it makes it harder for your medical staff to keep track of who they need to reach out [to].”
What It Takes
When physician advisors first step into that role, they almost never have the knowledge about rules, regulations, and processes they will need to succeed in the job, but all of that can be learned. The attribute most important to their success is respect from their physician colleagues, which is usually earned by developing collegial relationships while working in the hospital setting, Ceule says.
Good communication skills are essential. “You have to have the ability to have difficult conversations and not run from them,” he says. But physician advisors are supportive of their colleagues, not adversarial.
“When we have a difference of opinion, our job is to make sure that they are aware of all the different information that they may not necessarily have,” Ceule explains. “We do not supersede their clinical decisions, and we don’t say you’re making a mistake. If they disagree with us and do their own thing, that’s probably the end of it.”
Physician advisors also must be leaders who are motivated to improve whatever they are working on. They listen to complaints, ferret out root causes, and work collaboratively. “They want to be the ones that people call when they have a question and the ones that help the team solve a problem, not just a ‘head-down, get-the-work-done’ type of individual,” Ceule says.
They also derive satisfaction from reducing physicians’ administrative burden. Indeed, Barnes pivoted away from serving as medical director for her system’s wellness program so she could focus more on physician advisory work. “I thought the best way to actually make physicians’ lives better was just to make their work better,” she says.
Getting Started
Ugarte Hopkins, a pediatrician, sees a “strong misconception” that physician advisors are typically adult care hospitalists. Rather, the requisite attributes are medical knowledge, the ability to read patient charts with a physician’s insight, and the ability to communicate effectively with physicians.
At Avera McKennan, Barnes found that moving incrementally into a physician advisor position works well. She recruited three physicians to work one day a week as physician advisors.
“I think it’s really hard for physicians to go from a completely clinical job to a completely nonclinical job that they’ve never had experience in,” she said. “Allowing them to transition slowly and see what it’s like makes it easier. One of those people really liked it, and now she’s working as a physician advisor two days a week.”
Physicians who think they might be interested in physician advisory work might volunteer to join their hospital utilization review committee, which will help them test their interest level and start learning the issues, Barnes suggests.
Abuabdou, in an early step on his 10-year plan, approached UAMS’ then-chief clinical officer to suggest developing an inhouse physician advisory service. At that time, the hospital used an external vendor, an arrangement that resulted in less physician engagement and, therefore, minimal effectiveness.
As a trial, Abuabdou addressed the hospital’s challenge surrounding patients treated as outpatients with observation. He developed new processes with two goals: educating attending physicians using the clinical situation at hand and making recommendations that would give patients the appropriate status for their condition.
“When we improved the average observation hours by more than 50%, they asked to buy more of my time,” he says.
His next assignment was to develop new processes for resolving coding queries. “For the past five years, we had a success rate of 100%. We have never lost an account because of a query that was not answered,” he says.
Those successes propelled the creation of a program that currently includes three physician advisors.
On-the-job learning is common for physician advisors, although many supplement that with some formal training. Shortly after he started working as a physician advisor, Abuabdou pursued a healthcare quality management certification. Ceule received in-person training and follow-up phone support from a physician advisor who worked for a consulting firm. When new team members are added, he trains them and closely supervises their determinations for several months.
Ugarte Hopkins encourages physicians who want to explore physician advising to make their interest known. “If you have any interest at all, you really should jump on that because you will be an invaluable resource to the hospital,” she advises. “This is a way to stay within the hospital setting and still make an impact for patients.”