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The Physician Advisor’s Role as Healthcare Continues to Evolve, According to Adam Rench, MD

Dr. Adam RenchI’m part of the physician advisor staff at MedManagement LLC, also known as EdiPhy Advisors, which functions primarily as an independent review organization.

I became interested in becoming a physician advisor during my clinical practice, when I grew intrigued with the “nonclinical” approach to patient care. At the time I knew little about process improvement, utilization management, auditing, appeals, and other aspects of the physician advisor role, but I certainly felt drawn to the work.

The physician advisor role is constantly evolving. In a general sense, physician advisors perform utilization review/utilization management and provide guidance regarding medical necessity and patient status issues. We also review clinical records and documentation, analyze appeal and denial claims as well as quality and performance improvement activities.

Physicians interested in pursuing this kind of work should first gain a strong clinical base, and, if possible, continue to practice in some capacity. By networking with a hospital or clinic’s utilization staff, a physician can determine whether the role is a good fit. There are a variety of career options available, some of which will allow physicians to continue their medical practice.

Board certification, typically in a primary care field like internal medicine or family medicine, is a must for the physician advisor role. Clinical experience in those fields is a vital prerequisite. Most independent review organizations require physician advisors to have at least five years of clinical practice, and some, such as EdiPhy Advisors, also require ongoing clinical practice.

Given their broad skillset, it’s not hard to see how physician advisors can help an organization achieve regulatory compliance. Currently, the healthcare industry is worth $3 trillion. The regulatory guidelines, reimbursement schedules, and patient outcomes all figure significantly in this overall expenditure. By providing guidance on clinical and operational knowledge, documentation education, and leadership, physician advisors will continue to play an essential role in our evolving healthcare system.

Adam J. Rench, MD, CHCQM-PHYADV, holds positions as a senior regional physician advisor and associate chief medical officer at the military entrance processing station (MEPS). He is a Diplomate of the Board Certification in Internal Medicine (BCIM), which is governed by the American Board of Physician Specialties® (ABPS).

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Medical organizations throughout North America understand that our rigorous certification standards prove that ABPS Diplomates are capable of delivering the best patient care possible.

The American Board of Physician Specialties has provided me with the opportunity to demonstrate mastery of internal medicine through board certification. As a hospitalist, board certification is an expected credential, and hospitals recognize the American Board of Physician Specialties (ABPS) as one of the three standard credentialling bodies for Internal Medicine. Additionally, the ABPS has helped me develop leadership skills as a Board member and Committee Chairperson. ABPS has also helped me sharpen critical thinking skills as a test question developer and reviewer. The Allopathic (MD) and Osteopathic (DO) physicians in the ABPS are lifelong learners and frequently pursue multiple board certifications. I enjoy the camaraderie of my peers in ABPS.

Loren Jay Chassels, DO
Internal Medicine
When I think historically, advancement in medicine and patient safety and care has been driven by the diversity of people and scientific thought. That’s what I found at the ABPS and more. For over 60 years that is just who we are. I found a physician certifying body that provides a choice and voice to all physicians ensuring that patients are always placed first.

Jerry Allison, MD
Emergency Medicine
When I decided to pursue a full time role as a physician executive it was important to me to obtain additional professional training, education and work experience. Board certification through the ABPS in Administrative Medicine is validation of my efforts and a demonstration of dedication to professional development. We need more physicians to become full time health care executives, knowing there is a board certification option in Administrative Medicine encourages physicians to take the leap from full time clinical practice to healthcare organizational leadership.

Richard Paula, MD
Administrative Medicine
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