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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Personal challenge and motivation compelled me to pass my ABPS board exam. Measurement and confirmation of my own knowledge base reinforced my self-confidence. The ABPS, with its history of inclusivity, has allowed me to have a voice in the organization, while permitting me to impact overall national patient safety and care through certification. Participation in exam development afforded me the opportunity to witness the rigorousness of the exam process and psychometrically sound product, while developing meaningful collegiality, professional life enrichment, and warding off burn out.

Elizabeth Maxwell-Schmidt MD, FAAEP, FACEP
Emergency Medicine
Board certification through the American Board of Physician Specialties has served to substantiate my interest and additional training in several fields of medicine including Internal Medicine, Disaster Medicine, and Administrative Medicine. As a result, I have been able to serve my community in clinical, disaster response, and administrative medicine roles. Through the ABPS, I have become recognized as a leader in my various fields of interest.

Spencer Price MD, MPH, MBA
Internal Medicine, Disaster Medicine, Administrative Medicine
BCEM certification through ABPS has provided me with many opportunities. It has helped me demonstrate that I have special experience and expertise in Emergency Medicine beyond that obtained through my family medicine training. BCEM certification firmly established me as an emergency medicine specialist once I started working in emergency medicine full time. ABPS has also helped me network with other family physicians with a passion for improving rural and underserved emergency medicine practice.

Alex Beuning, MD, FAAEP
Emergency Medicine