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