Video: Non-Clinical Career Opportunities for Physicians as a Physician Advisor

Non-Clinical Career Opportunities for Physicians as a Physician Advisor

Edited Transcript from SEAK’s 2025 Virtual Non-Clinical Careers for Physicians Program

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Moderator: Our next talk is going to be on opportunities as a physician advisor, and we’re very pleased to have Dr. Lisa Varghese-Kroll as our presenter. Dr. Kroll, is a physician advisor, and appeal specialist with Med-Metrix. She has [many] years of experience as a physician advisor, is board certified in physical medicine and rehabilitation, and is an active writer and public speaker.

Dr. Varghese-Kroll has unique experience, a unique background in journalism, with a separate degree as well as experience in both print and broadcast media.

She is also the co-host of the health and parenting podcast Health and Home with Hippocratic Hosts which is listened to [on multiple] continents. She received her MD From the University of Virginia Medical School and her BS In broadcast journalism from Virginia Commonwealth, and she’s a seek alumna from a few years back. Welcome back, Lisa! 

Dr. Varghese-Kroll: Thanks so much, Jim. Appreciate that intro and hello to everyone. Good morning. Good afternoon. Good evening, wherever you may be. I’m very happy to be here to talk about physician advising, and for those of you who might know a little bit about it, or for those of you who have never heard anything about it. I’m hoping that this will serve as a primer and a bit of a deep dive into this very exciting specialty.

So what is a physician advisor? So a physician advisor acts as a liaison between a hospital’s clinical physicians and their utilization review team.

What does a physician advisor do? Well, this is by far not a comprehensive list, but some of the tasks that might fall into a physician advisor’s plate include helping the medical staff achieve medical necessity, compliance and improving their documentation, helping the UR team understand the reasons for the clinical physician’s decisions on each case and their unique perspective. A physician advisor might provide status recommendations and write appeals.

They educate staff on documentation requirements and policy changes. They can serve as a point of contact for payers, completing peer-to-peer discussions or formulating appeals and discussing those with them, and they can serve as an expert witness in administrative law which are judge hearings before Medicare judges in a nutshell. A physician advisor takes a major responsibility off the plate of their clinical physician peers while ensuring that that critical role is still filled for the hospital.

So what is medical necessity? Compliance? Well, essentially, it’s a complex process that aims to ensure that each patient is treated in the appropriate admission setting and according to evidence-based standards of care.

So why does it matter so much? Well, CMS, the Centers for Medicare and Medicaid services develop conditions of participation and conditions for coverage that hospitals must meet in order to participate in and be reimbursed by the Medicare and Medicaid programs. While these standards are intended to improve quality and protect the safety of patient beneficiaries, they were also implemented in order to drive accountability and compliance, and to recover reimbursement on previous claims that had admission statuses incorrectly submitted. The code of Federal regulation states that hospitals must have in effect a UR plan that provides for review of services furnished by the institution and members of their medical staff to patients who are entitled to benefits under the Medicare and Medicaid programs.

RACs are recovery audit contractors. They’re independent contractors who are authorized by CMS to audit hospitals and to keep a portion of the money that they recoup. So that project was a huge success from CMS perspective and RACs now exist in all States. Physician Advisors are the ones who play a very important role, not only in hospitals’ process for handling their interactions with racks, but also their processes for interacting with private payers.

So what are some of the things that a physician advisor might be consulted [on]? For again, this is not a comprehensive list, but at the top of any list would have to be inpatient versus observation stays, which admission status is most appropriate for each patient. They might be consulted on the medical necessity of outpatient procedures on CFR compliance for specialty services. They might be asked to provide the medical rationale for coding cases. And it’s important to note here that physician advisors, and coders are separate groups. These are completely different scopes. Physician advisors are not coders, however, coders often can benefit from having a medical expert to discuss the reasons for certain decisions on cases, so that they’re more enabled to select the best possible code for every case on their desk, so it can be a physician advisor who provides that rationale to them.

Physician advisors may also do peer-to-peers, and, as we already mentioned, they may be expert witnesses at AlJ hearings.

So what is a day in the life of a physician advisor like? Well, we tend to divide physician advisors into groups on-site and offsite. So for our on-site colleagues, they may start the day by rounding with teams. They’ll discuss cases, patients who are currently admitted with the attendings and with case managers.

[Physician advisors] educate both providers and non-providers on regulatory and compliance requirements. And these are always changing, due to elections, global events, legislative changes. And so education is a huge part of the scope of [a] physician advisor’s job.

They will ensure that proper documentation is on each chart before that patient is discharged, either by following behind the attending, or by discussing with them before they’re finished documenting. They write letters recommending the appropriate level of care, and they may provide perform peer-to-peers with insurance company medical directors on behalf of the clinical physicians. For our off-site colleagues they will evaluate cases by phone or electronically, they provide status recommendations via those same modes. They’ll write letters of recommendation or appeal.

[Physician Advisors] may lead remote meetings with physicians and medical staff to educate on regulatory compliance and documentation requirements, because, as we said, they are always changing. They’ll need to be available by phone for physician or staff consults. They, too, may communicate with payers for peer-to-peers or appeals issues, and they may represent client hospitals at ALJs.

But just as important as what a physician advisor does do is what [physician advisors] do not do and what they do not do is provide diagnostic or treatment recommendations, criticize ongoing care, or have direct responsibility for patient care.

So you may be wondering particularly if you’ve never had personal experience with a physician advisor, does any of this really make a difference? And physician advising as a field, has been around for long enough at this point over a quarter century, that we have data and can draw some conclusions. And one thing that we are able to see is that improving compliance and streamlining documentation which are things that physician advisors absolutely do directly lead to an improvement in quality of care, and that’s because they help optimize lengths of stay. They decrease medical errors, and they reduce the number of times that physicians have to return to the chart.

Physician Advisors also help prevent or correct inaccurate reimbursements, and that ensures that resources remain available to serve the community that can be especially important for small local community hospitals. So being a physician advisor means that you’re leveraging your previous hands-on experience in a new but equally important way.

So what are some of the typical requirements for the position of a physician advisor. Well, from a clinical perspective, an MD or DO is required as well as an active, unrestricted medical license.  Board certification in your specialty is preferred. [A number of] years of clinical experience and a high level of comfort reviewing cases across specialties. It is very rare that a physician advisor would review cases only in their own specialty.

So the faster you can have a comfort level or create a baseline knowledge of most specialties the better it’ll be from a non-clinical perspective. Written and verbal communication skills will be key for this role as well as the ability to very quickly gather and combine information and make rapid, excellent decisions with that information, being a strong clinician, having excellent interpersonal skills, being at the same time a great team player and a confident leader being able to strike that balance as well as being computer proficient typing [a healthy amount] of words per minute, but, practically speaking, probably faster. And if you’re off-site, having secure high speed Internet connectivity at home.

Now, some of the physician advisor companies out there. This, too, is not an exhaustive list, because this list is always changing. New companies come on the market. Old companies merge. But at the time of this recording some of the big names in the field are Med-Metrix, Corro Health Xsolis, [and others]..

So [for] these companies websites as well as LinkedIn, are your best friend when it comes to letting you know who’s hiring at any one given time, and who currently employs people that you know your current colleagues or former colleagues as their employees.

So one question I always get when discussing physician advising is whether this job can be done part time. And the answer is, yes, there are several ways that that can happen. If you’re off site, you will only take cases during your scheduled shifts, so you can negotiate with your employer to take only a certain number of shifts per week or per month.

If you’re on site. Smaller hospitals may only need you a few days a week, and there’s also the possibility of job sharing. If you know someone else who wants to work part-time, you may be able to split a full-time job.

So the fun stuff to talk about is always the benefits. What are the pros of this kind of job? Well, if you work offsite, you will never have to worry about traffic again. I live in the greater DC area, which has the dubious distinction of having the second worst traffic in the United States, so I did not regret hanging up my driving shoes. I do not miss rush hour, and you won’t have to, either.

You don’t have to worry about call [as a physician advisor]. You no longer need malpractice insurance [as a physician advisor], and you have the opportunity to learn a new subspecialty. Most of us in medicine really enjoy learning, and this is an area that very few of us had exposure to in medical school or residency training. So the opportunity to learn something completely new without another residency is really exciting.

You have the chance to collaborate with numerous other physicians on a daily basis all over the country, depending on where your employer’s client hospitals are located. They could be in any of the States, and that’s not even including your own teammates, who, if you’re remote, they too, may be in any or all of the other of the States. So it’s your chance really to get to know different hospital systems.

You’ll have the chance [when working as a physician advisor] to improve your regulatory and clinical knowledge base, which, as we mentioned, very few of us had exposure to during our education and training. And it’s especially exciting, because this is an area that for many physicians is fairly obscure and you’ll enjoy a reasonable work-life balance. The compensation benefits and bonuses in this field are competitive, and you’ll apply your established clinical experience in a different way, and you have the satisfaction of knowing that you’re helping your fellow physicians in the process. And this probably is the biggest benefit to me personally, the thing that I enjoy the most.

But of course we have to talk about the drawbacks. What are the cons? We just went over the pros. But what are what are the negatives to being [a physician advisor]? Well, one is that the training process can be intensive, because, as we mentioned, many of us have very little exposure to this before we become physician advisors, there’s a lot to learn, and so training can be on site, out of State for several weeks, and training will continue even after you return home, because there is so much to know because the legislative landscape is always changing. Much of that learning is self-guided.  Physician advising is fast paced in a different way than clinical medicine is fast paced, and that does take some getting used to because patients are admitted to hospitals [all] days a week. Some weekend and holiday hours may be necessary [as a physician advisor].

Team meetings are crucial because things are always changing and they can occur outside of your scheduled hours or outside of your time zone, based on where your teammates may be located as well. Managing client relationships can be challenging. This is less of an issue now than it was years ago, but even now we will sometimes encounter attendings who have had no experience with physician advisors, and whose default is to assume that we’re the enemy. So it takes time to build trust and to help them to understand what our role is, and that we’re here to support them. Like all consultants, sometimes you’ll recommend things that the attending does not want to hear or doesn’t agree with. So that takes some finessing, and it can be a challenge as well. If you work remotely, you’ll need to worry about ergonomics. You will have to put some money into your home office to arrange it so that you’re protecting your spinal health, your vision, etcetera.

Power outages become an issue. If you work outside of the house, a power outage at home during the workday doesn’t really make that much difference. But if you work from home, a power outage can be the difference between working that day or not working that day, and it can put a huge burden on your teammates. So this is something to be aware of as well. Dependent care is still necessary. Physician advising is not the kind of job you can do and expect to watch your small children or your elderly family members. The last thing you want to do is to be on an official call with a judge and hear the strains of [a kid’s TV show’s] theme song in the background. It is important to remember that you cannot fire your nanny or your daycare. It’ll take effort [establishing relationships with other remote physician colleagues] if you’re no longer working in person with your colleagues. There’s no more water cooler time. There’s no more grabbing lunch in the cafeteria. If you live in different states, you can’t even meet after work.  [Establishing relationships will your colleagues] will require initiative, and it has to be a personal goal. It’s not something you can rely on happening organically.

And then there are the things you need to consider when you’re moving into any form of nonclinical medicine, not just physician advising. If it’s your [first] time leaving clinical medicine, then you may have to face a potential change in self identity as a doctor. But it’s important to recognize that just because you’re no longer seeing patients doesn’t mean that you’re not still using your education and training. American healthcare as it stands today very much relies on physician advisors. It’s a critical role that’s just as important. It’s just different.  [Let’s talk about] keeping your clinical skills fresh. If you want to continue practicing clinical medicine while working in non-clinical medicine, that will take initiative. It takes a plan. It’s something that you have to make sure you’re taking steps towards.

So what if you’ve decided that you might want to pursue a career as a physician advisor. What are the steps that you’ll need to take? Well, firstly, you’ll need to read. You really cannot read too much. Not only will you want to brush up on your own specialty, but you’ll also want to go back and review diagnoses and treatment plans for things that you might not have seen since Medical School. The faster you can become comfortable with other specialties, as we mentioned before, the better.

You may want to join the American College of Physician Advisors, ACPA. In order to take advantage of their library of learning resources and to network with others you can consider attending their annual conference. You’ll want to use the application and interview process to showcase your communication skills and professionalism, traits that are absolutely imperative in physician advising. Stay confident. Remember that you’re an expert, but at the same time be respectful of other physicians for many of you, this may be the 1st time that you’re no longer in charge of the patient’s care. So it’s important to remember that and always stay positive like, whether you’re a physician or an accountant or an underwater basket weaver. Everybody wants the person with the smile on their face on their team over the person who has a complaint every hour, so keep that in mind and always focus on your positivity.

There are also board certifications available. There’s also an advanced certification, and these may be further down the road, but they’re good things to keep in the back of your mind, and to have an idea of working towards, if that’s your goal.

So who am I? And how did I get here? Really? Briefly, my story began with a bachelor’s degree in broadcast journalism which gave me the opportunity to have a lot of really wonderful experiences. I was able to intern at the White House at CNN with Dr. Sanjay, Gupta at Warner Brothers, in Hollywood, and after that I went to medical school, did a PM&R Residency was board certified in PM&R and as an attending I worked in both the VA System and private practice, but as the years went on I was looking for a way to incorporate more of my communications background and experience into my medical career. So I attended SEAK and I became a physician advisor and I’ve been fully in the world ever since. I’ve never looked back, and I can honestly say that I have enjoyed almost every moment of it.

So thank you so much for joining me today. If you have any questions, please feel free to reach out, and I really hope that I’ll have the opportunity to cross paths with some of you as colleagues in the future. Thanks so much.

Q: Thank you so much, doctor. I know this probably varies. But any sense ballpark, how many cases you would deal with in , say, an hour and say a shift, what’s kind of your volume? Is it like items a day or more?

A: No, that’s a great question, and it really depends on your employer and their proprietary system. Some cases are more complex than others. 

Q: How prevalent are these are [physician advisor] jobs? Are there like a lot of these jobs out there? There’s always going to be openings. Can you give a sense of that, doctor?

A: Yeah. And that is something that undulates a little bit. It does flex depending on where medical budgets are being directed. So for a while everyone was outsourcing, physician advising, and in that case there was a sort of a glut of jobs. And then there came a phase where hospitals were starting to move it in house, in which case they really only needed a handful of physician advisors. So I would say that at this point there are several companies that are almost always have, several of them hiring [physician advisors], so it’s certainly something where you can expect there to be job openings at any time, but whether they will be job openings that require you to be on site and therefore will be need to be somewhat near your home or job openings that will be remote, and therefore you may have access to more of them. That kind of comes and goes.

Q: And in terms of the market like today, do you have a sense as to what percentage of the [physician advisor] jobs are in house versus contract on site?

A: I don’t have a solid number for that, but I would say right now that there are more, I would say there are more remote than on site jobs. I’m not sure I could give you a number. 

Q:  And you mentioned you know, if you’re off site, I guess the hospital could be anywhere. Do you need a license wherever the hospital is [to be a physician advisor], or is that not an issue?

A: No, you just need one license in one of the States [to be a physician advisor] which is really fantastic. Now, there are some very niche exceptions to that which won’t apply to most people. But there are some very specific payers that require someone, for example, with a California license to work on California cases with a very specific sub payer. But really your employer will kind of handle that and find people who are already on the team who have the relevant license and funnel the cases, those cases specifically to them. It’s not a common enough issue that most people need to worry about it.

Q: So you’re obviously a people person. You like to communicate verbally and things like that. What percentage of your job [as a physician advisor] is typically, you know, bookworming, not bookworming stuff. But you know, you’re viewing records? And you’re doing alone stuff versus actually being out there talking to people?

A: Yeah, it depends, too, on your role. But I would say, on average, there is a lot of record review which I personally enjoy. It’s kind of like, it’s kind of like research back in our student days. It’s really interesting. And it’s also a little bit of detective work. You know. It’s you’re finding factors in that patient’s case that help make your case. We’re going to pretend we’re attorneys for a second. If you’re making a case for why this patient should be inpatient, or should be observation, you’re looking for the couple of pieces of data in that EMR, that will support your case, and those pieces of information might not be very obvious. You might have to go down into dusty corners to find them. So I really enjoy that. Then the other % is talking to either staff members at the hospital talking to them about the case, talking to them about deficiencies in the case, or talking to payers, you know, arguing your case about why a status should be one way or the other, arguing your case before a judge about why an appeal should be overturned, or a denial should be overturned, or discussing with them what other pieces of information they might be missing from the Client Hospital.

Q: Every time I ask you a question you make me think of a different question. I’m sorry, Doctor, so payers, you mentioned payers. So I would imagine that you’re interacting with counterparts in utilization review as the payers obviously a lot of the same skills that you would use in your job would be used on the payer side is their job mobility? And have you known people to go over to the insurance side of things. The payer side, after being a physician, advisor?

A:  Yes, definitely. It goes both ways. Absolutely. We have for sure had colleagues go to the insurance side and had many, many insurance medical directors come over to our side. So you do find that the experience on both sides will help you. 

Q: Is it fair to say that you know your schedule [as a physician advisor] weeks or months out? So none of this call stuff – you can have a life and plan your life?

A: Exactly. That’s actually one of the biggest benefits of this position [as a physician advisor] is just the amount of control that you get back over your life.

Q: [Physician advisors have] time for side gigs. Correct?

A: Yes, exactly. I mean, I know so many people who are involved in incredible side gigs, some of which have nothing to do with medicine, but you know they’re artists, or they’re coaches of teams and things. And so they sort of had the chance to give a little bit more of themselves to this other endeavor that they might have had to bury for their many years in clinical medicine. So that’s another real benefit of physician advising.

Q: Alright. So in addition to this role, in addition to your podcast, you’re a mom and have you found in your experience the remote jobs to be flexible in in the sense that if you want to pick up my kids at school every day, so they don’t have to take the bus, is that something that you might be able to work out? Or is it more like, I have to lock myself in a in a dungeon?

A: No, I think it’s much more the former than the latter. I think there is a little bit of a tendency sometimes to think of remote jobs as being completely free and easy. And that is not the case. I mean, you are really expected to be there for your scheduled hours, but that being said  for the most part, your teammates also understand that things come up, and you know people want to be flexible for each other, and so certainly, if there is something that you need to be there for your kids or other family members, I have found that that [most] of the time you’re able to do that you can work that out with your colleagues. You can. If it’s something that’s recurring, you can just work that into your schedule from the beginning. People are very understanding of emergencies and things that pop up. Of course you don’t want to take advantage of that right? I think that’s true in any job, but the flexibility is certainly much, much more than that of clinical medicine that you can’t deny.

Q: All right. Now I get to cross-examine a little bit. So you said you’re earning potential [for a physician advisor] – I think the word you used is competitive, so compare it to like what a primary care physician would make to start, are we talking around the same or a little bit more?

A: Yeah a little bit more, I’d say, more than starting salary for a primary care physician, I think, for a highly specialized surgeon, it’s going to be significantly less. So you’re really, then, at that point, thinking about whether the work life balance is making up for that financial change, but for a lot of physicians they’re going to be very pleasantly surprised to see that they’re making notably more [as a physician advisor] than what they might have been making clinically.

Q: Specialties preferred [to serve as a physician advisor], if any, or specialties not preferred?

A: I would not say there are no specialties that are not preferred [to be a physician advisor], because physicians in general are able to get back into that mindset of learning about all specialties. You just have to go back to the idea of being in medical school, but specialties that are more preferred. Some different companies have different needs. But I’d say in general, primary care is very highly valued [for physician advisor roles], just because that is more general. Of course I’m not a generalist. I’m a specialist. I’m a rehab physician and that has its own benefits because there are specialized services that require physician advisor, input, as I had mentioned, inpatient rehab inpatient psych is another one. So you may find that if you’re a specialist, even if you’re a specialist, there is actually a niche you, which is what I was very grateful to find for myself. But yeah, primary care is very highly valued, but it doesn’t mean that, that’s all anybody wants. As long as you can demonstrate that you are open to learning that you’re willing to read. I really think that most people, most companies, will at least give you a chance and consider you.

Q: Some of the things that professionals really like about their work is that it’s not really so much the prestige, but the intellectual stimulation, the intellectual challenge of it on a scale from one to with being the most intellectually stimulating. Where would you rate [the intellectual stimulation of serving as a physician advisor]? 

A: I just enjoy [the intellectual stimulation of serving as a physician advisor] every day. I have no idea what case is going to come up. It’s so fascinating like it could be anything from a NICU baby to someone going through alcohol detox to someone in Florida. They were not things that I saw on a daily basis. 

Q: And you mentioned some doctors continuing the practice, did you? Do you? Did you? Or do you continue to see patients on the side.

A: I do not anymore. But I have plenty of colleagues who do, and I have plenty of colleagues who don’t. So really, either way, whichever you choose, you’ll be in good company. No one will think it’s odd There’s definitely a place for you.

Q: Any issues or challenges maintaining your license or boards, not seeing patients.

A: Not so far as I’ve had. I’m licensed in states in Maryland, North Carolina and as long as you keep up your CME Requirements. You know, every state has their own CME Requirements and annual fee, etc. That kind of thing. It has not been a problem. If you were to return to clinical medicine, every State has their own requirements for that. So some States do say, if you have been, let’s say, out of clinical medicine for months, then they require you to shadow someone before you can return. So that is something that if you think you’ll return to clinical medicine in the future. Either you need to be very clear on what your State’s requirements are for reentry, or you need to keep a hand in clinical medicine all along. So volunteer at a free clinic, or take one shift a month, or whatever you need to do so, 

Q: And in terms of your boards. Have you had to recertify, doctor, since you’ve been doing this.

A: I have. Yes.

Q: And how much of a pain in the neck was that, not being in the field?

A: None, really, because boards now almost all specialties are really moving towards rolling certification. There are very few now, I think, that are still doing the big exam every [so many] years, which is what it was when I 1st graduated. But now, because we’re doing rolling certification and because nonclinical medicine is becoming every year more and more common.

I haven’t found it to be a challenge at all. I just do my quarterly questions. I keep up with all the requirements, the projects, the fees, and everything, and as long as you do that, and they know that I’m nonclinical. It’s not a problem.

Q: Do employers give you time for and pay for the CME? And do they give you time for and pay for the boards and the licenses?

A: Yes, it would, depending on your employer, and also depending, if you’re salaried. But yes, in general [if you are] salaried. 

Q: All right. Now, the fun question, can you tell the audience a little bit more about your podcast because they might be interested in that.

A: Sure I’d be glad to. Well, I’m the co-host of a health and parenting podcast called Health and Home with the Hippocratic Hosts. I host it with my longtime friend, who is also a board certified physician. She’s a pediatrician, and we cover any topic under the sun that has relation to health or to raising great kids. We’ve had such a fun time. We’ve had an amazing array of experts on the show that we get to chat with [and] learn from.

We talk about our own experiences in medicine, we do subseries. We did an excellent subseries on mothers in politics, where we’ve interviewed various women who’ve been elected to office around the country. And it’s just been really exciting. And a fun way to yeah, you know, use more of my communication background and that kind of thing. But also it’s been a fun time for me in terms of learning more about how to be a better parent and just a better citizen of the world, because, you know, health affects us all, whether you’re a parent or not. Anything having to do with medical news, medical breakthroughs. They’re all going to affect us in one way or another, and we’re just really thrilled to be to be a trusted voice in that community that people can come to learn and to have a good time doing it.

Moderator: Thank you very much, Dr. Varghese-Kroll. You are a bundle of energy as always.

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