Physician Advisors: To Practice, Or Not To PracticeClarissa Barnes, MD, CHCQM-PHYADV, FACP The struggle between clinical practice and physician advisor duties is as old as the physician advisor role itself. Dr. Ronald Hirsch recently wrote an article exploring some of the pros and cons to continuing a clinical practice on RACmonitor.com. It’s an excellent look at the range of considerations. In addition to personal considerations, there are employment considerations that may make continuing a mix more palatable from a work-balance perspective as well as improve your ability to attract new talent and protect yourself from staffing issues.
Where you are in your career often makes a big difference in what you are personally willing to do and what others you may want to hire are willing to do. As many of us know (and the recent American College of Physician Advisor survey confirms), many physician advisors are new to this work. Often, they have little experience before they start. It can be quite difficult for someone to make the jump to full-time physician advisor work when they’ve never done physician advisor work before. It is hard to “give up” clinical work (even if you want to or think you are ready) when you are still not sure what you’re getting in return. I have seen physician advisor job postings attract little interest at one position at 1.0 FTE but get multiple applicants when offered as 5 positions of 0.2 FTE.
Splitting up FTE works well in recruiting new candidates to the physician advisor field because it allows them to try it out so they can be comfortable that this is work they enjoy. If it does not work out and they leave their physician advisor role, it also benefits the hospital or health system because it is a lot easier to flex up to cover the 1 day a week they have left open than have to start all over again finding a full-time person.
Ultimately some of the strongest arguments against continued clinical practice stem from the inherent nature of having multiple roles. Namely, it can be hard to compartmentalize and what should be two roles you alternate between often becomes two roles you fill simultaneously. The solution can be to stop doing one role and take up the other full-time. However, there are other options that allow you to keep your jobs separate and preserve your sanity. Specifically, the model stated above where 5 people split 1.0 FTE of physician advisor work so that everyone works one day a week works well when you have physician advisors who want to keep their clinical roles. If their clinical roles are shift-work oriented such as hospitalist or emergency physicians, they can keep their roles distinct and these preserved boundaries help promote work-life balance.
The added benefit of physician advisors who still practice clinically is that they take anything they learn back to their practice group. For example, recently two of the newer physician advisors at my hospital found themselves working clinical as ER physician and admitting hospitalist. They had an entire discussion with each other about antibiotic selection for pneumonia and how that meant they should document that they were concerned about gram negatives as a cause instead of a “simple pneumonia” based on their recent educational exposure as part of their physician advisor training. Obviously, physician advisors will educate other physicians as part of their administrative time, but real-time education and discussion because your physician advisors are also seeing patients can be priceless.
In the interest of full disclosure, as someone who is mid-career, my FTE between administrative and clinical duties seems to be constantly in flux and the decision on how much time to devote to each is one I seem to struggle with constantly. I anticipate a time where it will be too difficult to maintain the amount of clinical time I have currently, but there are ways to make it work so that you don’t get burned out and there are benefits to keeping a presence in both worlds.
Dr. Barnes is a System Physician Advisor for Avera Health in Sioux Falls, SD.
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