Is Your Physician Advisor a Leader or a Follower?
By John Zelem, MD, FACS
I recently read a book “Steeping Stones of Leadership” by Jim Zelem. Aside from being my brother, this book espouses the basic principles of Leadership. This truly translates into the role of a physician advisor who interacts and engages with utilization review (UR), case management, physicians, and executives. In former times, the physician advisor walked a fine line. Executives saw them as a physician, and many times the physicians saw them as an executive. Luckily, that thinking has pretty much disappeared. Today this relationship should end up as a win-win situation, engaging and accommodating both sides.
It can be quite challenging to define what makes a leader. Leadership is earned, not granted, and, more often stems from social influence. It does not arise by authority or a position of power, that’s a boss. In addition, one is not a leader unless someone is following them. Some, but not all, of the most important qualities of a leader are:
- Be a team member
- Accept change
- Accept failure
Being a good physician advisor requires passion, an intense enthusiasm for what one is doing. This is not just a job; it is a profession. It requires ongoing education, learning new skills, keeping up with new regulations, many times long hours, humility and strong convictions at the same time, and much, much more. It takes passion and conviction to learn this skill as there are really very few, if any, established training programs. Yes, there are reputable organizations, societies, offering seminars, webinars, and other training aids, but a lot is learned in the “school of hard knocks.” Experience is a great teacher, and that takes time. Whether it is done part-time or full time, it requires passion.
When I mentor a new or even existing physician advisor, there is one overarching goal, integration. They need to integrate with UR/case management, physicians, and executives. They need to be viewed as a team member, someone who is on their side as there may be times in their future where there may be disagreements in decisions made and conversations had. And that’s ok, because if everyone always agreed, one of you is not needed. That brings up the next quality and that is trust. There needs to be trust, although firmly associated with trust is integrity and honesty. “Integrity means following your moral or ethical convictions and doing the right thing in all circumstances, even if no one is watching you. Having integrity means you are true to yourself and would do nothing that demeans or dishonors you.”
Another important statement is that in order to be a leader, you must have people following you. Can you really follow a person you don’t trust? In addition, trust is earned, not granted.
Another quality of leadership is being a team member. As they say, “there is no ‘I’ in team.” One can and should manage a team but not control it. Part of that requires understanding personalities; people are complex and many times hard to understand and predict. There is a plethora of personality tests, personality profiles, and books available that can help. In order to understand others, it is helpful to understand your own personality which may be a polar opposite to the person you are trying to interact with. I remember from long ago hearing that you may never really know what is going on in the life of the person you are interacting with, accounting for how they are interacting with you. We forget that all the time; I do!
Accepting change and accepting failure in my opinion must co-exist. Change is inevitable. If you are stuck in the status quo, nothing new will happen. A physician advisor should be an agent of change yet expect to meet resistance because change can be painful, and produce a lot of pushback. Along with change may be failure, but failure is an event, not a process. Failure may just show you one way something may not work, but that’s great. Move on to the next step! In so many meetings I have been in when proposing something different, a change, I would hear over and over “that won’t work”. I would get to a point of impatience and say: “OK, I’m tired of hearing what won’t work, tell me what we need to do to make it work.”
Physician advisors should also be outcomes oriented, not task oriented. Marcela Sapone has said “Ticking off tasks on our to-do lists might make us feel productive. But to truly be productive, we must clearly visualize the outcomes we want and design everything we do around getting them.” PA’s are doing case reviews daily and for a large portion of their day. What if they had to work towards a metric of reducing observation cases at least 90 percent every day. That’s a task! But what about the quality of those reviews; what will end up being the denial rate. It will escalate and the overturn rate will plummet. What is the desired outcome? Accuracy. What are the collateral benefits? Decreased denials with resultant revenue preservation and integrity!
The last two areas to discuss for physician advisors as leaders are documentation and culture. Documentation improvement is ALWAYS described as an ongoing need. It starts with medical necessity to justify the acuity for an Inpatient level of care and working with clinical documentation integrity (CDI) to ensure adequate support and accuracy of the DRG’s, CC’s, and MCC’s utilized for billing. Physician advisors cannot do the documentation for physicians, but they can be a mentor.
A mentor is “An experienced and trusted adviser.” Why?
- They make the time for you
- They’re in your corner
- They help you win on your terms
- They lead by example
Lastly, as a great leader, whether the physician advisor is new to their position or have been in it for a while, they need to understand the culture of their facility because chances are very good that it will not change anytime soon. Culture is not taught, it is learned.
Last comment: none of what is presented here is meant to demean physician advisors as they practice today. They do a great job, but it certainly doesn’t hurt every once and a while to do some internal soul-searching to keep ourselves on the right track and improve.