Should you become a physician in utilization management? Wondering what “utilization management” is, and what a UM doctor does? A UM path can lead to a rewarding and fulfilling career for those who value flexibility, autonomy, and the opportunity to make a positive impact on healthcare outcomes. I’m no expert in this area, so I brought in a guest who is- Dr. Jonathan Vitale!
In this episode of The Career Rx we’ll discuss:
- Qualifications for utilization management positions, and what you need to be competitive
- What a utilization management doctor actually does, and how to determine if UM is the right nonclinical career for you
- Potential downsides to a nonclinical utilization management career you’ll want to consider before making a change
In my interview with Dr. Vitale, we explore the world of Utilization Management – a very popular nonclinical career option for doctors. Dr. Vitale is a board-certified family physician who transitioned from clinical practice to UM more than a decade ago. He tells us why many physicians choose UM for better work-life balance, potentially higher hourly income, less stress, and other benefits.
In this Episode:
- Dr. Vitale’s path from family medicine to utilization management
- What exactly is “utilization management” and what’s the job like?
- Pros, cons, and career advancement in UM
- Tips for physician job seekers interested in UM
Links and Resources:
Industry Insider – 12 hours of CME, learn exactly how to land a rewarding nonclinical career without a new degree, special connections, prior experience, or a pay cut
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TRANSCRIPT: Episode 128 – Utilization Management Careers: Guest Jonathan Vitale
Okay, great. Great. Well, today I’m so excited to have at first on this podcast I have with me a special guest. Dr. Jonathan Vitale is a board-certified family physician, as well as a certified physician executive through AAPL and also has been in utilization management working as a professional for the past 10 years currently managing a team for a large private National Insurance Company. And as I get so many questions about the world of utilization management, I know almost nothing about it. I reached out to who I know is the expert. Thank you so much for being on the show with me today.
Oh, Marjorie. It’s such a pleasure to be here. Thank you for having me.
Yeah, it’s absolutely my pleasure. It’s so interesting. I know our circles cross a little bit indirectly, mostly in the sort of online world I guess in Facebook and LinkedIn of folks looking for non clinical careers. But otherwise, I think our worlds are our, I don’t know fairly separated, I guess from an industry perspective.
So I’m so grateful to have you on to tell us you know a little bit about maybe your journey yourself as well as what people really ought to know since people have been asking you no doubt for a decade. What they need to know about a career in utilization management.
Yeah, you know, and it’s interesting you say that, because usually when people are interested in a career transition, they that non traditional, they typically go down either the UN path or the pharma industry path. And it’s always it’s always interesting to talk to people in both of those arenas, and see really how much we have in common the physicians who go into those paths have in common.
Yeah, but yeah, so but I focus of course, on UNM or utilization management. I’ve done that for about the past 10 years. And it’s a really wonderful career journey to go down. And it’s one that I encourage physicians who are burnt out who are dissatisfied with their current job who are bored, who are feeling underpaid, overworked, underappreciated, or who are just ready for a change. You know, I really encourage them to look into utilization management.
Well, I can’t wait to hear more about it. I mean, let’s start maybe from the beginning. Since you’re a physician, you’d like me though, we don’t work clinically anymore. At least not as a primary day job. Can you tell me a little bit you’re a family medicine doctor by training. So tell us a little bit about maybe what that was like from the time you finish training. Until the time you decided to change direction?
Sure, well, I’ve always had a lot of interests. I’ve always been interested in medicine and business and music and people I have all sorts of interests and I always knew, even when I was in medical school, I was one of those fortunate people who knew that I probably didn’t want to sit in the clinic or hospital for the rest of my career.
But in that same light, I knew that in order to have the most opportunities available to me, that I needed to go through training, get board certified finish residency. And get, you know, attending clinical experience. And that’s why I always emphasize to people who are especially people in training who are in residency who are feeling really burnt out, I always try to encourage them to finish and get board certified because it gives them a lot of the most opportunity, especially in UNM and UNM really 98 99% of the time, you do need to be board certified.
So that’s one of the one of the big things that people often want to know, in terms of my journey, you know, after residency, which I did in Chicago. I stayed there for a few years and I actually worked, did some locums work, and also did some health tech startup work and back then startups weren’t as common as they are now. So I was involved in some telemedicine startups and did a few other things like that.
Then I moved here to New York City in Manhattan, probably about eight years ago, and I took a job as an outpatient family physician at a very well known national concierge style, practice. Which has locations all throughout the country. And I thought well, this is this will be good for me because this is only a patient I always knew I did wanted nothing to do with inpatient medicine.
And I was like, this is all outpatient. This is I’m only going to be working four days a week the way they structured is you work four days a week, and I wouldn’t have called the weekend. I was like, this is going to be great.
That sounds very appealing.
Sounds great, right? Yeah, I started doing it. And here in Manhattan in New York City. The patient population is very specific. There are folks who are very entitled, who know what they want, who are coming in to see you to get what they want. And if they don’t get it, they’re going to write you a bad review and then walk across the street and get it from another doctor.
And it’s very much a customer service orientation, which I think is the way that medicine is headed. And I didn’t really find that super fulfilling.
So tough balance, right. Obviously, we want patients to be happy and satisfied have a good experience, but also if it’s in conflict with the expertise, your expert recommendations that can be that can be really tricky.
Yeah, it is it’s incredibly difficult, especially since you know if a patient comes in with, you know, a viral upper respiratory infection and you’re trying to and they are otherwise healthy and you’re trying to teach them that giving them an antibiotic wouldn’t do anything and it would, you know, disrupt their gut flora and all sorts of other side effects.
They can still go across the street and get one charge and care or somebody else and whether they take it or not. They’re still going to get better. Probably yes. Especially but if they if they take it and get better.
Then they’re gonna go in they’re gonna write the review online and say this doctor I went to to know what he was talking about. He wouldn’t give me an antibiotic. Then I went and got one and felt better within three days. So, you know, you deal with a lot of that it’s not no longer is it? I’m going to my doctor to do what he or she says and to take their professional opinion, or even shared decision.
It’s kind of gone. Yeah, I hear what you’re saying. I mean, we don’t need to go down a rabbit hole on this, but I wanted to acknowledge i I hear what you’re saying. So it sounds like it did not turn out to be quite as fulfilling.
Yeah. In addition to that, though, you start seeing you start seeing this and this is a very important point. I think physicians in particular, are used to being underappreciated, underpaid, overworked, from day one of being pre med. Yes. From day one in pre med, you’re told, Oh, well, you can’t have a social life anymore.
You have to just study all the time. You have to give up your summers you have to get an internship you have to do all these things to get into medical school. And once you do once you get into medical school, you’re again you’re overworked, you’re under appreciated, you’re underpaid, you’re on your rotations, people aren’t treating you well. And you’re not making you know you’re not making any money when you’re a medical student.
Then you get to residency and you’re finally making a tiny bit of money but you’re not really making any money and you’re maybe you’re working crazy hours. Basically, if you added up all the hours, you’re probably working minimum wage, and you’re probably hugely indebted. I mean, hundreds of 1000s of dollars, right?
Yeah, exactly.
And then you get out of residency in somebody’s hands you an attending contract. And you think it’s a lot of money because you haven’t seen you’re used to getting paid 50 or $60,000 a year.
And so I think a lot of people early on in their physician attending career and even later on don’t realize that in fact, they’re being grossly underpaid, overworked, underappreciated. And people in other fields have a much better life than they do and are paid much better for it, who maybe have to do all the things they had to do.
So I think that what I started noticing was, I deserve more than this. I have a lot more to offer. I want more flexibility in my schedule. I want to enjoy my work more. I want to get paid more. I want to have more opportunities to grow as a leader.
And also I was just more interested in how does insurance work you know, all because is a practicing clinician, you just think of insurance as the bad guys, right? They’re the people who tell you to do things. Right. It does seem that way. Yes. Yeah.
And you’re like wow, they must be some evil organization that does that. But I was always thinking well, they get to make a lot of decisions and how does that even work? And so that’s what led me on the journey to learning about utilization management. And my path from there.
So the rest kind of history but how I got started in it was actually doing a some small gigs, some small chart review gigs that I found online and after those opportunities I then got an opportunity working with a UN organization for 10 hours a week.
And then I was still working in a practice. And then I realized, wow, I’m making more money doing these 10 hours a week. Getting paid a lot more per hour than I am clinically and I found the work very interesting.
Before we go further in that it occurs to me there might be people listening who don’t actually know what utilization management is obviously a function within the insurance industry, but can you describe like what is what is the core function?
Sure. So utilization management is also called utilization review. Both are used interchangeably even though they’re not really the same thing. But really utilization, Minister management of health resources, so think of it as whenever anything is ordered by a physician, a NP or a PA.
It goes through a process of being reviewed for medical necessity for how evidence based it is and whether or not it’s included within the policy, that particular policy and then a decision is rendered as to whether or not you can get that service. And this is in every area of healthcare.
So everything from medications that you get to services you receive to durable medical equipment you receive to your physical therapy appointments to your home health appointments, to your nursing home visits, your inpatient rehab visits, your long term, long term acute care visits, your acute hospital stay visits, all of these go through utilization management at some point in the process of payment.
And I imagine that’s why it’s so important in in that world that that physicians are board certified and, in some cases, have active licenses or even practice a little bit right to make sure that they’re yeah absolutely.
So it’s very, very important that you’re board certified because many of these insurance plans actually have it such that they employ specialists who are reviewing those sorts of requests.
So they’ll have an oncologist who’s reviewing requests for chemotherapy, for instance, you know, or a radiologist reviewing advanced imaging requests, and that’s very, very important. And then what’s also important is when doctors request period appears with US companies or insurance companies, they also want to make sure that it’s with a legitimate fishing gear. Yeah. Was it true here?
Yeah, exactly. So, so keep this in mind too. A lot of you, um, ducks still practice a little bit, even if they just volunteer a little bit. And many of us have many state licenses and the reason for that is many much UNM Many UM companies require that you’re licensed in the state where the patient lives who’s getting the USM done, so it’s very common for you um, Doc’s to have 2030 state license.
Wow, what a huge amount of paperwork. That’s all that comes to my mind is tremendous. You Yeah, well, I’m sure there will be listeners who might take issue with whether or not they feel like you know, the peer-to-peer process is a good one or whether that person is truly their peer.
But I do think it’s important to at least acknowledge, right that the people who are on the other end of those phone calls are board certified are often clinically active and are very often in these especially sort of sub specialty areas are in those same, subspecialty because there are nuanced decisions to be made.
Yeah, and of course, it depends on the exact plan that you’re working with, but most private insurance companies do employ specialists to do those, sort of second level reviews on if somebody’s appealing a decision. Then it’s usually going to the specialist and those are also usually to do the peer-to-peer calls.
And then this might be slightly outside of your world. I don’t actually know but there is some kind of a similar function that works on behalf of hospital systems or physician groups, right to to try to ensure that things are set up so that they will be approved. I don’t Is that a physician advisor? Or maybe I’m out of my depth right. I don’t know, you’re right.
So physician advisors are also kind of under the umbrella of UNM. They’re usually hired actually by hospitals, or hospital systems, who will have their own sort of UNM experts to do the period appears to understand the guidelines a little bit more who can really go toe to toe with the with the UN companies and the insurance companies.
And you know, that’s usually a very good thing. Because what ends up happening is those physician advisors, will be doing peer to peer ‘s all day with physicians who they have a they have a relationship with meaning they do a peer to peer with them every day. They kind of know how each other thinks about these cases, and they can reach a consensus etc.
So it’s usually a very good thing. And those physician advisor jobs are great jobs to a lot of people. Try to get into those fields as well.
Okay, well, cool. So I took us on a slight detour, but you were saying that you realize that in the sort of part time gigs you were doing that you are being compensated more at least on an hourly basis. And, you know, I’ll just quickly interject for my audience here like I’m a specialist, right.
I’m an anesthesiologist, so I know that everybody knows that physicians make a decent living I think your point Jonathan is such a good one that we think about the number of hours worked and the decade that it took and the hundreds of $1,000 that it took to become a physician in the first place.
It’s really hard to get out of the out of the red there. But it’s probably much more difficult for primary care specialists than it is for someone you know, in an interventional specialty like my own, so I just want to acknowledge as well so that nobody misunderstands like we all we all make an OK living. I think it’s the bigger picture there. Right that you’re talking about. So important.
Absolutely. I mean, I’ll tell you, and I’ve been doing career coaching for many years, and I can tell you, one of the first questions people want to know is, how much how much can I make in that field? And that’s because, you know, many physicians do make a very good living. Yeah. And even though they may not be satisfied, and they may not like their job, they’re afraid of going to a job which makes them reduce their flight.
And I understand that I get it. And something that I also put in there though, which I think is very important, is when you’re looking at UNM jobs, you have to take a lot of things into consideration. You have to take into consideration that you’re not going to be on call, generally speaking, that generally speaking, you’re not going to work nights and weekends.
Generally, you have much less liability and you also get a lot of things that aren’t typical. If you’re at least if you work in a large un company.
You get a lot of things that are not typical to an employed physician job, things that his court like quarterly bonuses or annual bonuses. Usually, you get to purchase some stock from the company for a discount.
So there’s a lot of other things to add into that. Also, you typically get a little bit more vacation time. So all those things go into the calculation for sure. Same thing in pharma.
You know, it certainly is not about money. Most people end up making on average the same or more when they when they leave and the main thing, though, is it’s sort of a cash flow issue because there is that that bonus and equity right that takes a little while before you start to you know, it’s not necessarily in your every two weeks or every four week paycheck.
But one thing that that is true for pharma and I wonder if it’s true for you, is, you know, when you start, you’re at the bottom, and there’s only a very, very long and full of opportunities, sort of career paths ahead of you whereas most people coming from their clinical jobs, they’re already at the top, frankly, I mean, even if they haven’t achieved their full professorship or whatever.
There they are generally, if we’re talking about compensation here, within a few years of finishing residency, you’re really kind of maxed out I mean, you’ve barely will keep up with inflation.
That’s right. Pretty much. I mean, the thing about us there are not it’s not so much a corporate ladder, as is traditional. I mean, certainly there are opportunities like chief medical officer opportunities, and there may be some larger opportunities within some young companies. But generally speaking, when people are starting off as a full time job as a un doctor, their title will be medical director or Associate Medical Director usually served as associate or medical director and people always say, “Well, that sounds like a really high position.”
And it’s not that’s just basically the entry level for utilization management. And then most companies the way most companies are organized are, they may have a manager, they may have a team lead in that team, whatever team you’re working in, but otherwise there aren’t a whole lot of opportunities to keep moving up.
Okay, because UM traditionally was traditionally it was a job where it would all be retired physicians who did a little bit of extra income. And they didn’t really care about the corporate game.
Or moving out they’ve already done that they’ve already dealt with all that. They just want to make a little bit of income. And I would say that that’s still is a lot of the people who enter us a lot of people who enter you and first of all, now in UM there’s folks who are early in their career, made in their career and later many more folks.
Who are early on in their career to and I think which I think is very important point to make that you can make a career out of this early in your career. You don’t have to wait for five or 10 years. I did it early in the career and it can be done but the thing to keep in mind is a lot of these people don’t necessarily want to move up and be a CMO or they, they may a lot of folks in USM are really looking for more flexibility or looking for more time to spend with their families or kids are looking to be paid well and they really want to be able to come and do their job.
Turn off at five or 6pm and just be done. That’s yeah, that’s what most people are looking for in us.
Well, that’s so interesting and really important I’m sure to the listeners, especially if if you make a career pivot like that early to mid-career to at least, to know that you may have all of the benefits that you just described there and that it may also stay sort of relatively flat for the rest of your career. And that’s what that’s what it’s going to be most likely.
Yeah. Yeah, exactly. So it’s not and again, there are opportunities to move up.
You know that there are manager opportunities there as chief medical officer or opportunities, but those are fewer, much greater, fewer than the medical director opportunities. However, though, at most companies, they usually do give you a little raise every year. You know, that’s usually a little bit better than you would get as an employed physician.
But yeah, you’re looking for this, this this career projection that you just keep making more and more and more and more money. That’s going to be harder to do in UM. But it’s usually not a complaint because most people are usually very satisfied with their jobs and what their pay is, and especially if they’re coming from the primary care world, it’s usually either equal or a little bit more than what they got in the primary care world.
This is so great. I think as with all things in life and careers are no exception. It’s really about that finding the right match. I can imagine there are a lot of people listening to this are like, that’s not for me because I am ambitious, and I want to constantly learn and grow and do new things. And that’s super, and then probably a very large bucket who really just don’t like they’ve done a lot of learning and growing and they want to get comfortable and focus on other parts of life.
And I can’t I can’t stress that enough. are three that’s such a good point. I like I have a lot of people who I work with who have been there. I think ran clinics they were VPs of hospitals, CMOs of hospitals, and they don’t want to do that anymore.
They don’t want to deal with the bureaucracy. They just want to they just want to get their night they want to be paid fairly. They want to enjoy their work a little bit. Yeah. And then go enjoy life. And so that’s why a lot of UNM Doc’s have a lot of other things they do. Like me, I do my music. Yeah, pull me up with their mate, you know, travel a lot or be with their family. So but I would say it’s a very popular pivot for people with young kids who want time to focus on their kids.
Yeah, I mean, it makes sense based on how you describe it. Obviously, everything’s different from not every company does things exactly the same way in terms of flexibility and hours or so forth. Right. But it sounds like those common themes are pretty good.
What and you’ve said a lot of things that are really good at some things that might be neutral, or like we just talked about, right more suited to a particular kind of person is there in the cups, like comes to mind for you that you dislike about the work? Or just about maybe dislike is not the right word, but you know, maybe it’s not your favorite?
Yeah, you know, there’s not a lot and people always ask me that question. And, you know, I’m fortunate to work for a wonderful, wonderful company. But when I look at UNM as a whole some of the common complaints if there are any, are that people may find it monotonous to do the review the reviews all day. Some people who want may miss the interpersonal in person contacts that they get with seeing patients.
Some people also don’t like that. They’re in front of a computer all day and sometimes you’re at the mercy of the technology, whatever, whatever the technology is that that company is using. So those are typically the main some slides. The thing that is also important is people always say to me, Well, what if I don’t like it?
You know, can I get back into clinical world or what’s going to happen? And I’ve literally spoken with hundreds of people i i know lots of UNM Doc’s and I can tell you that 99% of the time, your biggest complaint will be that you didn’t make the switch sooner. Yeah, that will be your complaint. Yeah. Why didn’t I do this sooner? The good news, though, is if it for some reason is not for you, and you don’t like it.
You’re going to know very soon. You’re going to know within a few weeks, it’s not going to take six months, and so it’s not going to be a big deal. But also that’s why I encourage not only doing courage, but I think nowadays it’s basically mandatory if you want to get a un job because they’re so competitive, to do these un side gigs.
To kind of to kind of dip your toe into the world of human because my really my specialty is helping physicians who have no connections and no other special skill sets to get into UNM, and the wall asked me Okay, I’m ready to make the transition. But I keep applying to all these jobs and I don’t hear back or I’m rejected and usually that’s because they didn’t do the first most important step, which is the side gigs.
The small side gigs that don’t pay a lot, if anything. And this is the most important thing for people to realize is they have to they have to dip their toe in do some of those side gigs. And these are very small, small un companies that that maintain physician panels. And when they have certain requests, what they’ll do is they’ll look on their panel, and they’ll say, “Okay, I need to you know, I need a neurologist to review this or I need a family physician to review this.”
Then they look in their panel they constantly patients in their panel, say hey, will you do this review and they’ll pay you some very small amount of money that is laughable. And a lot of you and but people need to do it to get the experience. Yeah.
That’s why I tell people they need to do that. And for those for those listening, who want to know how to find these companies, I always suggested Nyro website and Ayar o.org. It’s the National Association for independent reviewer organization. And if you go to that website and you click on members, and you scroll all the way to the bottom, yeah, there will be the logos for the 20 or 30 companies that are a part of that organization.
Each one of those companies you want to go to their websites, and you want to apply to be on the physician panels. And you want to apply for every single company. Fantastic. Yeah. And you’ll hear back from a few of them, you won’t hear it hear back from all of them. Sure. But you’ll hear back from a few of them and after you do some reviews for you know six months.
You can easily put that on your CV and have something to talk about in your interviews and for people who can’t even do that. There’s other things you can do is get involved some hospitals have un committees, or peer review committees, chart reviews. There’s a whole host of things you can do to try to get a little bit of you have experience.
That’s really fantastic. I have not heard of that website, though. I’ve probably seen you mentioned it before. And yeah, it’s similarly in pharma with everyone is asking how do I get a job without experience? I think it’s a little different in that there probably aren’t as many types of part time gig opportunities but also it’s not needed in pharma. That’s just a myth. Sounds like it is needed in UNM and it can be gotten.
Yeah, in look. That’s not to say that the jobs I’m talking about the full time and play jobs are easy to get they’re not they’re very, very hard to get very similar. To but when I tell people to is look, physicians are not used to it being very hard to get a job right.
You’re if you’re a you know a family doctor out there practicing and you and you want to move tomorrow and move to Texas or California or Florida as long as you get a license in those states you can get a job within a week, probably less than that, right?
Yeah, it is very easy. So I always remind people, it’s not that it’s ridiculously hard. It’s just not ridiculously easy. And we’re used to just being ridiculously easy to get a job as an attending physician because there’s such a need in America for physicians.
Well, and there’s so much gatekeeping right. They only like so many into school and then you only get so many residency slots. So by the time you’re done, there is I mean, there’s a shortage which, you know, right.
So yeah, it is a lot easier to get a job I suppose. Assuming you know, finish the gauntlet. That’s right and get a job. Yeah, that’s right. Go through the process.
What you do boards, you do your board certified, you don’t have a license, you don’t have any issues with your license, you’re gonna get a job and you know, in many different places where his AUM applicant, that’s not good enough, right as you am applicant, not only is it not good enough to just have that as your experience, you also need a little bit of you um, experience and then also your persistence needs to be there and the timing needs to be right.
It which is so, so important. When people always say well, wait a minute, how come I I applied to all these jobs? And I didn’t hear back. They didn’t even send me a rejection email or they you know, I didn’t get any interviews. And I say, look, there’s a whole host of reasons why that happens. Yeah, that don’t happen in the clinical world. Yeah, right. It happened in that what happens in the corporate world? Well, jobs will get posted and then the cuddle fund, the funding will get cut off. Yeah. And so the applicant?
Yep, I would say the majority of time your application isn’t even looked at by a human. And it just goes into a black hole. So you may the company may have funding problems. They may have to post a job, but they all but they already know who’s gonna get it.
That happens a lot because they may know somebody internally or that it’s just not the right time. Of year like sometimes there will be positions posted for months at some companies, and they’re not really looking at the applicants.
So there’s all sorts of things that go on, which is why it’s so important for people who want a un position and I say this on all the forums and you have to be very persistent. They have to apply, apply, apply. But then part and parcel of that is able to network, so they need to be networking on the Facebook groups on LinkedIn. Great place to network is LinkedIn.
Yeah. And also these national conferences. You can go to the seat conferences a great place to go. And really the cool thing though, about all of this is we have these wonderful Facebook communities of physicians who have already made the transition who are more than willing to help you.
You run one of these groups, right I had about that when you introduce yourself but can you quickly?
Sure. So I’m the founder of the Facebook group room remote careers for physicians, and we have over 14,000 physicians it’s a private group all the all the applicants are screened to verify their physicians so an MD or do we don’t allow anybody else in and it’s basically a place for physicians to talk about remote careers.
So it’s not only UNM, it’s also Pharma. People also talk about some telemedicine they talked about startups, but I would say most of what people talk about is either un positions or pharma positions. It’s people helping each other out.
There’s a lot of people like me on there who already have these jobs who are trying to give advice, looking at CVS trying to trying to network with you that on also there’s a ton of job postings posted on this site that people will post I’ll post them for my company and these are one and these are great job postings, because now you have internal referral code that you can use. So I can’t stress enough how many how much people should join not only my group, which is free, yeah.
Where there’s other groups to other groups too. Absolutely. And you know, I think what you just said there, I don’t want to check and see if it’s the same but in very much in pharma.
If you have an internal referral, meaning you know, either you just clicked on someone else’s link or they fill out a little thing internally, even if they don’t know you deeply. If they refer you and you are hired, they get a sizable referral fee, right.
So people are quite happy to put your name forward. You know, it’s sort of two different tiers, right. It’s one thing to invest your own political capital or you know, at the company to say, hey, we put this person in front of you, you should really consider them if you don’t know somebody that’s hard to do.
But it’s very easy to click a box within the application portal right to make sure someone’s application gets looked at it’s all it’s really doing.
It that’s really what it is absolutely right. I mean, most you large insurance companies offer those referral bonuses. They want good physicians. They want physicians who will stay and let me tell you this too. And I’ve actually hired some people from my group. I have friends who’ve heard from my group.
We love people from the Facebook groups. Because we know they’re serious about the transition. That’s why it’s wonderful to join those groups or, you know, go to the seek conference or network on LinkedIn, just so that they can. They can vouch for you just a little bit and they’ll usually benefit to with either a bonus or at least they’ll get for bringing on a great person.
Yeah, so that’s fantastic. It’s a win, win. Let’s back up for a second and talk more about the seat conference. So for people who haven’t heard of this organization, it’s neither mine nor yours, but you are speaking at it this year.
So tell people a little bit about seek I’ve actually never attended, although I’ve heard of it for a long time. Yeah.
So seek is a wonderful organization. I don’t know how long ago was founded, but it is basically an organization for physicians looking for non-clinical careers. That’s what it is.
And they do workshops, they do educational sessions, and then they do various conferences throughout the year in person and virtually, but their main conference, and every year is in October in Chicago, and I’ll be speaking at it this year for the UNM group, but it’s a wonderful conference to go to just to see what’s available.
So I went there. The first time I went to the C conference was about to go to quit my outpatient Family Medicine job and just wanted to know what else was available. And you go there and there’s literally I think there’s over 1000 people, they’re all doctors, and then they have speakers. They’re from each of these industries.
So well. speakers on Pharma. They’ll have speakers on us they’ll have speakers on you know, Entrepreneuring on medical education, on government jobs, on, you know, all sorts of all sorts of physician jobs that you may not even realize work in.
Yeah, and you will, and they will also have recruiters there from some of those companies and you’ll meet them so it’s an amazing opportunity to network in person. And some people even get jobs from that conference. It’s incredible.
It is so I’m not only a speaker for UNM, but I’ll also be one of the coaches so you can sign up to meet with me during the conference which will be not only me though, there’s literally dozens of coaches there who you can meet with so we’ll have people from pharma, a lot of people from their people from horse un people who are doing entrepreneurial things.
You know, physician education that also the physician and vendors, some of the government. Yeah, it’s so interesting what people do with their physician credentials.
Yeah, the only knowledge I have on seek which I’ll just toss in here is they were founded in 1980. I believe so that’s a long time ago. And you know, I mean, it is and seek stands for skills, education, abilities and knowledge.
So when you think of an acronym for an organization, right, like it’s, so it’s SCA k.com. And I believe they were founded by attorneys and I think they started in medical, legal and expert witness type stuff. And now it’s like really grown though, to founders are attorneys.
That’s right. And they do they get to be on expert witnesses, which is a lot of what they do. So they do a live occasion on how to be an expert witness or a physician consultant. They do so they do all sorts of trainings for people interested in those things.
And they also publish a very thick, kind of phone book style directory every year that you can pay to be in that gets sent to hundreds and hundreds of companies and it says, hey, this person is available for expert witnessing to the UN jobs to do consulting on another project. So they have a really good reputation throughout the country.
Yeah, sense of whether or not that I mean, I don’t know that publication and nor would I, you know, hold you to that. Do you have a sense for whether or not that’s a good investment for a person to pay to get listed there or is it better to just, you know, pound the pavement yourself?
I think it depends on what you’re looking for. The physician expert witnessing positions are you have to have sort of an in with the legal companies that look for these people. And it’s my understanding that they send this directory out to the, to the federal legal entities that they have a good relationship with.
And a lot of them use that directory. I believe they actually have a money back guarantee.
So if you’re paying the fee, that’s very important. So if you pay the fee and you don’t get any hits from I think it’s like six months, they’ll give you your money back. That sounds pretty low risk.
It is low risk. It’s a wonderful organization, meaning they’re not looking to they’re really looking to support physicians, anything they can do to support patients. It’s a very physician friendly company. In the they’ve been around since 1980. I think you said so I definitely encourage people to check them out.
I guess our mailers all the time and it strikes me as very old school. It’s like, classic. Yeah, it’s charming, very, very classic, very charming, everybody. They’re the people who started are very nice. They, you know, very knowledgeable.
I would think by now two very knowledgeable. Yeah, Steve, who I think is the CEO, he’s incredibly knowledgeable and it’s just a really friendly group of Doc’s, when you go to the conference, you’ll meet hundreds of doctors like you and it’s just such a great thing to do that and meet people there.
Yeah, that’s so great. People always do worry about how they don’t know anybody in the industry that they want to get into. And, obviously there’s, yeah, there’s a lot of ways to to fix that. I mean, spontaneously, you can start to know people, right?
That’s not a fixed situation. But I imagine going to a conference like this, especially where there are not only speakers, but mentors and recruiters. I mean, it’s just like, again, I haven’t been but from what you’re describing it sounds like it’s like on a platter for you to at least get started right.
Yeah, I mean, there’s a few others like that, that are a lot smaller. You know, some other people put together workshops in person. And I won’t mention any of them here because I’ll probably get their name wrong, but the sequin is definitely the biggest, the biggest, most substantiated the most experienced, and it’s a great place to go if you really don’t know where to start, if you literally just don’t notice are probably you know, they have a lot of people there in clinical practice who are just looking at other options.
They have people there who are in training, they have medical students there they have residents there and then they have people who are you know, all sorts of people, people who are who didn’t do residency, people who you know, maybe you know, are looking for opportunities without a license, which there are many opportunities for those too, because it’s a great place to go and learn about that.
Well, so this reminds me because you’ve talked a lot about what it is that you need to do in order to be competitive for a job. But one of the questions I get asked all the time and I know you do, whether or not a person needs an additional degree, like an MBA or like being a certified physician executive, or some other number of things that you have, that I definitely don’t have. You have but I think I’ve heard you say before, maybe tongue in cheek that really like no one cares about that, at least in your career trajectory is that right?
Yeah, absolutely. So I always make this joke and full disclosure. Yes, I do have an MBA and yes, I’m a certified physician executive. Both are great, especially my physician executive is wonderful leadership training.
However, I got them after that after I got this position so they have nothing to deal with whether or not I had my position. And I tongue in cheek got that especially the MBA I basically got it to prove that you don’t need one. And I can absolutely 1,000% Say that you do not need an MBA you don’t need you know people also asked if they should be board certified by the app for certification. Also you can u m. I do not have that certification.
You know, I don’t know what that one is. Say that what that acronym is, so it’s the American Board of make sure I’m getting this right American Board of utilization review, okay. Yes. Like there’s a board certification for medical affairs. And nobody has heard him.
The acronym is AP CORE. Okay. But people will always ask when do you get board certified that by them and it’s an exam you take? No, you don’t. What you what you need to do, if you want to do u m the best thing you can have is experience.
And you’re not going to get experience with your MBA or you’re not going to get experience even with your app of course certification. The best thing you can do is get experience and network. So That’s why I always tell people save your energy and focus in on networking and getting experience.
Those things are fine to have, like my employer paid for my MBA. So I said why not? Yeah, you know, but also, though, about MBAs is worthwhile if you go to a top 10 program, because then you’re paying for the network. Yeah, that’s why they are valuable to people in the business world because now they have a business network. But if you’re just looking for the knowledge that’s on YouTube for free.
You want to learn about cash flows and income statements and balance sheets. That’s all on YouTube for free. But so definitely focus on the networking and get an experience in UNM
that absolutely, it sounds really sound advice and let me back up to really quickly so I don’t gloss over this because it’s a hot topic, especially lately.
So your Facebook group is Remote Careers For Physicians. Are all you have jobs remote.
Great question. No. Okay. We’re all remote. Most of them are though most of them are. Now here’s the thing. I got into remote careers back before remote careers were cool. So I founded this group, I think in 2018. I’ve always liked and this was back before it was kind of a mainstream thing. Yeah.
And many companies during COVID became remote. But now a lot of now a lot stayed remote. So I would say the majority of you, of you and physicians are remote, but then there are some, especially with the big like the big five health insurance companies.
Many of those physicians are remote, but some do require you to go into the office a few days a week, but I can say that most are remote.
Yeah, that is it’s definitely something that I think is still dynamic and in flux around Pharma. As you say, a lot of people figured out a lot of work that could be done remotely and many companies have embraced it.
Many have not their pendulum is swinging back in office culture for sure. But some I’m seeing are, you know, startups in the like, aren’t even bothering to establish a headquarters office. Everybody is always remote right.
And they’re happy with that this could be especially who may live in parts of the country where they don’t have headquarters have these kinds of folks in your city and the job that shouldn’t be limiting in this case? Is that right?
Yeah, that’s right. It shouldn’t be the one thing I’ll say about you. It’s a very commonly asked question is Well, can I travel internationally? answer’s no. You cannot do u m, at least US based u m you cannot do it International. You have to be on US soil to do it. There are various laws around or around that. Oh, interesting.
So you can’t be like the digital No, you can’t like log in from a from a cafe in Paris and do it your work? No, not if you’re doing un for a large insurance company. No, you can’t.
They have there’s all sorts of governmental HIPAA regulations. around that. Sure. Makes sense. Yeah. Yeah. But you can still travel around the US for the most part. So that’s also why a lot of people like it, of course, is because they have just more flexibility.
That’s to me. Hey, that reminds me of a question that I have. I was going to ask you and I will ask you before we wrap here if there are other things I haven’t touched on or myths that you want to bust, but you know, one of the things that’s been on my you know, brain in the curiosity category is obviously a core part of the function is looking at whether or not decisions or you know, tests or medicines, whatever are evidence based.
And I’m wondering if the evidence guidelines are personalized is not the right word, but like within a company, are they using ones that are self-developed or are they using ones you know, maybe like that the American College of cardiologists has furnished them with and how does that work?
Yeah, so it depends and the answer is really all of the above so but there are basic criteria for you mm. Like Milliman criteria you may have heard of, you know, or McG is, or interCall is another one, which are kind of basic industrial centers, around hospital stays and outpatient visits.
But then there are a lot of like, for instance, there’s a lot of there’s a lot of UAM jobs around more Medicare services or Medicare Advantage services and those are all CMS or Medicare regulations. publish those when you’re talking about internal guidelines, like does a company ever develop its own evidence-based guidelines on things?
The answer is yes, they do. They have their own peer committees they have their own evidence committees that are peer reviewed, reviewed peer reviewed literature and that meet regularly and that develop guidelines. And those are usually for things like, you know, oncology or radiology or, or what have you, but yeah, so the guidelines vary.
But if you’re looking to really impress an interviewer when you’re interviewing for UNM job, if you know what Interpol guidelines are and Milliman guidelines, the 10 steps ahead if you and you can easily just Google those and learn about them.
But yeah, that’s so interesting to me, because as you said that I think oh, yeah, that’s great, like for the interviewer. And then I also think to myself, if you’re a practicing physician, and you don’t even know what those guidelines are, how are you supposed to be delivering care that lines up with them?
It’s true and it’s a big thing. I think that this education should be taught in residency in medical school, I think people need to know. You know, for instance, if a physician is ordering, you know, home health, he or she should know for Medicare, he or she should know what the basic guidelines of Medicare are for the home health visits, which are all publicly available.
But yeah, it is unfortunate that, that that’s not more integrated into physician training. Yeah,
yeah. So much to know. Well, okay, so with that, let’s let me ask you then what I was going to ask you which is, are there any other either common myths for you?
Or just top things you think people really ought to understand about it?
I think what people really need to understand about utilization management and insurance is when you’re on the practicing side. You think that they are evil, that they are a terrible organization that just denies care?
And what you have to understand is utilization management is really there to protect the patients and to make sure that people are getting health care resources that they really need, because there is so much waste in our health care system. Because for every one doctor who is ordering was ordering an evidence-based head CT. There are a handful more who are ordering a non-evidence based head CT, right. And so you may be a great doctor, but there’s a lot of doctors who don’t practice the way you do.
And so in utilization management, you serve as the final check. To make sure that we’re not wasting money on tests or services that that are necessary are indicated or part of the plan. Meaning when you sign up with an insurance plan, and you sign on the dotted line. That doesn’t mean that you get anything or doctor orders, right. It means that you get whatever that plan is in the guidelines of the plan.
So oftentimes patients are very confused. They say well, wait a minute. You’re ordered this Why can’t I get it? And they have to understand that? Well, first of all, we have to make sure that it’s that the plan covers it. Secondly, we have to make sure that it’s evidence based. The reason for that is because we have 10 other orders that are not evidence based for that. And if we just gave it if we just gave everything out, we would be bankrupt.
So it’s a very important job. So I always say this to people. If you’re really really really passionate about making sure that patients are getting what they need. You M is a great job for you because I can tell you that if a patient really needs something, and it’s covered by the plan, the medical directors will move heaven and earth try to get them that you know they they will do that there. Keep in mind physicians that doing UNM are not incentivized to deny things.
There is no incentive to deny things. Everything is just unbiased. What’s the evidence? And what’s the what are the patient, patient records showing?
Oh, that’s interesting. I’m not sure that I knew that I sort of imagined not that I imagined that there was direct disincentive to approve, but I’m sure most people think that there that there is right that the default ought to be to not approve. I think that’s how people wonder if that’s how it’s done.
Yeah, it depends. You know, I can say a lot of it depends on the company. A lot of you M is done here. A lot of it is done with the computer. However, there’s no denials by a computer, which I think is important for people to understand that there’s a lot of laws in place to make sure that that denials are being done by a human but there’s a whole lot of approvals that go on by a computer algorithm.
And so, by the time it for instance, by the time it gets to a physician to review, a lot of people have already looked at it, meaning it’s been kicked out of the algorithm. The nurses have looked at it the reviewers beneath you have looked at it by the time it gets to the physician level.
A lot of people have looked at it. So it’s important for the general public and everybody else understand a lot of time goes into these decisions, and a lot of expertise goes into them as well.
And of course the physician makes the ultimate decision. But he or she is not influenced by anything. Actually, it’s illegal for them to be influenced by anything other than the evidence the guy that didn’t. And the member records and it’s everything is always a case by case basis as well.
Well, that’s really that’s really helpful. To know, as we’re kind of wrapping up our time here. I want to be sure to let people know how to get in touch with you because I know people will have questions.
They’ll have questions about a lot of the things that you’ve mentioned, I’m sure and also be potentially interested in your Facebook group and in the coaching that you do. So is it’s www.drjonathan.com is that right where they can find that’s my website so if so people are welcome to go there. If they’re interested in personal coaching with me I’m do a lot of career coaching.
Or if you just want to email me just drjonathan@drjonathan.com and ask me anything you want. I’m happy to answer and our remote careers physician group on Facebook is a wonderful place to post your questions a lot of input into them. It’s a friendly community that physician non I call it the non-traditional physician community is very friendly and very willing to help. situation you’re in for people listening to this. I know there’ll be a lot of people listening to this who are physicians who are burnt out.
We don’t know where to turn who think that they just have to figure out a way to retire early. And you know, there is hope. There are a lot of other opportunities out there for a job that you love. And you can still impact patient care in a very positive way. So never lose sight of that everybody listening.
Yeah, absolutely. There’s so many ways to make a difference. And especially in industries like yours and mine that touch just millions of patients far more than your I ever could in the clinic. really?
Yeah, absolutely. So every single day, you know, you make decisions that are you know, there’s decisions being made that are impacting millions of people in UNM and pharma. and these are decisions that are taken very seriously and your professional experience as a physician is dependent on for people.
You empathy. I think you’re treated with more respect by your colleagues and by the company because they really value your experience.
Well, it’s so important and I know that there seems to be for whatever reason, sort of a dark cloud of suspicion that follows various non clinical industries around but you know, even if those are not perfect industries, I am of the opinion that we have to have talented well intended smart physicians at the tables in those companies because other what a mess.
Yeah, definitely. I mean, in look, there’s opportunities for physician leadership in these companies like this. The CEO of several U M companies is a physician.
So and it’s wonderful to get involved in physician leadership and to have that seat at the table to have your voice and you don’t need an MBA to do that. Yeah. But you know, you just seem to be passionate and ambitious. Yeah. Well, thank you again, so much. I know this was a credibly educational period of conversation for me, I learned a ton.
I hope my audience has learned a ton to Jonathan Vitali. Everybody can find him. I’ll link things he does best, but Dr. jonathan.com and the Facebook group, and email so I’m sure people will be if I have any listeners. I’ll be reaching out to you, Jonathan. I don’t know how many that is. Thank you so much.
Oh, it’s my pleasure. Thank you for having me.
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