The evolution of health care services delivery, in concert with market factors, is producing new roles for physicians

By Bonnie Darves

In much the same way that advances in clinical care, health information technology, and treatments are expanding the practice settings and roles that young physicians can pursue, the rapidly shifting health care delivery environment and services market are opening up entirely new job opportunities for physicians. There is a growing demand for physicians who have not just top-notch clinical skills but also an interest in — and ideally, a passion for — facilitating change and innovation in medical care and health services generally.

That demand, in turn, is sparking creation of not only new care models but also entirely new jobs for physicians. Organizations are looking for physicians to advise on population health initiatives, for example, or to focus solely on boosting safety, or improving patients’ care transitions or their inpatient care experiences. On the business side, hospitals and health systems recognize that politically astute physicians are not just desirable participants but instead, crucial partners in aligning interests of hospital and physicians. And they’re carving out dedicated roles accordingly.

“We’re not just seeing new roles emerge. We’re also seeing that certain leadership roles that were traditionally filled by non-physicians are going exclusively to physicians — and that organizations are open to placing young physicians in a variety of new areas,” said Paul Esselman, senior executive vice president and managing director of Cejka Executive Search in St. Louis, Missouri. He cites as examples positions that combine clinical work with health care analytics, and physician jobs dedicated to reconfiguring care for high-acuity patient populations or to improving services utilization. Physicians are also being tapped, he noted, to help communities create efficient provider networks.

Many of these kinds of positions, if they existed before, were traditionally held by non-physicians, Mr. Esselman observed, but organizations increasingly recognize that health professionals who understand clinical pathways are perhaps better suited for these roles. “There’s so much data coming out of electronic health records now that organizations need physicians who can analyze and translate it for front-line providers,” he said.

Michael Watson, MD, co-founder of Paired Health, in Raleigh, North Carolina, which contracts with hospitals to oversee high-readmission-risk patients, expects rapid growth in physician roles in care continuity. “Physicians who want to pursue ways to make the [care] system better, or who have ideas for improving physician efficiency,” he said, will find a ready audience. “Organizations are open to non-traditional approaches to providing services to complex patients, and they’re looking for young physicians who can help them manage that care more effectively. Many young physicians have more capabilities in these areas than they realize,” Dr. Watson observed.

Changing delivery models spawn new roles

In light of the growing recognition that physicians are integral to every sector of health care, from providing front-line care, to implementing new care processes, to developing new medications and treatments, savvy organizations are expanding their views of where physicians’ skills are needed. Young physicians in early career will encounter opportunities that might not have existed five to eight years ago.

Some other novel physician roles include director of contracting and provider relations and, at the other end of the spectrum, chief of medical missions. The past five years have also seen rapid growth in nontraditional care delivery models, such as concierge and direct-care medicine, and an increase in associated management positions. (See sidebar, “New Hats Physicians Are Wearing,” for profiles of physicians who have pursued new types of roles.)

Travis Singleton, senior vice president at the national physician recruiting firm Merritt Hawkins in Irving, Texas, predicts rapid growth in physician jobs that incorporate the clinical and business realms, as organizations equip themselves for the changing services-delivery model.

“Organizations are looking for physicians to help them handle joint ventures, or who can take the lead in change management for their hospital,” Mr. Singleton said. “It’s a great time to be coming out of training, if you’re interested in management. Many organizations are looking internally to identify physicians who can help with the challenges they’re facing — and they’re putting significant financial resources into training MD leadership.”

Physician knowledge and skill sets are in high demand for health care consulting, in the pharmaceutical and biotechnology sectors as well as business strategy. Although physicians have long been involved in health care consulting, what’s new is that organizations, such as The Boston Consulting Group (BCG), are bringing in young physicians.

“It’s a very dynamic environment. I enjoy having an opportunity to work in many different sectors — and to work on some of the big problems in health care,” said Robert Hollowell, MD, a principal with BCG. In his recent work, he has analyzed physician use of a newly launched oncology drug, for example, and helped “dissect” a diagnostic product system to determine which aspects add the most value. He enjoys “digging into the data” in any engagement, and looks forward to doing more work in health care system improvement.

“In terms of my career future, I’m excited about working on ways to get the health care industry to cooperate across silos, to improve patient care,” Dr. Hollowell said.

Demand for “big-picture” thinkers

Another area driving new roles for physicians — care quality assurance and improvement — isn’t actually new. However, the roles within the realm are expanding, observes Craig Fowler, president of the National Association of Physician Recruiters. “We’re seeing more organizations hire physicians who will be focused solely on [care] quality,” Mr. Fowler said, as opposed to serving as committee chairs or taskforce leaders. He predicts that the trend toward direct employment of physicians will also spawn new positions in the corporate structure of health care organizations. In short, as hospitals and health systems employ larger numbers of physicians, those entities will need physicians in key leadership roles.

Mr. Fowler cites another nascent trend: hiring physicians to lead clinical departments or service lines in community hospitals and systems, as their counterparts do in academic centers. “We will see more of these ‘dedicated’ positions in the years ahead, outside academia, where physicians assume a strategic role that combines clinical and management responsibilities,” he said.

In Mr. Esselman’s view, the shift that’s occurring in physician opportunities is even redefining the notion of clinical vs. non-clinical jobs as more hybrids emerge. “The definition of ‘traditional’ physician positions is changing all the time. We’ll continue to see physicians tapped for their clinical expertise in a broader range of areas within health care,” he said.

New roles: What’s required?

How can young physicians explore and possibly pursue opportunities for these atypical positions? Most hiring organizations want to see some clinical experience beyond residency in physician candidates, and documented high-level skills. “That’s one key because it demonstrates that you have the patient care perspective and understand what constitutes a positive patient encounter for both parties,” Mr. Singleton said. “Experience as a department or service chief, as a hospital board member, or head of a group practice, positions you as having leadership or business skills. If you have an MBA or MHA, that’s a plus.”

It also helps if candidates have practiced in an environment that possesses some characteristics that illustrate where health care is headed: a group has taken on risk or has engaged in population health management, or one has implemented the medical home model. Organizations are also looking for physicians, even young ones, who have experience in a practice consolidation scenario — where they’ve helped integrate information technology systems or compensation structures that reward value or improved patient outcomes.

Beyond the practical and experience credentials, hiring entities are interested in candidates who have a bold vision or a strong interest in innovation, and an ability to articulate that. “Ideally, the physician would have all three — and a passion to find a solution to what isn’t working well in health care,” Mr. Esselman said. “It’s all about how you articulate your ideas and demonstrate your passion. Age or tenure aren’t important, but having a collaborative manner is key.”

Mr. Singleton cautions that these emerging jobs are not an escape hatch for burnout. “These roles are best for physicians who have much more motivation than simply wanting to get off the treadmill of clinical practice,” he said. “Organizations want physicians who are willing to embrace change and bridge the gaps.”

For physicians who don’t yet have extensive clinical practice experience to assume a big-picture role, but do have ideas for change based on their training or practice observations, and a tentative plan, should “raise their hand,” Mr. Esselman suggests, and expect to find an interested audience. “We have seen young physicians who have gone right from training into non-traditional positions, or proposed a new role, even if that’s not the typical route,” he said.

Physicians who want to explore unusual opportunities over a longer timeframe, while they build their clinical experience base, should seek both a mentor and business or leadership training from organizations such as the American Association for Physician Leadership, all sources for this article advised.

“Ideally, find a mentor who is a physician executive in a role that interests you, and who shares your clinical values,” Mr. Esselman advised.

Embracing new roles: Physicians share their stories

NEJM CareerCenter recently spoke with several physicians who have taken on new types of roles. They describe below how and why they chose their current positions, and what their workdays look like.

Chief Experience Officer: Adrienne Boissy, MD, MA

Dr. Boissy’s career progression to Cleveland Clinic Health System Chief Experience Officer has been anything but typical. She started out as a professional ballerina, then went to medical school and became a neurologist. From there she branched into bioethics, and followed her interests to research the language physicians use when they discuss diagnoses and treatments with patients.

Dr. Boissy’s primary job is to evaluate and improve inpatient experience. She focuses on the intersection of care-team communication and behavior, as those influence patients’ experience. In a typical day, she rounds on the patient units with executives, and talks to just about anyone she encounters in her travels. She meets with physicians and staff members, teaches communication skills, and publishes material on patient satisfaction. Dr. Boissy also serves as editor-in-chief of the Journal of Patient Experience.

Her job title, which Cleveland Clinic created, is rare. The clinic also hosts an annual summit for health professionals who work in patient experience. That’s changing, however, as health care organizations see their performance in patient experience reported publicly and their reimbursement affected accordingly. “The field has expanded rapidly in the last two years, and we’re seeing tremendous interest in this [role],” Dr. Boissy said, “as well as growing opportunities for physicians who are interested in these opportunities.” In 2014, for instance, more than 2,000 health professionals participated in the summit, up from a few hundred just five years ago.

Transitional Care Provider: Ken Ota, DO

A typical day for Dr. Ota, who works for Banner University Medical Center in Phoenix, Arizona, sounds a bit like “back to the future.” As a transitional care provider, he sometimes visits recently discharged patients — particularly those who are medically complex — at their homes or care facilities, with the objective of helping them self-manage better and stay out of the hospital. A hospitalist by training, Dr. Ota is part of a multi-disciplinary team that identifies at-risk patients before they leave the hospital, and keeps tabs on them after discharge.

Every day unfolds a little differently, explained Dr. Ota, a family medicine physician who led the formation of Banner’s transitional care service based on his interest in improving geriatric health. He spends most of his day seeing patients in various settings, from the hospital to the home, to the nursing facility or clinic, and also performs administrative duties. What he enjoys most is addressing previously unmet needs of the patients he sees.

“We’re in the heart of Phoenix, so a lot of our patients have low socioeconomic status and low health literacy — and many might never have received appropriate medical care before,” Dr. Ota said. “When you can improve things for them, it’s a satisfying experience.”

Concierge Medicine: Pamila Brar, MD

San Diego internist Pamila Brar, MD, always knew that she had an entrepreneurial bent, so when Scripps Clinic, where she completed her residency, asked her to practice in its new concierge medicine service, she jumped at the chance. In 2010, she branched out on her own. “I decided that I wanted to work for my patients — to spend more time advocating for them. I think this is a natural role, one that’s at the core of what physicians do. It’s hard to do that when you have a high-volume practice,” said Dr. Brar, who is president-elect of the American Academy of Private Physicians (AAPP).

Today, Dr. Brar manages the care of approximately 200 patients, and she finds her practice more satisfying than ever. “I really know my patients — their stories, their heartaches, what’s going on with their children.” Concierge physicians spend between 30 and 60 minutes on an average patient visit, per AAPP data, and see six to eight patients a day.

Dr. Brar acknowledges that concierge practice requires business acumen and a willingness to take risks financially, which isn’t for everybody. Despite this, concierge practice and direct-care medicine, which are emerging as popular retainer-based alternatives to fee-for-service care, are growing rapidly. Many nascent organizations, she said, are looking for young physicians to join their existing practices. “The opportunities in private medicine are outstanding for young physicians. Many patients are happy to have a younger doctor who is well trained and on the cutting edge,” she said.

Physician Advisor: Harry Rosen, MD

The position that California internist Harry Rosen, MD, holds now is so new and in flux that he’s reluctant to describe his responsibilities in the context of a formal job description. As the recently appointed physician advisor for The Good Samaritan Hospital in Los Angeles, Dr. Rosen either leads or acts as liaison for several components of hospital operations. These range from improving clinical documentation and coding, to creating or revising clinical protocols, to developing and implementing new evidence-based inpatient care programs.

Dr. Rosen also works with case management, interfaces with regional IPAs (independent practice associations) that work with the hospital, and serves as clinical liaison between the administration and the medical staff in moving care-improvement initiatives forward.

“It’s a very exciting place to be, even if it’s still a work in progress,” said Dr. Rosen, a hospitalist who still practices some weekends and is the author of The Consult Manual of Internal Medicine. “The beauty of this position is that I can be involved in all of it, and also pursue my personal passion — to fix the system as best I can,” said Dr. Rosen, who was tapped for the post because he is a top performer in quality metrics, outcomes, and patient satisfaction.

Dr. Rosen is convinced that ample opportunities exist for young physicians in the quality improvement arena. Many organizations are desperately seeking physicians who have that combination of clinical acumen and systems knowledge, and a willingness to lead change. “No field offers the variety of career possibilities or has as much bandwidth as medicine does now,” he said.

ACO Chief Executive Officer: Pariksith Singh, MD

Pariksith Singh, MD, of Spring Hill, Florida, was making inroads into population-based health care long before the term became a buzzword. He is well versed in quality improvement and utilization management, and has long been passionate about educating patients on healthy lifestyles and self-management of chronic conditions.

That’s why Dr. Singh jumped at the chance to lead his group’s recent transition to the Medicare ACO Integral Health Care, LLC. “Fifteen years ago, who knew that there would be such a things as ACOs? And I certainly didn’t expect to be running one,” said Dr. Singh, author of the book “2014 Health Care Primer: Fundamental Components of a New Revolution.”

What Dr. Singh finds most gratifying about his work is being on the leading edge of health care evolution, and managing health data in a hands-on manner. “We have 30,000 patients under our care, so we are practicing population medicine. It’s exciting to use data analytics to look at the care we deliver, and then improve that care and outcomes,” said Dr. Singh, an internist whose organization employs 120 physicians.

Health reform and the ACO arena are opening many new opportunities for young physicians, in Dr. Singh’s view. “Organizations are looking for physicians who are excited about the changes in health care and who have an interest in the practical aspects — in health IT, analytics, and using data,” he said. “There are many avenues that young physicians can pursue.”