Can The Physician Intervene at The Level of Database?
Generally speaking, No! The physician can’t.
The databases for healthcare IT are normatively accepted as industry standards, sometimes even by law.  Some of the examples of databases that are universally used by different industries operating in the healthcare market are given below.

• SNOWMED CT and LOINC systems for developing Electronic Health Records.
• ICD 10, ICD 10 CM, DSM codes for reporting diagnosis.
• PCS and CPT for coding medical procedures and tests.
• ATC classification for classifying drugs.
• HL7 for interoperability of medical messages, and continuity of care documents.

Some in-built features common in all these master databases create a breeding ground for huge troubles in the software/application. The two most important problems are listed below. 

1. All these are huge in size, with some of them being enormously large. This poses the problem of lots of redundant and unnecessary information being fetched each time there is a transaction.
2. One patient can simultaneously have many diseases, prescriptions and investigations. These keep on changing over time. So the amount of information captured for each patient at a point of time can be huge. In contrast, the entities in these databases have little links and relationships defined with other parts of the database. So, while the practice of medicine is grey in nature; the databases mostly exist as black and white, often leading to misalignment.

Due to these structural difficulties, the applications formed using such databases result in products that are often hated by their users. The typical example of this phenomenon can be seen in United States’ EHR industry, where the handwritten to EHR conversion has led to the emerging problem of clinician’s burnout.
However, the physician can sometimes intervene at the level of database, especially in the cases of true innovation, when an entirely new application is being formed and a new futuristic industry is being created. The synthesis of an appropriate medical database should be the core responsibility of the physician in charge of the product. For example startups deploying techniques like AI, AR, and VR in healthcare processes mostly build their databases from scratch and try to avoid the above problems by keeping it lean and focusing on relationships of individual entities.   

Why Seek a Leadership Position?
Working as a hospital executive enabled me to make measurable improvements in cohorts of patients. I relished the sense of accomplishment I felt by working on quality improvement and patient safety teams. The opportunities for advancement are excellent. Besides, the job payed much more than I could earn as a primary care physician.
The demand for hospital physician executives is rising, as are the types of jobs. Today you can find physicians in C-suite positions with roles beyond that of CMO, including, chief quality officer (CQO), chief clinical officer (CCO), chief medical information officer (CMIO), or chief patient safety officer (CPSO), and even as chief operating officer (COO) or CEO.
Steps to an Executive Career
The process of moving from clinician to hospital executive requires three major components:

• Demonstrating your interest and commitment;
• Acquiring and demonstrating the necessary knowledge, skills and experience; and,
• Convincing someone to hire you.

Unpaid Management Opportunities
I demonstrated my interest and gained management skills by volunteering on hospital-based committees and teams. The most meaningful experiences come when serving as chair of such committees. Here are a few examples:

• Medical Staff Department
• Quality Improvement Committee
• Pharmacy and Therapeutics or Formulary Committee
• Credentialing Committee
• Continuing Medical Education Committee
• Service Line Committees (Cath lab, Imaging, Laboratory, etc.)
  

Management Courses
To enhance your education, attend leadership and management courses presented by the American Association for Physician Leadership (AAPL), the American College of Healthcare Executives (ACHE), or the Greeley Company. Attend courses addressing:

• Financial Analysis and Reporting
• Negotiation
• Healthcare Law
• Measuring and Managing Quality
• Population Health
• Leading and Managing Physicians

More Management Experiences with Paid Positions
I further demonstrated my interest and enhanced my skills by working in a series of part-time paid positions while still practicing:

• Physician Advisor for Utilization Management
• Medical Director for a Family Planning Clinic
• Medical Director for an Occupational Medicine Clinic

Additional Experience on Nonprofit Boards
I gained additional experience running meetings, participating in major projects, and analyzing financial reports by serving on:

• Hospital Board of Directors
• Hospice Board, and Finance and Quality Committees
• County Board of Health

Serving as chair of the hospice and health boards were particularly useful in learning about annual budgets, financial reports, and working with other leaders.

Universal Tactics
Here are other helpful tactics to use concurrently:

• Find and use mentors. I had two excellent mentors, one a physician leader, the other a hospital CEO.
• Create a complete LinkedIn profile. This is more important today than ever.
• Join the AAPL. Take advantage of its business and management courses, career services, and job listings.
• Network. Reach out to colleagues, and former medical school classmates and co-residents, to find job openings.

Is a Business Degree Necessary?
At some point in the process, you might consider getting a business degree, such as an MBA, an MMM, (master's in medical management), or MHA (master's in health administration). But my advice is to get your foot in the door and then convince your employer to help fund the cost of the business degree.
Final Steps
The final part of the journey is to find opportunities and apply. A brief summary of that process is to:

1. Find openings by networking, and using recruiters (B.E. Smith, Cejka, Tyler & Co, etc.), the AAPL, and LinkedIn.
2. Do thorough research on the prospective health system and position being offered.
3. Prepare and send a cogent cover letter and resume, customized for each employer.
4. Rehearse for the interviews with a friend or coach.

Take this advice to heart, and follow this plan to land your first position as a hospital executive. The process may take a year or two to complete, but it's worth it.

Newer Non-Clinical Opportunities
 
Hospitals: In recent past, India has seen a rapid expansion of private hospitals. Over 200 new general hospitals attached to private medical colleges, 100 corporate owned super-specialty hospitals in metropolitan areas, and 100 privately owned general hospitals in tier II and tier III cities have sprung up in the last two decades. These require physician executives for administration.

Medical Diagnostics: Medical diagnostics has perhaps seen a bigger expansion than the hospitals due to lower investment requirements and faster returns, with the highest growth occurring in the medical imaging segment followed by the pathology services. The radiologist, pathologist and biochemists employed by the industry produce the desired output in the form of lab reports or imaging reports.  

Consulting (NGOs/Business): With the sole focus on improving efficiency and effectiveness of healthcare systems, management consulting companies as well as domain specific NGOs compete for providing “solutions” to their clients that may be from any corner of the healthcare industry. They hire physicians as healthcare consultants, with a select few working independently.

With the continuous push of market forces, these newer non-clinical opportunities and their takers seem to only grow in numbers in the near future.

About the author: Dr. Naval Asija is from India and has a postgraduate qualification in health administration. He has worked for a decade in diverse non-clinical roles in healthcare, namely, Medical Affairs Physician, Med-Tech Physician and Epidemiologist. He currently writes about various health issues. He also publishes the blog Journey of a Non-Clinical Doctor that intends to mainstream and empower non-clinical doctors.

The two basic types of medical malpractice insurance are “claims-made” and “occurrence.” The claims-made policy will only provide coverage if the policy is in effect. In other words, if a physician has a claims-based policy and decides to leave his/her job, he/she will need tail insurance to extend coverage for a significant period of time in case a claim is made. On the other hand, occurrence-based insurance covers a physician while on the job and after they leave, so a tail insurance policy is not needed.
 
Fortunately, after my Nephrology fellowship and prior to applying to jobs, recent graduates advised me to take jobs with occurrence insurance, so that is what I did. I am glad I took their advice because when it was time to leave my first job, I did not have to worry about tail coverage. However, not everyone has been as fortunate. Some of my former colleagues feel stuck at their jobs simply because they cannot afford to buy tail insurance coverage.

If you happen to have a job that has a claims-made policy, then you will need tail insurance and I have a few recommendations for you. Firstly, look at your contract to see if your current employer will cover tail insurance when you leave. If it is not covered, consider negotiating for that to be included in your contract. Also, determine how much tail is going to cost if your employer will not cover it, and put away a tail freedom fund to allow you the flexibility to leave a job without worrying about tail insurance costs. You can find this information by calling your insurance career. If none of these work for you, you also have the option to ask your new employer to cover your tail, and strictly stick to jobs that are willing to do that.

The Hardest Person to Sell Is You
Most clients report to me their surprise at meeting with business people who more often than not confer a level of unexpected credibility and deference on whatever they are talking about – even topics having nothing to do with medicine or healthcare.
 
In some ways it is unfortunate that physicians come from a world (medical practice) where they are treated rather harshly, perceived to be bad business people and have little influence on any topic outside the exam/operating room. Unfortunate, because they too often carry that same set of exceptions with them when they venture into new, nonclinical settings.

So, while you may believe you’ll be pushed to the wall for your opinions in business, the person most likely to do the pushing is you. So, take a step back, consider your education, your training, your basic intellect, what you expose yourself to outside medicine and practice, and realize your thoughts, suggestions, and opinions have value – in some places a lot of value. Don’t be so hard on yourself and learn to trust your instincts.
 
And, never forget, outside of medicine, “no matter what you say, what you recommend or opine, no one is going to die based on what you say.” That’s a quote from a client of mine who was so pleasantly surprised by life outside medicine. As she noted, “I no longer feel that everything I say and do has to be perfect.”
 
So, take a chance, voice your opinions, use your experiences, and you will likely be viewed as much as an expert as you are in practice.

4. Plan
Give yourself some lead-time. Once you've chosen a location and dates, make sure you have the corresponding state medical license. Licensing can take six months or more, even for well-qualified candidates with no malpractice history. Medical license boards verify all prior licenses and work experience, which can drag out the process for physicians who have worked in more than one location.
You will also need a Drug Enforcement Agency (DEA) number to prescribe controlled substances. Depending upon the state, a Controlled Substance for Practitioners (CSP) number may also be required. Hospital privileges are next, which can take a month or more.
 
5. Be flexible
With your fresh eye, some hospital procedures may seem inefficient and in desperate need of improvement. It's important to remember that as a temporary physician, you're not there to improve the workplace. Your well-intended input may not even be welcome! One piece of advice that I've heard from other locum tenens physicians is to "act like a guest in someone else's house." Come to work with a smile, provide excellent patient care, and treat staff with respect. That foolproof approach will reap many rewards.
 
Conclusions
Locum tenens physicians work temporary assignments in a variety of locations while earning a respectable income.

Starting a Business is Complicated
 
Actually, starting a business is fairly simple.  In fact, that may be part of the problem. It’s so simple that many people do it without taking the proper steps to create a strategy.  When you have the right systems, structures, and systems in place starting a business is actually pretty easy.  There can be a lot of moving parts, but if you realize that starting a business is not a “solo project”, and you get at least one other person to help you put the necessary systems in place, you can start and build a business fairly quickly.  The physicians I coach are always surprised at how quickly they can go from idea inception to business setup, and how fast they can even begin having patients or clients once they get past the view that it’s too complicated.
 
Don’t expect to make a profit for 5 Years
 
While in some business models this may be true, there are MANY business models where you can see a profit within the first 2 years and some within the first year. For those who choose to go big at the very beginning (meaning they are embarking on large acquisition projects that require huge capital up front), it may take more than 3 years to turn a profit. But for the physician who wants to transition into something more virtual (like virtual online programs, courses, information products, coaching, consulting, etc), turning a profit can happen much quicker than one thinks. My first practice (a cash based integrative medicine practice) took about 5 years to mature to profit status (likely because it was started just before the 2008 recession).  However, when I started my physician coaching and training company, it only took 10 months before I could fully transition out of my full time job.  So, it depends on what type of business you are starting as to how long it will take before it becomes profitable, however most businesses can be profitable within the first 2 years and some much less.

By Mark J. McCandless, CPA, CFP®, MTax
I love reading the Wall Street Journal. I learn interesting tidbits about sports that are not covered on sports websites. I learned about the importance of getting enough protein in my diet. I like the movie reviews that I can totally ignore because they don’t understand why I prefer action movies.  I look forward to the full page ads from some company that just screwed up pledging that they are devoted to fixing whatever it is that everyone hates them for right now. I even read the financial news!
However what I don’t like to read is that a regulatory body just indicted or sanctioned or otherwise punished a financial advisory firm. It reminds everyone why they have a negative view of the financial services industry. That is why I was struck by a recent article in the Wall Street Journal about the Securities and Exchange Commission (SEC) charging 79 financial firms with misleading their clients about the fees and other costs of the products they promote. Oddly, the Wall Street Journal did not list all of the firms but focused on perpetual bad - behavior poster child Wells Fargo. To find the firms involved I had to go to the SEC website. I was shocked at the number of well-known firms along with some smaller firms that were involved. The news release from the SEC as well a link is found here- check it to see if a firm you know is involved.

If a firm you work that is on the list, what should you do? First, click on the firm name listed and you will be able to see the complaint against the firm. Second, review the complaint and ask yourself if you are comfortable with the actions in which the organization engaged. If not, consider whether you should continue to work with the firm.
You will not find our name on the list. All financial advisory firms are not alike.  We have built our relationship with our clients based upon integrity and the quality of our independent advice. If you value this aspect of a financial advisory relationship, we encourage you to contact us.
In the meantime, I’ll get back to the Wall Street Journal. There is a great article about a guy who restored a 1920 Cadillac and one about the Federal Reserve trying to decide on the mix of Treasuries it will hold. Which one shall I read now?
Mark J. McCandless is the President of Pathfinder Wealth Advisors LLC, a fee only wealth management firm that specializes in helping physicians with income tax planning, investments, and financial planning. Pathfinder Wealth Advisors is a registered investment advisor and does not accept commissions for the sale of any investment or insurance products. He may be reached at Mark@Pathfinderwealthadvisors.com.

2. Practice the required skills
You get to learn a lot during clinical rotations. However, it is important that you practice the required skills before you start. Make a list of things you would like to learn, and practice what you have already learned, such as:
·      Taking history
·      Tying surgical knots
·      Oral case presentations
·      Writing notes
·      Presenting patients
·      Giving physical exams
You’ll feel confident when you have the opportunity to perform these tasks.
3.Hone your organizational skills
It is important that you stay organized during clinical rotations. Figure out a way to organize the patient information you will have at maintain and update while on rounds.
Use a notebook, or get a template printed to jot down important information, values and updates. Don’t use random scraps of paper and then shove them into your coat.

Think about it. As a physician, you represent about 0.3 percent of the entire population - a pretty elite group of people in a highly intellectually driven profession. But, there is only one thing in life that you can do? Rubbish. You can do just about anything you set your mind to do and much more, based on your intellect and learning capability, than most people.
Losing your license is a real shock - no doubt about it, but it forces you to look beyond the expected path and to create a new career for yourself.  Your challenge is to stop punishing yourself and start thinking not about what you could do, but rather about what you want to do, what you would like to do for a living, other than medical practice. But first, give yourself some time. Again, losing you your license is a traumatic event. Take a break, clear the air. Also, unlike medical practice, most of the rest of the world doesn't expect you to account for every minute of your career life nor are you expected to disclose every negative event in your life. In some ways, depending on your circumstances, this can be a new, clean break. 

I speak with many physicians who tell me they hope to secure a nonclinical job where they will be mentored, since they see this move as very new to them. To which, I state, no, you may want to be mentored, but no-one wants to have to mentor you, so when you walk through that door, you need to act like you've been there before. Organizations are more likely to hire you if they believe you bring new knowledge, new expertise and new opportunities than if your expectation is simply that they will teach you a job.

Further, mentoring, good mentoring that is, is not a commodity to be assigned, but is rather a relationship that develops. Nearly everyone I know, myself included, is mentored in each job by someone, if not by several people. But you don't ask to be mentored, you observe, you emulate, you ask questions.... see one, do one, teach one. See, you have been there before.
If you'd like to learn more, don't hesitate to contact me for an initial, no-charge, no-obligation Hallway Consult...voice or text to 720-339-3585 or email RFP@thirdevo.com.

About half of my clients want to move into an entrepreneurial endeavor as their transition from clinical practice. That’s great because I have found that physicians can be very effective entrepreneurs, if they make the right business choices.
 
However, the first choice is, what business? Most clients aren’t buying foundries, some do consider franchises, but most focus on the intellectual capital they bring directly to the table. Whether in public health, disease specific advisory, organizational knowledge, etc, their focus is on what they know – a smart move. Once decided, the statement I almost always hear is this, “I know there are some people already doing this, maybe I need to think of something no-one else is doing.” Wrong. There is virtually no area of consulting or advising that is so crowded that one more practitioner cannot enter.

When I’m hit by this statement, my first move is to a spreadsheet. The simple questions, how much can you charge, how many clients can you work with…. followed by, look how small a market presence you need to be successful. Do the math yourself if you have these thoughts. Most physicians can comfortably charge in the $300-$600 per hour range for special knowledge and skills. Plug into the hourly rate reasonable annual work hours, or billable hours – say 25% of a regular FTE or 520 hours. At the hourly rate midpoint of $450, that translates to $234,000 billed. If you think about work in project terms versus hourly billing, you’re looking at one to two projects each month consuming between 20 and 40 work (billable) hours .
 
I won’t get into the nuance of consultative billing practices, but let’s just say, that’s not an unreasonable goal. I’ll leave further What-if’s to you. The bottom line, there is plenty of room in the market-place for you.
 
If you’d like to learn more, don’t hesitate to contact me for an initial, no charge, Hallway Consult…720-339-3585 Voice or Text or RFP@thirdevo.com.

Some years ago I administered the Birkman Behavioral Assessment® to a group of high level members of a national physician executive organization. What differentiated them most from my control group was their elevated interest in “persuasive behavior.” Note, the Birkman assessment interprets “persuasiveness” with an orientation towards direct, persuasive communications.
While interests may or may not translate into actual behaviors, those results showed a heightened awareness in the need to convince others of their message. Most physicians don’t place a high degree of interest or actual behaviors on persuasiveness. And, in clinical practice, patients offer physicians a deferential level of persuasion based on experience and the simple credibility of, “being my doctor.”
Outside of practice, in pursuit of a nonclinical career transition as well as in nonclinical work, physicians, like everyone else, need to be selling their ideas, their recommendations and their results constantly.
While starting your sentence with, “As a physician,” may turn heads and gain initial
attention, it won’t guarantee you’ll get your way.
Persuasiveness is a skill, and a skill that can be learned. Learn to make a case for your point and presently it knowledgeably, logically and cogently, and you’ll find many more opportunities for success await you.
If you'd like to learn more, don't hesitate to contact me for an initial Hallway Consult... Text or Call 720-339-3585 or email: rfp@thirdevo.com.

By Robert Priddy
This is something I’ve said for years, and I’ve had it misunderstood on occasion to mean incorrectly, that I be­lieve other people aren’t smart. On the contrary, I believe most of the people I work with are more intelligent than I am. However, I don’t believe they all have the same knowledge base that I possess.
 
I would encourage you to take that same position. You will likely deal, in the nonclinical world, with very intelli­gent people. However, they will not possess your same knowledge base, your educational exposure or your context for decision-making.
 
Therefore, never assume your audience is operating on your plane. On a practical level, I coach my clients to appreciate that most conversations, most presentations, most interactions whether inter-personal or in groups can always be elevated to represent a higher level of knowledge. You can use abbreviations because you see everyone expects you to say HIPAA rather than Health Insurance Portability and Accountability Act, or you may skip a couple of slides, telling your audience it’s obvious the background content of those slides is unnecessary for the group.
 
It is best if you have a clear understanding of your audience’s subject knowledge. In some settings, you can simply ask the group to tell you their knowledge level. There is nothing wrong with asking, “Tell me your back­ground and experience with this...” But when in doubt be prepared to communicate at different levels depend­ing on their reaction... drowsy eyes or rapt, engaged attention.
 
As an aside, you might also consider the statement, never confuse intelligence with knowledge or knowledge with intelligence. Weigh your communications on the balance of whether it is predicated on knowledge or in­telligence, and move forward from there.

By Robert Priddy
You’ve landed a great nonclinical job, you’re making headway in the corporation, people rely on you, ask for you help and advice, you’re getting great feedback and positive reviews; and now your boss is asking if you should think about expanding your department… should another physician be hired? Nooooooooo! Is the usual response.