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Status, The Oxford Comma, and Other Obsessions

Our Relationship with Residents
By Juliet Ugarte Hopkins
Posted: 2021-11-08T02:05:00Z
* A version of this blog was originally printed as the President's Corner for the ACPA Update newsletter in April, 2021.

For physician advisors, residents are individuals we will work with in the future on a possibly two-pronged basis.   First, for those physician advisors who continue to practice clinically, they will eventually share patients and call with these individuals when they graduate and evolve into internal medicine or pediatric hospitalists, clinic-based family practitioners, general surgeons, radiologists, specialists in emergency medicine, and more.  Gone are the days when physician advisors were assumed to be most effective if they had an internal medicine background.  Time and time again we see subspecialists of all stripes effectively entering into the physician advisor fold, bringing their own unique perspectives and experiences into the mix.  Similarly, hospitals and health systems are realizing that physician advisory services are not only required for adult patient populations.  Increasingly, especially when it comes to challenges associated with commercial, Medicaid, and managed Medicaid payors, physician advisors with pediatric backgrounds are rapidly in demand.

Second, physician advisors working within academic hospital systems understand they are relied upon as potentially the foundation of knowledge involving hospital utilization, aspects of patient safety, optimal documentation, and continuity of care.  While it seems medical schools are investing at least some time into instruction on these topics, clearly the majority of the focus (one could argue, rightfully so) is on the science of medicine and clinical care of patients.  As such, it often falls on the hospital physician advisor to provide the lessons residents must learn related to “the business of medicine” in its myriad of forms. 

I think it’s safe to say the majority of us currently working as physician advisors have no recollection of learning, as a medical student or resident, about patient status, specificity of documentation for coding and billing purposes, or the merits of really thinking deliberately about which testing, imaging, or procedures are needed to take place before discharge vs. arranging for the outpatient setting.  From my own history, it was my tenth and final year of practice as a pediatric hospitalist in 2014 when I first met with someone who had a title I’d never heard before – a “clinical documentation specialist” – to discuss how “urosepsis” should never be documented and “asthma exacerbation” needed more qualifiers about the type of asthma the child’s diagnosis entailed.   

We are in a unique and frankly, exciting situation of finding ourselves as the tip of the spear.  Few, if any of us, received as trainees the instruction we now routinely disseminate.  How amazing it is to think we play a part in creating the future wave of clinicians who WILL enter their practice at least somewhat versed in the topics on which we focus?  Our efforts and initiatives will carry on not only through the work of better-rounded clinicians but also, might light the spark to create future colleagues in our world of “physician advisordom.”  

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