Becoming a utilization review (UR) physician can be a great career move – one that offers new challenges, freedom, and satisfaction – but before you can make the move, you need to prepare. With that in mind, we offer this guide to becoming a UR physician, including information on everything from the proper qualifications to ways you can find a job in the field.
Doctors Experienced in Treating Musculoskeletal Injuries Have a Major Advantage
Most work-related injuries involve sprains, strains, tears, breaks, hernias, and other musculoskeletal injuries. Types of medical practitioners who commonly work for UR providers include:
- General surgeons
- Physical medicine and rehabilitation (PM&R) doctors
- Orthopedic surgeons
- Pain management doctors
While most UR doctors fall into one of the above specialties, UR companies will also hire many other types of doctors in order to meet their clients’ needs. This list is by no means exclusive.
Make Sure You Meet State Requirements
Many states have requirements for becoming a peer reviewer. Although they vary by state, a few common requirements are:
- Board Certification: In order to comply with the Utilization Review Accreditation Commission (URAC), most UR providers require doctors to hold board certifications in their specialties.
- Experience: Most companies require that UR physicians have at least five years of medical experience.
- Active Practice: Some states require that UR physicians spend a specified amount of time in active practice each week.
These are general outlines of state and company requirements. Interested doctors should thoroughly research the requirements specific to their states.
UR Physicians Need Clean Backgrounds
Most UR providers use the National Practitioner Data Bank (NPBD) to verify that potential peer reviewers have no malpractice suits or disciplinary actions in their histories. UR providers also verify the doctors have no criminal activities on records. UR companies may also investigate physicians’ treatment patterns. They want to avoid doctors who may be known as “over-prescribers.” A peer reviewer with a history of prescribing unnecessary treatments would be unlikely to properly evaluate treatment requests.
The UR Physician Skill Set: Knowledge of Guidelines, Communication Proficiency, Research and Diagnostic Abilities and Flexibility
Being a successful UR physician requires more than passing background checks and meeting state requirements. Peer reviewers also need the proper skill set:
- Knowledge of UR Guidelines: Peer reviewers must follow guidelines when making decisions, so they need to thoroughly understand the applicable state guidelines. They should also familiarize themselves with commercial guidelines such as Official Disability Guidelines (ODG) and the American College of Occupational and Environmental Medicine (ACOEM) guidelines.
- Great Communication Skills: Communication is a crucial part of UR peer review. UR physicians need to have conversations with requesting physicians in order to thoroughly explore their treatment requests and make the right decisions. Peer reviewers must also create reports that convey their decisions clearly and succinctly to patients, attorneys, claims adjusters and requesting physicians.
- Strong Research and Diagnostic Skills: Reviewing a request for treatment is a lot like diagnosing and treating a patient – except peer reviewers are not present with the patients. Therefore, UR physicians need strong research and diagnostic skills. They must be able to analyze medical documentation from requesting physicians in order to make the right treatment decisions. UR physicians must also be adept at recognizing and identifying any co-morbidities that may affect the course or pace of treatment.
- Organization and Flexibility: UR physicians need to implement systems to handle the complexity of the peer review process, especially regarding interacting with requesting physicians. Requesting physicians may not be available when peer reviewers need to speak with them, so peer reviewers must be flexible in their approach to connecting with them.
Who Should Think About Becoming a UR Physician?
There are many profiles of doctors who may want to consider becoming UR physicians. Some of the more common characteristics of UR physicians include:
- Semi-retired doctors or others looking to decrease their practice time
- Doctors who want to reduce their insurance costs
- Doctors looking for a more professional freedom
- Surgeons who can no longer operate due to injuries
Find Job Opportunities: Conferences, Trade Publications, and Your Network
Physicians who want to work with UR providers can look to a number of sources for job leads:
- Trade publications
- Industry conferences
- Marketing campaigns launched by UR providers
- Referrals from colleagues who work with UR providers
The last channel is particularly important. Many UR providers source physicians through referrals from their existing members. If you’re looking for a role with a UR provider, you may want to turn to your professional network first.
Great candidates for roles with UR providers have successful active practices, extensive medical experience, and excellent communications and organizational skills. If that sounds like you, you may want to look into UR as an exciting new career endeavor. You’ll get to continue practicing medicine, sharpen your skills and contribute to medicine in a freer and more flexible environment.