The Challenges and Rewards of Being a Medical Director

| | Utilization Review

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Utilization Review (UR) medical directors oversee processes and decisions to ensure medical integrity, and often, compliance. The position is challenging, but also one that can elicit a sense of accomplishment and provide numerous opportunities for doctors. Here are just three of the reasons doctors find medical directorships fulfilling.

#1 Medical Directors Learn to be Top Notch Time Managers

Many utilization review medical directors maintain their active practice as occupational medicine specialists, orthopedic surgeons, or other medical specialities. Because of this, medical directors quickly learn to improve their time management skills. Directors must collaborate regularly with an array of health care providers, UR professionals, and sometimes adjusters and clients. They are also charged with overseeing the other physician reviewer panel to ensure consistent adherence to evidence-based guidelines and other procedures that ensure appropriate treatment for injured workers. Clearly, medical directors must strictly manage their time and priorities. This is a skill that will benefit them throughout their careers.

#2 Medical Directors Broaden Their Understanding of the Profession

Medical directors learn about a wide range of regulations, guidelines and the overall healthcare economic system. Keeping abreast of each state’s distinct rules, is intellectually stimulating – it seems that as soon as medical directors learn all the requirements, the regulations and guidelines change.

Learning the regulations in other states helps medical directors better understand the regulations that affect their own practices. Seeing the comparisons among states sometimes inspires medical directors to help improve their own state’s regulations. The reverse is also true; the doctor may help other states improve their regulations. In either case, the medical director gains added insight into the UR field to help create best practices that affect healthcare.

Being a medical director also means gaining a better understanding of the UR process, from both the practitioner and the UR perspectives. A medical director, in the course of his or her own practice, who receives a denial from a UR reviewer will understand why the request was denied and can more effectively present an appeal of the case.

#3 Medical Directors Help Other Doctors – And the Entire System – Become Better

When a client complains about a UR determination, the medical director may face an uncomfortable scenario as he or she must explore the issue with the reviewer. The medical director needs to turn client dissatisfaction into a constructive opportunity. Both parties must work to turn the conflict into a positive experience.

When the physician reviewer makes the right decision, and a client objects, the medical director must defend the decision. Similarly, a medical director may find that the physician reviewer made the wrong decision. Both of these outcomes can present difficulties, but medical directors have the unique chance to use these mistakes as opportunities to teach other physicians. As in any leadership role, this can be a rewarding aspect of a career.

The medical director is also in a position to help improve the entire UR process of their organization. By reviewing client disputes, medical directors can find ways to streamline processes and make UR more effective and efficient for patients and clients alike. Medical directorship is a challenge – but the job is fulfilling and rewarding. Medical directors are uniquely positioned to help their colleagues and organizations improve their work and better serve their clients and communities. No job comes without its share of difficulties, but for doctors looking for new ways to grow their careers, experience new learning opportunities, and give back to the field, the rewards are well worth the challenges.

Zenia Cortes, MD, Orthopedic Surgeon

Dr. Zenia Cortes brings her combined expertise in sports and orthopaedic medicine to UniMed Direct, along with insights from her experience in peer and utilization review.