Curbside Consult with Dr. Jayne 3/14/16

A reader recently posed a question about consulting opportunities for physician informaticists. He was interested in exploring whether consulting is right for him. Specifically, he was asking: what are the qualities of a great consulting company employer? Do people bypass working for consulting companies and consult directly with health systems? Mr. H asked consultants to weigh in, especially physicians. I haven’t seen anyone weigh in yet, so I’ll at least give my own thoughts.

First off, I don’t think my journey to being a consultant has been typical. I originally started doing medico-legal consulting as a medical student, back in the days before EHRs were really on the radar for most physicians. Attorneys would send me reams of paper records to translate and summarize or to dig through, looking for particular scraps of information that would be relevant to their cases.

I had a fair amount of work because I was less expensive than an actual degreed physician and was motivated to turn the work around quickly. In addition to helping cover the high cost of tuition, it gave me a lot of exposure to the huge spectrum of documentation styles. It also helped me see a variety of errors and omissions that were common in various situations.

I originally ran that business under my own name and filed as a sole proprietor for tax purposes. I continued to do that kind of work during my residency training, and as more hospitals started using electronic charting, I started to see less work that involved reading cryptic notes and illegible writing and more that involved sifting through pages and pages of redundant information.

Most of my clients found me through word of mouth. Most of them were from smaller cities or rural areas. That made it easier, as far as not being pulled into cases that might involve faculty or colleagues or that otherwise might pose a conflict of interest.

I maintained that client base until I left training, and then ended up getting into the world of pharmaceutical consulting. I had done some research and co-authored a paper on a particular disease process, which apparently made me an expert in the eyes of a particular manufacturer. They asked me to attend a focus group. Since it was being held at a lovely resort and I hadn’t had a vacation in seven years, I agreed.

Once there, I realized I was totally out-gunned by the other attendees, who had serious reputations in the field. However, the discussions were stimulating and they must have felt my contributions were valuable because they added me to their advisory board. We could see our recommended changes actually come to fruition in how they marketed their products. I felt I was doing good work.

It certainly wasn’t what you sometimes hear about with pharma companies flying physicians to sit on the beach and paying them enormous honoraria. Although we would generally meet in a nice location, they would keep us locked up in working groups eight hours a day. That work continued for a couple of years, and then as their two flagship products came closer to rolling off patent, they disbanded the advisory board.

I didn’t get into formal informatics consulting until a couple of years after that, while working as a physician informaticist for a health system. I had done a couple of side jobs for small practices – basically physicians who knew about the work I was doing for the hospitals and wondered if I could help them out with issues they were having with their EHR systems or other practice issues.

I would do an hour here and an hour there, mostly in the evenings and on weekends. Physicians were happy to do it on that schedule because it didn’t interfere with patient hours. A friend of mine was doing practice operations consulting independently and had a client who needed a great deal of assistance regarding use of their electronic health record, so he reached out.

Since his client was located in one of my favorite cities, how could I resist? We came up with a proposal for the client. Although they were larger than any of my previous consulting clients, they were smaller than the medical group operation I was leading at the time. I was honest with them, going onsite to deliver my proposal and explaining my experience and what I could and could not do for them. They wanted periodic on-site work as well as remote work, and my then-employer was agreeable to having me take vacation time for the periods when I needed to do work during the day.

When I started working with that client, I realized that I was actually bored with my day job. I didn’t have a lot of growth opportunity there and was tired of some of the politics. In addition to the client work, I started doing some work with vendors. Mostly just focus groups and the occasional paid demo, but also did some co-development work with a start-up.

I realized during that time that I should get serious about being an actual consulting firm and filed for my first LLC. I also had some connections at some of the larger consulting firms and started looking at those possibilities. Generally, though, they would require more travel than I was willing to agree to, so I didn’t pursue them despite the significant potential for earnings.

Looking at some of my colleagues that did end up working for the larger firms, they seem to fall into a couple of different models. Some are actual employees of a single consulting firm, and when they’re not on client engagements, they perform work on standardized methodologies and materials that will be used for future engagements.

Others are independent contractors, and when they’re not engaged, they don’t get paid. Those folks have to do a fair amount of self-promotion and marketing. I have one friend who “works” for three major consulting companies and has actually found himself onsite with a single client as an agent of both companies.

Once I got serious about having a business plan and operating as a real company, I also got serious about my credentials. I didn’t want to have to market myself as “homegrown informaticist seeking bigger gigs” and the board certification for Clinical Informatics was about to become a reality. I looked at masters programs and decided to just go after the board certification, figuring that plus 10 years in the field with a large health system was probably enough to take me to the next level. The rest is history and I’ve been an independent consultant for some time now.

To the reader’s question, though, some of us do consult directly with health systems. Depending on the size of the hospital or health system, it can be straightforward or complicated. Sometimes I can get away with just writing a proposal. Other times I am participating in a formal RFP process that can take weeks to put my bid together. It can be frustrating at times.

It can also be very rewarding, since I control my own calendar for the most part. If I don’t want to work for a while, I can. I still continue my clinical work, not only because I enjoy seeing patients and love my current employer, but because it’s easier to get benefits that way than dealing with it on your own. Being on your own also means being your own IT department, your own accountant (sometimes), and your own secretary. Although I now have a partner, we’re still doing most things on our own.

People often ask me for advice on hanging out their consulting shingle. My first recommendation is that if you haven’t completed a formal training program, consider board certification through the practice pathway if you are eligible. Preparing for the certification exam forced me to learn areas that I hadn’t really been exposed to as a practicing informaticist. I feel that having the certification shows you’re willing to go the extra mile even though it may just be another piece of paper to some.

AMIA is hosting a free webinar this week on this topic: “Clinical Informatics: Board Certification through the Practice Pathway – and Beyond” will be held on March 18 from 1-2 p.m. ET. William Hersh, MD, FACP, FACMI is the presenter. For those of you not familiar with Bill, he is also professor and chair of the Department of Medical Informatics and Clinical Epidemiology at OHSU. He also serves as chair of AMIA’s clinical informatics board review course, which I’d highly recommend. Topics for this week will include:

• Physician informatician roles and responsibilities
• Requirements for the “practice pathway” for board certification in clinical informatics
• Value of becoming board certified during the “practice pathway” period (which will be ending)
• Fellowship training required for certification after the “practice pathway” ends

Registration is available here and will also be archived at knowledge.amia.org for members.

What are your thoughts about being a consultant? What are the qualities of a great consulting company employer? Leave a comment or email me.

Email Dr. Jayne.