Physician Advisor Work Remains Essential to the Apprenticeship Inherent to Responsible Practice of Healthcare

When I was a resident, no one ever said to me, “Pay attention. One day this will matter when you are explaining medical necessity to support the Two-Midnight Rule.”

Which is good, because the rule did not even exist yet.

What I did have was the post-call morning report. I remember defending my workup of a patient with anemia, elevated ferritin, and abnormal liver function tests (LFTs), and explaining why I was not ordering every test ending in “antibody.”

At the time, that felt like a lesson in clinical reasoning and evidence-based practice. Looking back, I see it differently.

That was also part of my training to be a physician advisor.

It was training in stewardship. In judgment. In knowing that the best care is usually not the most care and understanding the harm that can come with overuse. And in being able to explain why a more selective approach was right for that patient, in that setting, at that time.

That idea sits underneath a Journal of Hospital Medicine article I coauthored, led by Dr. Bina Patel, about a physician advisor rotation for residents. The article describes an elective designed to fill a gap in training for quality, efficiency, safety, and care delivery. It introduces residents to the practical work of physician advisors and the broader system-based practice that shapes how care is delivered.

But for me, the bigger point goes beyond the rotation itself.

Medicine is still, at its core, an apprenticeship.

We learn from textbooks and lectures, of course. But we also learn by watching more experienced physicians think through uncertainty, explain clinical judgment, communicate clearly, and navigate the system with a keen focus on patient care. Some of the most important parts of becoming a physician are still taught in those real clinical moments.

That is especially true for the parts of medicine that sit at the intersection of bedside care and systems of care.

Many residents finish training with excellent clinical skills, but limited exposure to how documentation, medical necessity, care progression, discharge planning, denials, and regulatory expectations all intersect. Modern practice has gotten more complex, but many of these topics still sit outside the traditional curriculum.

That is the gap this rotation was designed to address. It introduces learners to a field many know little about. Some are seeing physician advisor work for the first time. They are not just learning rules and regulations; they are beginning to understand the purpose of the work and the many ways it supports patients, clinicians, health systems, and care delivery.

Recent learner feedback reinforced that point. One third-year internal medicine resident who completed the elective in March 2026 reflected, “Seeing the different sides of quality improvement, CDI (clinical documentation integrity), peer-to-peers, and other physician advisor work helps bring things together and shows why this work matters.” Another resident who completed the elective at the same time added, “This is the most I have learned on a single rotation since starting residency.”

To me, that gets at something important. We may be underselling one of the most significant parts of physician advisor work.

Physician advisors are often described by the tasks we perform: status review, CDI, peer-to-peers, denial appeals, care coordination, care progression.

But beneath those tasks is something more fundamental.

Teaching and learning are at the core of the role.

We teach fellow clinicians how clinical reasoning is communicated in the record. We teach colleagues how to explain why a patient requires hospital level care, why discharge is not yet appropriate, why the plan of care still requires acute services, and why the right decision is often doing less, rather than more. We help colleagues understand not just the rules, but the clinical and systems thinking behind them.

That educational role is deeply connected to stewardship.

Part of what we should be teaching learners and colleagues is how to distinguish necessary variation in individualized care from unwarranted variation that creates waste, confusion, and uneven outcomes. In that sense, teaching CDI, medical necessity, and care progression is not separate from good care. It is one way we help physicians deliver thoughtful, evidence-based care with greater consistency across a complex system.

And I think that educational core matters even more now.

As generative artificial intelligence (AI) increasingly reshapes utilization management, CDI, and denials, the human work of teaching, judgment, connection, and leadership will only become more important. The tools may change. The need for physicians to explain, guide, coach, and lead will not.

That is also why I value serving as co-chair of the National Physician Advisor Conference (NPAC). If medicine is still an apprenticeship, then our field needs places where that apprenticeship can continue, where experienced voices can teach, newer voices can step forward, and the best ideas in physician advisor practice can be shared openly. That is what a conference like NPAC can offer, and why it matters.

So, if I had to leave you with one message, it would be this:

We often think of physician advisor work as review, support, and problem-solving. It is all of those things.

But at its core, it is helping colleagues communicate clinical reasoning clearly and deliver the right care, in the right setting, at the right time.

It is stewardship in practice.

And it is work worth teaching forward.