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The call rang through, and I hurried to finish my bite of “lunch.”

The latest peer-to-peer phone call with an insurance company physician, now a near-daily routine.

I reminded myself to remain serene, and the discussion proceeded.

I counted to ten in my head. Three times.

I closed my eyes. Took several deep breaths.

The physician on the other end of the line did seem, to her credit, to be trying to find a way to approve the test I had ordered for my patient.

But not based on her expertise as a physician. I could surmise, from her talking through her process out loud, that she was attempting to find the right combination of “checkboxes” her employer required in order to get the test approved.

I couldn’t stand it any longer.

“So, what’s the reason for the denial?” I strove to keep the exasperation out of my voice. “It’s pretty straightforward. Don’t you agree this patient has a clinical constellation of symptoms and risk factors that justifies this test?”

Her tone remained upbeat. “If you’ll just bear with me. I’m trying to find a way…”

“But…aren’t you a physician? Isn’t the point of this call for you and I to discuss the case, and if in your medical opinion as a physician, you agree with me, then you, as a medical doctor, can authorize it?”

Her voice deflated. “It’s—I’m trying—you see—it’s an opportunity…”

The formulaic sentences trailed off.

I refrained from further comment.

She continued to talk through her workflow. Eventually, and again to her credit, she found the right series of “boxes” to check that allowed her to authorize the test. She gave me the approval number and we ended the call with forced politeness on both ends.

Afterward, I found myself ruminating on the question of, why?

Why do some physicians go to work for the insurance companies?

Out of curiosity, I did an online search, as if I was looking for such a job.

I found some interesting things:

1. None of the listings included the salary
2. But they all touted lifestyle benefits, including the regular, predictable hours.
3. They all espoused high levels of support and respect given to their physician employees
4. One major insurance company’s employment webpage showed a photo of adults dressed in formal eveningwear jumping into a swimming pool, as if when you go to work for them, you’re in for the party of your life.

However, I found only one transparent article online.

In the post, Working for Health Insurance – Is This Really the Dark Side?, Heather Fork, MD, CPCC, the owner and founder of The Doctor’s Crossing, posted an interview with one of her physician-clients.

Of note, the physician declined to be identified by her real name, or identify the name of her employer.

And this was the only reference I could find online as to how much a physician working for an insurance company might be compensated.

According to the interview:

What kind of compensation could a doctor anticipate for an entry-level position?

"Dr. Crawford [not her real name]: $200 – $220K.

What do you like about your job?

Dr. Crawford: I love working at home. I like my team. I like my superiors and the management structure of the company. They take your concerns into consideration and try to make it work for you. The benefits and pay are really good. I enjoy getting to use my medical knowledge. It’s not a simple job, but there is so much less stress than when I was in clinical practice.

What don’t you like about your job?

Dr. Crawford: There is a lot of typing and mousing. I was having trouble with my wrists before and I still do…I get up and take some breaks and move around.

How are you treated?

Dr. Crawford: Really well. In my last job I was a corporate employee. This is vastly different experience. I was warmly welcomed. I have one-on-one meetings with my boss. When I was in practice as a corporate physician, they always forgot Doctor’s Day. This year I received 42 Happy Doctor’s Day emails. It’s a much better feeling."

Hmmm, trading the grind of clinical practice, and this end of those peer-to-peer calls, for feel-good management, Happy Doctor’s Day emails and risking some carpel tunnel (but wait, we already are all forced to do that – spend more time at the computer keyboard than with our patients regardless…)

It’s almost enough to convince even me.

Almost.

Are you a physician with experience or insight in working for an insurance company? Tell us more about it! When and how did you make the decision to change roles?

Dr. Jennifer Lycette, MD is a medical oncologist in community practice for 11 years. She works and resides on the North Oregon Coast, where she lives with her husband and 3 children. Her personal blog, The Hopeful Cancer Doc, includes her writings on practicing oncology, maintaining hope in medicine, work-life balance, and various other musings.

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