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Alternative Careers in Medicine: Internal Consulting

Alternative Careers in medicine: internal consulting

8 questions answered about this alternative career path

No matter how tired I’ve been of clinical medicine, I’ve never regretted learning what I have learned. I would miss the information if I quit medicine – this is why internal consulting is so appealing as an alternative career path.  I’d be in a position where I would be able to use the information I have, learn more but be removed from the clinical grind that contributes to burnout.

I’m also at a point in my life where traditional (external) consulting wouldn’t be feasible. Many consulting jobs will require 70% travel time, which is nearly impossible with a family and children.  Internal consulting, on the other hand, would be at my home institution. I know the organization I work for, who the players are and how the processes work. I know the workarounds, what has already been tried and failed. Most importantly, I know the culture.

Below are eight questions I’ve asked myself while pursuing this career path. I used White’s The Well-Managed Healthcare Organization, 9th edas my primary reference, but a smattering of other resources is found below.


What is an internal consultant?

Internal consultants function in the same way external consultants do; they’re hired to address organizational problems. The difference is they’re hired and developed from inside the organization. They are considered to have an official position and may come from virtually any department in the facility, such as human resources, a service line or the quality department.


What is the purpose of internal consulting?

Primarily, it is to collect and present relevant information needed to solve organizational problems. An internal consultant supports the organization’s mission and vision through prioritizing the issues and addressing, measuring, and managing the projects designed to fix those issues.

They do not make the decisions regarding those problems; they provide the data to leadership to inform appropriate decision-making.


Why would an organization create an internal consultant position?

Internal consulting programs are gaining in popularity for a number of reasons. Harvard Business Review summarizes them:

“Internal consulting groups have a number of advantages over external firms, including a company-wide perspective, continuity into implementation, attraction of top talent to the company, higher levels of confidentiality, and greater cost-effectiveness.”

Internal consultants also have the advantage of deeper organizational understanding and a higher degree of trust from the people they’re working with than an external consultant might. They have already established relationships and know the institutional levers that facilitate change.

On the negative side, internal consultants may enter a project with preconceived notions about the people or programs involved in that project. They may be accustomed to the organizational culture to such a degree that they are unable to see a problem objectively. Also, since they are internal, they may have personal motivations for a project that supersede organizational objectives.


Who are the “clients” of an internal consultant?

The Well-Managed Healthcare Organization, 9th ed., defines “clients” as:

“any duly constituted organization unit- usually a process improvement team, a planning team, the governing board or senior management.”

In a phrase: Anybody affiliated with the organization.

The entire healthcare organization could be the client of the consultant. They could work senior leadership, a performance improvement team, or a particular unit or department (or any combination thereof). They could manage external consultants or external vendors.

An internal consultant could also be involved in the organization’s financial proposals.


How do you get a job as an internal consultant?

According to an article by designedlearning, there’s a chance you already are one. Here are a few signs that you may be working in this capacity already, including:

  • Having a specific area of expertise
  • Working to provide support to other departments or divisions
  • Working to help others solve their problems with sustainable solutions
  • Finding that others often come to you for assistance “at the last moment.”
  • Work to clarify other’s expectations and goals

I would add to this list that if you regularly work as what I call a “translator,” you may already be an internal consultant. For example, I have been invited to meetings that wouldn’t otherwise be a normal part of my role in the hospital essentially to translate. To help one side of the meeting understand what the other is saying, to help collect or interpret data, or explain processes to people in administrative roles.

If you already have these jobs, your next step is to formalize your position. Learn the languages of management and finance. Partner with your management team to let them know what you’re interested in and what possibilities exist. This may take time and it may start out in a part-time or PRN capacity. Understand this going into it; it’s just an opportunity to build your CV until you can create a permanent spot.

If you do not routinely carry out these functions but want to start building a portfolio of projects, go to where the action is. Start getting engaged in ongoing projects at the workplace, playing an active role. Hospital committees, strike teams, performance improvement teams, quality projects, research — these are all opportunities to make a name for yourself as an internal consultant.

If your hospital doesn’t have regular reporting of important information, do it yourself. Learn the skills no one else wants to know — be creative and aggressive in making a name for yourself as the “go-to” person within your organization.

If you want an easy way in, figure out how to make the EMR more useful.

Document what you achieve and what roles you have played. Once you become more established, you will be functioning as an internal consultant — then look to formalize your position.


What are the functions of an internal consultant?

The list is extensive — essentially any new project a healthcare organization has could be facilitated by an internal consultant. The Well-Managed Healthcare Organization, 9th ed lists many:

  • Support of performance improvement teams while providing structure and ensure accountability.
  • Provide an environmental assessment — a very thorough review of the organization in the context of the community, broad enough in scope to include market share, community attitudes, forecasts of volume, trends in clinical practice, trends in physician supply, competitors or associate attitudes
  • Forecasts of disease-specific demands and needs for clinical services, employment or supplies.
  • Help clients select relevant, evidence-based benchmarks.
  • Assessment of external causes of variation or threats to internal processes.
  • “Other” such as legal, ethical, compliance, research, human resources needs.
  • Support routine capital investment requests and financial health

The contractor functions to take organizational problems of any flavor and wrap them up nicely, putting a bow on them to facilitate client decision making.


Are there projects that shouldn’t be handled internally?

Internal consultants are not always the answer.  It is within their scope of practice to identify when an external consultant may be necessary.

Looking outside an organization requires a clear definition of the problem and ensuring that all internal resources have been exhausted. Once hired, an external consultant must be managed by the organization and be carefully monitored for success by a designated member of the organization.

Harvard Business Review’s article describe three circumstances where an external team should be selected over an internal one: A sudden need for a large number of consultants, when expertise is needed but not available internally or when findings of a project will be publicly quoted.


How do you measure the performance of an internal consultant?

The typical dimensions of operational scorecards also apply to internal consultants:

  • Demand for services (How many requests are made of the consultant; how many became engagements?)
  • Cost (Total direct cost of the consultant, hours of work completed, need for external consultants.)
  • Human resources (Satisfaction of clients via surveys, turnover rates, “would rehire” rates)
  • Productivity (Actual improvements in operational measures)
  • Quality (Accuracy of forecasts, timeliness, improvements achieved)


There you have it, 8 questions about this alternative career path compiled for easiest comprehension. If you’re looking to swap careers or try a new path, feel free to browse jobs on our homepage.

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About David Beran, DO

I am a practicing emergency physician with academic and administrative roles. I work full time as a medical director but am exploring multiple non-clinical avenues for my medical and public health degrees. Aside from blogging on, I work in file review, consulting, research and expert witnessing.

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