Why External Physician Advisor Support Is Essential 

For years, hospitals have debated whether to build Physician Advisor programs internally or partner with external teams. On paper, insourcing seems practical: hire a few physicians, keep the work close, and avoid vendor fees. 

However, today’s environment tells a different story. Between physician workforce shortages, increasing payer complexity, and the growing oversight required for tech-enabled workflows, fully insourced Physician Advisor programs are becoming increasingly difficult for staff, sustain, and scale. 

By 2036, the nation will face a physician shortage of 86,000. Demand for Physician Advisor expertise is climbing 6–9% annually, while the available physician workforce declines.

Hospitals recognize the reality that Brundage Group has long understood. External Physician Advisor support is no longer optional; it is essential. 

Area	Internal Physician Advisor	External Physician Advisor Program
Expertise	Knowledge limited to a single organization’s cases and payer mix.	National-scale expertise across diverse systems and payers, grounded in thousands of real-time reviews each month.
Coverage & Flexibility	Small teams (typically 1–3 Physician Advisors) create coverage gaps during nights, weekends,  holidays, paid time off (PTO), and turnover.	A fully staffed national team that delivers uninterrupted coverage 365 days a year and immediate surge support.
Scalability	Difficult to scale during spikes in census, payer scrutiny, or denials.	Purpose-built for flexibility; seamlessly adapts to fluctuating demand and supports hybrid operating models.
Recruitment, Onboarding & Training	High cost and time investment to recruit, onboard, and continuously train physicians on policies, DRGs, and evolving payer rules.	Recruitment, onboarding, and ongoing education are fully managed; immediate access to experienced Physician Advisors without internal overhead.
Management & Oversight	Requires ongoing internal leadership time for scheduling, performance monitoring, QA, escalation, and compliance management.	Centralized management, quality assurance, and reporting minimize internal leadership time requirements.
Operation & Hidden Costs	Often includes underestimated expenses such as credentialing and HR administration.	These costs are included in the contract, with minimal internal administrative burden.
Risk Management	Learning curves and inconsistent coverage can lead to delayed reviews, documentation variability, and potential revenue risk.	Experienced staff are typically  immediately effective, reducing the risk of lost revenue due to misaligned reviews or delayed  utilization  management.
Technology Enablement	Limited access to integrated tools; reliance on manual workflows and fragmented data.	Automated triage, tech-enabled workflows, and advanced analytics built directly into the Physician Advisor service model.
Strategic Impact	Competing priorities and responsibilities limit the ability to focus on data-driven insights and process design.	Executive-level analytics, denial management, and strategic advisory support that improve enterprise-wide performance.
Continuity	Vulnerable to resignations, stagnation, burnout, and limited coverage models.	Team-based model with deep bench strength, consistent quality, and long-term continuity.

Return on investment (ROI) is driven by expanded specialty expertise, coverage continuity, and organizational-scale insight—not increased per-physician workload. 

Why the Market Is Moving to External Models 

Hospitals are not abandoning insourcing entirely—but they are redefining it.  

Three market realities drive this shift: 

1. Physician Advisor Demand is outpacing supply. 
Escalating payer friction, growth of Medicare Advantage population, and increasing payer scrutiny are driving demand for qualified Physician Advisors faster than the workforce is expanding, resulting in a sustained supply-demand imbalance. 

2. Internal models cannot absorb volatility. 
A single resignation or high-denial month can destabilize hospital revenue cycle operations. External programs provide insulation, efficiency, and continuity. 

3. AI is adding oversight responsibilities, not removing them. 
AI accelerates case generation—but human clinical oversight remains essential. External Physician Advisor teams are already structured to manage the combined human + tech-enabled (AI) workload. 

How Brundage Group Fits into the Future Landscape 

Brundage Group is purpose-built for the realities hospitals face today. We provide: 

National-scale Physician Advisor coverage. 
Hospitals gain immediate access to a fully staffed, highly trained clinical team without the burden of hiring and ongoing training. 

Turnover does not disrupt hospital revenue cycle operations. PTO does not reduce coverage. Surges do not overwhelm staff. 

Integrated technology that accelerates reviews. 
Automated triage, AI-enabled insights, and streamlined workflows give hospitals capabilities that would take years to build in-house. 

A full spectrum of revenue cycle management resources. 
Status determinations, DRG optimization, denial prevention, peer-to-peer support, and appeals—handled by a cohesive team. 

Meaningful, measurable financial impact. 
Partners see stronger documentation, fewer denials, higher overturn rates, and enhanced revenue protection. 

The Bottom Line 

The question facing hospitals today is no longer “Should we insource?” but “Can we sustain it?” As demand rises, complexity intensifies, and staffing constraints grow tighter, internal Physician Advisor programs face increasing operational and financial risk. 

External Physician Advisor support provides the stability, expertise, and scalability hospitals need to protect revenue.

Brundage Group is ready to support organizations through this transition with proven solutions, national experience, and measurable outcomes. We partner directly with your UM teams, strengthen internal relationships, and integrate seamlessly into your revenue cycle operations to function as an extension of your team.