How to un-retire: Coming back can be tricky

A happy, enriching retirement always makes a physician's short list of financial goals. But retirement can be a moving target, even more so for physicians than for other professionals.

A number of factors, from a passion for medicine to elusive financial security, can keep doctors working longer than planned -- or convince them to pause retired life and return to the profession.

Un-retiring is often far more complicated than seeing if the lab coat still fits. Between landing a suitable practice situation, updating your certifications and licenses, and finding a company willing to underwrite a liability insurance policy, there are many issues facing a physician trying to reenter the work force.

But it is doable. "Doctors are in such short supply, and there are plenty of specialties in demand," said Kurt Mosley, vice president of business development for MHA Group, an Irving, Texas-based collection of six companies, including the physician recruitment firm Merritt, Hawkins & Associates.

The gradual slowdown of the stock market over the last several years has forced some physicians to rethink their retirements, while others simply haven't been able to find better ways to occupy their time, consultants said. But if it's taken a few years for retired physicians to realize they want to be back in the exam room, the return can be tricky.

Finances and licensing

Your retirement funds, for example, might not wait for you to leave medicine again. If you retired and started taking distributions from your retirement account before 59½, you have to continue taking distributions for five years or until you reach that age, whichever is later, said Ron Paprocki, CEO of Mediqus Asset Advisors, a Chicago-based financial and investment advisory services company for physicians. That means your distributions continue even if you return to work.

Licensing and continuing medical education requirements vary by state, and if retirees have moved on to a warmer climate after hanging up the stethoscope the first time, some of the rules may come as a surprise, said Nikoma Wolf, director of licensing for Staff Care, a locum tenens physicians staffing firm, and for LicenseStat, a separate company that assists physicians with licensing needs.

Some states, such as Texas, use a 10-year rule, which makes board certification within the previous 10 years a licensing requirement. Physicians who received lifetime certifications in the 1980s would have to take a special purpose examination, or SPEX, to regain licensing eligibility, Wolf said.

Other state quirks come into play as well, especially for physicians of retirement age, Wolf said.

Most state licensing boards require original documentation, which can be difficult to get.

"Some of the problems I've run into is medical schools have burned down or merged with other schools," Wolf said. "It's difficult to prove their existence. The longevity of institutions comes into play."

Some states require a personal interview with the licensing board, at which it's necessary to bring the original medical school diploma. Rather than remove the diploma from the grand frame it has occupied for decades, some doctors lug the mounted document to their interview, Wolf said.

The length of time a physician has been away is an important factor as well. Some states, such as Colorado, have established a rule that requires physicians who have not treated a patient in two years to prove that they are still competent. Beyond competency assessment, some states might issue a limited license and require returning physicians to complete a training or education program.

One organization, the Aurora, Colo.-based Center for Personalized Education for Physicians, assists physicians who have been out of practice for several years but want to get back into medicine. The center runs a type of mini-residency program that includes education and training updates on new medication, techniques and tests -- details a retired physician might have missed.

"The people we're seeing are physicians who are applying for a license somewhere," said Elizabeth Korinek, MPH, executive director for the center. "They're moving to a new state and haven't practiced there. They're physicians who have a good foundation, but they're not ready to see patients yet."

Looking ahead

With some additional training, however, these doctors are able to obtain an updated license and return to practice, Korinek said. But there are still plenty of physicians who return to medicine without undergoing additional training simply by anticipating that their retirement might not last.

The passion that drove a young person into medicine decades ago is often the same reason that person wants to un-retire after only a year or so of not seeing patients. If you retire but keep your license active, keep up with continuing medical education requirements and continue to read medical journals, then chances are you're not really ready for retirement.

Ben Wofford, MD, a family physician with an emergency medicine background, was 72 when he first retired in 2001. It took less than a year to realize retirement was "a shoe that didn't fit," and he decided to open a clinic for uninsured patients in Newton, N.C. He's now 75, and he's back to practicing medicine the way he remembers it before bureaucracy started to make it unbearable.

His practice, aptly named The Clinic for People Without Health Insurance, operates the way offices did when he started 40 years ago. He does not deal with insurance companies. He has a fee schedule but lets patients pay what they can, when they can. He employs family members to help run the office.

He doesn't even have a computer, a point he proudly proclaims. "I gloated the last time the power went out. My office was the only one that kept operating. We lit candles and didn't miss a beat."

Physicians who come out of retirement might want to start a new practice from the ground up, but they have other options as well. Many choose the locum tenens or hospitalist route to retain some of their new freedom by working a set schedule and having to deal with fewer bureaucratic hassles.

Donald Preuss, MD, an internist in Oklahoma City, stayed retired for three months before finding a locum tenens position at a nearby prison. He later took a hospitalist position with North Hollywood, Calif.-based IPC -- The Hospitalist Company. Dr. Preuss kept his license active during retirement, and having been on staff at local hospitals for 30 years made it easy for him to regain credentials, he said.

"I could see how that could be difficult, if people had more of a hiatus," he said. "The idea of having fewer administrative or business problems appealed to me, and as a locum tenens or a hospitalist, you don't have those worries."

With fewer hours and no call responsibility, those positions appeal to some un-retired physicians. But many doctors view them as fallback opportunities, chosen only after it's clear they won't be able to rejoin their previous practices.

"From a partner's or a potential employer's point of view, the doctor wants to come back, but the spot has already been filled," Paprocki said.

Even if the spot has not been filled, there are important logistics to work out, including the returning physician's schedule and compensation package, especially if the un-retiring doctor wants to work fewer hours.

Liability insurance also could be difficult to obtain, especially if the physician has been out of practice for a considerable time.

The cost of liability coverage can be significant, both in terms of future work and past work. When a physician retires, an insurance company will offer "tail coverage," at a cost usually larger than an annual premium, to cover any claim from a previous patient encounter that arises after retirement.

"Very often, tail coverage cost is something the individual physician is responsible for," Paprocki said. "He may have to pay it again if he returned, and he may not want to do that."

But for some doctors, any costs and hassles they might face are worth it, just to get back in medicine.

"When you retire, you're no longer part of living society," Dr. Wofford said. "You become an extremity of society, made up of other retired people. Your need to have the same kind of purpose in life is not met."