Doctors seek more help to get back in practice; refresher programs considered

As more physicians take extended family leave or retire early and regret it, medicine looks for ways to facilitate their return.

By — Posted July 24, 2006

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Many physicians who chose to take a lengthy break from clinical practice find that it isn't easy to re-enter the work force.

Their licenses may be current, but they feel their skills are out of date. They run into trouble getting hospital privileges or credentials. They also can face state medical board requirements for retraining but be left without a clear path to getting it.

Though some states have remedial programs for physicians who have had problems, retraining is a different issue, experts said.

It also requires a different approach. A practicing physician has patient charts that can be examined and colleagues who can be interviewed. A physician who has been out of practice doesn't have these evaluation benchmarks.

In the end, some experienced physicians find they are unable to return to practice because they can't get the refreshers they need, while others are left to devise their own retraining options.

But there are hints of change on the horizon. While there are no statistics on how many doctors seek re-entry, physician leaders say the number is growing. Consequently, the American College of Obstetricians and Gynecologists, the American Medical Association, a handful of state medical boards and other groups have begun to study what can be done to help doctors who chose to leave practice and now want to return.

"This is a real concern of state medical boards," said James Thompson, MD, president and CEO of the Federation of State Medical Boards. "It's becoming increasingly important because of rapid changes in science and because of the changing lifestyles of physicians."

Ob-gyn Edward Shapiro, MD, retired from medicine in his late 50s, but he missed it so much that he decided to return four years later. He had medical licenses in Idaho and Washington, but needed a new license to restart his career in Oregon. Oregon considers physicians out of date after they've stopped practicing for 12 months.

Dr. Shapiro needed to find a way to refresh his skills, but options were scarce. He even was considering a Colorado program geared toward remediation when contacts at ACOG referred him to Oregon Health & Science University in Portland.

He's now the first graduate from an OHSU pilot re-entry program, believed to be the only one in the country.

The pilot went well enough that the school is planning on helping another ob-gyn refresh her labor and delivery skills this fall, and a group of primary care physicians is expected to participate in an ambulatory medicine course this summer.

"There's a huge need for a program like this," said Dr. Shapiro, who can now start practicing in Madras, Ore. "There are a lot of people like me who get out of medicine and decide they want back in. I'm hoping that others will follow Oregon and set up programs."

Changing with the times

The need for re-entry programs has emerged because of lifestyle changes among physicians and technological changes in medicine.

For example, ob-gyns traditionally aged with their patients, said Michael T. Mennuti, MD, an ACOG past president.

"As patients aged, the physicians would stop doing obstetrics and did gynecology and gynecological surgery, then they'd eventually stop doing surgery but continued to see patients in the office," he said. "That's not the pattern now."

Dr. Mennuti said retraining programs could help physicians such as the one who contacted him because she had limited her patient schedule for several years to care for a sick child and was now ready to re-expand her scope of practice. He said programs also could help a physician who called him as she was leaving the country with her husband, who was being transferred overseas for his job. She wanted to know how she could return to practice when she came back in three years.

While Dr. Mennuti doesn't have established programs where he can refer these physicians, he said that is the goal. ACOG is actively looking for interested institutions to pilot programs geared toward physicians looking to retrain. The society also has formed a task force to develop a retraining educational framework, Dr. Mennuti said.

"One of my hopes is to come up with a plan that's workable and make it accessible to people," he said. "Our specialty really needs this kind of flexibility."

One state's experience

North Carolina is among states reporting a pattern of physicians looking to return to practice.

Thomas Mansfield, director of the North Carolina Medical Board's legal department and legislative liaison, chalked it up to changing demographics.

"You have physicians who decided to do something other than clinical practice for a while, like run a business making medical software or do research, then they want to move back into clinical practice," he said. "Women want to have children and spend a few years with them; male physicians put a higher priority on family life. Then there's the tech stock bubble that burst, and retired physicians who couldn't afford to be retired anymore."

A few years ago, the board began to notice license requests from physicians who hadn't seen a patient in at least two years. Each month the requests continued to come in, Mansfield said. To date the board has processed about three dozen of these applications, he said.

In response, the North Carolina Medical Board established re-entry guidelines and has legislation on the governor's desk that would turn the guidelines into law.

Now the board asks, but can't legally insist, that physicians who have been out of clinical practice for two years or more go through a re-entry process, which includes working with a mentor for six months to a year. So far, only two physicians withdrew their applications; all others have agreed to go through the process, Mansfield said.

The AMA, too, plans to study physician re-entry this year with a report anticipated mid-2007.

"We don't know how big an issue this is, but we do know there is a shortage of physicians in some specialties, and we suspect the physician shortage is growing," said William A. Hazel Jr., MD, a member of the AMA Board of Trustees.

Helping physicians return to the work force could be part of solving the shortage problem, he said.

Retraining also might be used for another purpose -- preventing burnout by helping a physician transition from one field to another, Dr. Hazel said.

"Either way," he said, "such a program could keep doctors practicing longer and shore up the work force."

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Setting limits

Among states with policies regarding physicians re-entering clinical practice after a lengthy voluntary leave of absence, a physician is considered "out of date" anywhere from one to five years of not practicing, with two years being the most common. In states without a policy, a physician with an active license can re-enter practice without going through evaluation or retraining. Medical boards with physician re-entry policies are:

  • Colorado State Board of Medical Examiners
  • Florida Board of Medicine
  • Florida Board of Osteopathic Medicine
  • Mississippi State Board of Medical Licensure
  • New Mexico State Board of Medical Examiners
  • North Carolina Medical Board
  • State Medical Board of Ohio
  • Oklahoma State Board of Osteopathic Examiners
  • Oregon Board of Medical Examiners
  • Tennessee Board of Medical Examiners
  • Texas State Board of Medical Examiners
  • Virginia Board of Medicine
  • Washington State Board of Osteopathic Medicine and Surgery

Source: North Carolina Medical Board

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Oregon medical school pilots a re-entry program

Oregon Health & Science University in Portland is testing a program to help experienced physicians dust off their clinical skills and re-enter the work force after a hiatus.

Donald E. Girard, MD, OHSU's associate dean for graduate medical education, said the idea was once rejected because department chairs felt the faculty had full-enough workloads teaching residents. But when faced with an ob-gyn with an exemplary track record seeking to move to Oregon to practice in a town short on physicians, attitudes softened.

OHSU's candidate, Edward Shapiro, MD, had retired after 23 years as an ob-gyn, but after four years he wanted to return to medicine. He had found a full-time position in Oregon, where he had never practiced, and in applying for a medical license he discovered he needed to retrain. Oregon's medical board won't issue a medical license if the physician hasn't had patient contact for 12 months or more.

OHSU created a retraining program, and on June 15, Dr. Shapiro became the first person to complete it. The program went well, and the school plans to continue it.

Dr. Girard said the school will be limited to 10 physicians a year at most, and the cost for the program will vary from physician to physician. For example, Dr. Shapiro paid $8,000 a month for his three-month stint. Retraining for ambulatory clinic work, though, might cost around $1,500 a month, Dr. Girard said.

OHSU's program has its own admissions panel to review an individual's credentials and interview candidates. If an applicant is approved, the appropriate program director will decide if it's feasible to facilitate the doctor's retraining. Then with the program director's OK, a curriculum is developed, including content, length of time and cost, which is then sent to the admissions committee for approval.

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