Clinical retraining programs hard to find

Shirley Ingram, MD, a rheumatologist in Oregon, was burned out. Paperwork and reimbursement pressures were unpleasant. At one point Medicare stopped payments for three months, and the practice had to take out a loan to stay afloat.

At the same time her second daughter was starting high school. "She thought it would be wonderful if I didn't work," Dr. Ingram said.

So the physician left.

That was seven years ago. With her two daughters in college, Dr. Ingram now works part time reviewing insurance files. She also has her eye on a part-time clinical position. But she needed a way to brush up on her clinical skills. Dr. Ingram is one of a fortunate few to find a retraining program. In July, she's set to finish a 12-week course in rheumatology and internal medicine at Oregon Health & Science University in Portland.

An increasing number of physicians want to return to medicine after an extended leave, yet there are few signposts to guide them. In the face of physician shortage forecasts, work-force leaders are looking to bring those sidelined physicians back to the clinic setting. And with more physicians wanting flexibility in their work schedules and careers, some anticipate that interest in re-entry resources will continue to grow.

In the past few years, a handful of refresher programs have emerged, including two in the last year alone. These programs are geared to get out-of-date physicians back up to speed. Also, 22 physician organizations formed a national working group last year to look at re-entry barriers and how to overcome them.

The American Medical Association, the Federation of State Medical Boards, American Academy of Pediatrics, the Assn. of American Medical Colleges, the American Osteopathic Assn. and several other physician groups and state medical boards are among the group's members.

The AMA plans to study physician re-entry along with these collaborators, with a report anticipated in 2008.

The national working group plans to gather data from physicians on why they left medicine, whether they would consider coming back and what barriers they believe they would face if they returned, said Holly J. Mulvey, director of graduate medical education and pediatric work force for the American Academy of Pediatrics, and who provides support for the physician re-entry working group.

Anecdotally, she expects the cost of medical liability insurance and the lack of retraining guidance to be the two main barriers.

"Physicians out there are floundering," Mulvey said. "And physician organizations are having a hard time helping them."

Arizona sizes up needs

No one knows exactly how many physicians are returning to clinical practice, but a study of Arizona's physician population suggests this number, while small, may be significant in a state with a shortage of 2,200 physicians.

"Most say either you need to import more physicians from other states or expand the medical schools, but there's not much talk about how to get physicians back into the practice of medicine," said Mary Rimsza, MD, medical director for the Center of Health Information & Research at Arizona State University in Tempe.

Dr. Rimsza and her colleagues at ASU between 2003 and 2006 surveyed physicians in Arizona who were renewing their medical licenses.

Among the state's 13,215 licensed physicians, they found 604 doctors who returned to clinical practice in this time frame. That accounted for 4.6% of the licenses.

"I was expecting much less than that," Dr. Rimsza said.

She expects other states would have similar results, and the number returning would likely be larger if there were guidelines for how to do it.

"The system is very inflexible," Dr. Rimsza said. "The only opportunity for training is residency. We don't have much in the way of refresher courses or other opportunities for people to hone their clinical skills."

Handful of programs respond to needs

As more physicians ask for retraining help, a few programs have emerged to address this need. The Interinstitutional Physician Training Program at Oregon Health & Science University in Portland is piloting a program that integrates these physicians into individualized fellowships within its graduate medical education structure. Its first participant graduated last summer, and four other physicians, including Dr. Ingram, have participated so far. The program can handle about 12 physicians a year. Only Oregon physicians in good standing are eligible, and training lasts from two to three months at a price of $2,500 to $8,000 a month. The doctors participate in rounds, see patients and do surgery under the supervision of attending physicians.

In Denver, the Center for Personalized Education for Physicians has had 36 physicians graduate from a program it started in 2003 for physicians wanting to practice after a voluntary hiatus.

Elizabeth Grace, MD, the center's medical director, said the first physicians she saw return were those who wanted to supplement their retirement income after the stock market fell. Now, she sees physicians coming back after taking time off to care for parents, recover from a spouse's death or heal from their own health problems. The program costs between $5,500 and $7,500, depending on the specialty. Doctors complete coursework in Denver and return home for their three to nine months of clinical work, which is set up with a local physician mentor.

Drexel University College of Medicine in Philadelphia may be the newest entry into physician refresher courses. It rolled out a six-week internal medicine preceptorship last year and has had three physicians graduate. It also has tracks in ob-gyn, surgery and pediatrics. Courses average $7,500.

Back in Oregon, Dr. Ingram is looking forward to returning to the field that once left her drained.

"When I stopped practicing medicine, it was not enjoyable to me at all," Dr. Ingram said. "Now I feel very differently about it."