What is Physician Re-entry?

Dr. Kimberly Templeton joins us on the blog today to talk about Physician Re-entry. If you're not familiar with the term, you are NOT alone. We didn't either. Physician re-entry refers to physicians who leave the practice of medicine for a period of time and then return to practice at a later time. This post is an EXCELLENT resource for those who may be considering a pause in their practice and how they can plan ahead for their return to their career.

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You have everything in your life planned:

Finish medical school? ✔️Check

Complete residency? ✔️Check

Start the practice opportunity of your dreams? ✔️Check

Have your first child, take 3 or 4 years away from practice, and then return-maybe part-time.? Uh….no.

Leaving the practice of medicine for an extended period of time is becoming more common. The most common reasons that physicians take time away- and thus decide to let their licenses lapse- include health issues, burnout, pursuing a different career (within or outside of medicine) or retiring, and family needs. This issue is somewhat different for women, as they are much more likely than men to leave practice because of family needs, reflecting societal gendered expectations, including raising children.

What happens if you want to come back to practice?

You wouldn’t be unusual: many physicians who have left practice often decide that they want to return, either because there has been a change in their lives (e.g., children start school), responding to community needs (especially for acute public health crises such as the COVID-19 pandemic ), wanting a new challenge, missing caring for patients, or having unexpected free time. While women, like men, may decide to return to practice for a variety of reasons, one of the most common for women is that their children have started school. This is reflected in the average age of returning physicians, which is about 10 years younger for women than it is for men. Physicians re-entry is also gaining more attention from a public health standpoint as another way to address the issue of physician shortages.

All state medical and osteopathic boards have defined periods of time that a physician can be away from the “active practice of medicine”, after which physicians may (and frequently will) be required to undergo evaluation of their current medical knowledge and clinical skills- the “re-entry” process. Re-entry refers to the path for physicians who voluntarily leave the practice of medicine, allow their licenses to lapse or change to inactive or exempt status, and then wish to re-active their licenses to return to practice. According to the AMA, “physician re-entry” is defined as “a return to clinical practice in the discipline in which one has been trained or certified following an extended period of clinical inactivity not resulting from discipline or impairment.” This extended period of time ranges from `1-10 years, depending on the state, with a national average around 2 years. The definitions of “clinical inactivity” or “active practice” are somewhat unclear, but these are typically NOT thought to include administration, research, or teaching and imply direct patient care. Re-entry is distinct from “remediation,” during which a physician may need time away from practice or a period of monitoring because of issues identified in his/her practice. Re-entry is also different from “re-training,” in which a physician is not in active practice while he/she trains for another specialty.

Once you decide to return to practice and start the work on getting your medical license reinstated, you may find that the process is somewhat cumbersome. Most states medical boards have regulations concerning re-entry that indicate a mandated or discretionary assessment of competence. There are various assessment programs around the country. Assessments typically include cognitive function screening, simulated patient cases that are specific to the area of training or intended area of practice, simulated patient chart reviews, clinical interviews, and possibly written testing. This process is expensive, with estimates of up to $20,000. This includes not only the fees of the for-profit assessment programs, but also the costs of re-locating and travel and any recommended educational programs. Although re-entry programs associated with academic health centers are not-for-profit, there are still costs associated with attending these programs. If issues are identified during the assessment process, a re-entry plan is developed. This may include additional CME or other education. In addition, supervised clinical experiences or independent practice with a preceptor may be recommended as a result of the assessment or if there are concerns about clinical skills, given the duration of time out of practice. The length of this period of monitoring is variable and may be 6 to 12 months. After completing a re-entry program, there is no guarantee of licensure or employment to then earn the money needed to offset the initial financial investment. Cost, along with the issues of identifying appropriate proctors, has been cited as the primary concerns of those who have contemplated, but not completed, a re-entry program.

You have planned everything in your career, including when to start a family, so make sure that you plan as carefully for what’s next after that. An important initial step is to know your options about returning to practice. Even if you don’t think that you’ll return to practice, plan as though you will. Things to consider when planning time away from medicine

1. If at all possible, maintain an active license. Although this means time and money spent on CME, this is significantly easier, and less expensive, than later needing to participate in a re-entry or assessment program.

2. Check the website of your state’s medical board to find out how long you can be out of the active practice of medicine before needing to undergo an evaluation to regain an active license.

3. Maintain your clinical skills. This may be a day or 2 every week or 2 at a free clinic, supervising residents in a local training program, or helping cover call at a local practice or emergency department. While this takes away from the time that you were planning on spending with your family, the reason you may have taken time away in the first place, this is less cumbersome than attempting to identify someone to act later on as a practice monitor or preceptor if there is concern whether you have maintained your clinical skills.

4. If you decide that you don’t have time for any clinical activity, check with your state medical society and/or state medical board to see if your state has a re-entry category of licensure and speak with someone at either of those groups to find out what the specific requirements are in your state. If your state has no such category, re-think your opinion that you don’t have time for clinical activity. A limitation on your license, even if this monitoring so that you can to return to practicing medicine, will not only lead to the issues with insurance companies and hospitals but will need to be reported whenever you apply for a license. Also, if your state doesn’t have a re-entry category of licensure, that would also be a good time to speak with your state medical society to find out why and to see if that can be addressed.

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