April 28, 2017

Leaving Medicine and Reentry – Know Before You Go!

doctor thinking

Hold onto that medical license and keep your stethoscope handy!

If you’re thinking about leaving clinical practice, don’t retire that license too fast or stay out of practice too long – unless you‘re lock, stock and barrel sure you’re not going back. Even then, it’s wise to keep everything current.

You may be burned out, wanting more time with your children, or needing to care for elderly parents. Perhaps you’re shifting into administrative work or have been enticed away to a start-up company. You might only intend to be away from practice for a year, but then before you know it, 5 years or 10 years have passed, or more. Maybe your financial situation has changed. Is it too late to return?

What is required to return to practice?

Depending on how long you’ve been out, your specialty, and other factors, it could be as simple as making a few phone calls, or it could be harder than climbing a double Mount Everest to return. And as with summiting Everest, no one guarantees your success.

Dr. Christine Stone, an internal medicine physician was gone for 14 years before she decided to return to practice. In her blog, Reentry Physician, she chronicles her return to primary care, which took 27 months and cost $40,000. To begin practicing again, Dr. Stone had to get her license back, pass her board certification, find a preceptor willing to supervise her, and then find a job. Every step took longer and was more difficult than she anticipated, but she made it and offers her blog as a way to help other reentering doctors.

What are the challenges to reentry?

Where do I start? First of all, each state sets their own policy on reentry, and close to 50% of the medical boards do not have a formal reentry policy (AMA fact sheet on reentry). Per the AMA’s 2011 medical board survey, 2.8 years is the average length of time out of practice after which some type of reentry program is required.

Second, the programs for reentry are few and far between, and they are not inexpensive. Each program has different features, but at a minimum, they involve some type of assessment to determine the physician’s knowledge base and clinical competence. The assessment phase on average runs around $10,000.  If there is a patient care component offered, it may be more of an observership or involve direct hands-on patient care.  The fees for this phase can be $10 – $20,000+, not including living expenses.

Dr. Stone did the CPEP Program (Center for Personalized Education for Physicians). CPEP is for physicians from any specialty who left medicine in good standing and involves two phases. Phase 1 is an assessment of clinical skills and knowledge base. Phase 2 involves practice-based learning which is usually done in the physician’s home community. It’s the physician’s responsibility to find a preceptor (supervisor), and this can be daunting.

After getting a lot of “No’s” when trying to find a preceptor, and even wondering if after coming so far, she was going to fail to meet her goal, Dr. Stone finally found a preceptor through a personal connection and was able to fulfill her reentry requirements. She is now working again in primary care.

Dr. Gould, a psychiatrist who had been out of practice for years filling several executive roles in healthcare, did the CPEP program as well. He also had an incredibly hard time trying to find a preceptor for the necessary supervision. About his reentry process, Dr. Gould recounted,

“Prior to starting the process I requested a meeting with the Minnesota Board of Medical Practice, having submitted my basic credentials to them, and asked them outright if, with the proper re-training, would they be willing to license me. If not, I wouldn’t waste my or their time. They were generous in being willing to preview my application and told me if I worked with a company they knew and had confidence in, like CPEP, they would. So, I immediately contacted CPEP and did whatever they wanted me to do, so when I returned to the Board, I had their approval.  Finding a clinical supervisor turned out to be the biggest problem in the whole process. I had my own malpractice insurance and was willing to pay a supervisor their hourly rate for supervisory time, but I needed some program that would let me see their patients as a mature trainee.”

After months of trying to find a supervisor, Dr. Gould’s persistence paid off and a connection from 20 years ago came through for him.

“All in all, Dr. Gould said, “the whole process took about 18 months and cost about $20,000.”

How About a Mini-Residency?

A reentry program in Texas has a solution to the challenges of finding a willing preceptor. The KSTAR/UTMB Reentry Program (A partnership of Texas A&M and The University of Texas Medical Branch) offers a mini onsite residency at UTMB in Galveston.

Physicians need to do a two-day assessment first to see if they qualify for the 3-month mini-residency. Most specialty and subspecialty programs will be possible for those who are eligible. Reentry physicians function as part of the medical team and have access to performing procedures. Liability insurance is available.

Another option is The Drexel Reentry Program in Philadelphia

Eligible specialties for the Drexel Program are internal medicine and subspecialties, pediatrics, OB/GYN, radiology, and anesthesia (other specialties may be possible). While there is no direct hands-on patient care, there is an extensive assessment followed by clinical rotations on the wards, simulated patient encounters, instruction, and feedback.

Lifeguard is a program in Harrisburg, PA open to physicians seeking reentry, including those who have been involved in disciplinary action or may not have finished a residency (depends on the state).

In an interesting twist on reentry, the Physician Retraining and Reentry Program (PRR) in California offers an online program for physicians wanting to reenter or transition into adult primary care. Physicians do not need to be from primary care to be eligible, and doctors from a variety of specialties, including surgery, have enrolled in this program. As a case in point, former urologist Dr. Michael LaRocque became restless in retirement and decided to do the PRR program. He now works as a primary care physician seeing patients at a federally qualified health center in California.

Is a formal reentry program necessary?

Every physician’s situation is different, depending on specialty, time away, state licensure, CME hours, etc. My recommendation is to find out what your state board requires.

One of my clients who left internal medicine for over a decade to raise her children just landed a great job at a progressive primary care clinic. She had kept her license active, and took an intensive Harvard Review Course to prepare for her boards, which she happily passed. She shared this information about her reentry for the blog,

“When I was starting my process, before I took my boards, I contacted Drexel, because I wanted to enroll. They told me to apply for jobs first, and if the employer required me to do a refresher program, to call them back. My current employer did not require me to do a refresher program. Before I started I did some shadowing of one of the primary care physicians. They are starting me slowly, seeing about 10 patients a day. So far, it’s been like riding a bike. My main questions are related to the EMR, and not clinical.”

If I’m transitioning to a non-clinical job, do I need an active license?

Many doctors are surprised to learn that a good number of non-clinical positions require an active license and even board-certification.

Do I need to keep clinically active to some degree?

If you are in a nonclinical job and are able to do some intermittent patient care (locums, volunteering, urgent care shifts, teaching, etc.) you could have a much easier time returning to medicine if you so choose. While this can be impractical for some jobs and specialties, it is worth considering and seeing what’s possible.

Does this mean I can’t take a break?

Absolutely not. I’ve seen doctors take significant time away and return without missing a beat.  Obviously, this depends on your particular situation, but for a reasonable time period, there is more latitude than you might think. Giving yourself time to recover from burnout, flex some different muscles, or devote time to family, can give you an entirely new perspective. Do your due diligence before you go, and if you plan to be out for a while, you might want to set aside some money in a “reentry jar,” just in case.

 

9 responses to “Leaving Medicine and Reentry – Know Before You Go!”

  1. Lynette D Charity MD says:

    Thank you! Thank you! This article has made me rethink my career plans. Although I am transitioning into another career, I now have decided to continue my practice as an Anesthesiologist even if it becomes super part-time. What a hassle to re-enter medicine after “taking a break” or just changing your mind. I will now maintain my license, my malpractice insurance, my DEA and keep my CME up to date! I guess there is a need to assess skill sets after a long hiatus from the practice (one can get rusty), but the fact that it’s difficult to find a preceptor seems counter-productive. Having an experienced physician “return to the foal”, especially with the shortage of physicians we are experiencing, it would behoove the medical community to assist them in any way possible. WIN-WIN in my book!
    But again, thank you for this timely article for my situation. At least I know that if I wanted to stop, I still would be okay as long as it is less than 2 years before I suddenly decide I want to return to medicine. I’ll mark that on my calendar!

    • Heather Fork says:

      You are so incredibly welcome Lynette! You also win the Doctor’s Crossing Blog Award as my most enthusiastic reader and commenter! It was very eye-opening for me when I did the research for this blog. I am very motivated to get the word out to our fine physician friends so they can be spared such challenges and discouragement as these doctors had in trying to get back to serving patients. It is my hope that more reentry resources become available and there is also more of a welcoming sentiment towards those needing a chance to refresh their skills. These are good doctors who are wanting to return and there is no reason not to give them a chance. It’s a tough pill to swallow to not be able to practice anymore if one so desires.

  2. Beth A Cardwell MD says:

    Hey, I just wrote a long comment and hit “enter” before filling out my ID info and hitting “Post Comment.” I guess it’s lost. I do want to take the time to say than you, though. This is the first summary of established reentry programs and the challenges, including dollars and years, faced by a reentrant physician. I was so pleased to see it in my email and know that others would also. And thank you Lynette for pointing out how counterproductive it is to keep experienced clinicians from returning to practice by having a process that is inconsistent, difficult to navigate, expensive and labor intensive for both the reentrant and the organizations involved.

    • Heather Fork says:

      Thank you very much, Beth, for reading and commenting. I am very sorry that you spent precious time sharing your thoughts and lost the information – I know how frustrating that is! You and Lynette are absolutely right in that we need to make the process easier for those willing to do the hard work to retrain and reenter. It’s hard enough without having to spend months and months trying to find someone who will let you work under them. I have the impression that the current reentry programs are run by very dedicated individuals who are passionate about helping physicians return. I encourage their efforts to improve and streamline the reentry process and am hopeful for continued progress going forward.

    • Lynette Charity says:

      Hi Beth!
      Thank you for your response. Medicine has become more challenging and not necessarily in a productive, meaningful way. We all need to find balance and sometimes a sabbatical is needed.
      Lynette

  3. Raluca I. Cascaval MD says:

    Thank you so much for this post, which is super-timely for my situation as well! I have been torn between the demands of working as a hospitalist and being a mom, too often feeling that I am not doing either one very well at all…I am willing to scale down to dedicate more time to my family (and having a life), but I worry about “taking a break” may mean getting too rusty and losing skills..I long for the quietness of the mind when you are not in the heat of working long hours that allows you to balance your perspective….for the time to read, to attend a medical meeting or take a CME course, go on a medical volunteer mission, or simply take a family vacation without wondering who and how long will cover the service…
    Knowing that there are options to refresh your skills or learn new skills (such as going back to primary care) means that there is hope! Is there any program that you are aware of specifically for Hospitalists?
    What do you consider ” a reasonable time period” to be away from clinical practice, and how does one maintain their license ( besides taking CME and renewing the applications)? How do you keep your malpractice insurance unless you are actively employed?
    Thank you again!

    • Heather Fork says:

      You are most welcome Raluca, and thank you for sharing your situation and desires for more work-life balance. It is so true that whatever we are doing is more enjoyable if we are not rushing all the time. I hope you are able to find the right situation for yourself. To attempt to answer your questions,

      1) I don’t know of any specific hospitalist reentry programs, but some, such as CPEP, KSTAR and Lifeguard do not exclude any specialties. It may depend on availability whether or not they can assist a particular physician.
      2. A “reasonable gap” was intentionally vague because of the various factors that enter in for a physician in this situation – such as specialty, career ambitions, preexisting skill and knowledge base, etc. But in general, I haven’t seen a 6 month – 1 year gap be a problem. And many physicians have left for longer, as we have seen and made it back. It does become harder after two years. Doing even a little bit of locums while on a “gap” can do a lot to fill in the CV and help keep skills current.
      3. Regarding malpractice, if you leave a practice setting, you want to check and see if they pay your “tail coverage” for any suits that could come up subsequently. This can be expensive, so best to check. Sometimes you have to purchase this “tail coverage.” If you are not seeing patients, you do not need to keep your malpractice active during a gap. If you do locums, they typically pay your malpractice. If you are doing limited patient care, you can also see about having less expensive malpractice coverage.

      I hope this helps! All the best to you!!
      Heather

  4. Beth A Cardwell MD says:

    Thanks for your response to my comment, Heather. I just completed the CPEP Reentry to Clinical Practice two day assessment in general pediatrics on April 10 & 11 and eagerly await the report which takes 8-10 weeks. Certainly this was a comprehensive, well organized program administered by dedicated professionals. And, Raluca, CPEP does reentry assessments in all medical specialties–and assessments for health professionals other than MDs/DOs. Their sites are in Denver and Raleigh NC.

    • Heather Fork says:

      Hi Beth!

      Congratulations on getting through the two-day assessment! Wow. I imagine you logged a lot of hours in preparation. I will be crossing my fingers for good news in 8 -10 weeks for you. Please feel free to update us. Your favorable impression of CPEP is good to know about for others considering this path. Thank you! Heather

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