For Physicians Who Want To Return To Practice, Path Is Unclear

While the U.S. faces a critical primary care physician shortage, thousands of doctors are trying to overcome the barriers to practice reentry after a hiatus. But lack of support and guidance from boards and professional associations make the path to reentry extremely difficult to navigate. This physician describes her as-yet-unfinished journey back to practice.

By Christine Stone, M.D.

Are you a practicing primary care physician, board-certified in either family medicine or internal medicine, and in good standing with your state licensing board? Do you have concerns about the relative lack of primary care professionals, especially now that 40 million new patients have been added to the U.S. health care system this year?

What if I told you that you, simply by carrying on with your usual daily primary care activities, could singlehandedly reduce the primary care physician shortage by a factor of one within 3-6 months?

Have I piqued your interest? If so, read on.

I am a general internist who resigned from practice 14 years ago and now am seeking to reenter my former specialty. I am what is called a reentry physician. We reentry physicians are those who leave medicine and then come back to it, for various reasons. To be clear, we did not leave due to any malpractice, bad habit or other malfeasance, but rather because another value in our lives took temporary precedence over the value of a medical career. Some of us take a hiatus to raise children; others do it to become caretakers for elderly family members; still others (me) pursue different vocations (fiction writing, but alas, I discovered I was no Michael Crichton!). Some leave due to personal illness, but then they recover. It is my understanding that a few truly unfortunate colleagues out there retired years ago quite comfortably, but have since found that their retirement savings could not withstand the ravages of the recent economy. As you can see, the reentry physician population is large and diverse.

We reentry physicians represent an invisible minority in American medicine. We are powerless and voiceless within the profession. All of the professional associations and the licensing boards in all 50 states have known about us for years, but the powers that be have been slow to create a pathway to reintegrate their reentering members, despite the fact that 50 percent of medical students are now women, and a good percentage of them will take time off to bear and raise children, and then want to return to practice.

The present primary care shortage only further points out the absurdity of the lack of a coherent reentry policy: According to the AMA, thousands of physicians like me are trying to return to practice in primary care specialties yet we struggle to learn the process for doing so, then we learn that there’s virtually no organizational support for that process. Rather than receiving collegial assistance from our professional organizations, we are told that we are on our own. We can reenter—but we have to make all the arrangements ourselves.

My own reentry adventure began with a telephone call to the Colorado state medical licensing board in January 2013. What, I asked, would be required to reinstate my license, given that I had been clinically inactive for so many years? I was referred to an agency in Denver that performs clinical competency evaluations. In order for the board to consider my application, I would have to have such an evaluation: a $7750 two-day affair.

In July 2013, having committed myself to attempting reentry, I quit my day job and spent 2 weeks studying for my clinical competency evaluation. I received the results in September, along with a detailed educational plan that involves my identifying a physician preceptor willing to mentor me. This was the specific plan that the state licensing board approved when they issued me a reentry license in October.

Since that time, I have been searching for a preceptor. Having no personal contacts within the profession any longer, I have presented my situation to the powers-that-be at the state department of public health as well as the division of general internal medicine at the state's medical school. To date, these professionals have not been able to assist me because there is no mechanism in their respective systems for reentry physician training.  I am not a resident any longer, nor am I an up-to-date physician. I do not need loan repayment or a visa, but I do need a few months of mentoring. These are all circumstances that seem to confound those trying to recruit doctors for the public health/nonprofit sector. Ironically, I already live in a medically underserved area and would like to stay in my community and serve. But there is no obvious pathway to get me to such employment, even though the community needs primary care physicians and I need work.

Despite the aforementioned obstacles, I remain optimistic that my reentry can succeed. I recently spoke to a physician in another state who went through the same process I am going through right now. After extensive searching, he did meet one local physician who was willing to mentor him. My successful return to practice similarly hinges on finding a willing physician mentor.

Which brings me back to my opening question: who wants to be a preceptor? Specifically: who is willing to assist a reentering colleague? I am a seasoned general internist who requires some clinical refreshing. I have an active reentry license in the state of Colorado. I have my own malpractice insurance. I am enrolled in maintenance of certification with the ABIM and anticipate being board-re-certified after I sit for the MOC examination later this year. At present, I am doing all I can do on my own to prepare for reentry into clinical practice.

Now I need your help, general internist or family physician in the Front Range area of Colorado.

Even if you don't live in Colorado and cannot personally assist me with my reentry to practice, you can still be a preceptor. I urge you to consider reaching out to a reentering colleague in your own state through your state licensing board. (North Carolina's board, which is pretty progressive on reentry, has already put out a call for physician mentors.) Through this contribution, you can singlehandedly help address the primary care physician shortage.

Christine Stone is a primary care physician who is currently in the process of reentering clinical practice after more than a decade away. She reckons that if Arsenio Hall can stage a comeback, so can she! You can reach her at reentryphysician@gmail.com.

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Posted by Sonya Collins on Feb 6, 2014 11:44 AM US/Eastern
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