Physicians Reentering Clinical Practice: Characteristics and Clinical Abilities

Abstract

INTRODUCTION: Limited information exists to describe physicians who return to practice after absences from patient care. The Center for Personalized Education for Physicians (CPEP) is an independent, not-for-profit organization that provides clinical competency assessment and educational programs for physicians, including those reentering practice. This article studies the medical licensure status, performance and correlates between physician characteristics and performance on initial assessment. METHODS: Sixty-two physicians who left practice voluntarily and without discipline or sanction and who were returning to practice in the same discipline as their previous practice participated in the CPEP reentry program. Physicians completed an objective clinical skills assessment including clinical interviews by specialty-matched board-certified physicians, simulated patient encounters, a documentation exercise and a cognitive function screen. Physicians were rated from 1 (no or limited educational needs) to 4 (global, pervasive deficits). Performance scores were compared based on select physician characteristics. RESULTS: Twenty-five (40.3 percent) participants were female; participants' average age was 53.7 years (female 48.1 years; male 57.5 years). Physicians left practice for family issues (30.6 percent), health issues (27.4 percent), retirement or nonmedical career change (17.7 percent), and change to medical administration (14.5 percent). Females were more likely than males to have left practice for child rearing (P < 0.0001). Approximately one-quarter (24.2 percent) of participants achieved a performance rating of 1 (best-performing group); 35.5 percent achieved a rating of 2; 33 percent achieved a rating of 3; 6.5 percent achieved a rating of 4 (worst-performing group). Years out of practice and increasing physician age predicted poorer performance (P = 0.0403, P = 0.0440). A large proportion of physicians presenting without an active license achieved active licensure; how many of these physicians actually returned to practice is not known. DISCUSSION: Physicians who leave practice are a heterogeneous group. Most participants' performance warranted some formal education; few demonstrated global educational needs. The data from this study justify mandates that physicians demonstrate competence through an objective testing process prior to returning to practice. Emerging patterns regarding the performance of the reentering physician may help guide future policy.

Improving America's Medical Education System: Perspectives From a State Regulator

“…A recent study of 62 physicians who voluntarily left practice and subsequently had their clinical skills evaluated found the average age of the participants to be 53.7 years. 37 Given the rate of change of the vital knowledge to safely and effectively practice as a health care professional, as well as the preceding discussion of continuing competency, there are concerns that such professionals may not be prepared to resume practice. Grace et al found that, of re-entering physicians who completed a clinical skills evaluation, "the majority (67%) were found to have educational needs requiring moderate to considerable reeducation or updating, and another 6.5% showed educational needs that were broad enough to recommend education in a residency program to prepare for a return to practice."…”

Challenges and solutions to returning to clinical training after research: a multidisciplinary survey of integrated academic trainees in West Yorkshire, United Kingdom

“…The Academy of Medical Royal Colleges (AoMRC) has found that ‘whilst there is little shortage of opinion in this area, there is little clear evidence’ [ 3 ]. An observational study of 62 doctors from the United States found that the majority (67%) of doctors who had been absent from practice for 18 months or more ‘were found to have educational needs requiring moderate to considerable re-education or training ... many re-entering physicians may not be ready to jump back into practice’ [ 4 ]. In 2017, Health Education England (HEE) conducted a survey of trainees and employers via the HEE Deans, the British Medical Association the AoMRC, research bodies, the NHS Improvement and NHS England medical directors, and chief professional officers.…”

Physician reentry–A timely topic for emergency medicine

“…A 2002 JAMA review of the topic cited caretaking responsibilities, personal illness, career dissatisfaction, and alternative careers as common causes of physician reentry 1 . More recent studies suggest that changes in career paths into a non‐clinical position (such as administration), family issues, military deployments, and career dissatisfaction also contribute to physicians leaving the workforce voluntarily 8,12–13,15 . A survey of over 6000 pediatricians younger than 65 found that 12% of respondents indicated they had experienced a period of clinical inactivity lasting >12 months.…”

“…An estimated 10,000 physicians qualify to reenter practice each year after a period of clinical inactivity 13 . Most physicians seeking reentry do not seek additional training, especially if not required by state or medical specialty boards.…”

“…Thirty‐six reentry physicians across a range of specialties completed the Drexel Medicine Physician Reentry/Refresher course that included a self‐assessment, future career goals, recommendations of referring organizations, and a quantitative assessment of knowledge and skills that were used to create individualized learning objectives and a personalized curriculum 16 . At the Center for Personalized Education for Physicians, 62 physicians participated in an educational program and clinical competency assessment that included objective clinical skills assessment including clinical interviews by specialty‐matched board‐certified physicians, simulated patient encounters, a documentation exercise, and a cognitive function screen 13 . An innovative solution to physician reentry between the medical board of the State of New Mexico and the University of New Mexico showed that their mini‐sabbatical program was very successful over the course of their 10‐year collaborative effort, with 11 out of 12 students attaining unrestricted medical licenses 17 …”