Physicians reentering clinical practice: Characteristics and clinical abilities

Department of Family Medicine, University of Colorado School of Medicine, Denver, CO, USA.
Journal of Continuing Education in the Health Professions (Impact Factor: 1.36). 12/2011; 31(1):49-55. DOI: 10.1002/chp.20106
Source: PubMed


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.
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.
Twenty-five (40.3%) 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%), health issues (27.4%), retirement or nonmedical career change (17.7%), and change to medical administration (14.5%). Females were more likely than males to have left practice for child rearing (P < 0.0001). Approximately one-quarter (24.2%) of participants achieved a performance rating of 1 (best-performing group); 35.5% achieved a rating of 2; 33% achieved a rating of 3; 6.5% 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.
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.

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    ABSTRACT: Physician reentry is defined by the American Medical Association (AMA) 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.” Physician reentry programs are creating an avenue for physicians who have left medicine in good standing to return to clinical practice. To date, however, programs have developed independently, with little coordination among them. If, as predicted, more physicians seek to reenter practice and more programs are developed in response, the need for information on program outcomes will grow. Valid assessment tools should be developed and shared across reentry programs to assess individual learner outcomes. This discussion paper sets forth Guiding Principles for Physician Reentry Programs as a step toward a more coordinated approach to physician reentry education and training. They serve as a reference for setting priorities and standards for action and, more specifically, offer a foundation from which programs can be planned, evaluated, and monitored. In addition to the guiding principles, an overview of physician reentry is provided including information on reentry physicians and physician reentry programs as well as a definition of physician reentry, reasons for taking leave and returning to clinical practice, and barriers physicians face as they seek to reenter clinical care.
    Journal of Continuing Education in the Health Professions 03/2011; 31(2):117-21. DOI:10.1002/chp.20115 · 1.36 Impact Factor
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    ABSTRACT: There is growing recognition of the need to reeducate clinically inactive physicians seeking to return to practice and in the facilitation of this return. Physicians seeking to return to practice face many challenges: maneuvering the various requirements of licensing, medical, and credentialing boards; finding an appropriate educational program to become up to date in current practice; paying for the program; and overcoming personal obstacles. Educational programs also face challenges: cost of development and maintenance; allocation of staff and faculty time to reeducate returning physicians alongside other learners; provision of emotional counseling and career guidance; interpretation of varied licensing and board guidelines; and the need to tailor one's program to individual trainees. Despite these challenges, some programs are returning physicians to the workforce. To provide perspective, we review why physicians leave medicine and return. We then discuss challenges for returning physicians and program developers and highlight current educational resources and organizational efforts to facilitate return. We close by offering next steps for programs to facilitate return.
    Journal of Continuing Education in the Health Professions 03/2012; 32(2):142-7. DOI:10.1002/chp.21137 · 1.36 Impact Factor
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    ABSTRACT: Few formal educational programs are available in the United States to assist physicians wishing to return to medical practice after clinical inactivity. Little published data on physicians who complete these programs exist. We describe the Drexel Medicine Physician Reentry/Refresher course and present our findings on participant demographics, performance, and goal attainment following course completion. Physician self-assessment, future career goals, recommendations of referring organizations, and a quantitative assessment of knowledge and skills were used to create individualized learning objectives and physician's curriculum. Initial assessment included demonstration of clinical skills using standardized patients and medical knowledge using the National Board of Medical Examiners Comprehensive Clinical Medicine Self-Assessment Examination. Progress in knowledge and clinical skills was measured by repeat assessment at course completion. We questioned physicians 3 months after course completion to determine if initial goals were attained. Thirty-six physicians completed the program from November 2006 through November 2010. Most physicians demonstrated significant improvement in core clinical skills and knowledge at the end of the course. All physicians who sought employment, hospital privileges, and refreshing skills as initial goals were successful. The Drexel Medicine Physician Reentry/Refresher course provides a unique model for successfully returning inactive physicians to clinical practice.
    Medical Teacher 04/2012; 34(4):285-91. DOI:10.3109/0142159X.2012.660215 · 1.68 Impact Factor
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