After taking a break from family medicine for several years, family physicians Russell Brofer, D.O., of Arlington, Texas, and Liesa Harte, M.D., of Austin, Texas, decided to return to full-time practice. However, because they had let their medical licenses lapse, they found it wasn't simply a matter of hanging out an FP shingle. They both needed to complete a physician re-entry program. Fortunately, one such program was nearby.
For Brofer, the John Peter Smith, or JPS, Physician Re-entry Program in Fort Worth, Texas, allowed him to return immediately to a position with his former employer, CareNow. For Harte, the JPS program gave her the confidence to establish her own personalized medicine practice.
Although both Brofer and Harte made their transitions relatively easily, other physicians don't have as smooth a road. In fact, the AMA recently announced the release of new recommendations(www.ama-assn.org) designed to improve the re-entry process for physicians after an extended absence.
In its recommendations, the AMA defines physician re-entry 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."
There are a number of reasons why a physician might take a voluntary leave of absence from clinical practice, including family leave; caretaking or relationship issues; personal health reasons; career dissatisfaction; or the pursuit of alternate careers, such as administration, military service and humanitarian leave.
For those physicians, the United States does not have a comprehensive physician re-entry system, according to the AMA report, which lists several barriers to re-entry, including
- lack of information on the process of and requirements for re-entry,
- high monetary costs of participating in re-entry programs,
- lack of geographical access to the limited number of programs available, and
- lack of consistency in state medical licensing laws and regulations.
The Academy's physician re-entry policy says that processes for re-entry should
- be transparent for physicians and the public,
- integrate current licensure and maintenance of certification procedures, and
- focus on helping physicians deliver effective, efficient and high-quality care.
For detailed information about issues involved in re-entering the physician workforce, visit the Physician Reentry Into the Workforce Project website(www.physicianreentry.org). The project is a collaboration of organizations and individuals that aims "to develop resources and strategies to assist organizations, as well as individual physicians, who are seeking physician re-entry information." The AAFP is a contributor to the project.
The AMA recommendations offer five principles intended to provide a coordinated approach to physician re-entry:
- Ensure that there is a comprehensive, transparent and feasible regulatory process for physicians to return to clinical practice.
- Develop policies that assure the quality of re-entry programs and the readiness of the programs' graduates to resume practice.
- Create an evidence base that can be used to inform policymakers, re-entering physicians and re-entry program development.
- Develop means to ensure that a physician re-entry system is financially feasible.
- Ensure that all stakeholders participate in planning for a physician re-entry system.
Joane Baumer, M.D., a member of the AAFP Commission on Education, helped develop the AMA recommendations. Baumer, who also is chair of the department of family medicine at JPS Health Network and founder and director of the JPS physician re-entry program, told AAFP News Now that since she started the 100-day-long re-entry program in 2006, seven family physicians -- Harte and Brofer among them -- have completed it and an eighth FP presently is enrolled. All of them, she said, wanted to return to practicing family medicine.
According to Baumer, physician re-entry programs are a way to get trained family physicians back into clinical practice and help alleviate physician shortages. Some who enter these programs took a leave from clinical practice to care for young children or elderly parents or to work in administration. Others are retired physicians who haven't practiced for a few years but who want to return to practice.
"If they haven't maintained their licenses and clinical skills, they have to get more experience," Baumer said.
To help returning physicians meet that goal, the JPS re-entry program is intense and personalized. Participants first complete an assessment that includes taking a National Board of Medical Examiners shelf exam. Then, they move on to one-on-one clinical preceptorships and research projects. Family physicians in the program participate in small-group discussions, attend lectures with residents and receive individualized attention from an FP faculty member who knows the learner's knowledge gaps and career preferences.
If an FP in the program wants to return only to ambulatory care, for example, Baumer matches him or her with an ambulatory care physician. The re-entering physician shadows the faculty member, seeing and presenting that physician's patients, and then can move rapidly to seeing his or her own patients.
In addition to the John Peter Smith Physician Re-entry Program in Fort Worth, Texas, other physician re-entry programs include
- the Oregon Health & Science University Physician Reentry Program in Portland,
- the Center for Personalized Education for Physicians Clinical Practice Re-entry Program in Denver,
- Drexel University's Drexel Medicine Physician Refresher/Re-entry Course in Philadelphia and
- the Physician Assessment and Clinical Education Program at the University of California-San Diego.
All programs have different costs and requirements.
"It's up to the preceptor to decide when (the re-entering physicians) see patients," Baumer said. "A lot of these physicians have thousands of hours behind them, and they get up to speed in six weeks."
Family physicians in the JPS program are evaluated on the Accreditation Council for Graduate Medical Education's six core competencies and complete one of the self-assessment modules that are a component of the American Board of Family Medicine's Maintenance of Certification Program for Family Physicians. If they perform well on a final examination, Baumer attests in a letter that the physician is competent for independent practice.
"It's very much like a residency compressed into three months," Baumer said.
The physicians, however, have to pay about $10,000 to $20,000 for their retraining and more if they have living expenses -- all of it from private funds.
Brofer worked for the CareNow group of urgent care centers in the Dallas-Fort Worth area for years before he and his wife, also a family physician, took a break in 2004 to travel across the country and look at different practice sites. After a stint in Georgia, where they both had medical licenses, the couple decided to move back to Texas in 2008.
Because he had let his Texas license lapse and had been away from patient care for four years, Brofer discovered he had to go through a series of steps to get it back, including an assessment program at Texas A&M Health Science Center's Rural and Community Health Institute. He then entered the JPS program, describing it as an "intense refresher" that blended patient care, didactics and reading.
"The educational value of what I went through with her (Baumer's) program was tremendous. Just to mingle again with the residents was so valuable," he said.
After receiving a certificate of completion from the JPS program, "my license arrived on my doorstep" within a few days, Brofer said. He started immediately at Care Now in Arlington, Texas, and became its medical director 18 months later.
Harte wanted to return to full-time practice in the United States after years spent rearing five children, living in France and caring for patients there part time and with supervision. When she returned to Texas in 2005 without an active medical license, she completed the Federation of State Medical Boards Special Purpose Examination and a clinical skills exam before starting the JPS re-entry program.
After receiving her Texas medical license, Harte started her own personalized medicine practice in Austin. Although she praised the JPS re-entry program, Harte said it required a significant financial investment, and she called for more options for re-entering physicians, especially women physicians.
"It's up to the state boards, but there has to be more than one way to be retrained," Harte said. "There are different ways to determine competence."