Physician reentry: How to overcome challenges of returning to clinical practice
David Mitchell—Roughly 10,000 U.S. physicians qualify to return to practice each year after taking a break from clinical work. It’s uncertain what that number will look like this year as hundreds of physicians from a variety of roles exit the federal workforce.
What is clearer is that reentry can be challenging.
In one survey, more than 80% of inactive physicians thought the process of returning to clinical practice could be daunting, and 36% of those who did reenter practice found that it was, in fact, difficult.
When his wife accepted a new job in a new state in 2013, family physician Ryan Mullins, MD, CPE, joined her, leaving his clinical practice in Texas. Mullins served in executive roles at a hospital and later a health information technology company in the Kansas City area.
By the time his wife, Amy Mullins, MD, CPE, FAAFP, took a new job and moved again in 2023, Ryan Mullins had been out of clinical practice for nearly a decade. Complicating matters, physician executive roles in the couple’s new state, New Mexico, were relatively scarce. He found multiple challenges and barriers to returning to clinical work.
In this Q&A, Mullins shares his lessons learned for other physicians who are pondering return to practice.
When you were working in administrative roles, did you consider keeping a foot in the clinical space?
Ryan Mullins, MD, CPE
Mullins: There was always a debate in my mind about whether I should do a day or half-day a week, but the cost of malpractice insurance was prohibitive. I would have lost money. It wasn’t worth the cost, unfortunately. It was painful going through all this, but I don’t know if I would have done that part of it any differently.
Why did you start looking for clinical roles?
Mullins: When we moved to New Mexico, there were limited options for administrative roles, and a lot of administrative roles that were available required some clinical work. There also was a huge need for doctors here, and it was a great way to become part of the community.
What was the most challenging aspect of returning to clinical practice?
Mullins: The hardest thing was credentialing. I had a clean record, no lawsuits, but if you haven’t practiced recently, references are a big sticking point. Employers want three to five references from people who have worked with you. It’s understandable, but in a situation like mine you’re not going to have it, especially if their requirements are specific to people who have worked with you in the last three to five years. That was a huge challenge. I lost one job opportunity because the practice required hospital privileges, and the hospital needed references from people who had practiced with me in a family medicine practice in the last five years. I didn’t have that.
When you’re talking to a potential employer, ask them to be specific about what’s required, especially if there are hospital privileges involved. With the job I eventually got, I didn’t need hospital privileges. That allowed me to get back into medicine. It’s worth getting specific during the interview process to make sure that there’s some due diligence, because sometimes the recruiter doesn’t always understand the bylaws and requirements.
Do you have any tips regarding licensing?
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Mullins: It will always take longer than you expect for licensing, especially if you have been out of practice. It took four months to get my state medical license. Then it took another three and a half months to be re-credentialed by Medicare.
Whenever you’re applying for something, like a medical license for a state or hospital or insurance credentialing, always make sure it’s clear what the feedback mechanism is. I ran into an issue when I was applying for the New Mexico medical license. I’ve applied in other states, and if there was an issue, they would contact me. In New Mexico, I was getting nothing. I didn’t know there was an issue with my submission and that they needed me to sign something. I went back to the website and looked at it, and the status wasn’t obvious.
Even if you think that you’ve taken all the steps, follow up on it, preferably weekly, to make sure that everything is progressing. It’s time consuming, but I learned the hard way that you’ve really got to stay on top of it. If you don’t, it's going to delay things. It was very frustrating.
Did you have issues with Medicare or Medicaid?
Mullins: If you don’t have an active Medicare provider number, I would bring it up with the hiring organization. You could potentially start practicing before you get one, but if Medicare rejects your initial application, any patients you’ve seen would be unpaid. My organization didn’t feel comfortable with that risk, so I had to wait several months to see Medicare patients. Some organizations have teams in place that can make sure all your boxes are checked. They might go ahead and allow people to practice.
Layoffs happening at the federal level definitely impacted my personal experience as it took much longer to get my Medicare credentialing when compared to usual expected timelines.
Do recruiters exclude you from searches if you’ve been out of practice? If so, how important is networking?
Mullins: I’ve had limited success with professional recruiters. I was getting three or four calls a day from recruiters. They don’t care if you want to stay local. They’re willing to try to relocate you. If you’re more interested in staying local, then you’ve got to get out there, talk to different practices and learn where the needs are. There are lots of practices that need more doctors here in New Mexico, but they don’t necessarily have the clinic space to hire anyone. They are at maximum capacity. So, who has room or is expanding a facility? The practice I joined had space. That’s a key consideration. Networking goes a long way, even for established physicians, just making connections and building trust.
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How did you assess your job offers? What was important to you?
Mullins: As I mentioned, you need to find out what’s required in terms of privileging and credentialing.
Another thing that’s been a big struggle is that in the area where I’m located, the average family medicine doc makes significantly less than the rest of the country. That creates challenges. Whenever you’re getting paid a lower amount for your work, you’ve got to talk to practices about whether they’re doing value-based care. Are there going to be other financial opportunities? Are there shared savings that could be dispersed? That’s something you’ve got to consider.
There are typical questions you have to answer in a job interview, and there are questions you should ask regarding things like pay and benefits, but you also have to ask hard questions:
- How will you be supported by other clinical staff?
- What is the culture like?
- How much autonomy will you have?
How did you prepare for returning to clinical practice?
Mullins: I read a lot of the AAFP journals, particularly AFP, for CME. I was really trying to focus on areas that I needed to improve on, different topics I wanted to brush up on. I was trying to get better and make sure that I understood all the evidence-based medicine that I could. I relied more on my AAFP membership through this process than any other time in my career because of access to journals. Even as I’ve gotten back to practicing, I have used those resources again because there are going to be issues where you are rusty.
I didn’t have a DEA license. I’d let that lapse many years ago because I wasn’t seeing patients and wasn’t prescribing. There were requirements with that I had to go through and get substance use training.
The AAFP offered a course on substance use disorders that met those requirements. It was a 16-hour course, but it was free and helpful. You’re going to need something like that if you haven’t practiced recently and need to get a new DEA license.
What was it like seeing patients again?
Mullins: There was a lot of apprehension with getting back into medicine and worrying about, “Am I good enough to do this?” I think it’s natural that a physician may have a little fear. I try to be very honest with patients. I told them, “I haven’t done this in a while. I’m going to be a little rusty.” They were OK with that. They were desperate for help, and I was willing to help.
Though I had not done formal practice for 11 and a half years, I’d done medical missions over the years. I still remembered a lot of the skills. There was a lot of gratitude expressed by patients being able to get in to see me because I was new. I was often seeing people who would normally see my partners. It was like, “I can’t believe I actually got in to see someone the same day I called. I’ve never had that happen before.” It’s always fun when patients feel gratitude for what you're providing, and you feel like you’re helping the community. That’s made it worthwhile getting back into clinical medicine.
No one else in the community was taking new patients, so I was getting everyone. And I didn’t always feel qualified to do that. It can be overwhelming when you see someone who really needs to be seeing a geriatrician, and they're on 25 different medicines.
A lot of what we do in family medicine is education. We investigate what disease processes we think are going on, and we’re sometimes counselors. To be able to take the time explain what diabetes is to a patient, or a different disease process, a lot of people really appreciated that. Frequently, I got comments like, “No one’s ever actually explained what this was.” So, it’s good to see the light bulb turn on for them and see some real progress with them taking control of their health.
What was the most surprising thing about returning to practice?
Mullins: When I first got out of residency, I was in solo practice. Then I joined a large multispecialty group, so I’ve worked in different settings. What was shocking was, I was suddenly doing a lot of things that my nurses had previously done. I was doing all the TB tests, allergy injections, referral work—a lot of things that slowed down efficiency. It makes sense because they didn’t have staff that could support some of those things. But I noticed that it was like that throughout the state. Connecting patients with subspecialists is challenging in New Mexico. A lot of people have to go out of state to see subspecialists, which is unfortunate. There are lots of surprises every day.
I think just about anyone can get back into practice, and it may be difficult. There were a lot of challenges. I knew that going in, but I’m glad I did it. We need to have clinicians using their knowledge, and I think there are more opportunities now, whether it’s through telehealth or other things. Being able to help patients may not always be in a typical clinic setting or a hospital setting. If you find a way that you can help, even through volunteer work, I think it’s still good for clinicians to participate.