Introduction

The Physician Reentry into the Workforce Project is a multi-organization, collaborative effort that aims to address the wide range of issues related to physician departure and subsequent reentry into the workforce, specifically clinical practice. This is being accomplished through a number of venues including the development of these Issue Briefs. This issue brief examines the data that is available on the subject of physician reentry and describes the challenges and types of data that is needed.

A significant barrier faced by those who seek ways to address physician reentry into the workforce challenges is the need for more knowledge and information on the topic. Specifically, there is a not enough known about those physicians who are currently inactive, those physicians who were inactive and have since returned to clinical practice, and those physicians anticipating a leave of absence from clinical practice. To date, this knowledge has mostly been based on anecdotal reports that have not provided the needed direction for addressing the issues of physician reentry at the state and national level. This issue brief identifies reentry physician surveys, challenges of data collection, additional data needs and Resources for more information.

Surveys on Physician Reentry

Arizona Physician Workforce Survey

Mary Ellen Rimza, MD collected licensure data from Arizona Allopathic and Osteopathic Boards from 1992 to 2006. A 100% return rate was achieved, and information included specialty education, demographics, and practice location. Surveys were also included with Arizona licensure applications. The response rate for these surveys was 80%. These surveys provided important information on practice characteristics and work hours. The findings demonstrated that the majority of reentering physicians were male, most attended U.S. medical schools, and 85% practice in urban areas. The survey concluded that there is a large “shadow workforce” of physicians; the number of physicians who leave and reenter practice is substantial and could reduce physician workforce shortages; and, the reasons why physicians leave practice and reenter practice require further study.

AAP/AAMC Pediatricians over 50 Survey

The American Academy of Pediatrics (AAP) collaborated with the Association of American Medical Colleges (AAMC) and to field a cross-sectional survey focused on work patterns for pediatricians 50 years and older. The survey was sent to 1600 pediatricians through 3 mailings between February and May of 2006. Seventy-two percent of the 1600 pediatricians responded (women 26%, men 74%). Findings found that women were more likely than men to report that they had ever taken a leave of absence of six months or more from medicine. Also, most pediatricians in this survey did not have any retraining before reentering clinical practice. The most common reason for considering reentry was missing patient care. The researchers concluded that, given the growing number of women in pediatrics, there will likely be an increase in the number of pediatricians seeking to disengage from clinical practice for a period of time.

AMA Masterfile Survey

With funding from the American Academy of Pediatrics and the American Medical Association Women Physicians Congress, Ethan A. Jewett, MA conducted a 2008 survey of nearly 5000 physicians under the age of 65 who are listed in the AMA Masterfile as inactive. These physicians reported that they are not engaged in either direct patient care, research, medical teaching, or health care administration. The survey achieved a 36% response rate. About one third of the sample were actually inactive, almost 30% were fully retired, nearly 15% had been inactive but had reentered the workforce, and almost a quarter were continuously active.

The data from the survey indicate that most inactive physicians have been out for more than 5 years and are uncertain about their plans to return to medicine. Although both men and women report that personal health concerns were a major driver for leaving medicine, women disproportionately left the workforce to care for children or other family members. Men cited issues related to the administrative and business aspects of medicine as a reason for leaving more than women. For both inactive physicians and reentered physicians, the primary incentive for seeking to return to medicine was the availability of part-time practice or flexible scheduling. Few physicians who reentered the workforce after an extended period of inactivity indicated that they had undergone any retraining or educational programming before returning to practice.

Data Acquisition Challenges

There are a number of challenges related t0 the collection of data on reentry and inactive physicians, such as:

It may be more difficult to gather data on inactive physicians than active physicians

States and specialties differ in their definitions of “inactive”

State licensing and specialty boards vary in the information they collect and make available for analysis

The number of physicians completing current reentry programs is still relatively small

Additional Data Needs

Areas where additional data is needed include:

It is not currently known how many doctors would participate in a reentry into the workforce process. The AMA Masterfile survey (referenced above) has yielded some information, but more data are needed, particularly to elucidate specialty-specific trends.

Plans are currently underway to conduct a state-level data analysis modeled after Dr. Rimza’s Arizona physician workforce study. This project proposes to analyze routinely collected state medical boards relicensure, administrative, and survey data.

Developing a standardized survey collaborative between state licensing boards and state societies to describe the population was suggested.

The Physician Reentry into the Workforce Project is not aware of any data from impaired physicians (remediation) programs that could guide future deliberations on reentry issues. It is speculated that state medical boards, which may have data on physician impairment programs, might be able to supply information on reentering physicians. (Note: for the purposes of this Project, we are limiting study of reentry to those physicians who elect to leave practice voluntarily, and not for reasons, such as substance abuse, breach of medical ethics, malpractice, or other disciplinary issues.)

Resources

The Web site at www.physicianreentry.org provides additional information on the Physician Reentry into the Workforce Project. The Web site also contains practical Resources for both physicians seeking to reenter the workforce and others interested in the issue, including employers, educators, regulatory groups, and medical and specialty societies.

Fair Use Policy: Individuals or organizations interested in distributing this Issue Brief or using its content should acknowledge the authorship of the Physician Reentry into the Workforce Project in an appropriate citation.

Suggested Citation: Physician Reentry into the Workforce Project. Issue Brief: Data on Reentry Physicians. Elk Grove Village, Ill. American Academy of Pediatrics; 2009.