Introduction

The American Academy of Pediatrics (AAP) Division of Workforce and Medical Education Policy is spearheading the Physician Reentry into the Workforce Project. This Reentry Project is a collaborative effort that aims to address the wide range of issues related to physician reentry through a number of venues including the development of these Issue Briefs.

A recent survey on physician reentry into the workforce identified that flexibility of practice influences the decision of physicians to leave or to reenter the workforce. The Reentry Project surveyed members of the American Medical Association’s (AMA) Young Physicians Section regarding their perspectives on the issue of flexibility and reentry into clinical practice. Respondents were asked to think of employers, medical schools and State/Specialty Societies when answering the following questions:

What Incentives Should Be Offered, by the Groups Below, to Physicians Who Cannot Work Full-time to Encourage Them to Stay in Practice?

Among the Responses/Perspectives Shared:

Employers:

  • Offer job-sharing, part-time, and no or reduced call positions (practitioners who also have home responsibilities such as child or elder care may not be able to respond to out-of-hours calls, especially if the need to find an alternate caregiver on short or no notice)
  • Provide locum tenens work benefits
  • Offer flexible work schedules
  • Provide low cost or free quality childcare
  • Offer reduced administrative overhead expenses proportionate to part-time status
  • Offer larger financial incentives as these are key to keeping physicians in practice
  • Be open to non-traditional work schedules and work to accommodate varying work patterns of physicians especially as physicians become scarce in certain specialties and/or localities
  • Provide part-time positions with full-time benefits (even if the employee has to pay more for these benefits)
  • Provide childcare with extended hours
  • Provide continued health insurance and medical malpractice insurance Provide a clear delineation of responsibilities
  • Offer time for primer courses and CME
  • Offer more opportunities for job sharing- many older physicians and young physicians would be interesting in job sharing, the older ones to ease into retirement and the younger ones to ramp up into full-time as children become old enough for school
  • Ease priviledging, allowing physicians to cover for others for vacations etc.
  • Provide practice management options to handle issues that are not directly related to patient care
  • Provide opportunities to handle routine daily activities such as shopping, haircuts, chores and errands as well as assistance with picking children up from day care
  • Offer assistance to help employees get back into practice
  • Provide productivity incentives even for part-time physicians
  • Provide opportunities to moonlight/work per diem

State /Specialty Societies:

  • Consider pro-rating membership dues
  • Provide information on locum tenens positions
  • Provide conferences with a focus on “a-typical” career paths
  • Provide mentoring Resources Offer decreased costs for certification and re-certification
  • Offer family-friendly CME (with childcare and/or family centered activities available)
  • Provide specialty specific Resources about making part-time practice work
  • Offer primer CME courses, networking and outreach Offer better malpractice insurance options for part-time and very part-time work
  • Provide practice management options to handle issues that are not directly related to patient care
  • Provide discounted benefits and flexible CME requirements (rollover hours etc.)

Medical Schools:

  • Make more visible to students the range of positions available in residency and in practice, as opposed to the old model of “every hour you are awake and half the ones you should be sleeping” model, which does not allow for other responsibilities
  • Offer loan rate discounts/tuition discounts for those willing to work full-time
  • Provide low cost or free high quality focused, relevant CME, to keep women involved in academics as well as practice
  • Provide childcare while faculty attends lectures or rounds with residents
  • Provide mentoring for writing articles
  • Offer active reaching out and mentoring to part-time workers who might be able to write from home
  • Offer part-time teaching positions
  • Offer free visiting positions (opportunities to sit in on clinics once or twice a week)
  • Accommodate non-traditional work schedules and/or part-time arrangements in order to preserve both the physician’s current contributions to the medical profession/medical society/medical school as well as the individual’s future ability to easily return to full-time practice if able and desired
  • Offer extended training schedules or part-time work options
  • Offer shared residency or medical school slots
  • Offer Resources to help pay for or find childcare that has extended hours
  • Offer better training about how to handle difficult situations regarding communication with patients/families/colleagues
  • Offer better practice management training on issues such as billing, documentation etc.
  • Provide much more support for shared positions and the involvement of good clinicians and teachers that may not keep up a rigorous research portfolio
  • Allow physicians to precept medical students part-time at hospital run clinics
  • Create volunteer opportunities for physicians such as student run free clinics that could be precepted by volunteer physicians

What Resources Could Be Provided, by the Groups Below, to Reentering Physicians to Help Them Get Up to Speed After an Extended Period of Clinical Inactivity ?

Among the Answers/Perspectives Shared:

State/Specialty Societies:

  • Offer accelerated review courses, both aimed at certification exams and at re-establishing practical skills
  • Offer mentorships with physicians currently in practice to allow returning physicians to briefly work with their mentor to re-establish clinical skills/habits/reflexes
  • Provide mentorships
  • Provide focused CME
  • Offer matching with local preceptors
  • Offer reduced dues similar to “first year in practice” discounts
  • Provide networking opportunities for informal training
  • Clear and nationally standardized expectations for re-training requirements to ensure maintenance of licensure, or re-activation of licensure
  • Provide through expert consensus and (when available) evidence-based process retraining pathways for clinicians returning to practice after an extended leave
  • Provide reentry education focused on specialty-specific clinical scenarios not just typical CME “updates” on certain diseases
  • Provide networking and outreach Offer mini-board review style courses over one full week of intensive review specifically geared toward reentering physicians
  • Offer support to get reentry physicians back into the workforce
  • Work with licensing and certification bodies to allow reentry without needing to repeat an entire residency or fellowship
  • Further opportunities for focused recognition of practice
  • Support recognition of the value of non-clinical activities.
  • Offer reduced fees for staying up-to-date while not practicing
  • Help organize or sponsor reentry training/refresher programs run by specialty departments or graduate medical education (residency programs) in medical centers, in parallel to already-established residency programs at those centers
  • Offer CME boot camp
  • Offer reentry into workforce conferences

Medical Schools:

  • Make clear to students that the school remains willing to be the “sponsoring institution” for USMLE examinations of the appropriate levels, even after graduation
  • Offer placement help beyond the initial residency placement counseling to currently-enrolled students and make sure that it is known to alumni
  • Provide preceptorships/rounding opportunities for clerkships
  • Offer clinical skills verification exams
  • Offer a reduction in fees for CME review courses for non-practicing physicians similar to “retired” physicians
  • Offer informal retraining like a mini-residency or apprenticeship opportunity to do residency in another field
  • Offer remediation or refresher courses
  • Provide mini board review style CME courses over a week geared toward intensive review for reentering physicians
  • Allow shadowing
  • Provide Resources specifically focusing on updates in medicine that are specialty specific and then topic specific
  • Provide electives
  • Provide reentry programs for 6 months to a year that pay similar to a residency program
  • Help organize or sponsor reentry training/refresher programs run by specialty departments and/or graduate medical education (residency programs) in medical centers, in parallel to already established residency programs in those centers
  • Provide simulation training and skill verification
  • Offer opportunities to teach/precept as a way to gain clinical skills

Employers:

  • Offer mentorships within the employment setting
  • Allow returning physicians to return early and shadow currently-employed physicians to refresh clinical skills and learn local systems (records etc.) without immediately having to assume full patient-care responsibilities
  • Fund CME or clinical verification exams
  • Offer supervised clinical work for a period of time that is adequate to assure good skills
  • Provide mentoring/proctoring for reentering physicians
  • Provide informal training opportunities like mini-residencies or apprenticeships
  • Go beyond being aware of people who have been away from clinical practice to being willing to employ them
  • Develop a standardized program by specialty that could be carried out by employers
  • Invest in the reentry physician by creating opportunities for the physician to work in a chaperoned environment with another physician perhaps at a reduced compensation during the retraining period
  • Provide an extended orientation
  • Offer proctoring with other physicians in the same specialty, especially for surgical specialties
  • Provide opportunities to work with senior physicians
  • Support for job sharing and other part-time arrangements so that the whole reentry issue can be avoided
  • Assist with paying for fees associated with education, licensure and certification
  • Support equal opportunity- perhaps hiring under the condition at the physician will complete a reentry training program successfully
  • Help organize or sponsor reentry and refresher programs run by specialty departments and/or graduate medical education in medical centers in parallel to already-established residency programs at those centers

Comment

This survey was sent to the electronically to the AMA Young Physicians Section to individuals for whom e- mail addresses were available. This survey was fielded in August 2009. The Introduction to the questionnaire asked respondents to comment even if they were not a reentry physician and/or were not planning to become a reentry physician. Despite a low response rate it is evident that the responses received are creative, well- intended, sometimes though-provoking, and in all instances, useful. The Physician Reentry into the Workforce Project will be considering the information gleaned from this survey as we move into the next phase of the Reentry Project, our Maintenance of Practice ™ initiative. The plan is to develop Resources to help physicians who plan to leave the workforce, but intend to reenter in the future, hence the use of the term: Maintenance of Practice.™ The Physician Reentry into the Workforce Project is grateful to those AMA Young Physicians Section members who took the time to share their ideas and perspectives. We also thank the AMA Young Physicians Section for allowing us to field this survey.

Resources

The Web site at www.aap.org/reentry 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: Perspectives on Flexibility and Reentry into Clinical Practice from the AMA Young Physician Section. Elk Grove Village, Ill. American Academy of Pediatrics; 2009.