Physician Reentry into the Workforce

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Physician Reentry into the Workforce

• Holly J. Mulvey, MA
• Ethan Alexander Jewett, MA
• Co-Directors

Physician Reentry into the Workforce Project
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Definition

• Physician reentry into the workforce can be
  defined as returning to professional
  activity/clinical practice for which one has been
  trained, certified or licensed after an extended
  time period.

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Who are the stakeholders?

• Federal/state governments
• Regulatory groups (state licensing boards)
• Federal agencies
• Hospitals (including The Joint Commission)
• Medical/specialty societies
• Specialty boards

• Organizations invested in physician workforce
  planning
• Groups with an agenda that focuses on women in
  medicine
• Individual physicians

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Some reasons for leaving the workforce

• Health
• Substance abuse
• Retirement
• Burnout
• Loss of licensure
• Family needs (children, elderly parents)
• Career change (eg, administrative position,
  research)

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Some reasons for reentering the workforce

• Miss colleagues and/or practice environment
• Miss caring for patients
• Too much free time on my hands

• Financial reasons
• Responding to a need in the community (ie,
  natural disaster)
• To pursue a new challenge or area of medicine

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Why is this issue important?

• Many physicians leave clinical medicine for a
  period of time
• Federal investment in GME Medicine is a public
  good.
• Unmet patient need underserved areas and
  anticipated public health crisis
• A mechanism to bring more flexibility into the
  system (eg, the attractiveness of medicine as a
  career)

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Some questions to consider

• Is the structure of the health care system too
  rigid to accommodate diverse practice/career/perso
  nal needs?
• Do MDs need to leave because the system wont
  give?
• Will we face an unstable MD workforce?

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AAP participation in the AAMCSurvey of
Physicians Over 50

• Collaboration of AAMC, AAP, and 8 medical
  associations
• AAP used existing Periodic Survey of Fellows
  survey instrument
• 1158/1600 surveyed (72 response rate)
• Women26 Men74

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Work/practice opportunities
If flexible work hours or part-time option had
been available at the time of your retirement,
how would you have changed your practice?
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Reduced hours/part-time
Have you worked in a reduced-hour or part-time
position during your medical career?
If yes, did you take the time to care for
children or other family members?
Mean6.1 years
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Extended leave from medicine
Mean (WM)1.5 years Women23 months Men14 months
Have you ever taken an extended (6 months or
more) leave of absence or sabbatical from
medicine?
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Reasons for extended leave
(for Pediatrics)
Did you take the time to care for children or
other family members?
Women 71 Men 14
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Retraining before reentry
(for Pediatrics)
Did you have any retraining before reentering
medicine?
Women 23 Men 18
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Reasons for reentry
Why have you considered reentering medicine?
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Physician Reentry into the Workforce Project
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What are our assumptions?

• Physicians returning to the workforce will face
  questions about their competence to resume
  clinical practice.
• The educational needs of physicians who wish to
  return to clinical practice are extremely
  diverse.
• With the growing proportion of women in
  pediatrics and other specialties, there will
  likely be an increase in the number of
  pediatricians taking an extended leave during
  their career or returning to medicine after
  retiring.
• Physicians who choose to leave the workforce for
  a period of time risk losing their state
  licensure, their Board certification and hospital
  privileges.

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Assessment and Evaluation

• This workgroup will need to identify appropriate
  methods for evaluating an individual physicians
  competence and need for retraining. Once a
  physician has undergone retraining, a valid
  assessment will need to be in place to assure the
  public that the physician is skilled and
  competent to resume the practice of medicine.

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Education
This workgroup will be charged with determining
how to respond to each physicians educational
needs through Web-based and live CME, shadowing,
preceptorships, mini-residencies, and formal
reentry programs. This group should also
identify strategies to defray the costs of such
training opportunities to make them affordable to
the individual physician.  
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Licensure, Maintenance of Certification, and
Credentialing
One of the challenges of this workgroup will be
to identify strategies to help physicians
maintain their professional standing while they
are absent from the workforce. It will also need
to propose a process for physicians to regain
their professional credentials if they lose them
and wish to return to active clinical practice.
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Workforce
This workgroup will need to determine how the
workforce is likely to be affected, and how to
mobilize physicians into the workforce once they
indicate a wish to return to practice.
Additionally, the group should consider how to
marshal workforce resources in innovative ways to
respond to public health emergencies and emerging
models of health care delivery.
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Works-in-progress Workforce survey

• Random sample of 5000 physicians under 65 listed
  as inactive in the AMA Masterfile.
• 3 mailings, 1/4/08, 2/1/08, 3/11/08
• 1,515 valid surveys, 584 bad addresses
• 2,868 nonrespondents
• 34.6 response rate, as of 3/28/08
• Data presented at June 2008 AMA-HOD Annual
  Meeting (Women Physicians Congress)

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Reentry survey topics

• Licensure and maintenance of board certification
• Liability insurance
• Financial need
• Family responsibilities
• Professional satisfaction
• Work hours and professional responsibilities
• Part-time practice
• Retraining modalities

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What do we hope to learn?

• Reasons for physician exit and reentry
• Incentives to encourage inactive physicians to
  return to medicine
• Barriers to inactive physicians returning to
  medicine
• Demographics of inactive physicians

• Specialties most affected by physician exit
  and/or reentry
• Retraining/educational needs of reentering
  physicians
• Availability of opportunities and portals to
  reenter medicine

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Works-in-ProgressReentry Web page redesign

• Redesign in March 2008 to mark transition from
  planning to implementation
• Expansion of resources related to the work of the
  Project and its workgroups (internal)
• Addition of resources for physicians seeking to
  reenter the workforce (external)
• Showcase research initiatives

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Other reentry products in development

• Journal article on reentry data on pediatricians
  from joint AAP-AAMC Survey of Physicians over 50
• Proposed joint AMA-AAP conference in fall 2008 on
  physician reentry issues
• Abstracts and manuscript on reentry survey data
  planned for 2009

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Visit us at www.aap.org/workforce
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Contact the Division of Workforce Medical
Education Policy

• Holly J. Mulvey, MA
• Director
• Division of Workforce and Medical Education
  Policy
• American Academy of Pediatrics
• 141 Northwest Point Blvd.
• Elk Grove Village, IL 60007
• hmulvey_at_aap.org
• 847.434.7915
• 847.434.8000 (fax)

• Ethan Alexander Jewett, MA
• Senior Health Policy Analyst
• Division of Workforce and Medical Education
  Policy
• American Academy of Pediatrics
• 141 Northwest Point Blvd.
• Elk Grove Village, IL 60007
• ejewett_at_aap.org
• 847.434.7914
• 847.434.8000 (fax)