After taking a 10-year break from practicing medicine to raise four sons, Dr. Kate Gibson was ready to go back to work.
The family physician had been reading about a shortage of primary care doctors and knew she could help. But when Dr. Gibson, 51, applied to work at her former hospital near Los Angeles, she was turned away. She’d been out of clinical practice too long.
“I really thought it was not going to be that hard,” she said.
Like many professionals, physicians take time off to raise children, care for sick family members, or recover from their own illnesses. Some want to return from retirement or switch from nonclinical jobs back to seeing patients. But picking up where they left off is more difficult in medicine than in most careers.
thinkstockphotos.com
In medicine, change occurs quickly. Drugs, devices, and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.
“My hands feel like those of an intern,” said Dr. Molly Carey, 36, an Ivy League–educated doctor who recently enrolled in a Texas retraining program after 4 years away from patients.
After extended leaves, doctors must convince medical boards to reissue their licenses, hospitals to grant admitting privileges, and malpractice insurers to provide coverage. Only a handful of programs around the country are set up to help physicians brush up on their skills, and they can cost doctors thousands of dollars.
“Medical schools do a fantastic job graduating brand new medical students,” said Dr. Humayun J. Chaudhry, president of the Federation of State Medical Boards. “But what about people who have already graduated and need to get some retraining? There is clearly a dearth of those kind of training programs.”
Policy makers and professional organizations are pushing to make the process less burdensome and costly – in part because it may help ease shortages of primary care doctors.
Getting experienced doctors to dust off their white coats is cheaper than starting from scratch, said Dr. Robert Steele, director of KSTAR physician programs at Texas A&M Health Science Center, College Station. He oversees a miniresidency program at the University of Texas Medical Branch, Galveston, in which returning doctors divide their time between seeing patients and attending classes. The 3-month training includes the latest on medications, procedures, disease management, and treatment.
“[Returning doctors] just need polishing up to practice safely and competently,” Dr. Steele said.
Patient safety advocates argue that minimum standards should be set to ensure that doctors coming back after a hiatus are providing the best care possible. As it stands, no nationwide standards or requirements exist, and states have different requirements.
“Patients would like to think that any doctor who is seeing them or doing procedures on them is at the height of their career,” said Joe Kiani, founder of the Patient Safety Movement Foundation. “If a doctor has been out for a while, they are not.”
Dr. Carey had a great education, graduating from medical school at the University of Pennsylvania and completing a residency in 2011 in obstetrics and gynecology at Brown University and a Providence hospital. But after taking just 4 years off to care for a sick grandmother and another relative, she felt she needed to freshen her clinical skills. So she moved from Rhode Island to Texas to take part in the KSTAR program, hoping to gain more confidence as a surgeon and become more marketable.
Setting standards and removing obstacles
Reliable numbers of how many doctors suspend their practices aren’t available, but the American Medical Association estimated in 2011 that 10,000 doctors could reenter practice each year.
The Federation of State Medical Boards wants states to create a standard process for physicians to show they have the skills to return to medicine. It is asking licensing agencies to track whether doctors are still practicing and whether they are doing so in their area of training.
The American Academy of Pediatrics and the AMA also are trying to remove obstacles for doctors who want to return to work after taking time off. And Rep. John Sarbanes (D-Md.) has proposed legislation to help expand reentry programs for primary care doctors and help cover physicians’ costs if they agree to practice in high-need areas.
After hitting a wall with her former employer and others, Dr. Gibson enrolled in an online retraining program in San Diego, which cost her $7,000. She spent 4 months completing the courses last year and a week shadowing a family physician. Then she took a written exam and was evaluated during mock visits with “patients” played by actors.