Charting a Course for Clinical Reentry

In light of the physician shortage, the American Medical Association has released recommendations to help standardize and simplify the process of reentering the clinical practice.

The AMA defines physician reentry as a return to practice in the discipline in which one has been trained or certified following an extended period of clinical inactivity not resulting from discipline or impairment.

Physicians wishing to return to clinical practice after a period of inactivity often face considerable barriers due to a lack of consistency among state licensing boards. In addition, hospitals and specialty board organizations have no standard mechanisms for credentialing and certification after such an absence.

The AMA addresses this and several other issues in the recommendations, which are as follows:

1. Develop an understanding of the expectations and needs that relevant stakeholder groups have for a physician reentry system.

2. Develop physician reentry policy guidelines across state medical licensing jurisdictions that are consistent and evidence-based. These guidelines should clarify:

• The length of time away from clinical practice which necessitates participating in a reentry process
• The definition of how much involvement in clinical care constitutes active clinical practice and the clinical practice requirements for maintaining licensure
• The impact of loss of specialty board certification on maintenance of licensure

3. Establish mechanisms to permit reentering physicians to engage in clinical practice under supervision as they participate in a reentry program. These include:

• A site (such as a medical school or teaching hospital) that provides reentering physicians with opportunities for supervised clinical practice in their previous clinical fields
• Hospital credentialing committees that allow reentry program participants to work under supervision
• State medical licensing boards that establish a non-disciplinary licensure status option for reentering physicians during their reentry education and training
• Development and validation of a process for previously board certified physicians not eligible for maintenance of certification to participate in reentry training necessary to return to their field and original scope of clinical practice

4. Work with state medical licensing boards and medical societies to develop a certificate of program completion that meets the need to document physician readiness for clinical practice.

5. Increase consistency among reentry programs by establishing a mechanism by which programs can assess and demonstrate graduates’ comparable preparation and readiness for independent practice within the physician’s intended scope of practice.

6. Encourage the development of modular programs to meet the specific learning needs of individual reentering physicians.

7. Consider a physician reentry program accreditation process that includes a review of program outcomes.

8. Study the feasibility of introducing alternate licensure tracks for reentering physicians that allow a limited scope of practice.

9. Study the relationship between time away from practice and maintenance of clinical knowledge, skills and behaviors.

10. Study new models of organizing physician reentry programs to include the feasibility of providing physicians with an educational “home” base.

11. Continue to develop valid and reliable assessment tools for physician knowledge and skills. Assessment of reentering physicians should occur at three points: (1) entry to a physician reentry program, (2) completion of a physician reentry program, and (3) a standard time after which a physician has returned to active clinical practice.

12. Establish a national physician reentry database to:

• Provide programmatic information to reentering physicians
• Track trends in reentry such as number of reentering physicians, program costs and outcomes

13. Study the workforce implications of a system that supports physician reentry .

14. Pursue multiple funding streams to support the development, implementation and evaluation of a national physician reentry system.

• Collaboration and communication among stakeholders
• Principle: Ensure that all stakeholders participate in planning for a physician reentry system.

15. Establish process for ongoing communication between medical regulatory bodies, physician reentry programs, medical associations and societies, and other key stakeholders to further the development of a national reentry system.

• Mitigating the cost of physician reentry programs for physicians and regulatory bodies
• Supporting the development and maintenance of physician reentry programs
• Creating mechanisms for the assessment and evaluation of physician reentry programs

16. Continue to educate medical students, residents and practicing physicians on career-planning strategies and resources should they need to take a hiatus from clinical practice.