As our last post detailed, the employed life isn’t a good fit for all physicians who enter it. Employed doctors don’t have the burdens and uncertainties of running a business, but they may have to play politics or follow onerous policies. Interestingly, the employed physician model, in addition to potentially damaging morale, also might not improve hospital care.
Of course, independent-practice physicians aren’t necessarily happier, according to one survey. Plenty of advice is available for physicians who want to join the employed medical professional workforce. There are also steps to take after a physician leaves employment, possibly to “re-transition” to private practice. The issue of physician re-entry into the workforce is gaining importance. In addition to dissatisfaction/burnout, physicians might change or leave practice due to injury or illness, military service, a family situation, or in pursuit of continuing education. This issue cuts across demographics as well as specialties.
Leaving medical practice affects relationships with patients, practice partners, colleagues, and family members. Re-entering practice will affect these same groups, and there are often financial implications. Physicians who leave should create a plan in advance based on the assumption that they will re-enter practice in the future. (Note: This is a good practice even if that seems like a remote possibility on the day they shut the door.)
Departure in good standing from any practice will make re-entry a smoother process. Consider the following:
- Know the state’s licensing and certification requirements for change-of- practice activity. These vary by state. Some require maintenance of licensure; some allow physicians to put their license into inactive status.
- Maintain clinical competence. This can be critical to the re-entry process. Keep current on practice guidelines and recommendations by networking with colleagues or finding a mentor for the period of clinical inactivity. Consider attending continuing medical education (CME) programs.
- Whenever possible, physicians in active practice should cooperate with retraining efforts of returning peers and colleagues.
The Federation of State Medical Boards (FSMB) offers 12 guidelines on re-entry for state member boards, created by the Special Committee on Reentry to Practice. The guidelines highlight some key re-entry issues, such as data needs, mentors for reentry physicians, and medical liability insurance.
After time away, physicians must convince medical boards to reissue their license practice. Depending on their specialty and preferences, they might also have to seek admitting privileges and they’ll need to get malpractice coverage. Often, practitioners returning to the field are surprised to discover how much care can change in just a few years. Physician re-entry programs can help physicians get back to practicing medicine, but these programs can cost thousands of dollars.
Nevertheless, sometimes time away is the only prescription for a doctor’s situation. It’s hard to “hit the reset button” while seeing patients, taking care of administrative details, taking call, and completing all those other tasks that fill the day. Plan to unplug completely, some experts advise, which is admittedly no easy task for the professional who’s accustomed to constant engagement.
Harder still, the physician must have his or her own internal permission to take this time to concentrate on the task at hand, planning a future. Soul-searching can require some time away from screens; it’s not something that can be cured or fixed, and it might not happen in a convenient timeframe. Consider:
- What worked? Your last job might have been awful, but did it have any good points?
- Why didn’t it work out? Was it a personnel mismatch? Were there ethical concerns? Too much work? Dysfunctional systems?
- Is it time to walk away for good? The skills required to practice medicine can be applicable to plenty of other opportunities in a range of professions.
Physicians who want to return to the profession need to understand what must change for them to be happy (or, at least, happier).
Finally, take heart: Even though modern healthcare includes plenty of ways to discourage loyalty, satisfied patients will follow a physician if it’s possible. Likewise, colleagues will usually refer respected peers to prospective patients.
Also, physicians who are re-entering practice have a couple of advantages. First, they understand how much work and planning are required. Second, they’ve probably realized that a lot of their fellow practitioners, employed or independent, are working at high-overhead jobs they hate and that happy doctors are becoming an endangered species. Going back into a practice can work for experienced physicians, if they bring along the lessons they learned the first time around.
