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Mini-fellowships: Physicians re-enter medical practice - Spring 2014
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By Kim Dianich, CMSR PHR, Senior Physician Recruiter, PeaceHealth Medical Group, Vancouver, WA

In the many CVs that come across your desk each week, you may have noticed an increase in the number of candidates who have completed a re-entry or mini fellowship program in hopes of returning to practice. As the physician candidate pool continues to tighten, especially in primary care, you may wish to keep an open mind when considering these candidates. Educating your organization’s leaders about these candidates and the programs they complete may help you tap into a hidden source of candidates.

The American Medical Association (AMA) defines physician re-entry as, “a return to clinical 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.” There are a number of reasons physicians may leave practice, including:

  • Raising children.
  • Taking care of elderly parents or ill family members.
  • Wanting to develop their skills or to improve their competencies in a specific area of medicine.
  • Focusing their career on a different area of medicine (research, informatics, pharmacology).

Re-entry programs provide these physicians with training that allows them to resume a clinical practice. Unfortunately, there is a stigma associated with re-entry programs which often causes recruiters and organizations to pass over these candidates. Fortunately, there are a handful of reputable, accredited re-entry programs in the United States, including:

  • The Center for Personalized Education for Physicians (CPEP) Clinical Practice Re-entry Program – Denver, Colo.
  • Drexel Medicine Physician Refresher/Re-Entry Course – Philadelphia, Pa.
  • LifeGuard® – Harrisburg, Pa.
  • Physician Assessment and Clinical Education Program (PACE) – San Diego, Calif.
  • Texas A & M Health Science Center KSTAR Program – Fort Worth, Texas

This is list is not inclusive of all programs in the US – if you know of another qualified program do let me know.

Physicians have multiple options to consider as they try to find their way back into clinical practice. One such option, LifeGuard, conceptualized by the Pennsylvania Medical Society, works with physicians who are seeking reinstatement of their license, no matter the reason. Each physician is thoroughly assessed and a remediation program is tailored specifically for them to allow them to obtain licensure again. “The program is fairly new with only three years’ history, however each physician’s program is customized to meet each physician’s unique needs,” says LifeGuard administrator, David A. Hess. LifeGuard cannot guarantee physicians will get their licenses back, but it provides the physician with tools that assess clinical skills and medical knowledge highlighting areas of clinical skills deficits; offers remediation educational plans which are customized to target the recognized areas of deficiency; and facilitates preceptorships with practicing physicians who provide hands-on practice experiences as the LifeGuard participants step back into the practice of Medicine.

The AMA has a webpage dedicated specifically to physician re-entry programs and includes information related to regulations pertaining to individual state medical boards. Currently 60 percent of the state medical boards have regulations about licensing physicians who have been out of practice; many more are in the process of developing plans.

How does a re-entry program work?
Legitimate processes, recognized by state medical boards, are put into place. A program (independent of the state board, hospital or medical group) assesses the physician’s current skills by utilizing various assessment tools. LifeGuard typically administers the Post Licensure Assessment System’s (PLAS) practice-based exams (created by the National Board of Medical Examiners [NBME] and Federation of State Medical Boards [FSMB]); performs a neurocognitive assessment; conducts a mentor interview; and, based on the specific physician needs, utilizes a number of other assessment tools in order to provide a complete profile of the physician’s clinical skills. These additional assessment tools may include standardized patients, simulation laboratories, and peer review to name a few. The program then facilitates a preceptor experience for the physician. The physician works with the preceptor for a specified period of time based on the number of years that the physician has been out of practice. The program then verifies that the physician has completed all necessary work and ensures that the mentor is confident that the physician is ready to resume practicing medicine through an intensive evaluation process.

Physicians who go through these re-entry programs are dedicated to making sure that their skills are up-to-date in order to provide the best patient care possible. In addition to the time commitment required to complete a program, the cost may be substantial. The initial assessment with a program like LifeGuard can cost between $8,500 and $10,000. There are also costs from lost wages if the physician was working in another profession or must incur child care expenses to participate in the program. The new employer or recruiter may be confident in the clinical competency assessment and remediation plan a physician receives in a re-entry program and know that a re-entry program graduate has the skills necessary to practice medicine.

Some organizations understand the wealth of knowledge physicians re-entering practice can bring to their patients. For example, Marci Jackson, Physician Recruitment Manager at Marshfield Clinic in Marshfield, WI, says that her organization has a strong plan for physicians with this type of background and welcomes them in with a repayment program, should they work a certain number of years with the clinic.

What is the re-entry experience like for physicians?
A prime example of a recruit that could have been lost due to the large gap in her CV is Pamela Yanoviak, M.D. - an Internist with Evangelical Community Hospital in Lewisburg, Pa. Dr. Yanoviak had been away from medicine for 12 years raising children and caring for her elderly parents. In her time off, she explored other careers in education and obtained a master’s degree in school psychology, all while maintaining her required CMEs for medical licensure. Her new career in psychology allowed her a stronger work/life balance, but did not satisfy her calling to medicine.

After years out of practice, Dr. Yanoviak began to have dreams about practicing medicine again…in Philadelphia. When she discovered the Drexel Refresher/Re-Entry course while conducting an online search, the dream became reality. Her mentor, Dr. Nielufar Varjavand became instrumental as a structured plan was formulated specifically for Dr. Yanoviak—that included academic medicine, research, lectures, grand rounds and clinical rotations. She valued the personal contact with Dr. Varjavand who provided constant encouragement. Meanwhile, Dr. Yanoviak contacted the Pennsylvania Medical Society who recommended that she enter the LifeGuard program. LifeGuard assigned a physician-led assessment to guarantee that Dr. Yanoviak met current standards of medical care. They oversaw online clinical simulation and case review tests, and completed a neurocognitive evaluation of her. LifeGuard recommended a 2-month preceptorship for Dr. Yanoviak alongside a currently practicing Internist, David Zelechoski, M.D. with Evangelical Community Hospital’s medical group; Andrew Gibbons, Evangelical Community Hospital’s Physician Recruiter assisted in coordination. The LifeGuard team assisted Dr. Yanoviak in obtaining a stipulated medical license to do the preceptorship. The entire process was confidential, allowing Dr. Yanoviak to work alongside her peers without them having knowledge of her situation.

Components of both the Drexel Refresher/Re-Entry Course and LifeGuard programs created a solid foundation for Dr. Yanoviak to return to medicine. She successfully passed through the re-entry program in 2011 and obtained an unrestricted medical license. With the assistance of Dennis Burns, AASPR, Manager, Physician Recruitment at Evangelical Community Hospital, she secured a permanent position with Evangelical’s medical group. Dr. Yanoviak is very grateful for the opportunity to re-enter medicine and serve patients in her community.

There are many more cases of physicians successfully re-entering the field of clinical medicine after completing a re-entry program. The stigma associated with these programs still exists to a degree, but with education organizations may soon see this as a viable candidate pool. Physician recruiters who wish to dip into this pool will need buy-in from their hiring leaders and C-suite. Having a firm understanding of the process and what these physicians go through to prepare to re-enter the field may help you build your case. You may not be successful in recruiting re-entry program physicians for all specialties; however, as the number of available physicians shrinks, advocacy for hiring physicians who have successfully completed an accredited re-entry program could be an answer to an everyday recruitment challenge.

Resources:
AMA Physician Re-Entry Education
AMA Physician Re-Entry Regulations
Drexel University Physician Refresher Course
LifeGuard®
The Federation of State Medical Boards (FSMB)

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