Physician Reentry into the Workforce

Transcription

1 Physician Reentry into the Workforce The Current State and Direction Alliance for CME 37 th Annual Conference January 21-24, 2012 Holly J. Mulvey, MA Co-Director of The Physician Reentry into the Workforce Project

2 What does physician reentry look like?! Dr. Jane Rizzardi is a cardiologist, who has been practicing in a large academic medical center for 10 years. She has accepted a new and demanding job in a North Carolina university with a better salary, benefits, and academic appointment, which will allow her to be near her elderly mother.! About a year after arriving, her mother, who suffers from other health problems, has a stroke, and as an only child, Dr. Rizzardi contemplates leaving practice for several years to take care of her.

3 ! She cannot adapt her position to work part-time on a limited basis. A colleague at the university points out to her that after 2 years of being clinically inactive, the state medical board will give her an inactive license! What questions &concerns does Dr. Rizzardi face?

4 ! What preventive measures can she take before leaving practice to facilitate her reentry into the workforce in 2+ years?! How does she find relevant and affordable reentry training to sharpen her skills in cardiology to meet licensing, certification, and credentialing requirements?! How will she be able to prove to herself, the state licensing board, and others that she had remained competent in cardiology?! Will she be able to maintain her board certification and/or her hospital privileges?

5 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.

6 Physician reentry is not remediation, resulting from disciplinary intervention due to a breach of medical ethics, substance abuse, loss of one s medical license or similar events.

7 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

8 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 (e.g the attractiveness of medicine as a career)

9 The Physician Reentry into the Workforce Project! Collaborative Project of many organizations, including the AMA & FSMB! Established in 2005! Key domains include: Education Workforce Assessment & Evaluation Licensure, Maintenance of Certification & Credentialing!

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11 Survey Details! Random sample of 4975 inactive physicians under age 65 from AMA Masterfile! Three survey mailings (Jan, Feb, Mar 2008) Small incentive for prompt return (drawing for gift certificates)! Adjusted response rate 36.1%! The survey also queried respondents about the following personal characteristics: Marital status Race and ethnicity Overall health status Current financial status! Also learned that many who were listed as inactive had already reentered the workforce

12 Reasons that physicians are not currently active in medicine! Both women and men rated as top reasons for being inactive personal health issues, the hassle factor of practice, rising malpractice premiums, and lack of professional satisfaction.! The #1 reason women cited for inactivity (35.5%) was the need to care for young children, compared to only 1.6% for men.! Another key driver for women was the need to care for other family members (23.4%), which only 7.2% of male respondents noted.

13 Reasons that would encourage inactive physicians to return to practice! Availability of part-time work or flexible scheduling was cited by both women (57.7%) and men (41.6%) as the primary reason they would return to practice.! Women (53.2%) indicated that a change in family or personal circumstances would encourage them to return to practice much more than it would for men (30.0%), although it was still relatively high for men.

14 Additional considerations for reentering the workforce! Financial needs! Desire to provide volunteer services! Responding to a need in the community (ie, natural disaster)! To pursue a new challenge or area of medicine! Miss colleagues and/or practice environment! Miss caring for patients! Too much free time on my hands

15 Length of time since inactive physicians were last in practice 27.1% of inactive physicians indicated that they were working in another field! (38.3%) (19.1%) (24.1%) (6.7%) (11.8%)

16 Status of licensure, liability insurance and specialty certification! Nearly 60% of inactive physicians retained all of their medical licenses, 20% maintained some but not all, and 20% no longer had any medical license.! About 70% of inactive physicians did not maintain medical liability insurance. 25% kept tail coverage only, and 2% continued full coverage.! 35.6% of inactive physicians reported some kind of specialty certification, while 64.4% reported no certification

17 Exploration of return to practice! Half (50.3%) of the inactive physicians have explored becoming active in medicine again.! The top ways they explored returning were by talking with professional colleagues (45.8%), talking with potential employers (40.4%), reading about the process and/or requirements (38.3%), and contacting the state about licensing (27.9%).! Before reentering medicine16% of the respondents participated in online CME, and 22% in live CME.

18 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.! Live and online CME will need to be targeted to the learning needs of inactive and reentering MDs to prepare them to face the challenges of a quickly evolving practice environment.! Physicians who choose to leave the workforce for a period of time risk losing their state licensure, their Board certification and hospital privileges.

19 The Physician Reentry into the Workforce Project The Maintenance of Practice Project (MOP) A 3-part project that will address: 1. the needs of the individual physician; 2. the needs of the employer; and 3. the needs of the specialty society

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21 Inventory The 4 key questions that frame a physician s reentry experience:! What should I know before I leave?! What should I do before I leave?! What should I do while I am out of the workforce?! What should I do now that I have reentered?

22 What should I do before I leave?

23 TIPS Maintain CME with emphasis on face-to-face programs where there is ample time for Q&A or access to experts. Know the yearly Maintenance of Certification and Maintenance of Licensure requirements for your state. If you are a procedural specialist, attend programs with hands-on cadaver or simulated practice sessions. Do NOT just read journals or listen to CDs. Check with the medical school nearest you to see if they offer any retraining or other academic help. Develop a network. Look for opportunities through your local medical chapter/societies, available electronic networks, and other organizations for informal training as well as venues beyond intellectual sources for continuing medical education.

24 The Physician Reentry into the Workforce Project Physician Reentry Online Portal for Pediatricians This online interactive Web site will be the resource for those seeking to reenter and/or planning to leave clinical practice. Information and resources on the Web site will include:! Checklists and assessment for physicians! Links and reminder notices would be provided for things like CME related to their practice area and needs. Users would be able to customize a page for their specific needs:! Their specialty and state regulations regarding MOC, licensure and certification! Online educational materials available to meet their needs! CME available in their community

25 It is key that physician reentry be viewed as a typical part of a physician s career trajectory, involving strategic planning and careful consideration not just on the part of the reentry physicians but also within medical specialty societies and amongst educators and policymakers.

26 The Physician Reentry into the Workforce Project Holly J. Mulvey, M.A. Co-Director Kelly J. Towey, M.Ed. Co-Director The Physician Reentry into the Workforce Project is a collaborative initiative of many individuals and organizations both within and external to pediatrics. The American Academy of Pediatrics (AAP) has both supported and funded the Physician Reentry into the Workforce Project since its inception in The Reentry Project is directed by the AAP Division of Workforce & Medical Education Policy.