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Transitioning Back Into Clinical Medicine

Doctors fear leaving medicine because they worry how hard it might be integrating back into clinical medicine. Rightly so. Many state medical boards require you to jump through several hoops before letting you practice clinical medicine after an extended absence.

Transitioning back into clinical medicine is getting harder and harder. Not only are state medical boards creating stricter rules regarding this, but malpractice insurers and medical groups are developing minimum work history requirements.

The average time a physician is out of practice is 5 years. After 2 years of no clinical activity you have to participate in some sort of a reentry program. Each state has their own rules.

Some states will consider your administrative work as sufficient. Others have a minimum amount of clinical work they expect or else your license will be considered to have been inactive.

Clinical Reentry Programs

There is good money in this. Doctors who’ve been out of practice may have had to take time off for personal reasons, for health issues, or may have had their medical licenses terminated.

Regardless of the cause, many physicians attempt to get back into clinical medicine and often do so successfully. If you’re familiar with your state’s medical board process, you can prepare early and transition back into clinical medicine smoothly.

UC San Diego has such a reentry program and so do a few other large health centers. UCSD has the “Physician Retraining and Reentry Program“. For a healthy sum of money they will let you rotate through their various clinics.

Before doing this, it’s important to connect with your medical board first. They will likely have their own unique requirements. If you agree to satisfy those, you’ll be given a provisional license until you meet all of their criteria for full licensure.

The UCSD program is 180 hours which doesn’t include the in-person clinical work you would do.

Period of Clinical Inactivity

If you’ve been away for more than 2 years, you generally will need to engage in some sort of immersion or reentry program. This will be determined by your particular medical board. Some are okay with you up to 3 years.

There are exceptions. Perhaps you were away for 5 years but continued to volunteer or did MOC’s and CME’s. Each state medical board will consider cases individually. A medical board hearing is often required.

If you know that you will be taking time off from clinical medicine, it’s a good idea to talk to an attorney or your state medical board and decide what the best approach might be.

Inactive Medical License

You might have the option of inactivating your state medical license instead of completely giving it up. This makes it much easier for you to transition back into clinical medicine.

In the inactive state you still have to pay a little every year but it’s much cheaper than an active state medical license. Upon reactivation, you’ll have to go through a similar process as initial licensure (document submission, background check). However, your chance of activation is much higher.

Medical Malpractice

Even if your state medical board okays your reentry, you might run into some issues with certain malpractice carriers. This is not a common issue with a private carrier, but might be a problem when you’re applying for a job and need a group policy coverage.

A reentry program can often appease these malpractice insurers. Other options are to petition their credentialing committee with your attorney. You want someone with experience in this regard. Reentry programs often have attorneys they can recommend.

Cost of Reentry

It’s hard to say how much it will cost. If you’re a primary care doctor then you’ll spend somewhere in the $10,000 range, if you’ve been out for more than 2 years.

For specialists it could be up to $20,000. This doesn’t include the income lost during a year where you might need to be supervised by a colleague or a medical group.

The money will be spent on:

  • legal fees
  • medical board fees
  • reentry courses
  • CME’s
  • 3rd party evaluations
  • exam fees
  • chart audits

State Medical Boards

Not all medical boards have an official reentry policy; some decided on a case by case basis.

An experienced attorney who is familiar with the administrative process for physicians and is connected with your state’s medical board will give you a solid idea of what to expect.

Some state medical boards will require you to demonstrate competency even with just one year out of practice. While others are okay with up to 5 years.

Some states will accept any administrative work you do in medicine as clinical work. Others require direct patient contact.

The NBME puts out the SPEX exam which many state medical boards will use to demonstrate your clinical competency. You can take this 5-hour exam anytime in the year and take it multiple times if needed for a $1,300 fee.

Practice Mentors

Seems that the medical boards are lenient in this regard. Either they will choose a pre-approved clinical mentor for you or let you come up with your own.

This mentor has to be approved by the medical board and has to be a physician practicing in the same specialty as yourself. Their role is mostly supervisory and should last a minimum of 6 months.

Chart audits might be requested by your state medical board in order to demonstrate your competency. This is often done before your provisional reentry license is converted into an unrestricted license.

Path of Least Resistance

Imagine you’ve been out of practice for 5 years. You want to get back into clinical medicine but your state medical board wants you to jump through 1,000 hoops.

Your medical license might be terminated or inactive. In order to activate it, you’d need to enter some sorto of reentry program. But here are some options to consider which might be easier:

1. Practice Internationally

Some countries are desperate for physicians. It might sounds complicated but it might also be a wonderful experience.

Using a recruiter, you might be able to apply for a medical license abroad. Even without an active US medical license, it’s possible that you might be able to gain a medical license overseas.

The advantage is that when you come back to practice in the US, you can show that you’ve had clinical experience. It will be up to the medical board, but they might accept this.

2. Choose a Lenient US State

Some states have strict medical boards and others are lenient. It all depends on the individuals on that board. You can get this inside knowledge by talking to attorneys who are well-connected with the medical boards.

Choose wisely. Some state medical boards will work with you willingly in order to get you started practicing medicine. Others will fight you every step of the way.

After 1 year of practice, you can take your experience and ask for other state medical licenses.

3. Start by Volunteering

Asking for a medical license to volunteer might be met with less resistance. You could petition the medical board for a volunteer license, especially if you’ll be volunteering in an organization with other physicians.

This might be a much easier pathway for you to transition back into clinical medicine.

4. Shadow Another Physician

Start your reentry process before petitioning the medical board. You might be able to find a physician colleague with their own medical practice and shadow with them.

After 3-6 months you could ask the medical board to allow you to transition back into clinical medicine sooner because of this experience.

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