1. Physician Reentry into the Workforce Holly J. Mulvey, MA Ethan Alexander Jewett, MA Co-Directors Physician Reentry into the Workforce Project

2. 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.

3. 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

4. Some reasons for leaving the workforce  Health  Substance abuse  Retirement  Burnout  Loss of licensure  Family needs (children, elderly parents)  Career change (eg, administrative position, research)

5. Some reasons for reentering the workforce  Financial reasons  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

6. 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 (eg, the attractiveness of medicine as a career)

7. Some questions to consider  Is the structure of the health care system too rigid to accommodate diverse practice/career/personal needs?  Do MDs need to “leave” because the system won’t give?  Will we face an unstable MD workforce?

8. AAP participation in the AAMC Survey of Physicians Over 50  Collaboration of AAMC, AAP, and 8 medical associations  AAP used existing Periodic Survey of Fellows survey instrument  1158/1600 surveyed (72% response rate)  Women=26%; Men=74%

9. Work/practice opportunities If flexible work hours or part-time option had been available at the time of your retirement, how would you have changed your practice?

10. Reduced hours/part-time Have you worked in a reduced-hour or part- time position during your medical career? Mean=6.1 years If yes, did you take the time to care for children or other family members?

11. Have you ever taken an extended (6 months or more) leave of absence or sabbatical from medicine? Mean (W+M) 1.5 years Women 23 months Men 14 months Extended leave from medicine

12. Reasons for extended leave Did you take the time to care for children or other family members? Women = 71% Men = 14% (for Pediatrics)

13. Retraining before reentry Did you have any retraining before reentering medicine? Women = 23% Men = 18% (for Pediatrics)

14. Reasons for reentry Why have you considered reentering medicine?

15. Physician Reentry into the Workforce Project

16. 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.  With the growing proportion of women in pediatrics and other specialties, there will likely be an increase in the number of pediatricians taking an extended leave during their career or returning to medicine after retiring.  Physicians who choose to leave the workforce for a period of time risk losing their state licensure, their Board certification and hospital privileges.

17. Assessment and Evaluation This workgroup will need to identify appropriate methods for evaluating an individual physician’s competence and need for retraining. Once a physician has undergone retraining, a valid assessment will need to be in place to assure the public that the physician is skilled and competent to resume the practice of medicine.

18. Education This workgroup will be charged with determining how to respond to each physician’s educational needs through Web-based and live CME, shadowing, preceptorships, mini-residencies, and formal reentry programs. This group should also identify strategies to defray the costs of such training opportunities to make them affordable to the individual physician.

19. Licensure, Maintenance of Certification, and Credentialing One of the challenges of this workgroup will be to identify strategies to help physicians maintain their professional standing while they are absent from the workforce. It will also need to propose a process for physicians to regain their professional credentials if they lose them and wish to return to active clinical practice.

20. Workforce This workgroup will need to determine how the workforce is likely to be affected, and how to mobilize physicians into the workforce once they indicate a wish to return to practice. Additionally, the group should consider how to marshal workforce resources in innovative ways to respond to public health emergencies and emerging models of health care delivery.

21. Works-in-progress: Workforce survey  Random sample of 5000 physicians under 65 listed as inactive in the AMA Masterfile.  3 mailings, 1/4/08, 2/1/08, 3/11/08  1,515 valid surveys, 584 bad addresses  2,868 nonrespondents  34.6% response rate, as of 3/28/08  Data presented at June 2008 AMA-HOD Annual Meeting (Women Physicians Congress)

22. Reentry survey topics  Licensure and maintenance of board certification  Liability insurance  Financial need  Family responsibilities  Professional satisfaction  Work hours and professional responsibilities  Part-time practice  Retraining modalities

23. What do we hope to learn?  Reasons for physician exit and reentry  Incentives to encourage inactive physicians to return to medicine  Barriers to inactive physicians returning to medicine  Demographics of inactive physicians  Specialties most affected by physician exit and/or reentry  Retraining/educational needs of reentering physicians  Availability of opportunities and portals to reenter medicine

24. Works-in-Progress: Reentry Web page redesign  Redesign in March 2008 to mark transition from planning to implementation  Expansion of resources related to the work of the Project and its workgroups (internal)  Addition of resources for physicians seeking to reenter the workforce (external)  Showcase research initiatives

26. Other reentry products in development  Journal article on reentry data on pediatricians from joint AAP-AAMC Survey of Physicians over 50  Proposed joint AMA-AAP conference in fall 2008 on physician reentry issues  Abstracts and manuscript on reentry survey data planned for 2009

27. Visit us at www.aap.org/workforce

28. Contact the Division of Workforce & Medical Education Policy Holly J. Mulvey, MA Director Division of Workforce and Medical Education Policy American Academy of Pediatrics 141 Northwest Point Blvd. Elk Grove Village, IL 60007 hmulvey@aap.org 847.434.7915 847.434.8000 (fax) Ethan Alexander Jewett, MA Senior Health Policy Analyst Division of Workforce and Medical Education Policy American Academy of Pediatrics 141 Northwest Point Blvd. Elk Grove Village, IL 60007 ejewett@aap.org 847.434.7914 847.434.8000 (fax)