Physician Reentry into the Workforce Ethan Alexander Jewett, MA Division of GME & Pediatric Workforce American Academy of Pediatrics Committee on Pediatric Education November 18, 2007

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.

Why is this issue important? Unmet patient need – underserved areas and anticipated public health crisis Many physicians leave medicine for a period of time Federal investment in GME – “Medicine is a public good.” A mechanism to bring more flexibility into the system (e.g the attractiveness of medicine as a career)

Who are the stakeholders? Federal/state governments Regulatory groups (state licensing boards) Federal agencies (Veteran’s Health Administration) 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

The Physician Reentry into the Workforce Project

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.

What are our assumptions? (cont.) 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.

Reentry into the Workforce Project Workgroups Assessment and Evaluation Education Licensure, Maintenance of Certification, and Credentialing Workforce

Education Workgroup Activities Learner’s Bill of Rights for physician reentry programming Critical elements for physician reentry programming Needs assessment Education Evaluation Online clearinghouse of reentry programs/educational offerings Accreditation and standards for reentry programs

Joan F. Giambalvo Memorial Scholarship Fund Award Established by the AMA Women Physicians Congress to support health services research on professional issues related to women in medicine. Ethan Alexander Jewett, MA Senior Health Policy Analyst American Academy of Pediatrics Physician Reentry Into Clinical Practice

Research Proposal This research project will query a random sample of physicians on several issues related to physician reentry. The sample will consist of 5000 physicians under 65 who are listed in the AMA Masterfile as clinically inactive. It will include physicians in all specialties. It is hypothesized that many physicians wish to return to the workforce, but are prevented because of the absence of structured and affordable reentry training programs.

Structure of Survey Physicians not currently active in medicine Physicians currently active in medicine (includes clinical practice, research, teaching, and administration) Physician demographics (i.e., age, gender, marital status, dependents, race/ethnicity, health status, financial status, USMG/IMG, education, specialty/subspecialty.

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

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

Partnership with the American Medical Association Resolution 316 passed at House of Delegates (A-06) RESOLVED, That our American Medical Association, in collaboration with appropriate state and specialty societies, the Accreditation Council on Graduate Medical Education, and the American Board of Medical Specialties, study the issue of physician re-entry into practice, after a leave of absence from practice, or a limitation of certain aspects of practice, including a consideration of issues related to retraining, certification, and credentialing (Directive to Take Action); and be it further RESOLVED, That the proposed AMA study on physician re-entry into practice also assess the overall impact of re-entry issues on the physician workforce. (Directive to Take Action)

Partnership with the American Medical Association (cont.) Guiding Principles for AMA Council on Medical Education Report (in response to Resolution 316) Survey on Physician Reentry into the Workforce AMA-AAP Joint Conference on Physician Reentry into the Workforce (projected for fall 2008) – topic likely to be on overcoming barriers to licensing, credentialing and maintenance of certification.