1. Characteristics of Arizona Physicians Reentering Clinical Practice 2003 - 2006 Mary Ellen Rimsza, MD FAAP Physician Reentry into the Workforce Conference September 10, 2008 Do not copy or distribute without consent from The Physician Reentry into the Workforce Project

2. Characteristics of the Arizona Physician Workforce Low physician to population ratio (219/100,000) Disparate Urban/Rural Distribution) Only 11% of practicing physicians attended medical school in Arizona Only 17% of practicing physicians completed residency training in Arizona Shortage of about 2,200 Physicians

3. Arizona Physician Workforce Database Licensure Data from Arizona Allopathic and Osteopathic Boards (from 1992-present)  100% return rate  Includes specialty, education, demographics, and practice location  Licensure is done every two years Surveys included with licensure application  80% + return rate  Includes practice characteristics, work hours  Completed every two years

4. Study Methodology Determined number of patients seen per week for each physician using survey data from 2003-2006 Not in Clinical Practice: had active license, but reported no patient care in either survey Reentered Practice: reported no patient care in first survey and some patient care in second survey

5. Results 13,215 physicians had active license and practiced in Arizona in 2005  274 physicians not in clinical practice for both surveys  604 physicians reentered practice  95 physicians left clinical practice but maintained an active license

6. Characteristics of Physicians Reentering Practice Majority of reentering physicians (75%) were men Majority of reentering physicians (83%) attended U.S. Medical School 85% practiced in urban areas

7. Comparison of Physicians Reentering Practice with Total Physician Population *Active, Arizona Physicians as of 12/31/2005 ** Active (any state,) as of 12/31/2006

8. Specialty Changes of Physicians Reentering Practice

9. 63 Specialty Changers: A Closer Look

10. Characteristics of Physicians who Changed Specialty 85% practiced in urban area 27% Female Mean age: 50.53 84% US Medical School Graduates

11. Characteristics of Physicians who Changed Specialty 21% (13/62) had at least one malpractice settlement or judgment 16% (10/62) had at least one licensing board action

12. Characteristics of Physicians who Changed Specialty Malpractice Settlements  10/62 had one settlement  0/62 had two settlements  3/62 had 3 or more settlements Board Actions  5/62 had one board action  2/62 had two board actions  2/62 had 3 or more board actions

13. Discussion Only a small number of physicians who leave and reenter practice may have done so due to board action Physicians who reenter continue to practice in communities of similar size to their previous practice Reentry results in an increase in primary care physicians and a decrease in surgical specialties

14. Conclusion There is a large “shadow workforce” of physicians The number of physicians who leave and reenter practice is substantial and could reduce the current physician shortage The reasons why physicians leave practice and subsequently reenter practice requires further study