Physiatry Practice Management Resources

Medicine is no longer a straight-line career path.

Some doctors take time out to start a family; others try working in industry for a while; still others find themselves coming out of retirement when their investments don't provide the financial cushion they expected. Whatever the reason for the departure, more doctors are returning to practice after being away for years.

"Re-entry is a growing issue because the old patterns of medicine are breaking down," says Jesse Roberts, medical director of the North Carolina Medical Board. "Doctors aren't as fixed in their location as they used to be, or fixed in medicine for that matter. Increasing numbers of women have become physicians, and many take time off from practice to start families."

Getting back into the workplace after a hiatus entails planning, patience, and possibly putting yourself back into the role of student for a while.

We asked some doctors who'd taken time off to tell us about their re-entry experiences. We also asked for advice from licensing experts, state medical board representatives, and recruiters. Their major piece of advice is most helpful for those who are planning a stint away from practice: Never let your license lapse; you may change your mind.

"To reinstate a lapsed license, often you have to start the application process from scratch," says Jeffrey Sisk, president of the Internet-based job site, PhysicianWork. "State boards vary on their requirements for skills training and timing because there's no formalized national procedure, but in general the reinstatement process can be very lengthy." The licensure board typically has to verify your information and check out disciplinary actions. As for you, there may be letters of recommendation to provide, fees to pay, and numerous forms to fill out. It's also likely that you'll have to take one or more assessment tests and attend a retraining program or proctorship.

To keep your license current, you'll pay, on average, a couple hundred dollars a year and will more likely than not have to take CME courses, but it will probably be worth it if you want to return to practice.

The road back starts with the state board If you have let your license lapse, your first step in getting back into practice will be your state medical board. You'll find contact information for each state board at the Federation of State Medical Boards' Web site, www.fsmb.org

Most state boards require that a license be updated or renewed within a certain period after you first applied—typically 10 years; otherwise, they require you to take the Special Purpose Examination (SPEX) to determine your current competence.

SPEX is a computerized test with 400 multiple-choice questions that focus on broad-based knowledge central to clinical encounters and good practice. The content is organized by categories of clinical problems, not by specialty areas, and it emphasizes an individual's ability to recognize frequently mishandled problems, drug interactions, ethics, and procedures. "It's a stripped down version of the USMLE," says Dale Breaden, director of public affairs at the North Carolina Medical Board.

For a list of SPEX testing centers, see www.prometric.com . SPEX costs $800, and study guides can run from $500 to $2,000. For more information, call the Federation of State Medical Boards, 817-868-4041.

Can the test be waived? In some states, yes, if you're certified by the American Board of Medical Specialties within your state's time limit.

"The SPEX is the re-entering physician's biggest obstacle," says Nikoma Wolf, director of physician licensing for License STAT and Staff Care in Irving, TX, "especially for older doctors and for specialists because it covers generalized information that those doctors haven't thought about in years." For the doctor who's spent his career specializing in GI issues, for example, now he has to bone up on psychological testing, setting bones, and cardiac murmurs.

If you fail the SPEX, a few private companies offer refresher courses. Two of the better known are the UCSD Physician Assessment and Clinical Education (PACE) Program in San Diego and the Center for Personalized Education for Physicians, or CPEP, in Aurora, CO. "Our re-entry doctors are put up in inexpensive housing and make rounds with our staff," says William Norcross, PACE's founder. A two- to four-week training course for primary care doctors costs between $2,000 and $4,000.

CPEP is more extensive and is designed to help physicians become familiar with new technologies, drugs, protocols, and guidelines that may have changed significantly while they were away, says Elizabeth Korinek, executive director of CPEP. "We set up a process so they can safely transition back into clinical practice." The entire program—including books, online courses, and tapes—costs between $5,250 and $6,500 and takes about three months for a primary care doctor to complete. Physicians in certain specialties may need as much as six months.

Employers will be skeptical Getting an active license is only the first hurdle you'll have to clear before you can go back into practice.

"A hiatus is usually viewed with suspicion by anyone looking to hire you," says Daniel Stern, of Daniel Stern & Associates, a physician recruitment firm in Pittsburgh. "A prospective employer will probably launch an investigation into why you stopped practicing. Also, he needs to know if your skills are up to par."

To present yourself in the best light, your cover letter should indicate candidly that you've been out of practice for a period of time and why. "The more thoroughly your CV and cover letter detail your employment history, the better off you'll be," advises Nikoma Wolf.

To explain disparities, you might say something like, "You'll see on my CV that I've been away from medicine for more than three years. An automobile accident in December 2001 left my wife with debilitating, chronic injuries, rendering her unable to adequately care for our children. I resigned from the 10-physician family practice I had been with, and stayed at home to care for my family on a full-time basis. During that hiatus, I kept up licensing requirements and clinical reading, and my malpractice carrier put my policy on suspended status."

As on your cover letter and CV, be totally upfront during your interview, advises Jeff Sisk. Provide a full explanation of your hiatus at the outset.

"The reason for your being away is important," Sisk says. "If, indeed, it was to assist a severely ill or injured relative, you have a good chance of a compassionate reception. You'll have a tougher re-entry if you took time away from medicine to pursue a business endeavor or just because you wanted time away. In those instances, employers may doubt that you're serious about returning to practice permanently."

On the other hand, an employer will likely understand a short—less than a year—gap if you had a valid reason such as a family medical problem or personal illness.