| Returning to Practice |
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Page 2 of 2 It's easy to see why potential employers ask for assurances, Sisk says: "It's an expensive proposition for a practice to bring in a new physician—what with relocation fees, signing bonuses, malpractice insurance, and recruiting fees—so they're looking to hire physicians who are likely to stay awhile." Your insurability may take a hit David Sousa, senior vice president and general counsel at Medical Mutual Insurance Company of North Carolina, says that over the past 12 months there's been a spike in liability insurance requests from doctors re-entering practice. One such physician, a surgeon, had canceled his policy to take a job as medical director for a small rural hospital. After four years as an administrator, he wanted to do outpatient care. Only after it had verification that the doctor had gone through a proctorship program did physician-owned Medical Mutual take on his risk. "Taking time off from practice for more than a year most definitely affects your insurability," Sousa says, "so some type of formalized retraining program is needed." What about family leave, or health matters, or burnout? "It depends on the circumstances," says Sousa. "We'll offer a suspension if the doctor is certain to return within a year." His advice: "Never walk away from a practice without making some insurance arrangement—purchasing tail coverage or arranging for a temporary suspension of your policy—so there's never a lapse in coverage." Call your insurer and speak to the underwriter directly responsible for your account. And make that call well in advance of your return to practice so you have time to file a lot of forms. If you've been away from practice and intend to join a group, the group might be unable to cover you unless its partners are willing to pick up extra coverage or buy tail coverage from your former carrier. Consider taking locum tenens work. "It not only boosts your CV," advises Sisk, "there's a chance your temporary employer may hire you full time." In many cases, the locum tenens company provides malpractice insurance. The contacts you make as a locum may come in handy. Just ask Karen Winter, an FP in Elyria, OH, who took two years away from her practice to care for her husband during a major illness, and their three children. "When I indicated that I was ready to return full time, the credentialing organizations asked for letters of recommendation from physicians who'd worked with me specifically within the past year," says Winter. "Fortunately, I'm doing an extended locum assignment, and the physicians I work with there will be able to provide me with the necessary letters." Boards look to standardize Warren Wolfe retired to Fredericksburg, VA more than a year ago after 40 years in family practice in Cherry Hill, NJ. But after a short time he decided to "get back in the saddle." "My New Jersey license was still valid, but when I applied for a job, they gave me more than 25 pages of forms to fill out," he says. "It wasn't enough that I produced a three-page document from the American Osteopathic Association attesting that I've met all its credentialing requirements. I had to get a letter from my previous liability carrier stating that there were no judgments against me. "It'll be at least another month before I can start practice again, and then only part time. There has to be a way to handle re-entry without all the hassle." State medical board members aren't without sympathy. Jesse Roberts is chair of a new subcommittee of the North Carolina Medical Board whose goal it is to come up with a formalized plan for re-entry. "First we need to define which doctors qualify as re-entrants," says Roberts. "How long must a physician be away? When does a hiatus become so long that patient safety is at stake? What evaluation tests and remediation program does that doctor require?" William Roeder, executive director of the New Jersey State Board of Medical Examiners, says that in his state, "license reinstatement is not a cookie-cutter system. Every application is treated on a case-by-case basis. We look at the amount of time the doctor's been away and the CME courses he's been taking." The credentials committee may require the re-entering doctor to take a formalized CPEP program or work in a supervised setting for a time. Saralyn Mark, senior medical adviser to the Office on Women's Health within the US Department of Health and Human Services and an assistant clinical professor of internal medicine and ob/gyn at Yale University School of Medicine, is working on formalizing the re-entry process. "If such a program is ever to be federally supported," she says, "it will need to have a core set of standards and practices that would have to be met—a comprehensive preassessment of physician skills, curricula that could be individually tailored, and a standardized examination of core competencies. That would ensure that physicians who successfully completed these programs would have the skills necessary to provide safe and quality care and be eligible and competent for licensing and board certification."
Written by: Dorothy L. Pennachio Resources for re-entry
Accreditation Council for Graduate Medical Education
American Board of Medical Specialties
CPEP (Center for Personalized Education for Physicians)
Federation of State Medical Boards of the United States
National Board of Medical Examiners
National Board of Osteopathic Medical Examiners
PACE (Physician Assessment and Clinical Education) Program
United States Medical Licensing Examination |
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