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Aug 16 2016

Easing challenges associated with reentering the practice of medicine

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Eleanor E. Greene, MD, MPH, and Karen Burke Haynes, MD

ARTICLE SUMMARY
    • Clinicians who seek relicensure after an extended break are often unaware of obstacles to reentry
    • Careful planning before inactivating the professional license can help ease reentry
    • NC reentry applicants are responsible for demonstrating competence to practice



Physician reentry into the workforce is a topic that has received greater attention in recent years, gaining recognition as an important workforce issue in 2002. Mark et al. defined reentry as “returning, after an extended absence, to the professional activity/ clinical practice for which one has been trained, certified or licensed.”

The past decade has seen a significant rise in the number of clinicians, both male and female, who have chosen to leave active practice for periods of time that often exceed two years. Reasons vary from starting a family, caring for elderly parents, burnout or personal health and wellness needs.

Clinicians who choose to cease active clinical practice are often unaware of the potential hurdles they may encounter when reentry into practice is attempted.

In North Carolina, physicians and physician assistants (PAs) who allow their professional licenses to lapse for a length of time greater than two years may face barriers to successful reinstatement. For some, the acquisition of hospital privileges and professional liability insurance coverage may not be assured without additional training or some other reentry activity. A review of the literature regarding the subject reveals a wide variation in the criteria used by state licensing boards regarding the length of time a medical professional is allowed to be inactive before reentry/fit for duty requirements apply.

Clinicians who are unaware of reentry policies are often blindsided by the significant requirements that typically must be met to obtain reinstatement of an inactive NC license or issuance of a new NC license and reestablish practice. Additionally, research in the area of performance after an absence from active patient care has established a decline in clinical skills that may impact patient outcomes. These facts suggest that maintaining fitness for duty during absence from active practice would be beneficial. This requires preparation and commitment to staying abreast of educational needs, changes in clinical practice and administrative requirements related to the reentry in one’s state of residence intended practice.

For approximately the past decade, NCMB’s practice was to work with individuals on a caseby- case basis to determine specific needs to be addressed upon reentering practice. This process typically resulted in a reentry program that involved the licensee securing a professional mentor and completing a phased reentry process that culminated with the reentry candidate practicing independently. In recent years, however, it became obvious to the Board that reentry candidates needed more attention and expertise than NCMB can provide. Administrative rule 21 NCAC 32B .1370 states the Board’s current reentry requirement and process.

Although NCMB no longer takes an active role in developing or directly supervising reentry programs, the Board has an interest in informing both inactive clinicians who are pondering reentry to active practice and licensees who may be considering a break about current expectations.

The American Academy of Pediatrics (AAP) and associated organizations have led the charge in better understanding the demographics of clinicians who choose to take time off from active practice and the obstacles to reentry they encounter. These organizations have also led the way in developing strategies for making the reentry process more attainable, and less stressful.

The authors recommend the Physician Reentry into the Workforce website sponsored by the AAP as an excellent resource. Practitioners can use this site to research the topic of reentry, educate themselves about developments and access tools for planning. Perhaps the most promising resource is the reentry portal developed for physicians. Topics covered include strategies for exiting practice, activities to pursue while out of practice, and information regarding the safe practice of medicine. While the needs of all subspecialties are not addressed with this tool, it is a valuable starting point.

NCMB recognizes that the current medical practice environment places great demands on clinicians, many of whom may value a season away from clinical care. If this is something you are considering, understand that planning and preparation will ease the pathway to reentry when you are ready to resume practice.


Current Reentry Rules
NCMB adopted administrative rule 21 NCAC 32B .1370 in March 2016. The rule sets out the Board’s expectations for clinicians seeking reentry to active clinical practice. The Board requires applicants who have not held an active license for two or more years to comply with the rule. Factors that may affect the length and scope of the reentry plan include:
    1. The applicant’s amount of time out of practice;
    2. The applicant’s prior intensity of practice;
    3. The reason for the interruption in practice;
    4. The applicant’s activities during the interruption in practice, including the amount of practice-relevant continuing medical education;
    5. The applicant’s previous and intended area(s) of practice;
    6. The skills required of the intended area(s) of practice;
    7. The amount of change in the intended area(s) of practice during the time the applicant has been out of continuous practice;
    8. The applicant’s number of years of graduate medical education;
    9. The number of years since the applicant completed graduate medical education; and
    10. As applicable, the date of the most recent ABMS, AOA or National Commission on Certification of Physician Assistant certification or recertification.

Source: 21 NCAC 32B .1370

Reentry Resources Online
Access information about reentry at www.ncmedboard.org/licensure/reentry

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