Can I Return to Practice?

I often speak with physicians who have an extended absences from medical practice and wonder if returning to practice is their best career avenue. The answer to that question is that it depends. First, it depends on if that is what you really want to do, and second, it depends on the circumstances surrounding your absence and the amount of time you've been away. 

So, first, let's decide if this is what you really want to do or if you simply expect it to be an easy, "low impact," process. Only you can make that decision, but you do really need to ask yourself some hard questions that differentiate what you think you can do versus what you want to do. 

Next, let's consider the facts of returning to practice after a hiatus. Even small gaps in work can create questions, regardless of the validity of the explanation or reason. Most importantly, if you have been out of practice for two years or more, that timeframe becomes a significant disqualifier.  What I’ve consistently encountered is that after two years of practice absence a physician’s practice reentry is made very difficult, and each year thereafter simply compounds the challenges. While I do not know if this timeline is codified anywhere, it seems nearly universal in practice.

Next, did you leave practice voluntarily or based on licensure restrictions, terminations or other reasons not of your choosing? If so, you'll need to consider any impediments those past actions may place in from of you. And, you'll need to determine if they can be corrected and at what cost... cost in time, in effort and in emotional strength. 

So, regardless or the reasons for leaving or what you believe will be the process to return, I advise securing expert legal counsel with deep experience in physician licensing, credentialing, contracting and work-related issues.

That said, consistent issues I see returning physicians dealing with include:

  1. Med/Mal carriers are often reluctant to insure a physician with such an absence as they may be considered a greater risk. Check with your available carriers to determine their criteria.
  2. Medicare may not allow the physician to participate due to that gap in practice. Then couple that with the inability to obtain med/mal insurance. About all you can really do with Medicare is file for participation - unless in your practice you will elect to not accept Medicare.
  3. Medicare qualification is the basis for participation in other insurers. Therefore, commercial insurers may choose to follow Medicare’s lead. Check with insurers in your market and ask for a copy of their provider contracts.
  4. Obtaining hospital privileges depending on your specialty and expected range of practice.  Typical medical staff bylaws, as a basis, require the physician to have med/mal coverage and perhaps to be a participant in Medicare and other insurance programs. Check with the hospitals you're interested in and ask for a copy of the bylaws. Some are even published online.
  5. Next, to counter the previously noted issues, the physician may seek to participate in a physician re-entry program. An example of this is the Center for Personalized Education for Professionals in Colorado. This can be costly, can require multiple years and is contingent on several coordinating factors that may make implementation challenging. If you chose to follow a practice re-entry path, I would advise you to expect it to require several years and an expense likely between $10,000 and $20,000 and possibly more, and I would advise securing specialized legal guidance in the event some of the contradictory and or compounding occurrences noted above are encountered.
  6. Another “re-entry” avenue is to complete a new residency program or perhaps a fellowship program. However, few programs will accept a physician beyond the typical "resident age." The ROI economic equation of medical education/training is predicated on the physician providing many decades of practice in return for the cost of training. That simply doesn’t exist with someone beyond the typical age of a resident or fellow. So, if you're in your late 40's, 50's or 60's you'll want to check with many programs and try to establish some concrete assurances before making you re-entry plans. 

These are just some of the issues to process and to be aware of in considering returning to practice. The last issue is the medical board in your particular location. If you've relinquished your license, start reinstating it now. If you've maintained it, keep doing so. And, the same is to be said for your boards. The windows are closing for practice for non-board certified physicians. 

Regardless, if this is your interest, I'll be happy to discuss your objectives with you and share my experiences from addressing these issues with many, many physicians over the years.