By Bill O’Neill, Director of Outreach & Communications, Reentry to Clinical Practice Program, CPEP – The Center for Personalized Education for Physicians
“When a patient is newly covered by Medicaid, that doesn’t guarantee a primary care doctor will take them on – and they often end up coming to us. Our ER traffic increased 10% between 2013 and 2014.”
Chief Financial Officer of HCA-HealthONE and the HCA Continental Division
By now, the growing shortage of physicians in the United States has become common knowledge. “Geographic maldistribution” issues compound the problem. Some fortunate regions have an abundance of physicians, while others fall far short. HCA’s D’Argonne adds “The supply of physicians varies a lot depending upon the community. Lots of people want to move to Denver for the climate and lifestyle, so there really isn’t a noticeable shortage here. On the flip side, smaller cities without those advantages can face a very different situation.”
Changing Models, Changing Needs
The historical model of reimbursement in which incentives are aligned with increasing volume of procedures and services is fading fast. David Watson, Chief Medical Officer of the Centura Health Physician Group, comments, “Health systems are moving to managing population health in an ever increasing manner. Population health is best served at the primary care level and the supply of PCPs is insufficient to meet demand. The need to increase the number of providers, especially in the primary care field, is likely not going to stabilize for well over a decade.”
So what to do about these issues? Expanding the number of physicians by increasing the number of Medicare-supported residency programs may be an option, but federal budget scenarios are tight and developing new slots could take years. Working to grow the number of allied healthcare providers – PAs and NPs – can also help, but those providers are limited in the types of cases they manage.
Reentry Physicians as a Partial Solution
“Reentry physicians are like a ‘rapid deployment force’ – a relatively quick way to expand the number of practicing physicians when compared to expanding the medical school-residency-fellowship pipeline.”
President and CEO of the Colorado Hospital Association
“Reentry” applies only to clinicians who left practice voluntarily for two years or more due to a variety of reasons, such as family obligations, personal health reasons, alternate careers, or retirement, and wish to return to the workforce to practice in the same specialty. The term does not apply to those who left practice for disciplinary reasons.
A lot can happen in a physicians’ life – and in the medical world – while he or she is away from patient care. Physicians may be required to demonstrate competence in order to obtain a medical license or join a practice. The clinician may choose to participate in a formal reentry training program, such as the program offered by CPEP, or engage in a self-managed reentry process.
“The literature indicates there is often a gap between a physician’s opinion of his or her competence vs. the results of an objective, third-party assessment. Working with an established, structured assessment and education program may result in the best outcomes for reentry physicians their prospective employers, and most importantly their patients.”
Scott Kirby, M.D.
Medical Director, North Carolina Medical Board
There are a handful of formal reentry programs across the country providing evaluation and education services. The length, activities, and cost of these programs vary. Established in 2003, CPEP’s Reentry to Clinical Practice (RCP) program is one of the original programs in the field. Through the RCP Program, participants complete an educational needs assessment in clinical skills and medical knowledge and an educational plan is developed. These structured plans include focused study, precepted education, and resumption of clinical activities under gradually decreasing levels of oversight. Once the clinician successfully completes the Reentry Plan, they receive documentation from CPEP summarizing their reentry efforts and their preparation for independent practice.
While physician shortages are major problems that lack easy solutions, hospital systems and group practices should explore the potential benefits of hosting reentry physicians in a preceptor setting. These candidates are experienced, highly motivated clinicians who can provide significant economic benefit to their hosts while bringing much-needed services to the communities in which they live.
To download a copy of “The Roadmap to Reentry” developed by CPEP and the American Academy of Pediatrics, click here.
To access directories of structured reentry programs, visit the Physician Reentry to the Workforce Project website.
About CPEP and RCP
CPEP is a 501 (c)(3) organization that works to promote quality patient care and safety by enhancing the competence of physicians and other healthcare professionals in all 50 states from its offices in Denver, Colorado and Raleigh, North Carolina. CPEP’s RCP program has had a broad impact since its inception, with over 150 physicians from states enrolled in the Clinical Practice Reentry Program since 2003.