Concerns have been raised over the last several years about a current or impending physician workforce shortage within the United States [10–12]. The potential of inactive or retired physicians to fill a workforce gap has not yet been adequately explored. The cost of mobilizing this 'shadow workforce' of physicians, either in a long-term capacity or to respond to an acute health emergency (e.g. a bioterrorist attack, pandemic, or natural disaster), is likely to be significantly less than that of expanding medical school class sizes and residency training slots. It would also be more efficient, as the timeframe for a reentry training program (variable from program to program) is substantially shorter than for training new physicians from scratch. Reincorporating these physicians into the active workforce would allow the public to benefit from their clinical knowledge and experience and recuperate its financial investment in the initial training of these physicians.
In this study of inactive physicians younger than age 65, the average length of time away from medicine for reentered physicians was 4.3 years. However, over 60% of the currently inactive and retired physicians had been out of medicine 5 or more years, including a fifth to a quarter for more than 10 years. Less than a quarter of currently inactive physicians had firm plans to reenter. Over two thirds of retired physicians and 80% of inactive physicians kept at least one medical license, although this may be relatively easy to achieve as there are few states that require measures of clinical activity to maintain licensure .
Given the amount of time out of practice for some of these physicians, formal training in any reentry pathway, if so chosen, is critical. In the last 10 years, major developments in pharmacology, surgical procedures, medical technology, coding, patient privacy, quality improvement--to name just a few--have dramatically altered practice. Increasing demands from the public for documentation of competence will have to be addressed, particularly considering only 37.5% of reentered physicians reported having any retraining before returning to practice. Freed et al. found that pediatricians who had been clinically inactive were less likely compared to those who had been continuously active to agree that a formal reentry program be required after an absence of 2 years . Although this could be the result of over-confidence in one's ability, this could also reflect the difficulty of finding accessible programs. Formal reentry programs are few, and often present financial and geographical barriers, and may likely account for the low incidence of use among survey respondents. Live and online continuing medical education (CME) will, therefore, need to target the learning needs of inactive and reentering physicians and prepare them to face the challenges of a quickly evolving practice environment. An individualized plan to maintain professional credentials and relationships during inactivity, moreover, may help physicians who are thinking of leaving the workforce for an extended period to anticipate needs for CME, licensure, board certification, credentialing, networking, and other areas, so that they will be able to return to practice more easily.
A common perception among inactive physicians is that reentry to practice would be difficult. The actual experience may not be so, as a majority of respondents who had reentered did not find the process difficult. Easy access to information on how to return to practice, as well as guidance on how to maintain professional credentials during inactivity, may help to dispel the misconceptions of retired and inactive physicians. Free-response answers on the survey suggest that some inactive physicians perceive the health care system to be too complicated and inflexible to permit them to reenter.
The influence of family responsibilities on the decision to withdraw from clinical practice was particularly felt by female physicians in our study, as found by others . The ability to work part-time or with a flexible schedule was the reason most often cited for being able to reenter by those women who had, and was the most compelling factor that would lead currently inactive women to reenter. The same is true for male physicians, who more often stated they left clinical practice for personal health reasons. The importance of a reduced or flexible schedule for these physicians cannot be overstated. A full one quarter of inactive physicians is working in fields other than medicine, which may be the result of their dissatisfaction with the structure of the current health care system. The 'hassle factor' of practice, rising malpractice premiums, insufficient reimbursement, and professional dissatisfaction were frequently cited by retired and inactive physicians as reasons they left medicine; many of them are now working in areas that, presumably, do not have these negative characteristics. Fewer reentered physicians cited these characteristics as reasons they had initially left medicine. Physicians who choose to return may not have experienced as intensely the hassles of practice--thus their return--or alternatively, have rationalized their return by 'softening' the negative memories of their past practice experience. These physicians are working, on average, 40.6 hours a week, which for many physicians would be a part-time schedule. Such a practice arrangement may serve to reduce the 'pain' of the perceived 'hassles' of the past, and it is clearly more accommodating for those with conflicting family responsibilities. Addressing these structural issues would likely reduce the number of physicians who choose to become inactive in the first place.
Our response rate of 36.1% was low, yet not surprising. Our population of physicians - 'inactives' in the AMA's Physician Masterfile - conjures up a cohort of physicians not highly engaged in medicine, with a matching lack of interest in a survey about their inactivity. In addition, over 20% of initial respondents considered themselves active in medicine and had not taken a leave from medicine longer than 6 months, suggesting that there is room for interpretation as to what an inactive physician actually is. We do not generalize our findings to all inactive physicians, who are most likely a particularly nebulous group. We do hope that we have provided a useful start at describing a group of physicians who could be encouraged to stay active in the workforce.