Medical Staff

Growing need for physician retaining programs

Medical Staff Affairs Monthly, June 18, 2007

We are entering the hot months of the year and it reminds me that summer school is traditionally a time and a place for remedial education. This, in turn, leads me to reflect on the growing need for retraining programs for physicians who are many years or even decades past the completion of their residency programs. This training may be needed due to a leave of absence from practice, a career detour away from clinical activity, or because some set of clinical skills needs to be refreshed and strengthened. Hospitals have few resources to turn to when they want to help a medical staff member overcome clinical deficits or refresh faded skills. However, this situation may be improving.

Last year, 22 physician organizations created a national working group to look at barriers that keep physicians from re-entering the workforce once they have left. As they consider ways to overcome these obstacles, they will hopefully urge expansion of formal re-training programs.

The AMA is working on a report on this subject for release in 2008. Meanwhile, there are some excellent models of re-education programs springing up across the nation. For example, Oregon physicians looking to re-enter active practice can get help at the Interinstitutional Physician Training Program at the Oregon Health and Sciences University in Portland. This effort places doctors for two to three months into individualized fellowships that are integrated into the university's graduate medical education programs. In Pennsylvania, the Drexel University College of Medicine has begun to offer physician refresher courses in areas such as internal medicine, pediatrics, surgery, and ob-gyn. One of the most experienced such programs is located in Denver where the Center for Personalized Education for Physicians has been at this work since 2003.

As the physician shortage in America continues to worsen in the years ahead, hospitals and their communities will certainly want all available and willing doctors to be providing local medical care. Assisting failing doctors or helping physicians re-enter the clinical workforce will provide needed physician manpower. Hospitals will want to keep close tabs on the growing number of re-training opportunities and may want to consider collaborative arrangements with medical schools and teaching hospitals to further enhance the available resources.Hospitals will also want to keep abreast of the burgeoning availability of simulation tools for training and re-training. In many cases, education using simulation technology will become fairly easy to implement locally, without having to send physicians to distant sites to improve critical skills. For those interested in where this technology is going, I recommend that you read through a special report on simulation-based training in the August 2006 CRICO/RMF* Forum at http://www.rmf.harvard.edu/files/documents/Forum_V24N2.pdf

Sometimes collegial efforts to improve doctors' skills aren't sufficient and they lose their medical licenses or have formal sanctions imposed by a state medical board. Research shows that 88% of physicians who were so disciplined in 2006 held licenses in two or more states. In today's mobile society, medical staffs must be careful not to harbor physicians who have lost their licenses elsewhere. And with more and more practitioners of telemedicine, some practitioners have licenses in dozens of states.
A valuable preventive tool has been the Disciplinary Alert Service of the Federation of State Medical Boards. The service alerts medical boards by e-mail within 24 to 48 hours when one of their licensees is disciplined in another state. It is becoming more common to see state boards take reciprocal actions against the licenses of those disciplined elsewhere. Learn if your state board participates in this valuable service. Meanwhile, The National Practitioner Data Bank launched its Proactive Disclosure Service on April 30. This enhancement to the NPDB will notify hospitals, health plans and other subscribers within one business day when the data bank gets a report on a physician or other practitioner. Reports include board discipline, malpractice payments, and professional society actions. Credentials committees and MECs will have to be prepared to act promptly to consider the implications when such data comes their way.

Fortunately, only a minority of physicians will need re-training or be subject to formal discipline. But hospitals and medical staffs should be ready to act when necessary.

Best regards,
Todd Sagin
National Medical Director
The Greeley Company

* CRICO/RMF is the patient safety and medical malpractice company owned by and serving the Harvard medical community since 1976.

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