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Re-entry to Physician Workforce Problematic

In the monthly GME e-Letter, we often reference reports of current or predicted physician workforce shortages, particularly in primary care. In response, we received the following e-mail from Rosalyn Carson-DeWitt, MD, who finds it ironic that “there are no viable reentry paths for physicians who graduate from medical school, take a hiatus from medicine, and then wish to return.”

(Note: The Council on Medical Education has drafted a report on physician reentry, for discussion at the June meeting of the AMA House of Delegates. In addition, the American Academy of Pediatrics has developed the Physician Reentry into the Workforce Project.

I would like to comment on the many articles I have read that warn of a domestic and global physician shortage, specifically in primary care areas. These articles all cite the decreasing number of medical students who are choosing to pursue primary care, the small number of residency graduates who are interested in working in physician-shortage areas, and the expected increases in need for medical care based on an aging population in the United States. Other articles have projected a potentially severe and sudden shortage of available physicians in the event that a US national health insurance program puts medical care within the financial reach of large numbers of the population who have previously been unable to access care.

I realize that I speak for a small minority of people – maybe just for myself, in fact – but I would like to call to your attention to the problem of physician reentry. There are no viable reentry paths for physicians who graduate from medical school, take a hiatus from medicine, and then wish to return. I have read articles and seen the notes from conferences that give lip service to this problem, and have read articles predicting that increasing numbers of (mostly) women who take time to care for their families will be in this position, but there seems to be little practical action undertaken to devise a pathway for medical school graduates in this situation.

In my case, I graduated from medical school in 1991 and took time off to have a family. During my time away from clinical medicine, I have stayed abreast of medical information by developing what I thought would be a temporary career in medical writing, with a couple of thousand publications in my name. Four daughters later, and after a long stint of caring for my mother who struggled with inflammatory breast cancer for over 10 years, I am extremely interested in returning to medical training, either in family medicine or pediatrics. However, doors are being slammed in my face at every turn. Apparently, being away from medicine for as long as I have leaves me with essentially no options for returning. Most residency training programs require that an applicant have graduated from medical school within the previous two to five years, and there are no avenues for those of us who would like to apply for a residency when that timeframe has expired.

While I realize that I alone could not shoulder the burden of increased need for primary care physicians (!), it is an irony to me every time I read an article trumpeting the need for primary care doctors and compare it with my experience of being prevented from returning to the profession I always dreamed that I would be able to practice.