Physician Re-entry: Challenges and Considerations

In response to unprecedented patient volumes amidst the COVID-19 crisis, regulatory agencies around the world have called for additional healthcare workers to bolster the medical workforce [1]. Physician re-entry is one avenue for doing so. Many retired physicians have re-entered clinical practice to increase the physician labor supply in the fight against COVID-19 [2]. 

Currently, there is no national policy regarding the context and requirements for physician re-entry into the medical workforce [4]. Ultimately, state medical boards, specialty medical boards, and local institutions govern the decision to allow a physician to re-enter clinical practice [4]. Only six medical specialties sponsor formal physician re-entry programs as an avenue for physicians who have left medicine in good standing to return to clinical practice [4]. A few specialties, like obstetrics-gynecology and anesthesiology, provide individualized, supervised clinical experiences to allow for successful re-entry [4]. Most medical specialties do not require the completion of a formal re-entry program [4]. An estimated 10,000 physicians are approved to re-enter practice each year [4]. The majority of physicians seeking re-entry do not pursue additional training, especially if not required by state or medical specialty boards [4]. 

The rapid licensure of retired physicians due to the COVID-19 pandemic has received significant media attention [3]. In the United States, a growing number of states have waived or expedited licensure for inactive or retired medical licensees [1]. In New York alone, over 40,000 retired physicians have returned voluntarily to the medical workforce [5]. A diverse range of measures has been implemented to recruit former physicians, including pro-bono license reinstatement [1]. Some states have proactively implemented restrictions in order to regulate this sudden expansion in the medical workforce [1]. Strategies include retired physicians working under a delegation or service agreement with a licensed supervisor and time-limited licenses related to the pandemic [1]. 

However, this trend is tied to significant ethical dilemmas [3]. The risks to older physicians re-entering practice from retirement is substantial [3]. Healthcare workers are more at risk for infection than the general public [3]. They are on the frontlines of the pandemic, working with patients who have, on average, more severe COVID-19 illness [3]. Patients with higher viral loads also transmit the virus for longer periods of time [3]. Additionally, social distancing of 6 feet or more is often challenging in the hospital setting [3].  COVID-19 infection poses a serious threat to the older population, with age being the most consistent risk factor for poor outcomes [2]. While only 6% of infected healthcare workers are 65 years old or older, they represent 37% of deaths [2]. The case-fatality rate of COVD-19 increases with age, often doubling or quadrupling when comparing those in their 60s to those in their 70s [2]. One study reported that the median age of physicians who died after contracting COVD-19 was 66 [2]. 

Moreover, with the urgent calls for help and fast-tracking of medical licensure, recently re-entered physicians may be rushed into situations for which they lack adequate training [2]. The greatest need for healthcare personnel has been in critical care and emergency medicine, yet only a fraction of volunteers has come from these specialties [2]. 

The enthusiastic response to volunteer amongst retired physicians has certainly helped with COVID-19 efforts [2]. However, it is important that health departments carefully consider how to best protect and preserve their workforce, with special consideration for older healthcare personnel [6]. When possible, hospitals and other organizations should emphasize roles with less risk of COVID-19 exposure [6]. These roles may include consulting with younger staff, advising on the use of resources, speaking with the families of patients, and interacting with public and community health organizations [6]. 

References 

1. Peisah, C., Hockey, P., Benbow, S., & Williams, B. (2020). Just when I thought I was out, they pull me back in: the older physician in the COVID-19 pandemic. International Psychogeriatrics, 32(10), 1211-1215. doi:10.1017/s1041610220000599 

2. Sabath, B., & Colt, H. (2020). Sending retirees to the frontlines?. Journal of Community Hospital Internal Medicine Perspectives, 10(5), 386-388. doi:10.1080/20009666.2020.1804226 

3. Ruhnke, G. (2020). Physician Supply During the Coronavirus Disease 2019 (COVID-19) Crisis: The Role of Hazard Pay. Journal of General Internal Medicine, 35(8), 2433-2434. doi:10.1007/s11606-020-05931-x 

4. Guth, T., Luber, S., Marcolini, E., & Lo, B. (2020). Physician reentry–A timely topic for emergency medicine. Journal of The American College of Emergency Physicians Open, 1(6), 1614-1622. doi:10.1002/emp2.12317 

5. Randolph, G. (2020). One Virus, Undivided … Equity, And the Corona Virus. Laryngoscope Investigative Otolaryngology, 5(3), 586-589. doi:10.1002/lio2.398 

6. Buerhaus, P., Auerbach, D., & Staiger, D. (2020). Older Clinicians and the Surge in Novel Coronavirus Disease 2019 (COVID-19). JAMA. doi:10.1001/jama.2020.4978