Reentry physician

Retraining begins

As of this month, I have formally started upon the clinical retraining plan which was drawn up for me over a year ago by the organization which performed my clinical competency examination. The first stage of this plan involves me essentially being an apprentice to a practicing internist. Which seems to be going fine, even though I am very slow at charting now because of having to learn the EHR software. (For instance, tracking down the results of a patient's prior diagnostic study can involve searching 90 different folders spread across 3 separate tabs—and that is just the section for prior diagnostics!)

Also: now, instead of dictating one complete note to a medical transcriptionist as in times past, I have become the transcriptionist, typing separate notes (one for HPI, one for assessment & plan) into the system. All else is generated by dropdown menus and checkboxes, the navigating of which I find very tedious indeed. Apparently, in this medical world I have returned to, the medical transcriptionists are now out of jobs; the physicians transcribe their own notes at no extra pay; and I guess the transcriptionists' former salaries are now paid out to the EHR vendor for use of the software? Pretty neat trick, that. I, for one, miss dictating a coherent narrative. Taking this away seems to also take away part of my diagnostic thought process, and unfortunately this is in no way made up for by the abundant menus and checkboxes. Still, I realize I must adjust to this new way of managing information, because the system will certainly not adjust to me.

Speaking of diagnostic thought process, I am finding that all the basics are still with me but my fingertip knowledge is sometimes lacking. Here is where being apprentice to the good doctor really benefits me, because she is bringing me up-to-date on all the latest. Quinine sulfate is no longer used for leg cramps and is now off the market in this country? Who knew? These are the sorts of factoids I need to add to working memory now.

Of course, starting retraining has brought new expenses: I have just paid out in excess of 5K for a one-year malpractice policy. Also, I must pay the monitoring organization $650 monthly until they tell me it is time to stop. As usual with this reentry process, it remains to be seen which is going to happen first: I reenter medicine as a practicing physician OR my resources run out before I reach that point. I have a feeling it is going to be a near-run thing in the end. Stay tuned.

 

Could not have said it better my own self

The High Cost of a Return to Medicine

A shadow of my former self

After more than a year of earnest searching, I have found a local internal medicine physician to shadow. Henceforth in this chronicle, I shall refer to this godsent physician as "the good doctor" because truly she is so to me.

Obviously, this is a very big deal, because having such a mentor is a key requirement of my reentry plan. At this point, I have completed every reentry educational task which I could do on my own; from this point on, reentry requires active motivated assistance from another physician or physicians (I know, before I said it took only one—but more on this particular point later). 

In the end, I made this very important contact through pure chance: my aunt's next-door neighbor, a retired physician, graciously agreed to speak to his former colleagues on my behalf. He actually went in person and spoke with them face-to-face. Without this kind act, I am quite certain that I would still be out there knocking on doors, looking for a preceptor (and being politely refused).

Because making this connection has been such a big deal for me, I find myself reluctant to share too many details just yet. I am shadowing an internist in the outpatient setting. For the most part, the internal medicine office environment has not changed: there are the MAs who run things and really know what is going on—kind of like sergeants in the army; the LPNs who work the phones and deal with prescriptions. There are still patients and appointments, though it looks like pretty much everyone gets a 20-minute slot these days. There are still folks who are sick and folks who are well, not to mention folks who are well but worried and folks who are unwell and not worried enough. The biggest change is the intrusion of the computer into the examination room: every piece of data goes into the EHR now, and mostly this data is being input concurrently with the patient's visit. The steepest learning curve I have right now is not learning how to prescribe the newer diabetes medications, but rather learning the EHR software—which is complicated and clugy—requiring much in the way of mouse use and scrolling, and amazingly cannot accommodate a Dvorak typist like me. (Note to future EHR designers: some of us physicians type Dvorak!)

Every patient I see when I shadow the good doctor knows that I am a reentering physician and has explicitly agreed to let me tag along. Some even ask me about reentry, not because they are worried about my capabilities, but rather because they seem genuinely interested. So far, everyone at this particular practice has been extremely nice to me, including even the patients. I could not have asked for a better place to become the shadow of my former self.

 

 

More reentry tasks: OSHA and HIPAA training

Here are two fairly simple and relatively inexpensive physician reentry tasks:

• Complete a HIPAA training course. I just did this one online.
• Complete OSHA training for the healthcare provider, either online or at a local in-person course. I have arranged to sit in on one of these classes locally.

Both of these certifications will be required of you before you proceed to any sort of clinical retraining scenario, and, unlike DEA registration and NPI sign-up, you do not have to provide a practice address (which since you are reentering you most likely do not have) to be able to obtain these certificates.

Certified again

I found out yesterday that I passed the ABIM MOC examination. Getting the results took almost 8 weeks?! Not sure what is up with that. I mean, it was a computer-based standardized test.

It is good to know that my multiple-choice-test-taking ability is intact, even though I have not practiced medicine in 14 years. For me, the taking and passing of the MOC examination is very much form without substance, because being "certified" again is basically meaningless unless I can find a preceptor who will help update me on the clinical end of things. 

So at this point in the reentry process, I am licensed again and now certified again too. I have spent over 10K on professional testing alone, which actually represents the largest chunk of reentry expenses so far. Dr. Wes has opened my eyes on just how revenue-enhancing professional testing is for certain entities. It is amazing how much folks can and do charge for providing form without much substance. Reentry physicians especially need to be aware of this, because they will likely be taking and paying for at least two clinical competency examinations (one on the front end of training and one on the back end) as well as the MOC examination.

I am glad I passed the examination, but then again I have always done well on multiple choice tests. Passing this test does not mean that I am a good doctor and it does not mean that I am good to go in terms of practicing right now. Until my "certified" is backed up with some recent clinical experience, it is form without substance.

Work in progress...

It has been a while since I posted anything here! My reentry to medicine continues to be a work in progress, a real-life Fool's Journey. At this point, almost a year into the process, I have learned to expect that nothing will happen quickly. Also, the very devil is in the details of reentry each step of the way. 

Here are some things I have discovered since my last post:

• My state's medical school is not in a position to help me with any aspect of my reentry education or training. According to them, they would have to change the university's bylaws in order to accommodate someone like me. In their eyes, I am beyond the pale. At least they took the time to meet with me and discuss the matter, and at least they were polite in their refusal. But at this point it is fair to say the academy has no interest in reentering physicians.
• Taking the ABIM MOC examination without benefit of recent clinical experience may not have been the best idea ever. I took the exam a couple of weeks ago, after 6 months of intensive studying to the test (MKSAP), including a formal review course (ACP). I experienced the examination as long and hard. There were many questions at which I had to guess. My brain was fried at the end of it. I was glad I had practiced doing questions on the computer and in my head without benefit of writing materials, because the magic marker and high-gloss "paper" provided during the test was completely inadequate for writing anything down. I will not know the results of the exam for some weeks yet, but I have already decided that if I did not pass, I will not attempt it again without some recent clinical experience.
• The New England Journal of Medicine is not as well written as it used to be, say 15 years ago. I used to enjoy reading it cover to cover, and now I find it painful. I have to take it in short bursts, because the very text has become chopped up and offensive to my reader's eye. Particularly annoying is trying to get meaningful information out of printed laboratory data, which is published in a "value in units (another value in a different set of units)" format. Imagine multiple sets of these in the same paragraph of text. Ugh. 
• In my opinion, the Journal of the American Medical Association needs to put the art back on its cover. How very bland and unappealing it is now! Perhaps it is reflecting the current state of the profession and/or the AMA? 
• Whither preceptorship? This is the $64,000 question at the moment. Without a willing preceptor, my Fool's Journey may come to an abrupt end. It will be interesting to see if I can locate one before my resources run out. Fortunately, I have some help on this.
• Speaking of resources, I just tallied up my reentry expenses and they stand at around 14K at the moment. This figure does not include lost income due to unemployment since last July. To reenter medicine in my case has required a period of long limbo. If one does not embrace the uncertainty and play the Fool, one will probably not succeed.

Reentry quote

Do not go where the path may lead, go instead where there is no path and leave a trail.

Ralph Waldo Emerson

Other reenterers

Here's an article from the New York Times yesterday. Apparently other professional women besides physicians do reentries too! The website mentioned in the article, iRelaunch.com, looks very interesting and I am going to have to check it out in depth.

Bringing myself up to date

I was so pleased last week to discover that UpToDate finally created a month-to-month subscription option for $45 monthly. This allows me, an unemployed reentry physician, to avail myself of updated clinical information without having to plunk down $499 in one fell swoop for an annual subscription.

So far, it appears that UpToDate can take the place of the massive textbook and journal library that I used to maintain back in the day. Having the information available digitally also frees up all that space on my bookshelves (which will allow me to fill that space with non-medical texts, but that is a different story entirely and has nothing whatsoever to do with reentry or even with medicine...)

It should not have surprised me that UpToDate was conceived by Burton David Rose. I have never met this physician, but he is one of my clinical and intellectual heros because he writes textbooks that one can actually sit down and read. As any reader of medical textbooks knows, it is a rare thing for a medical author to be able to convey necessary information and also write readable prose. 

If you are a reentry physician, I do recommend obtaining an UpToDate subscription sooner rather than later in the reentry process. It is going to help not only with your reeducation, but also with retraining if you are lucky enough to get to that point.

Who wants to be a preceptor? (Colorado)

The Colorado Rural Health Center has taken a serious interest in reentry physician training. This is a promising development for all Colorado reentry docs!

Wanna be a preceptor and help reduce the primary care shortage in Colorado? Here's your chance. Check it out.