Returning to Practice After Taking a Break From Clinical Medicine: A Physician’s Guide to Time Off
- Nisha Mehta, MD
- Mar 1
- 11 min read
Taking a break from clinical medicine - whether for personal health or family reasons, burnout, relocation, to raise children, or for other professional or personal pursuits - is something that many doctors consider doing at some point during their career. However, it can be overwhelming and challenging to transition back into clinical practice after a significant period of time off. Many members in our physician communities have questions about how their clinical skills will hold up during their time away, potential future issues with the job search, licensing, or credentialing, how they’ll manage finances during that time, or if taking a clinical break is even a possibility. As such, we’ve compiled some resources and experiences from the community to help you navigate the decision to take a break, things to be mindful of, and guidance about how to pursue re-entry into the clinical workforce.
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Acknowledging the Challenges of Taking a Break From Clinical Medicine
While there are many completely understandable reasons why physicians may want to take time off from practicing medicine, the nature of the field and the requirements to maintain your ability to practice render large breaks from clinical work challenging. Therefore, it’s very important to be aware of what the roadblocks may be when planning your absence and do your best to avoid them if your intention is to return to clinical work eventually.
Not only is there a stigma amongst employers against physicians that have taken substantial periods of time off, there may be hurdles to licensing and credentialing if requirements and clinical skills are not maintained during the time away. Even if these weren’t an issue, many physicians report self-doubt when re-entering clinical practice, and imposter syndrome can be very real. While we all hope that our skills are like riding a bike and will return once we’re back in the setting, this isn’t always the case in fields where standards of care change rapidly or where procedural skills can get rusty.
There’s also the emotional factor involved in making the decision to leave medicine, whether it be guilt about abandoning patients or colleagues, worries about the family’s financial situation, or fear of what other colleagues may say about their decision.
The challenges of actually returning can also be difficult to navigate. Re-entry may require letters of recommendation, numerous forms, and fees depending on how long you’ve been away. In a situation where there is a very large gap in years practicing, there may be a need to retake board examinations, undergo a retraining program, and/or find a physician colleague to supervise you.
What Counts as a Substantial Break From Clinical Medicine?
Unfortunately, this varies a lot from state to state and from specialty to specialty. There is no one uniform answer about how much time off will be an issue, although most members on our physician community recommend keeping breaks to less than 6 months to reliably avoid issues with re-entry. This is because most licensing and credentialing applications will ask you to explain gaps greater than 6 months. An older survey from the AMA in 2010 stated that 51% of medical boards have a policy on physician re-entry, that 2.8 years is the average length of time out of practice after which state medical boards require reentering physicians to complete a re-entry program (range is from 1 – 10 years), that 55% of medical boards without a physician re-entry policy were either currently developing or planning to develop a re-entry policy, and that 92% of medical boards do not require a physician to engage in a certain amount of patient
care for relicensure.
Many specialty medical societies and state medical boards now have information on re-entry on their websites, so look up those specific to you or contact them to see if there are any formal guidelines so you can plan accordingly.
Key Barriers to Re-Entry After Time off From Clinical Medicine
In the United States, the following barriers for return to practice are often reported:
Need to explain clinical gaps on licensing and credentialing
Maintenance of certification requirements and lapsed board certifications
Lack of information or availability of re-entry programs
The costs of re-entry programs, with most programs costing in the five figure range
Difficulty finding preceptors for the practice based component of re-entry
The costs of re-doing board exams, both financial and in terms of opportunity cost
Difficulty with malpractice coverage
Different state to state and specialty requirements and guidelines about time off
Stigma associated with taking time off in the job market
Planning Ahead for Your Break From Clinical Medicine
Notify Your Job as Soon as Possible
Depending on your reason for taking a break, this may or may not be possible, but in general, the best way to avoid burning bridges as well as the potential legal and financial consequences of breaking a contract is to give advanced notice to your job. Review our Physicians Guide to Leaving or Quitting Your Job before resigning. Leaving on good terms with your job will keep doors open in the future both at the current job as well as in getting you necessary paperwork and references upon your return.
Maintain Your Network
Do your best to stay in contact with former coworkers and mentors to keep your network alive and if possible, secure written references before you leave.
Keep Up Your Continuing Medical Education
If you intend on returning to clinical practice in the future, it’s important to stay on top of your continuing medical education. Make sure you have the required number of CMEs to keep your license current and stay up to date on the current research and best practices in your field. Keep meticulous records of any CME or clinical practice like locums or per diem work done during your career break.
Budget for Your Absence and Re-Entry
Before you leave, understand what your plans are for financing your break. If you’re part of a dual income family, this may be less of a concern, but nonetheless, check how the lack of your income will affect budgets and ensure that you plan for necessary reduction of expenses or other sources of income as necessary. Re-entry to the field can also pose a financial burden. Put money aside before taking your break to go towards your licensing fees, CMEs, potential re-entry program, and time you will be without work that you may not have budgeted for. Be conservative in planning your savings needs throughout the process as it could take longer than you plan to get a job post-break.
Know Your State and Specialty Requirements for Longer Clinical Breaks
Investigate the specific regulations of your own state and specialty. As above, some states have a pre-existing structure in place for re-entry, whereas others are much more subjective and may require individually discussing your case with the licensing board. See if there are guidelines on your state medical board website as well as your specialty specific medical society websites, or speak directly with them to discuss their policies as well as any potential hurdles you may encounter. Be diligent with staying up to date with state and specialty requirements as they may change significantly over the course of your break and require you to adjust your plan for re-entry. Look into re-entry programs near you, and if there aren’t any, be prepared to move temporarily to a state that has a re=entry program.
Work Part-Time or Locums or Volunteer to Avoid Large Gaps in Clinical Work History
A break from your role doesn’t necessarily mean you need to stop practicing entirely. If it’s possible for you to work part-time, per-diem, or locums during your clinical transition, we recommend doing so. This will not only provide you with supplemental income, but also help you keep up your skills and demonstrate your competence when you are ready to return to clinical work more substantially, and avoid having to report gaps in clinical time on related licensing and credentialing questions. You can also choose to work on a voluntary basis in order to keep up your skills, such as at a free clinic or a resident clinic. Just make sure you are covered from a malpractice standpoint no matter what you choose to do.
Preparing for Your Return to Practicing Clinical Medicine
If your clinical break was unexpected or you weren’t able to plan your re-entry before your break, it’s important to start planning now. Remember that in order to return to your specialty you will need to demonstrate your competence not only to your medical board but to any future employers who may be wary of your practice gap.
The pathway to demonstrating competence for medical boards can either follow a mandated process or be discretionary. Some employers will require a re-entry program, whereas others may not. If you already have a goal employer in mind, contact them about what they will require before assuming that you need to do a re-entry program if your state or specialty doesn’t require it based on your time off.
Assessment and Re-Entry Programs for Clinical Competency
There are assessment programs throughout the country which vary in their scope, but usually involve a screening for cognitive function, simulation of clinical scenarios, cases, and/or chart reviews in the specialty of your practice, and sometimes a written examination. The costs of these programs are typically very expensive, and finding proctors can be hard as well.
If the preliminary requirements of the program determine that there is an issue either with core knowledge or clinical skills, or depending on the state and specialty requirements, there may be a need for a more extensive plan for re-entry. This can involve getting additional CME or doing further educational programs, or actually needing a preceptor for clinical experiences or supervised practice for up to 6-12 months.
Additionally, note that simply completing a program doesn’t guarantee that the medical board will approve your license or that you will get a job. Sometimes, even after going through a re-entry program, the first license that is issued will still have restrictions or issue a limited license that can be problematic for credentialing, contracting, or malpractice. Some states actually have a special “re-entry” license.
Characteristics of a Good Re-Entry Program
The AMA provides the following guiding principles for helping you determine if a re-entry program is right for you and a credible option:
Accessibility: by geography, time, and cost
Collaborative: ability to communicate and partake in resource sharing
Comprehensive: covers all relevant areas
Ethical: based on the principles of medical ethics
Flexible: in order to maximize program usefulness for physicians
Modular: meets the specific needs of individual physicians
Innovative: in employing state-of-the-art educational formats and content
Accountable: by establishing mechanisms for assessment and evaluation
Stable: to ensure adequate funding for programs
Responsive: to changing circumstances
Examples of Re-Entry Programs
Unfortunately, it is widely felt that the number of re-entry programs currently established in the United States does not yet meet the demand of returning physicians. Several popular re-entry programs include:
The Center for Personalized Education for Physicians (CPEP) Clinical Practice Re-entry Program - Denver, CO
Drexel Medicine Physician Refresher/Re-Entry Course - Philadelphia, PA
LifeGuard Re-Entry/Re-Instatement Program - Pennsylvania
Physician Assessment and Clinical Education Program (PACE) - San Diego, CA
KSTAR/UTMB Health Reentry Mini-Residency Program - Galveston, TX
Physician Retraining and Reentry (PRR) program in conjunction with UCSD - online
There may be more programs out there, as many are recognizing the need for these programs as physician demographics change and in response to the pandemic.
The Cost of Physician Re-Entry Programs
Physician re-entry programs can cost anywhere between $6,750 to $20,000 or more depending on which program you choose and what specialty you are re-training in. Remember also that you’ll need to cover additional expenses such as cost of living, potential relocation fees, and licensing all whilst losing out on your physician wages. Some programs also include an ‘initial assessment' fee to determine a physician’s knowledge and clinical skills before starting the program that can cost up to $10,000. Know that programs that include a direct patient care component, which while great for proving competency, are also typically more costly than those based solely on knowledge.
Finding Preceptors for Clinical Supervision or Re-Entry
One of the hardest things for physicians re-entering clinical medicine can be having to find someone that is willing to serve as their proctoring or monitoring physician. The thought of working under another physician can be hard to stomach and reaching out to potential physician preceptors can be difficult from an ego perspective. It may require reaching out to many physicians before someone says yes. For one, this is a time-intensive commitment for the physician that says yes to being the proctor, and secondly, there may be concerns about liability. They may also feel uncomfortable with providing feedback and potentially having to remediate physicians or say that they are not competent to return to practice. On the flip side, there’s also the potential that personal relationships or conflict of interest in hiring someone may lead to someone declaring someone competent when they’re not ready to return to practice.
Mini-Residencies
There are programs called “mini-residencies” which provide another model for re-entering physicians. These are currently pretty limited as there are several logistical hurdles to establishing them, including that these physicians don’t hold an active license and their work can’t be reimbursed by third party payors, and in general there is limited funding for these sorts of programs. Existing residents and fellows may also voice concerns that these physicians detract from their own ability to get required experience or procedure numbers within their program. As physician shortages amplify, it will be interesting to see if these opportunities expand.
Finding Your First Job After a Clinical Gap
It’s important to be realistic with yourself when it comes to finding a position post-break. The same positions you once considered potentially obtainable may no longer be a viable option for you (at least at this point in your career). While you can still look into positions with the same seniority you had at the beginning of your break, you should also consider - and prepare to accept - a more junior role or a pay cut.
In case it’s been a while since you’ve been on the job market, you may want to review our Transition to Practice: A Guide to the Physician Job Search and Interviewing for Graduating Residents and Fellows to garner a baseline for determining what role you want and what to ask in interviews.
Addressing a Break on Your CV
Addressing your break can be a difficult task when it comes to your CV. Many professionals recommend keeping discussion of your break to a minimum on your CV so as not to draw too much attention away from your professional career. Use your cover letter and interview to expand and explain your reasons for your break and why you are excited and ready to return to practice. Occasionally, your break from practice can be a great asset to your marketability, so don’t be afraid to emphasize how your hiatus diversified your experiences, taught you important life lessons, or provided you with valuable insight into the healthcare system.
Interviewing Post-Break
The interview process post-career interruption can be ruthless. You may face a possible stigma around leaving your esteemed career or prioritizing your personal over professional life. Be ready to face objections and challenge misconceptions about your pause. If you find the conversation of the interview going towards details of your break, do your best to veer the interview back into the topic of why you are wishing to reenter the profession, and what your qualifications are to do so. If you’re needing a refresher on how to prepare for interviews - use our Tips to Nail Your Interview as a starting point.
Conclusion
While taking a significant break from medicine can pose challenges when returning to practice, it can absolutely be navigated if the desire to practice is there. The key to doing so with as few hurdles as possible is trying to plan ahead and know what you need to do to minimize barriers to re-entry. As demographics in medicine change and physician shortages amplify, we hope that some of these hurdles will become less pronounced as pathways become clearer and more re-entry programs or mini-residencies are developed.