A board-certified anesthesiologist with six years of clinical practice leaves in order to care for ailing parents. After a five-year hiatus, the physician wants to return to clinical practice. What are the options available?

It is not possible to know how many anesthesiologists are in a similar situation of seeking to return to clinical practice after taking a career hiatus. The reasons for career hiatus vary tremendously, ranging from family obligations (e.g., raising children or caring for a family member) to recovering from a personal illness (physical or mental). Because clinical competency requires constant maintenance of technical and critical decision-making skills, particularly during rapidly changing clinical situations, anesthesiologists are hesitant to take a hiatus when it is unclear how to reenter clinical work. For the specialty, losing highly trained physicians from the workforce with no reentry path is even more detrimental to the current workforce shortage. Anesthesiologists risk burnout, wellness issues, and compromised patient care when they continue to work despite stressful personal situations. They fear an extended hiatus will prevent their eventual return to practice. However, it is important to note that there are options available to allow for reentry, providing a safety net for the individual anesthesiologist. This support is not only beneficial to the individual but also to the specialty.

Although there are several options, in this article, we highlight two different reentry processes with which each of us is involved. The first one describes an external program available for any physician. The second describes an example of how anesthesiologists can contact their residency program to do a “reentry” fellowship.

The first example is called KSTAR (Knowledge, Skills, Training, Assessment, and Research), which is based out of Texas A&M Health in College Station, Texas (asamonitor.pub/4cIKORe). KSTAR is an internationally recognized program that provides comprehensive assessments, evaluations, return to board eligibility, and reentry programs for physicians. KSTAR also has a three-month (or longer when needed) reentry mini-residency for qualifying physicians. The University of Texas Medical Branch is the main site for the reentry mini-residency, and my (AEA) department is the starting point for anesthesiologists going through KSTAR. Prior to KSTAR contacting our department, the anesthesiologist applies and goes through the assessment and evaluation process during a two-day, on-site program. The assessment may include, but is not limited to, standardized patient encounters, record review, NBME multiple-choice testing, cognitive screening, and physician discussions and interviews. The application process includes background checks, license review, and CME reviews. After successfully completing the assessment program, the anesthesiologist can apply for reentry training with UTMB. Through KSTAR, the anesthesiologist will purchase medical liability insurance via the Texas Medical Liability Trust. At UTMB, the anesthesiologist works under the supervision of anesthesiology faculty, similar to a resident. Rotations and experiences are individualized to meet the goals of the anesthesiologist. During the three-month period, the anesthesiologist continues to meet weekly with the KSTAR medical director. The program requires a fee for the assessment ($12,600), cost of the mini-residency ($13,500), liability insurance, and living expenses in Galveston. The anesthesiologist will not receive a salary from UTMB.

In some circumstances, a second pathway may be the residency program where they previously worked or trained. Training programs amendable to the concept may require interviews, references, and active maintenance of medical board licensure. The Ohio State University, for example, has created a fellowship for such purposes, but it limits consideration to former trainees or faculty who are also candidates for jobs afterward. Since the program is overseen by the graduate medical education (GME) office, the anesthesiologist is employed as a trainee for six months, receives medical liability insurance like other clinical subspecialty fellows, and is later considered for employment to help facilitate the final transition to practice. The clinical experience is individualized, includes lectures and simulation with residents, and clinical oversight progresses toward autonomy over the six-month period. Programs wishing to consider creating such a program should work closely with their GME office and credentialing boards. It is also important to note that while a completion certificate is provided, it does not imply certification of competency.

In our experience, anesthesiologists commonly face several challenges during reentry. The first is overcoming the hurdle of self-doubt about returning to clinical practice. For most, the basic skills of anesthesiology come back quickly, including technical skills like I.V. placement and bag/mask, intubation, as well as nontechnical skills like communication, evaluating the patient, and crisis management. The second challenge is technology. Since the introduction of the electronic medical record (EMR) in the last decade, some anesthesiologists need to learn how to use modern forms of EMR documentation. Again, despite the hesitancy, most reentry anesthesiologists quickly adapt to this new technology. Another challenge is the expansive use of ultrasound for vascular access, regional anesthesia, and point-of-care ultrasound (POCUS) diagnosis. Reentry anesthesiologists need this experience and would ideally be exposed to an ultrasound curriculum within the program. For the three-month reentry KSTAR program, experience is obtained in the third month, but often the reentry physician will work with our program to develop additional experience outside the required time. For a reentry fellowship, ultrasound experience can either be included as part of applicable rotations or as a separate experience.

Rob Steele, MD, FAAFP, former Medical Director of the KSTAR program, has over 20 years of experience in physician clinical performance evaluation and remedial programs. In a recent podcast about the reentry physician and the challenges of coming back to practice, Dr. Steele provided insights and advice to physicians considering a clinical hiatus (doctorscrossing.com/episode165/). First, maintain an active medical license, take CME courses, keep your DEA certificate, and maintain your board certification. This facilitates more career options and reduces the likelihood of specific medical board requirements for retraining. Second, if there is a way to avoid completely stepping away from clinical practice by working part-time, returning to full practice could be easier. In his experience, having a hiatus of fewer than two years often allows a physician to return to practice without a major assessment or retraining. In the current workforce shortage, one should be able to find a “prn” position with a local group(s). Third, the anesthesiologist needs to understand the requirements for credentialing. Many facilities require peer evaluation of someone who has worked with the anesthesiologist in the last two years. Hence, even with an active license, the anesthesiologist who has been out of practice for more than two years may require some sort of supervised clinical practice to fulfill credentialing requirements.