Program Seeks to Help Retired Docs Enter Primary Care
Retired Rancho Santa Fe surgeon behind online refresher course that allows retired physicians, specialists to work in family practice
A successful career in medicine is neither regularly scheduled nor part time, but a local surgeon hopes to deliver both to retired doctors who want to continue seeing patients a few days a week with none of the usual financial frustrations and time commitments attached.
In early August, Dr. Leonard Glass, a retired Rancho Santa Fe reconstructive and plastic surgeon, launched Physician Retraining & Reentry, an online course designed to help specialists make the jump to primary care without requiring a return to medical school.
The program, which is only for doctors who have maintained their medical licenses, aims to refresh and deepen the family medicine skills of doctors who spent their careers in a medical specialty. Though they would have learned about the proper procedure for conducting a general physical examination, or managing a chronic condition like diabetes, that instruction likely occurred decades ago.
Curriculum developed by professors at UC San Diego School of Medicine hopes to bring these doctors up to date with 100 hours of online instruction.
Glass, who worked locally in private practice and also did a stint as a surgical professor at UC San Diego before retiring in 2005, said he hit on the idea of an online retraining course about two years ago after reading an article in The Wall Street Journal that talked about a pending shortage of doctors in primary care.
“It just got me thinking about the primary care shortage and the fact that no one’s doing anything about it,” Glass said.
That shortage has been extensively studied and quantified. One of the most recent studies, published in the Annals of Family Medicine in December 2012, finds that America will need 51,025 more primary care physicians by 2025. The increasing need, the study states, is due to population growth, the aging of the baby boomer population and to the Affordable Care Act of 2010, which seeks to insure an additional 25 million uninsured Americans.
PART TIME, NO STRINGS
While the exact number of needed family medicine doctors is a subject of debate, the industry seems to agree that the nation’s medical schools are not doing enough to keep up.
Even though he does not think his retraining plan can fix this problem, Glass said he believes that retired doctors are an untapped resource that can help. He cited a 2011 study, published in the journal Human Resources for Health, that surveyed 4,975 inactive physicians nationwide and found that there were certain factors that influenced a doctor’s ability to return to the workforce.
“A large percentage said they’d like to come back if they were part time, no nights, no weekends, no financial responsibilities such as paying for medical malpractice insurance, rent and overhead,” Glass said.
Glass is betting that his program, which costs $7,500, will appeal to surgeons and other types of specialists who have kept their licenses current in retirement and are itching for a chance to start seeing patients again on their own terms.
Technically, in California at least, any doctor with a valid medical license is allowed to practice family medicine without additional training.
But most, Glass said, would not be comfortable with that alternative. Doing so would likely require a full-time commitment and it would be difficult to get an existing group practice to hire a specialist without additional training.
“Primary care, family medicine, is a specialty today. The retired doctors know that, and they know they’re not competent to do it without additional training,” Glass said.
A specialist himself, Glass turned to the pros to develop his ideas into a curriculum.
DESIGNED FOR DOCTORS
He asked Dr. William Norcross and Dr. David Bazzo, both professors in the Department of Family and Preventive Medicine at UC San Diego School of Medicine, to build the 15-unit course from the ground up. Both are well-known nationally for their work in UC San Diego’s Physician Assessment and Clinical Education Program (PACE), which assesses and retrains doctors and other health care professionals who run into trouble with the state medical board or civil justice system.
Bazzo said he and Norcross oversaw the work of a team of UCSD faculty who were assigned units designed to encompass everything a doctor might see in a primary care setting, from diagnosing cardiac conditions to performing patient examinations.
“We asked what are the diagnoses that are seen, and what are the topics that need to be covered so that a person will feel fairly comfortable walking into a practice setting,” Bazzo said.
Each unit includes a pre- and post-test that doctors must pass in order to move on to the next unit. They must also pass a final online test covering the whole curriculum before traveling to UC San Diego for a final hands-on test in the university’s new primary care simulation lab. There, Bazzo said, they must see 10 simulated patients, actors trained to accurately portray a range of maladies, before they receive 100 credits from the university’s continuing medical education office.
The units do not seek to rewrite the canon on primary care curriculum. Rather, they refer to standard texts used in medical school like Kumar and Clark’s “Essentials of Medicine” and “UpToDate,” an online resource used by more than 700,000 clinicians worldwide.
For those who complete the course, Glass said his organization plans to help doctors find placement in clinics and other medical offices in their area.
“They’ll have maybe one or two fewer days on the golf course, they’ll be able to pad their retirement savings, they’ll get to see patients again and they’ll be helping to solve a health care crisis,” Glass said.
RETIRED SURGEON SIGNS UP
Dr. Theodore Dodenhoff, a retired plastic and general surgeon who lives in Arizona, is the first to test drive the new curriculum.
Dodenhoff, 78, said he is good friends with Glass and jumped at the chance to try the program. He said that the course isn’t short or easy.
“There is just a tremendous amount of knowledge that is required for anyone to start over,” Dodenhoff said.
He said the idea of doing a stint in primary care is appealing as a way to keep active in retirement but said he would still want to shadow current doctors before trying to see patients on his own.
The idea seems to be novel in the medical continuing education sphere.
After looking at the program’s website, Dr. George Mejicano, senior associate dean for education at Oregon Health & Science University, said he was not aware of any similar program in operation.
“I believe it is unique. I have not heard of another program like that,” Mejicano said.
He added that the direct involvement of Bazzo and Norcross, who are known for their work in the PACE program, help provide credibility.
“This is a legitimate group with high experience in physician assessment and they’re very well-known,” Mejicano said.
Having not read the 15 units of curriculum, Mejicano said he was not willing to pass judgment on its potential effectiveness. But he said he does wonder about how the program will address certain issues. For example, how would the program make sure doctors’ skills in doing minor medical procedures, like treating a boil, are up to date?
While this kind of skill might be razor sharp for a retired surgeon, it might be less so for, say, a retired psychiatrist.
“In other words, are these skills already in their wheelhouse, or are these skills that they never really had,” Mejicano said.
He said he would also want to know how the program addresses fundamental changes in the way doctors today practice, like the use of complex electronic medical records systems.
Bazzo said that the program does not address medical procedures like the ones Mejicano referenced. But he said that doctors are free to enroll in supplemental continuing education courses for skills they need to sharpen.
“If they want to learn to do procedures, there are certainly training workshops to learn many procedures. People already in practice learn new procedures in the same way,” Bazzo said.
Likewise, he said that electronic medical record training is better handled in a hands-on workshop setting.