The benefits of entering medicine are well-documented: it’s a challenging field, with interesting, purposeful, sometimes life-saving work, and generally guarantees a high-paying career. But like in any other career, sometimes life goes in a different direction than previously planned. Sometimes changes, like personal illness or emergencies, family changes, burnout, or other reasons, send a doctor on another path.
What happens when those clinicians decide to return to caring for patients? Re-entering medicine isn’t easy, as such candidates face credentialing, regulatory guidelines, financial hurdles, and other obstacles. Perhaps the biggest obstacle is finding and acceptance into one of the few re-entry programs operating in the United States, such as Drexel College of Medicine’s Physician Refresher/Re-Entry program. These programs are critically needed. As our nation’s care teams rally to keep up with a rapidly changing pandemic, the Association of American Medical Colleges (AAMC) projects that the United States will experience a shortage of between 54,100 and 139,000 physicians by 2033.
Fulfilling this need, physicians in Drexel College of Medicine’s Re-entry program often have a long story to share when they get back in the classroom. Many share stories of unusual patient cases they’ve treated over the past few decades, and some have stories about why they left, whether for family or health reasons, or a non-clinical job. They all bring those tales to the re-entry program where they begin a new chapter of their life story — bringing their skills up to date before jumping back into the rapidly evolving field of clinical medicine. Those needing a medical license renewed must pass a competency exam first, but requirements differ depending on state where the physician will practice.
When they start classes, they soon learn the re-entry program comes with a storied history of its own. Among the first couple programs nationwide at its inception, Drexel’s program remains among few re-entry programs today.
The refresher curriculum dates back to 1968 at Woman’s Medical College, which was founded 118 years earlier as the first educational institution to train women in medicine. Although the re-entry program’s focus during those first couple years was helping women, the program later allowed men to enroll when the college started admitting men in 1970 as the Medical College of Pennsylvania.
“As the first medical school to bestow a MD degree to women students, the founders thought to develop a refresher program for the physicians who would leave medicine to raise their families,” said Physician Refresher/Re-Entry Course director Nielufar Varjavand, MD, a professor in Drexel College of Medicine. “However, it turned out that soon more men enrolled in the program than women.”
The program was put on pause in the 1990s when the Medical College of Pennsylvania closed, but then was restarted in 2006 as the “Drexel Physician Refresher/Re-entry program” and redeveloped to draw from the university’s excellence in education, technology, and established leadership in re-entry training, by offering both onsite and distance learning opportunities.
“We developed a brand-new program and it has been growing with new tracks and specialties ever since,” Varjavand said. “We’re recognized nationally and internationally now and have enrolled students from around the world.”
Most other programs offer an assessment, only, but Varjavand says the Drexel program is filled with passionate educators whose goal is a personalized curriculum that seeks out where a student can most improve and work on bringing their practical knowledge up to date. Each student comes to the program with a personalized goal in mind. In 2012, Varjavand and colleagues published a study in Medical Teacher which reported that, of the 36 physicians in the program from 2006-2010, 86 percent achieved the goals they set when they enrolled. This can be achieved in a few months depending on the student’s goals.
The program’s own goal to train clinicians hit its own snag when clinic opportunities ended with the closing of Hahnemann University Hospital last year, then with the pandemic hitting the region, but they pressed on. Drawing from online tools developed for a remote program for a student who couldn’t travel to Philadelphia, they adapted the training to move online for the COVID-19 era.
Transitioning everything online also made the training more accessible to trainees who previously came from all over the country to Philadelphia. This June’s cohort of four students completed all of their education and evaluations online: testing, standardized patient evaluations – taking patient’s history, examination, and coming up with a treatment plan – as well as other assignments.
“We review work together in a group setting over Zoom so they learn individually and teach each other while getting feedback from each other simultaneously,” Varjavand says. “There were intensive online group discussions, and during downtime they did asynchronous self-paced learning.”
That format worked well for Brin Schuler, MD, a family medicine doctor in Illinois, who left the field after a stroke in summer 2018. Upon completion of the Drexel program, a letter was granted for Shuler’s employer.
“I can’t dream of doing anything other than practicing medicine,” said Schuler, who will soon be treating patients again at an internal medicine practice in the Midwest.
For Schuler, a letter about her refresher was the goal. For program graduate Michelle Naps, MD, the goal was license reactivation.
“When inactive physicians enter the program, the first thing we do is ask them what their goals are,” said Varjavand. “Those goals are individual—some people come to us on their own, and sometimes licensing boards send them—but the key thing they have in common is that they miss medicine.”
Naps worked for 15 years in medical software development before beginning the re-entry process to enter addiction medicine. Naps was board certified in clinical informatics and wanted to use that knowledge in a clinical career with the latest knowledge in the field. After completing the 12-week program and with a reactivated license, Naps participated in a fellowship at Philadelphia’s Corporal Michael J. Crescenz VA Medical Center studying mental illness research and treatment on the front lines of the opioid epidemic. She is now a staff physician at the VA Medical Center in their opioid treatment program.
“The program filled in some gaps I may have missed during the last 15 years, said Naps. “I am better prepared to collaborate alongside my colleagues now.”
To date, the program has trained more than 400 physicians, and it looks like no pandemic or other obstacle will stop them from fulfilling their mission to equip more doctors with the skills and information they need to serve in the field they love.