VISTA Staffing Solutions | Locum Tenens

The AMA has recognized an issue that VISTA and other locum tenens companies have been concerned about for many years—getting physicians back into the workforce after they have left clinical practice for an extended period of time.

We get calls all the time from physicians who left practice for family or health reasons or who pursued alternative career tracks and are ready to get back to hands-on medicine. Unfortunately their options are limited, complicated, and often very expensive.

We have referred physicians to a few re-entry educational programs, including one at Drexel University College of Medicine in Philadelphia and to the Center for Personalized Education for Physicians in Denver. The North Carolina Medical Board also has a program, as does the University of Florida College of Medicine in Gainesville.

On January 25, the American Medical Association, in collaboration with the Federation of State Medical Boards and the American Academy of Pediatrics, issued recommendations calling for a comprehensive and transparent regulatory process for physicians to return to medicine.

VISTA supports this call because we agree that bringing physicians back to medicine is one more step toward managing the physician shortage. (We believe that keeping them in the workforce through flexible options like locum tenens is another.) It is much faster and cost effective to refresh and recertify a trained physician than it is to wait for medical schools to expand and produce more doctors. The AMA estimates that as many as 10,000 physicians might opt to rejoin the ranks every year.

Plus, in our experience, “boomerang” physicians often bring a renewed sense of energy and commitment back into medicine with them.

This discussion is in the early stages. We will keep you posted as it progresses. In the meantime I’ll pass along the advice our recruiters give to physicians considering a professional transition—keep your license or licenses active! It’s the best way to ensure that you will have options down the road.

Here’s a rundown of the relicensing requirements for physicians who want to return to medicine after an absence (unrelated to discipline.) These guidelines apply to both MDs and DOs unless noted.

Alabama: No policy.
Alaska: Policy under development.
Arizona/MD: Re-entry program required after 10-year absence.
Arizona/DO: Re-entry program required after two years out.
Arkansas: Policy under development.
California: Re-entry program required after five years out.
Colorado: Re-entry program required after two years out.
Connecticut: No policy.
Delaware: Decided on a case-by-case basis.
District of Columbia: Re-entry program required after one to five years out.
Florida/MD: Re-entry program required after two years of inactivity or five years of retirement.
Florida/DO: Re-entry program required after five years out.
Georgia: Re-entry program required after two years out.
Hawaii: No policy.
Idaho: No policy.
Illinois: Re-entry program required after two years out.
Indiana: Re-entry program required after three years out.
Iowa: Re-entry program required after three years out.
Kansas: Re-entry program required after two years out.
Kentucky: Re-entry program required after two years out.
Louisiana: No policy.
Maine/MD: Re-entry program required after one year out.
Maine/DO: No policy.
Maryland: Decided on a case-by-case basis.
Massachusetts: Re-entry program required after two years out.
Michigan: No policy.
Minnesota: Re-entry program required after two to three years out.
Mississippi: Re-entry program required after three years out.
Missouri: Re-entry program required after two years out.
Montana: Re-entry program required after two years out.
Nebraska: Re-entry program required if a physician has not practiced in at least one of the prior three years.
Nevada: Re-entry program required after one year out.
New Hampshire: Decided on a case-by-case basis.
New Jersey: Re-entry program required after five years out.
New Mexico/MD: Re-entry program required after two years out.
New Mexico/DO: No policy.
New York: No policy.
North Carolina: Re-entry program required after two years out.
North Dakota: Policy in development. Currently on a case-by-case basis.
Ohio: Re-entry program required after two years out.
Oklahoma/MD: Policy in development.
Oklahoma/DO: Re-entry program may be required after one year out.
Oregon: A physician out more than 12 months may be required to take a competency exam or additional training. This is dependent on specialty.
Pennsylvania/MD: Re-entry program required after four years out.
Pennsylvania/DO: Policy in development.
Rhode Island: Policy in development.
South Carolina: No policy.
South Dakota: Decided on a case-by-case basis.
Tennessee: Re-entry program required after five years out.
Texas: Re-entry program required if a physician has been out of clinical practice for more than one year within the past two.
Utah: Re-entry program required after two years out.
Vermont/MD: Re-entry program required after five years out.
Vermont/DO: Re-entry program required after one year out.
Virginia: Re-entry program required after four years out.
Washington/MD: Re-entry program may be required if out for two years, but this varies by specialty.
Washington/DO: No policy.
West Virginia/MD: Re-entry program required if out for 18 months.
West Virginia/DO: No policy.
Wisconsin: Re-entry program required after five years out.
Wyoming: Decided on a case-by-case basis.

Source: State Medical Licensure Requirements and Statistics, 2011, American Medical Association (www.ama-assn.org/ama1/pub/upload/mm/40/physician-reentry-regulations.pdf)

State medical license renewal applications are much simpler than initial applications and re-licensure applications. The vast majority of state medical boards now offer on-line renewal.

The process generally requires the following:

• Verifying personal data
• Answering questions regarding discipline, criminal matters and mental health conditions
• Certifying completion of mandatory CME for the prior one- or two-year registration period

CME requirements range from 12 hours per registration year in Alabama to 50 per registration year in Illinois, Maine, Washington, Massachusetts, Pennsylvania, New Hampshire, New Jersey, and North Carolina. Specific class content may be required such as risk management, palliative care, and ethics.

Additionally, a certain percentage of your CME must be designated Category I. Make sure to keep your CME certificates, because boards often conduct audits and may request proof of CME. You may also want to apply for the AMA Physician’s Recognition Award, which measures Category I CME content. This certificate is accepted as an equivalent for licensure renewal by more than 75 percent of state medical boards.

You will usually receive your renewed license certificate in 15 to 30 days after the application is submitted.

Your first step is understanding your eligibility, which varies by state, and is based on:
• Whether you are an American or international medical school graduate and, in some states whether your medical school is approved by the state. VISTA’s team will research a state medical board’s website or utilize the WHO Directory of Medical Schools or the ECFMG FAIMER Directory to determine if a school is acceptable.
• The length of post graduate training you have completed. International graduates are commonly required to complete three years of PGT; American grads may meet eligibility with one or two years of training after graduation.
• Limitations on licensure examination, e.g., some states do not accept a “state” exam—these were the norm prior to NBME, FLEX and USMLE.
• The status of your original license. Some states require that your first license remain active.
• When you took the USMLE; USMLE failure rate on each of the steps; weighted score of the exam.
• How long it’s been since you took a licensure exam along with ABMS certification. Some states invoke “The 10-year Rule,” which states that if a physician has not taken a licensure exam within 10 years of application and is NOT board certified, he or she may be required to take the SPEX Exam.

VISTA’s recruiters review all locum tenens candidates’ applications and work with our licensing specialists to determine whether these requirements will impact your ability to qualify for a new state license. This is an important step in assessing locum tenens opportunities.

Once we help you determine your eligibility, a Licensing Specialist will walk you through the steps required to apply for the license. It is important to decide if you can meet the requirements, especially if you may be required to take the SPEX or obtain ABME certification. It is also important to know up front if a state will require an on-site interview or exam.

Once you have worked through the above, you must complete and certify the application for licensure and an FCVS profile application, if required by the board. Additionally, for those states that require an associated controlled substance certificate, you must complete a separate application and meet specific requirements.

The VISTA Licensing Specialist then begins requesting primary source verification of your credentials, which always include:

• Medical Education- all schools attended
• Post Graduate Training
• Licensing Exam Scores
• All state licensure – active, inactive, and training
• Professional’s statement regarding history of malpractice experience, discipline, and mental health issues that could affect or limit his/her ability to provide competent medical care.
• ECFMG for all international graduates

These additional verifications and requirements are requested by most states and processed by the Licensing Specialist:

• AMA or AOA Profile
• Federation of State Medical Board Clearance
• NPDB
• Transcripts
• Practice experience – this varies by state in terms of how far back your work history needs to be verified.
• Liability insurance coverage
• Certified birth certificate
• Legal proof of name change, if applicable
• Fingerprinting and background checks
• CME required for licensure- FL
• Passport photos
• Referencing – many states have their own forms; others require a statement

The Licensing Specialist contacts primary sources and then follows up to assure a response to the board is completed.

Once the application and all requirements for verification and documents are received by the board, the Licensing Specialist will stay in contact with you and the board until a decision is made.

If at any time during the application, you experience an unusual negative experience, even something like a traffic ticket (yes, just for speeding) you must notify VISTA and fully disclose the circumstances to the board you are petitioning for licensure.

Tricky question. It’s tough to pin down processing time for a new state medical license because, although the requirements are the same for each applicant, a physician’s unique history and situation impact processing time.

For example, an American medical graduate with no malpractice claims or disciplinary issues, who has practiced in one location for the 10 years since completing training, will take much less time than an American medical graduate with the same length of time in practice, but who worked in five locations and had a significant malpractice settlement.

In VISTA’s experience the wait for a locums license has varied from three weeks in New Hampshire to two months in North Dakota. Temporary licenses, requested in conjunction with an application for a permanent license, can be issued in a month in Hawaii. It may take up to three months to get the same license in South Carolina. Full, permanent licensure can be processed in two months in Hawaii, but may take as long as one year in Texas.

There are also a host of variables that are essentially out of our hands—and yours. VISTA’s licensing specialists are very knowledgeable about most of these processes and calculate an expected delay into the overall time frame when discussing licenses with you. California, for example, has a 45-day waiting period once an application is at the board before any action is taken on an application. North Carolina has specific deadlines for application completion so an application can be reviewed at a scheduled board meeting. The deadline is usually six to eight weeks in advance of the meeting.

All medical boards experience heavy application volume from March through August because physicians are completing their post-graduate training programs and preparing for practice. We plan for an additional one-to- two week delay during this time.

At VISTA we help physicians apply for licenses in anticipation of locum tenens assignments, and for new permanent positions through our Physician Licensing Resources Division. One of our medical directors has had up to 19 active state medical licenses at one time, so don’t let the prospect intimidate you. Concentrate on the steps that follow, and VISTA will make the process as simple as possible.

• Keep very thorough records of practice experience dates, locations and addresses, especially when on locums assignments.
• Maintain a file of certificate and document copies. If any of these have been lost, obtain an official copy from the institution issuing the certificate.
• Be prepared to provide a detailed and thorough explanation for any or all disciplinary actions or malpractice cases.
• Do not discard court documents, even if very old, or letters from attorneys or from medical boards. Do not depend on attorneys to maintain your documents.
• Thoroughly read and understand every question asked of you on a medical application, especially those concerning malpractice, discipline, arrest/conviction history, substance abuse, and mental health. Be sure to answer correctly and provide a full explanation for each circumstance.

For more information about licensure in conjunction with a locum tenens position talk with your VISTA recruiter or scheduler. If you are interested in help obtaining a new state license independent of locum tenens work, contact our Physician Licensing Resources Division at 800-366-1884. Adventure awaits. We can get you there!

Forget travel, forget rental cars, forget apartment keys under the mat at midnight…Getting licenses in new states can actually be one of the most challenging aspects of locum tenens practice—or medical practice in general for that matter. But there is a glimmer of “standardize this process for the betterment of humankind” hope on the horizon.

A new, on-line application process called the CLAF, Common License Application Form, has been launched. Ohio was the first board in the country to implement it in 2007, followed by Kentucky and New Hampshire. The new on-line system application is linked from each board’s web site to the Federation of State Medical Boards. Physicians do need to have an FCVS Profile or apply for one to use the CLAF system.

As other licensing boards implement use of this system, physicians will be able complete one application using the CLAF. The common information that all boards require is integrated into the form used by the state board, leaving only state specific data requirements to complete.

This process will save physicians the tedium and time of entering the same information on different applications every time they apply for a license in a new state. I can’t imagine anyone appreciating this more than a seasoned locum tenens physician, or the agency supporting said physician.

Kudos to the Buckeye, Bluegrass, and Granite states for taking this leap into the information age.