In 1991, after six years of practicing family medicine in St. Paul, Minnesota, Dr. Bob Elson hung up his stethoscope to pursue a career in medical informatics.

For the next 18 years, Elson successfully navigated that growing field – which works to improve doctors’ practices by integrating new technology, like electronic medical records – while occasionally seeing patients as a part-time hospital doctor.

Elson and his wife Jane Joseph moved to Shaker Heights in 2001 to be closer to her family – and to raise their own.

When they moved, Elson, a native New Yorker, completely stopped seeing patients. But recently, the 55-year-old concluded it would be best to dig out his white jacket from the closet.

“I’d been completely out of direct patient care for about a decade when my wife and I decided about two years ago that it would be a good idea to get back into (it), in part because I miss that and felt I’d strayed too far from my doctoring roots,” he said. “But truth be told, I also wasn’t making enough money consistently as an independent consultant to foot the bill for my daughters at fine institutions of education.”

Of Elson’s three daughters, one is finishing her junior year at Johns Hopkins University in Baltimore, while a second will start at University of Pennsylvania in Philadelphia this fall. His third daughter just completed her freshman year at Shaker Heights High School.

“Being a doctor again was sort of a fallback employment option, which was certainly nice to have in the current economy,” said Elson, a member of The Temple-Tifereth Israel in Beachwood.

Starting the process

Elson isn’t alone. Whether to pursue other careers or for family reasons, doctors sometimes step away from practice for an extended period of time, said Joan Wehrle, education and outreach program manager for the Ohio Medical Board.

The first step to returning is to reactivate one’s medical license.

“Medical licensure is your baseline,” she said. “You have to have a license before you can legally practice in the state.”

Ohio medical licenses are valid for two years. Physicians are required to complete 100 hours of continuing medical education course work, complete a renewal application form, and pay a $305 renewal fee to keep their Ohio medical license in active status.

If a doctor doesn’t renew his license by the expiration date and it’s been less than two years since it expired, the doctor can complete the required continuing medical education work and renewal application and pay a late renewal fee to get his license reinstated to active status.

If a doctor doesn’t renew his license by the expiration date and it’s been more than two years since it expired, the doctor must apply for restoration of his license and pay a restoration fee.

Also, the Ohio Revised Code authorizes the medical board to require applicants outside of that two-year window to pass an oral or written exam, or both, to determine the applicant’s present fitness to resume practice.

In 2010, 11 physician applicants in Ohio were required to take an exam, Wehrle said. Of those, six licenses were activated, and five chose not to take the exam. In 2011, five physician applicants were required to take an exam, and all had their licenses activated.

Those numbers are relatively low. Ohio had 43,864 medical, osteopathic and podiatric medicine doctors as of Dec. 31, 2011.

Anecdotally, the board experienced an increase in license-reinstatement inquiries in 2007, when the economy started to worsen, Wehrle said.

Elson didn’t obtain an Ohio license when he first moved here, but he continuously maintained his Minnesota license, continued obtaining continuing medical education credits, and maintained his family medicine specialty board certification – all of which helped that part of his re-entry to practice run more smoothly.

Back in the game

As for the rest of his return, Elson characterized it as an “uphill climb.”

“There’s no clearly prescribed pathway for re-entry once you’ve been out of patient care for a while,” he said.

By the summer of 2010, by which time he obtained his Ohio license, Elson discussed starting a three- to six-month “makeshift residency program” for retraining, but it never materialized. Elson then was offered a position as a hospital doctor at University Hospitals Richmond Medical Center in Richmond Heights, he said, explaining a “retooling plan” was worked out for him.

“It was a wonderful re-entry experience and a good re-introduction to hospital medicine, but it became clear that some additional, or more formal, retraining would serve me well,” he said.

Elson then sought out a fellowship, which he found at Cleveland Clinic. He’s due to finish that fellowship at the end of June, at which time he’ll look to join a practice, he said.

The path back has been peppered with challenges, including adjusting to things that have changed since he last practiced, Elson said.

“I had to learn new ways to do old things,” he said. “(But) bedside manner and clinical judgment – things you’d expect a more mature physician to have – those came back pretty naturally.”

“The other ... biggest challenge has been being a trainee at 55, given not just my medical and clinical experience, but my life experience – and then having to be in an environment that is really tailored to training doctors who are most commonly just coming out of their residency program and are 25 to 30 years younger,” he said.

Elson feels the issue – and the economics of it – deserve a closer look.

“The problem becomes one of the business model,” he said. “For a physician in mid- or late-career to take the time out to do a full-year retraining program at basically an intern’s salary is very difficult financially, so the physician has to be willing to put some skin in the game and recognize they have to largely fund their retooling.

“But I don’t know whether there’s enough demand out there to put together a formal, structured residency or fellowship program specially targeted at physicians re-entering practice,” he said, suggesting that the answer might lie in better modifying or restructuring existing training programs.

mbutz@cjn.org