I am a cardiologist who retired early and now would like to return to work after 10 years. I am grandfathered, as far as my board certification is concerned, for internal medicine, and was board-certified in cardiology, but I did not recertify when the time came to do so because I was retired. Approximately 80% of my time was spent doing inpatient care when I was practicing. I am seriously thinking about now returning to work as a hospitalist. Having been away from inpatient care for as long as I have, however, is of concern to me. I was wondering if you could suggest the best route to take to bring myself up to date.

Dr. C.E., Indiana

Dr. Hospitalist responds: Welcome back! As hospital medicine continues to grow, we’ve seen many new entrants who might have been out of clinical practice for a period of time. The good news is that there is no strict pathway back to practice, but that’s also the bad news. As you’ve indicated, your state license is active, which is a big first step.

There are a couple of ways to look at this issue. The first is addressing your own comfort level with current HM practice. Having been out of practice for a decade, certainly a lot has changed. As you note, your ABIM certification remains active, so retaking an exam is not necessary. You could consider a board review course, but these tend to focus strictly on how to succeed at the exam, not to bring you up to date in clinical practice. I think the same could be said for the Focused Practice in Hospital Medicine exam: You will gain certification, but passing the exam itself won’t bring your skills up to date. Additionally, the FPHM exam requires enrollment in the Maintenance of Certification through the ABIM. Although it’s highly recommended, it would better serve your needs in the long term, instead of getting recredentialed right now.

To start, your best bet is a clinically focused internal-medicine meeting. SHM and the American College of Physicians offer national meetings in the spring, and there are a number of regional HM meetings in the fall in San Francisco, Chicago, Boston, Atlanta, and Colorado (www.hospitalmedicine.org/events). Not only will you gain knowledge, but also CME credits, which most hospitals (and states) require for privileging.

The next hurdle, which is probably even more important, is the practice requirements for the hospital(s) where you’ll be working. By way of example, my hospital requires, for initial appointment, “documentation of inpatient services to at least 12 patients in the prior 12 months.” That is but one example, but it’s a reasonable starting point.

For sake of argument, let’s assume you can’t meet the criteria. Most hospitals will require a mentored relationship in which you will have to see and document a specified number of cases under the auspices of a supervising physician. That might mean 10 cases, or it could be 80 cases, but the hospital should be able to lay out the explicit criteria in advance. Once those cases have been signed off, then your file can return to credentialing for review. Beware: This whole process could take a lot longer than you might expect, so three to six months might be the expected timeline.

One other resource to note would be something like the Center for Personalized Education for Physicians (CPEP; www.cpepdoc.org/re-entry-program.cfm), which tailors education plans for physicians who are re-entering practice. Some hospitals will ask for a formal evaluation through this resource to obtain a structured response and skills evaluation. It’s applicable for any location, and it helps provide both sides with meeting the expectations.