Guidelines on Re-entry to Surgical Practice

  • The ABS supports the re-entry of surgeons to active surgical practice and endorses the following guidelines for surgeons seeking to re-establish their clinical careers.
  • Most surgeons who have stopped practicing fit into one of three categories, which may impact how a specific re-entry pathway is constructed:
    1. Voluntary withdrawal from practice
    2. Involuntary withdrawal from practice due to medical issues
    3. Involuntary withdrawal from practice for performance or professionalism issues
  • A re-entry pathway is warranted after two or more years removed from surgical practice and should address the following elements.

Re-entry Elements

1. Assessment of status of practice at departure
  • The surgeon should provide reference letters from the 1) chief of surgery; and 2) chair of credentials committee at the primary practice location of the individual at the time of his or her departure from practice. The letters will specifically address any issues relevant to surgical practice such as malpractice history, professionalism or patient care issues.
2. Re-entry pathway constructed by the local physician champion
  • Specifics of the re-entry pathway should be constructed by the local physician champion and include assessment of the six competencies: medical knowledge; patient care; professionalism; communication; practice-based learning; and systems-based practice. Medical knowledge will have individualized assessment based on factors such as certificate/MOC status and duration of clinical inactivity. Patient care will be assessed by the proctor. Individualized pathways may warrant additional assessment of patient care (e.g., oral examination) depending on circumstances. Individuals who withdrew involuntarily from practice (groups 2 and 3 above) will also usually require assessment of physical and/or mental health status by a specialist.
3. Proctoring plan
  • All pathways should include a proctoring plan. The duration of proctoring will be individualized based on factors such as complexity of anticipated clinical practice. A local proctor who is a diplomate of the ABS must be identified and agree to serve in this role for the duration of the trial period. The proctor will provide a final assessment based on the six competencies.
4. Outcomes assessment
  • The hospital should complete a Focused Professional Practice Evaluation (FPPE) per Joint Commission guidelines within six months of beginning independent practice.
5. Maintenance of Certification
  • The individual will be required to come into compliance with the ABS Maintenance of Certification (MOC) Program, and must meet MOC requirements as needed based on his or her individual situation.
  • Individuals seeking to re-enter practice should consult with the ABS regarding their situation prior to developing a re-entry plan based on the guidelines above. The ABS will review and approve the re-entry plan prior to implementation. The ABS will also track the outcome of all re-entry plans. To initiate this process, individuals should contact Dr. Jo Buyske in the ABS office.

Posted: September 2012

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