How To Return To Clinical Practice After A Gap
As I prepare to start my palliative care fellowship in a few months, I have the misfortune privilege of going through graduate medical education onboarding again. For a mid-career trainee, being given a form that asks you to account for every day of your life since medical school can be a bit daunting, but the aspect that’s most unpleasant for me is the culture in medicine to require an explanation for any and all gaps. While I haven’t received any pushback on my gaps thus far, I always feel uncomfortable being asked to explain what could have been so important that I chose to devote a period of my life to something other than clinic, research, management, or education.
There are many reasons a physician might have gaps in her training or her career as an attending. She may have gaps due to being a patient herself and needing time to care for her health, she may be caring for a loved one with serious illness, or she may have a child she wants to spend irreplaceable time with during crucial periods in their development. She may have other hobbies or passions she never gave herself time to pursue, or she may be suffering from burnout and needs time to recover and decide how best to move forward. While I hope for a day in which we don’t have to explain how we spend our time outside of work, in this article I want to normalize returning to clinical practice after a gap and outline how you can do so intentionally and confidently.
Know Your Worth
The first step in returning to practice is to talk back to the negative and unrealistic messages you’ve received that the only way to be a competent physician is to work at least 60 hours per week with little time off for vacation or other non-clinical obligations. Many specialities are facing critical physician shortages, and holding ourselves to impossible standards of perfection is going to leave more patients in the lurch. If you’re a physician, you’ve likely completed four years of college, four years of medical school, and a minimum of three years of residency training. So at this point, you’re a professional learner - if you don’t already know the answer to a clinical question, you know how to find it.
You should also undertake this journey with a firm sense of what’s important to you. If you’re returning to work after a break from clinical care, that doesn’t mean you have to accept any job that will have you. Remember: a job that leads to burnout makes your future in medicine less sustainable, and that’s the most expensive decision you could make. Decide which aspects of the position are negotiable and which ones aren’t. Are you willing to have a longer commute for lower volume? Are you willing to take a job with lower pay if it means a more supportive work culture? You may not be able to get all the things you want, but you should be able to prioritize what’s most crucial for your health and wellbeing.
Have A Study Plan
When I returned to clinical practice after a gap, I had two main study strategies to bolster my knowledge and my confidence. Before starting to see patients again, I had a study plan where I reviewed my bread-and-butter cases to make sure I was up to date on best clinical practices for managing the most common acute and chronic conditions I would encounter. If you’re behind on CME, utilize your time wisely by completing some knowledge assessments and earning CME hours while you brush up on your skills. Once I was back to seeing patients, I tried to select one topic from each day that I felt I could use a refresher on, and I would spend about 5 minutes reviewing that topic at the end of the day. This combination of front-loaded and on-the-job studying gave me the confidence I needed to get back into clinic while acknowledging that I would still need to learn some things as I went.
Your study resources will vary depending on your specialty. I like UpToDate because it’s easily searchable, but I have a hard time getting the information I’m looking for quickly and succinctly. For primary care, the American Academy of Family Physicians has clinical recommendations that provide useful summaries of screening guidelines and treatment recommendations. If your specialty is more procedural, adapt these strategies to your situation. Consider attending hands-on trainings or ask to shadow a colleague - shadowing isn’t just for students! If you feel your learning curve is particularly steep, negotiate limited volume early on (even if it means less pay) to ensure you have time to build your comfort and find the information you need as you go along.
Find A Mentor
In 2023, I returned to in-person clinical practice after seeing patients exclusively through telehealth since 2020. We were short-staffed on my first day, and I’m not exaggerating when I say I dissociated when my first patient needed a blood draw and I learned I was going to be the one doing it. What made this situation viable was that my boss is an incredible mentor. She was patient with me when I pestered her with questions, and she normalized not knowing the answer when she wasn’t sure. She encouraged me to establish efficient workflows, and she supported me in setting boundaries. She owns her own practice and had served as one of my preceptors back when I was a medical student, and my reaching out to her years later about an unrelated project opened the door for a wonderful, mutually beneficial position for me within her practice.
Finding mentors throughout my career has been a bigger challenge than I had thought it would be. In this case, my mentor happened to also be my boss, but your mentor could just as easily be a colleague or friend. Search through your professional contacts and reach out asking to have short, informal conversations in which you ask questions about their life and practice that are relevant to your career. Many people are flattered to tell their own story, and you’ll quickly get a sense of their openness to hearing more about your own plans and ambitions. Mentorship doesn’t have to be an official agreement - just make sure it’s someone you trust because your experience will be much richer if you can bring honesty and vulnerability to the relationship. If you have trouble finding a mentor or prefer a style that’s focused more on discovering your own solutions, a coach can also be a crucial resource.
Returning to clinical practice after a gap can feel daunting. You’ve proven your capability as a physician through rigorous training, and you can return to patient care with confidence by knowing what’s important to you, building your knowledge base, and putting a strong support system in place. If you’d like some assistance developing your mindset and creating a plan, or if you’d like to have a coach as part of your support system, please schedule a free consultation with us today.