After three mailings, a total of 1576 completed surveys were returned. Another 613 surveys were returned marked "deceased" or with bad addresses. The adjusted response rate was 36.1% (1576/4362). Females (42.2%, vs. 32.8% for males, P < 0.001), those over age 60 (38.4%, vs. 34.6% for under 60, P < 0.01), and those with addresses in the Midwest or West of the United States (40.3% Midwest; 39.8% West; 34.5% South; 30.1% Northeast; P < 0.001) all had somewhat elevated response rates.
Respondents were asked, "Are you currently active in medicine?" and were provided examples of activity in medicine (providing clinical services, conducting medical research, medical teaching, health-care administration, and other professional medical activities). Responses that could be selected were: currently active in medicine; fully retired from medicine; not currently active in medicine; and never active in medicine. Although members of the sample were identified as "inactive" at last entry into the Masterfile, 584 (37.0%) reported they were currently active in medicine at the time of our survey, and of these, 358 reported that they had not taken a leave from medicine of 6 months or more. These latter respondents may have been among those who were coded as "inactive" because they had indicated they were semi-retired, or temporarily not in practice at the time of their last AMA census response but may have been working in, for example, medical education (although fewer than 20 hours per week). We excluded them from the analysis, as, for our purposes, they had never been not active in medicine. We included the remaining 226 currently active respondents who reported that they had at some point taken a leave of six months or more from active medicine, and had then reentered medicine. Nine respondents were excluded because they reported they had never been active in medicine, and 47 were excluded for failing to answer the screening question, "Are you currently active in medicine?" This left a final sample of 1162 physicians, divided into three groups: 436 (37.5%) fully retired, 226 (19.4%) reentered, and 500 (43.0%) not currently active.
Table reports characteristics of respondents by status. As expected, the fully retired group was older than both of the other two groups. This group also included the lowest proportion of females. Respondents were predominantly married (77.8%), white (86.2%) and of non-Hispanic ethnicity (95.8%). The reentered group was more likely to report excellent or very good health status (75.6% vs. 58.9%, retired, and 59.3%, inactive). The reentered and fully retired groups reported somewhat better financial health than those not currently active. There were no significant differences between the groups for location of medical school (89.4% United States) or for board certification rate (36.5%) (data not shown). The fully retired group had proportionately more general surgeons and physicians in other surgical specialties, while the reentered group had more internists, and the not currently active group had more pediatricians.
Characteristics of fully retired, reentered and not currently active respondents
Table reflects the current experience and status of respondents not currently in the workforce. Over half of those who are fully retired (59.9%) or currently inactive (62.4%) reported last being active in medicine five or more years previously. More of the not currently active group (27.1%) are currently working in non-medical fields than of the fully retired group (16.9%), but substantial majorities of both groups did not report working in another field. The majority (71.2%) of those who are fully retired reported they have no future plans to become active in medicine; of those not currently active in medicine, 55.3% were "not sure" about plans to return. A large majority of both groups reported retaining at least some medical licenses, although the fully retired respondents were somewhat more likely to report that they had not retained any licensure. Among those with specialty or subspecialty certification, similar majorities reported that their certifications were current. Only a minority had retained any medical liability insurance, and this was almost always tail coverage only. Fully retired respondents were slightly more likely to report retaining tail coverage.
Physicians who are fully retired or not currently active in medicine (N = 936)
Those who have reentered active medicine reported a mean of 40.6 hours worked per week. Among these respondents, the average length of time they had been away from active medicine was 4.3 years (not shown).
Table reports the reasons that respondents retired or became inactive. The most frequently cited reason for being fully retired or not currently active in medicine was personal health issues (37.8% for both groups); this reason was frequently cited among those who had reentered active medicine as well (28.8%), second only to the need to care for young children (29.6%). Substantial proportions of both fully retired (27.8%) and not currently active (21.4%) physicians cited rising medical malpractice premiums as a reason for leaving active medicine; this was the reason for a substantially smaller proportion of those who had reentered (13.7%). Fully retired physicians were more likely to cite 'hassle factors' (37.4%) and insufficient reimbursement (20.6%) as reasons for leaving medicine. Those not currently active were more likely than the other physicians to cite the need to care for other family members (15.2%).
Reasons not currently active or reason became inactive (before reentry) a
Reasons for becoming active again are shown in Table . Responses were significantly different between those who were fully retired and those who were not currently active; the leading response among the former group (34.2%) was that "nothing" would lead them to consider becoming active in medicine again. However, when we exclude those who responded that "nothing" would lead them to consider returning to active medicine, the appeal of many of the remaining reasons to return was very similar for the two groups. The most common response among those not currently active was that availability of part-time work or flexible scheduling (51.1%) would lead them to consider becoming active in medicine again; this was also a common, but less frequent, response among those who were fully retired (42.5%, P < 0.05). The availability of part-time work or flexible scheduling was also, by far, the most commonly cited reason for becoming active again among those who had reentered (47.8%).
Reasons to consider becoming active in medicine again or reason reentered a
Nearly a quarter (23.7%) of the fully retired respondents had explored becoming active in medicine again; respondents who were not currently active were twice as likely (50.3%) to report having explored returning to medicine (Table ). Both groups had used similar strategies to explore reentry, and over 80% of both groups felt that it would be difficult. Of those who had reentered active medicine, slightly more than a third (35.9%) reported that it was difficult to reenter. All three groups were likely to identify limited opportunities for part-time or flexible work schedules as a barrier to reentry. Only 37.5% of the reentered group had retraining before entering practice again. Those who had retraining were, on average, out of the workforce significantly longer than those who did not (6.1 years vs. 2.9 years, F = 28.56, P < 0.001; not shown). Very few of those who reported receiving retraining had been involved in what might be described as formal training for reentry; seven had been in a reentry program, and five were in mini-residencies. Many more used continuing medical education, either online (15.9%) or live (22.1%), as their reentry educational program.
Efforts to reenter active medicine, not currently active and reentered physicians (n = 1162)
Additional analyses were performed to examine possible gender differences in family and work responsibilities of our respondents. Table presents the reasons for leaving active medicine for those not currently active and those who have reentered active medicine. Among those not currently active, the most striking differences are the much higher proportions of women who indicate the need to care for young children (35.5% vs. 1.6%, P < 0.001) or for other family members (23.4% vs. 7.2%, P < 0.001) as to why they left active practice. Among those who have reentered active practice, men are more likely to report reasons for leaving related to the structure and practice of medicine ('hassle factor', malpractice premiums, lack of professional satisfaction, insufficient reimbursement, practice not viable) and women to report family needs (care for young children, care for other family members). Overall, characteristics of the practice environment were cited infrequently as a reason for leaving among women who have reentered, especially in comparison to men of either group, but also compared to women who are currently inactive.
Reasons left active medicine for those not currently active and those who have reentered, by gender a
Both female and male physicians who are not currently active in medicine report diverse reasons that might lead them to consider becoming active in medicine again (Table ). Women were significantly more likely than men to report availability of part-time work or flexible scheduling (57.7% vs. 41.6%, P < 0.001) and a change in family or personal circumstances (53.2% vs. 30.0%, P < 0.001) as reasons to consider becoming active again. However, among those who have reentered, missing colleagues is also a reason more likely to be reported by female respondents (28.1% vs. 17.0%, P < 0.05). Men were significantly likely to report reentering to pursue a new challenge (24.1% vs. 9.6%, P < 0.001) or an opportunity with less administrative responsibility (16.1% vs. 5.3%, P < 0.01).
Reasons to reenter active medicine, by gender a