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Negative ramifications of time out of medicine?

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Good Morning,

I'm seeking sage advice from my colleagues on the forum. I became a PA about ten years ago (as a second career; I was previously a university professor in the social sciences). I started working right after graduation, spent four years in family medicine, and then transitioned to my passion - women's health. Last July I applied for a one year visiting professorship in my discipline (psychology) at a small, liberal arts college in a highly desirable location - a town in a neighboring state where my spouse and I had thought of retiring one day. Quite unexpectedly, I was offered the job in August and accepted it. I had no termination language at all in my contract as a PA (at my CP's request).

I am now one semester into this experience. Although it has taken hard work with long hours to be back in the classroom with three new preps, it has gone well. Well enough, in fact, that the college has offered to extend my contract for a second year. They have additionally offered a salary increase, reimbursement for conference fees and travel expenses, and funds to establish my lab here. It is enticing in many ways to consider a second year, and I especially love the location (I am four blocks from the water).

However, my long range plans include a return to medicine, and eventually, global health. I'd like to spend time in Africa and in South America with underserved women and am working on a financial plan that might allow us to live on minimal compensation for these endeavors. But...I'm concerned about the impact of a two year absence on my future hiring prospects. Of course I've thought about adding a weekly shift in some medical capacity to my schedule, but this is a small town with limited opportunities to do so, and I am constrained by my classroom as well as other college commitments. I've also thought about whether it might be feasible to do some locum tenens work during the upcoming summer. At present I have asked for a bit more time to wrestle with this decision so I can sort out the question of my future as a PA.

I'd appreciate any wisdom and experience on this topic. Many thanks. 

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Here's a return question for you that may make yours a moot point potentially.  Does your current state require a minimum number of clinical hours to maintain licensure?  If so, and you don't meet those requirements, then licensure becomes an issue.  I can say for certain, since we're in this position at my workplace; you probably wouldn't receive an interview (not my decision, and yes, I took a year and a half off to care for an elderly parent).  Someone recently questioned a post that I had made re:  Texas and maintaining licensure.  It was noted in the state documents at the time that I went back to work and it stated that I had to have a minimum equivalent of 6 months of FT work (whether FT or enough PT hours to equal FT work) over the preceding two years to renew my license, which I did.  When I went back to look again a couple of weeks ago I couldn't find it though it has to be in there somewhere otherwise one could stay out of practice for years and just renew their license.

Edited by GetMeOuttaThisMess
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There are many licensed PAs in PA education, so it can be done. Many of us have a clinic release day each week to work. I still work for my original practice; others do time in the ED, etc.

Reading between the lines of the OP, I wonder if eventually you will pick one career over the other. Your needs change, after all. Whatever makes you happy.

You don’t have to choose; I still have 3 different jobs (PA, educator, occasional paramedic.) And grandfather...

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Thanks for sharing that state specific detail of license renewal. I checked the regulations of both states in which I am licensed and found nothing specifying hours in practice for renewal, but I am contacting the state PA associations in each state for further guidance. As UGoLong stated, most of my PA professors spent little time (and in one case, spent no time) engaged in weekly clinical practice. The full time faculty generally completed one 8 to 12 hour weekly shift in their various medical specialties (ED, OR, FM, HIV). 


While teaching does "make me happy," I cannot imagine having spent long, hard, expensive years training as a PA and sweating over the first few anxiety-producing years of practice and then not returning to medicine after this one (or two) year hiatus. Additionally, I am not really tenure eligible (I'd probably retire before running out a six year tenure clock and search committees would be wise to that) and visiting professorships are rarely longer than one year (this is an interesting exception).

I'm actually questioning whether I agree with the provisions of the Texas law. Of course being in the field keeps us current, and knowledgeable, and skilled, but am I unskilled and un-knowledgeable after two years in other pursuits? There would still be CME to be earned for NCCPA certification and for licensure, and I am not a new grad with no experience to consolidate my PA education. Maybe a four year hiatus, or longer, might reflect a more significant decline in ability to practice? Just contemplating the intention of the law here...

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I would say that yes, significant time away from clinical practice makes one rusty, and maybe even dangerous. I spent over ten years in EM but I’ve been out since the mid-00’s and if I were to just walk back in and pick up EKG’s and review some x-rays I’d be a little rusty. On the other hand show me a lac warranting sutures and I can whip up a running horizontal mattress like no one’s business even today. I would also argue that I’m probably better at some medical cases now than then. I would agree that one day a week in a clinical setting for faculty staff doesn’t alone keep one sharp but compared to my having been out for a year and a half, they would have me beat hands down if I had been within my first 5-10 years of clinical practice. It’s the core background that one obtains once in practice that you rely upon to bounce back. If the experience duration is small then there is typically less there to draw from.

We should all review our state guidelines annually, and certainly be familiar with them before accepting that first job. You cannot expect the employer to be the knowledgeable one.

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