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Published 12/1/2010
James A. Keeney, MD

Getting back into the game

A professional career does not have to end with retirement

Do you want to return to orthopaedic practice after an off-season away from patient care? Are you considering a return into a robust practice from either a low-volume or narrowly focused practice environment? Although your circumstances may introduce some individualized considerations, the following basic strategies can help you “get back into the game.”

Lay the groundwork
You’ll need to be sure you have the credentials—medical license, board certification—before you reopen your doors.

Medical license: Is your medical license still current in your state of practice? If your license is no longer active, contact your state licensing board to find out what steps you’ll have to take to recertify. What continuing medical education (CME) requirements do you need to meet to reactivate your license and have your license renewed in the next cycle?

Board status: Contact the American Board of Orthopaedic Surgery. Determine both your present board status and, if you are approaching renewal, what steps you need to take to complete the maintenance of certification process.

Define your practice
What type of practice did you have, and what type do you want now? In what areas of orthopaedic practice are your strengths? Are you returning to a focused subspecialty practice, or do you want to engage across the spectrum of orthopaedics?

Assess yourself honestly; in areas where you may have weaknesses, you’ll need to sharpen your knowledge and skills before you actively engage in patient care.

Re-establish your knowledge base
Although several sources are available, the Academy’s Orthopaedic Knowledge Update series can bring you up-to-date in both general orthopaedics and individual specialty areas such as spine, trauma, or sports medicine. The Orthopaedic Self-Assessment Exam (OSAE) is a gauge for assessing your level of knowledge, as well as earning CME credits, either before or after you hit the books.

You can use the OSAE to strengthen your problem-solving and clinical decision-making abilities, compare your performance with that of your peers, and identify areas of strength and weakness. Based on your personalized score report, you can plan future study.

Hone your surgical skills
Consider attending at least two courses to refresh your experience and skills in orthopaedic surgery. Select courses that address procedures that you anticipate performing with greater frequency, or ones that will broaden your skill set.

If you affiliate with a residency-training program, inquire about access to an arthroscopy or cadaver lab. Because participation in on-call (emergency department) coverage can help to build up your practice, a trauma skills course should be on your list. Although these experiences may involve significant up-front costs, they provide the opportunity to elevate your skill level. You may be able to negotiate for financial assistance from your practice or hospital if you demonstrate how your acquisition of additional expertise will be a mutual benefit.

Look to mentors
Your hospital may have established surgeons who are willing to take you on as a first assistant while you regain your skill set in a particular area. Consider contacting the chief of orthopaedics or medical chief of staff to discuss whether you can be granted temporary privileges to assist at surgery (on an unpaid basis) with a lead orthopaedic surgeon.

As you re-establish your practice, consider requesting those surgeons to assist you during complex cases. Look for ways to compensate them for their time and expertise away from their practices.

As you get back into full swing in your practice, assess where additional educational opportunities will be beneficial to your practice. These will be helpful in maintaining your certification and licensure and in ensuring that you provide your patients with the best musculoskeletal care.

James A. Keeney, MD, is an orthopaedic surgeon and a member of the AAOS Practice Management Committee. He can be reached at keeneyj@wudosis.wustl.edu