Clinical Preceptorship: A Viable Physician Side Hustle?

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When I was a medical student, I had dozens of excellent preceptors in my rotations throughout Minneapolis, St. Paul, and the surrounding suburbs. Luckily for me, I didn’t have to go searching for them. They were either faculty of The University of Minnesota or had a relationship with the school.

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Some students today have a much more difficult time lining up preceptors and clinical rotations, particularly if they are attending an off-shore or for-profit school that doesn’t have the same faculty relationships that a research university typically has.

Today’s students are also competing with students in other degree programs for physicians’ valuable time. In today’s post, Chase DiMarco highlights some of the benefits and a few of the cons to taking on the role of a preceptor.

 

Clinical Preceptorship: A Viable Physician Side Hustle?

 

“Show me a student from the BMS who only triples my work and I will kiss his feet.”- The Fat Man, House of God

 

“Those that can’t do, teach.” This is probably one of the most frustrating statements for educators, including those in medicine. Despite instructors being some of the most overworked and underappreciated members of society, the need for higher degrees of education is still on the rise.

Fortunately, most physicians do not seem to abide by this false sentiment of condescension and strive for higher positions of leadership. These positions, undoubtedly, require educating others in some form or another. However, many physicians do hold a false belief regarding their abilities and options to teach at their current position, clinic, or hospital.

Some may also be unaware of the benefits that they and their learners may receive upon entering into a preceptor position. Others may also be naive to the growing need for preceptors in various educational environments, let alone how to navigate this academic sector.

There are numerous benefits – financial, community growth, and higher education – that will need to be discussed more openly in order to meet the rising educational needs for our current healthcare system.

 

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Why We Need More Clinical Preceptors

 

There is a growing shortage of preceptors and increasing competition between different student types for the same clinical clerkship spots. Whereas MD students were able to readily find a position in many specialties with relative ease in the past, they now compete with DO, NP, and PA students for many of the same clinical rotations.

This factor is not an innately bad change, but it does mean that more preceptors are required to adequately compensate for the increased demand of preceptor sites.

On top of the growing need for staffing and clerkship sites, certain positions and populations also face unique training and education challenges. Rural medicine preceptors, for instance, may need additional guidance to properly support their students in this specialized environment and demographic.

Though university hospitals provide ongoing faculty development for their staff and independent contractors, these resources are much less available to preceptors working within the community clinical setting.

Balancing the patient care requirements of their clients while still providing value from student interactions is often a difficult task.

More recently, clinical clerkship advice and medical knowledge stems less from traditional resources (eg: medical societies recommendations) and more from Podcasts, LinkedIn Groups, etc… which may give community preceptors more opportunities to hone their skills and begin peer discussions. However, few seem to be aware of these resources.

 

How Can I Become a Medical Preceptor?

 

Precepting is as important today as it was decades ago, if not more so. However, since the rise of the French schools in the 18th century, more of the medical education focus has revolved around the classroom. This mindset has shifted in recent years and, especially with the outbreak of COVID-19, a greater appreciation for clinical education slowly predominates. With the recent announcement that the USMLE Step 1 will be changing to pass/fail, clinical experiences will likely also become a more important aspect of the residency selection process.

Although the American Association of Colleges of Pharmacy releases a periodic National Survey, it is unclear how other healthcare professionals stack up or even how many physicians partake in clerkships each year. Without quantitative statistics, it is difficult to express just how dire the need is for growth in this sector.

Not only does our future in healthcare rely on the quantity of additional sites and leaders, but in the quality of their instruction. In the past, incentives for growth were few and many in positions of teaching were just as likely to be there out of institutional obligation than for intrinsic desire to instruct. This, luckily, is changing.

 

Why Should I Become a Preceptor?

 

Of course, there are those that enjoy teaching. However, with large patient loads, ever-changing EMRs, and more institutional focus on work-life balance, it never hurts to have a few incentives to nudge physicians towards this leadership pathway. Here are some of the little known benefits to potential preceptors.

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Taxes

 

Several states have realized in recent years how important it is to properly train the healthcare force that serves their local communities. Sometimes, preceptors are not compensated for their efforts through their internal organizations and, without incentives, it may be difficult to find the quantity and quality of voluntary individuals. Some states now offer tax incentives for medical professionals that precept medical students, physician assistants, and advanced nurse practitioners to thank them for their contributions to society and education.

 

  • Arizona: This state offers an underwhelming $100 credit per clinical experience up to $1,000 per year under HB 2137.
  • Colorado: In 2016 they passed the Rural & Frontier Health Care Preceptor Tax Credit (HB16-1142) allows for a $1,000 credit to primary care preceptors. It does cap the number at 200 preceptors per year so apply early (or advocate for an expansion of this program)!
  • Georgia: Their Preceptor Tax Incentive Program (PTIP; HB 287) was updated in 2019, in part, to combat the $1,000’s per rotation being paid by off-shore and out-of-state medical institutions to supply clerkships to their students. Medical student preceptors will receive $500/rotation for their first 3 rotations and $1000/rotation for 4-10 (caps at 10). PA preceptors also receive $375 and $750, respectively. It does not seem to limit preceptors from also collecting compensation on top of this tax incentive but confirm with the Department of Health.
  • Hawaii: In 2018, the Healthcare Preceptor Tax Credits (HI SB2298) law was amended due to growing concerns about it’s growing population and lack of clinical education sites. It allows advanced practice registered nurses, pharmacists, and physicians to earn $1,000 per rotation up to $5,000 per year in tax credits for clinical education training.
  • Ohio: The Ohio Primary Care Workforce Initiative (FQHC preceptors) pays stipends to preceptors in Medicine, Dentistry, Advanced Practice Nursing, Physician Assistant, and Behavioral Health. The FQHC “has the potential to reach the $50,000 soft cap” and “offers up to 60 stipends of $250 per preceptor.” Speak to your hospital director for specifics and limitations.
  • Maine: Beginning 2020, preceptors are granted a $500 tax credit per 100-hour clinical rotation for up to $1,500 per year under the Health Care Preceptor Tax Credit (HP0917).
  • Maryland: The Preceptor Tax Credit Program (Senate Bill 411 / House Bill 1474) published in 2017 to give a tax credit to those “who have served as a preceptor in certain preceptorship programs and work in certain areas of the State with a health care workforce shortage.” A $1,000 credit is given per student per 160-hour rotation up to $10,000 per year. Also, preceptors may not receive compensation for these rotations from “an organized system of clinical experience.” For physicians and preceptors not in areas of shortage or that have surpassed their annual tax credit limit, they may qualify for compensation of their overages through organizations. Check with the Department of Health for questions.
  • South Carolina: The Preceptor Tax Incentive Initiative (Senate Bill 314) passed in 2019 to allow tax credits for preceptors in family medicine, internal medicine, pediatrics, OB/GYN, emergency medicine, psychiatry, or general surgery that dedicate at least 50% of their practice to serving Medicare, Medicaid, or self-pay patients. They are entitled to $1000 per 160-hour rotation for up to $4,000. Similar provisions are applicable to PA and NP preceptors.

 

There are legislative pleas to add similar programs in states like New York, Rhode Island, North Carolina, and Massachusetts, but it is too early to determine if any changes are coming. Some physicians state that these incentives are limited and often are more trouble to apply to than they are worth. However, there are other financial incentives that preceptors may apply for by offering independent away rotations.

 

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Physician recognition/awards & CME:

 

Continuing medical education credits and awards are rarely the sole reason for a preceptor to teach but they can be the icing on the cake for a professional that is on the fence. Depending on the physician’s or preceptor’s specialty, many can earn half or more of their required CME/CE for each cycle. This, ultimately, can lead to less time in a classroom or online webinar and more time focusing on leisure, family, or personal development. These awards can also distinguish preceptors from their colleagues if they are looking to apply for certain educational or administrative positions in the future.

 

  • The ACP offers several society awards including the Outstanding Volunteer Clinical Teacher Award of the American College of Physicians and the Herbert S. Waxman Award for Outstanding Medical Student Educator to those that teach students or hold positions as internal medicine interest group leader, clinical clerkship director, program director, or faculty member.
  • The AAFP allows for up to 60 Prescribed CME credits for teaching health professions learners during their 3-year re-election cycle.
  • The AMA FAQ document states that they will recognize any accredited CME by the ACGME or LCME as an AMA PRA Category 1 credit (which do not offer teaching credits) as well as independently recognize the teaching of medical students as a PRA Category 2 credit. They also award the Physician’s Recognition Award to those that earn an average of 50 CME per year.
  • The Society of Teachers of Family Medicine gives out the Master Preceptor Award to several preceptors each year to those that allow students to “participate meaningfully as members of the health care team.”
  • The ABFM allows up to 75 credits per certification cycle for teaching medical students.
  • ACOFP recognizes preceptors for their Master Preceptor Award and offers up to 60 credits of Category 1-B CME. Credit is not awarded for precepting physician assistants, nurse practitioners or allopathic medical students.
  • The AAPA offers the AAPA Preceptor of the Year awarded to PA preceptors for demonstrating “a commitment to excellence in the clinical education of PA students.”

 

Interestingly, it is not easy to find CME for teaching within many of the sub-specialty medical societies. Most simply do not offer incentives to their physicians which may decrease the frequency of these specialties as clinical rotation sites. This is where a preceptor more likely may be obligated to take on the extra burden of teaching without proper compensation.

Strained and poor educational environments may be one cause of decreased patient safety and these may turn into bad clinical habits. One would think that the medical societies involved in heart disease, lung disease, and diabetes – some of the most common killers of the American people – would offer more direct guidance to their future members and students.

For those that exist, the extrinsic value of these incentives may supplement the physician’s intrinsic interest in education or helping their environment. There is much work to be done in order to meet current needs and future healthcare changes. Future preceptors should also be aware that not all student environments are created equal.

 

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New Options as a Clinical Preceptor

 

There are generally two paths to travel to become a preceptor. Those in larger university systems may have an easier time setting up rotations internally. Yet, these are also more constrained as their applications are usually handled by the Visiting Students Learning Opportunities (VLSO) program run by the AAMC.

The preceptor’s schedules, number of students, fees, and many other features are also often managed by their hospital or university administrator. This provides little to no autonomy and can decrease the experience for both students and physicians.

The VLSO system has been overhauled in recent years but there are still limitations that remain, especially for students seeking very specific rotations. Speak to your Clinical Director or related department for more information.

Community preceptors, on the other hand, now have many options to choose from as well. Some become entrepreneurs, setting up their own independent rotation sites. Others join networks of third-party rotation agencies. These agencies handle, to different degrees, the scheduling, student acquisition, and documentation of clinical clerkships.

However, these features often do come at a cost ($100’s-$1,000’s/week) which is then passed down to students. A review of many of the most popular agencies in 2018 found that students were charged anywhere from $275-$4,000/wk. This extra cost may or may not be covered by their tuition fees.

Whether you have been a preceptor for many years or are just looking into this position for the first time, it pays to see all of your options. Some prefer to have their institution handle everything on their behalf.

Others prefer to manage their schedules and compensation, personally utilizing this opportunity as a medical side gig. Still others simply love to give back to medicine and to their community without the need for financial gains.

No matter which category you fall into, your students and their future patients will appreciate your hard work. With the above resources, you now have a roadmap to finding out more information and receiving community support when needed. Join your fellow colleagues and help shape the future of medicine, today.

 

The author, Chase DiMarco is a medical education blogger, podcaster, and author and the founder of FreeMedEd.org. For questions about how to start or make the most out of your preceptorship, feel free to contact him via email.

 

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Do you function as a preceptor for students and trainees? Are you compensated for the service? Do you see the preceptor role as a viable side gig for a physician?

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