Open Journal of Nursing, 2013, 3, 481-484 OJN Published Online November 2013 (
Utilization of retired physicians as nursing faculty
Patricia L. Starck1, Shelly Liss2, Gerda Gomez1, Michael E. Speer3
1The University of Texas Health Science Center-Houston School of Nursing, Houston, USA
2Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, USA
3Departments of Pediatrics & Ethics, Baylor College of Medicine, Houston, USA
Received 13 September 2013; revised 12 October 2013; accepted 28 October 2013
Copyright © 2013 Patricia L. Starck et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The nation’s nursing shortage is predicted to worsen,
as nurses retire (supply) and more patients have ac-
cess to care with the full enactment of the Affordable
Care Act (demand). Schools of nursing are under
continuing pressure to increase enrollment in entry
level nursing programs [1-4]. Nurse educators have
been engaged in a variety of creative and innovative
projects to increase enrollment with some success. A
primary reason for the lack of educational capacity is
the shortage of nursing faculty [3-7]. The University
of Texas Health Science Center-Houston School of
Nursing undertook an innovative project to alleviate
the nursing faculty shortage at that school. Working
with a retired physician group, physician volunteers
were solicited to teach in the laboratory portion of an
undergraduate health assessment course. Twenty-two
physicians volunteered in the first year in a class that
involved forty baccalaureate students in their first-
semester. The objectives of the project were twofold:
First, to determine the suitability of retired physi-
cians to serve as teachers of baccalaureate nursing
students and second, ascertain possible monetary
savings by using these physicians. Both of these goals
were realized. The students valued the physicians’
enthusiasm, wisdom and experience and the cohort of
physicians equaled the equivalent of four nursing
faculty members. With an average annual faculty
salary of $100,000, savi n gs were significa nt .
Keywords: Retired Physicians; Supply and Demand;
Nursing Faculty Shortage
There is both an acute and chronic shortage of nurses in
the United States [1-4]. Janiszewski determined that the
four most important causes for the shortage were the
aging workforce (In 1980, 25.1 percent of Registered
Nurses were under the age of 30 compared to only 9.1
percent in 2000 [5]), declining enrollment in schools of
nursing, the changing work climate, and the poor image
of nursing [3]. Indeed, there are many more career op-
portunities for women in the work force over the last
quarter century, particularly within the field of nursing
itself [4]. The shortage is particularly troublesome in
Te x a s ( Figure 1), and schools of nursing are under con-
siderable pressure to increase enrollment in entry level
nursing programs. There are adequate applicants for a
field projected to need an increased labor force. The
problem is in educational capacity. Specifically, the issue
is an inadequate supply of nursing faculty [5-7]. Nurse
educators have engaged in various sorts of creative and
innovative projects to produce more with less, as well as
to invent new models of nursing education [7]. Use of
regularly employed nurses as preceptors, use of part-time
or contract nursing faculty, use of “loaned faculty” by
hospitals, etc. have been tried with varying levels of suc-
cess and sustainability.
As a result of a casual conversation, the leadership of the
University of Texas Health Science Center-Houston
School of Nursing evaluated the idea that retired
physicians might be able and willing to volunteer their
time to teach nursing students. First, enquires were made
to the Texas State Board of Nursing to determine whether
retired physicians could teach entry level baccalaureate
nursing students. The Board determined that they could
independently teach non-clinical nursing courses, but not
clinical courses unless it was as a co-teacher with a
nursing faculty member. Of note, it also was determined
that physicians who participate in clinical nursing
education are not required to maintain malpractice
insurance. The Executive Vice President for Academic
Affairs of the University System, a physician, also
P. L. Starck et al. / Open Journal of Nursing 3 (2013) 481-484
Copyright © 2013 SciRes. OPEN ACCESS
Figure 1. Projected supply and demand for nurses in
endorsed the concept. After consideration of the options
and best fit, it was proposed that retired physicians be
invited to teach the laboratory component of the basic
undergraduate adult and pediatric health assessment
course which is in the first semester of the curriculum.
This course consisted of two hours of didactic work per
week and three hours in the laboratory conducting a
health history and physical exam. Fellow students, pro-
grammable manikins, and community citizens served as
patients, with creatively arranged symptoms and reac-
tions that generally reflect a combination of pathophy-
siologic processes.
The Retired Physician Organization (RPO) of Harris
County, Texas, a component of the Harris County Me-
dical Society with over 500 active members, was ap-
proached for a possible source of volunteer physicians.
Utilizing a project management liaison to serve as a
bridge between the School of Nursing (SON) adminis-
tration and faculty and the RPO, volunteer physicians
were recruited using the following criteria:
Retirement within the last five years, or other evi-
dence of staying current with medical practice.
Teaching experience preferred.
Computer skills preferred.
In the first semester, there were four lab sections of 10
students each. A course grid was prepared, and the phy-
sicians were asked to sign up for one or more individual
Before the start of the course, a mandatory 3-hour phy-
sician orientation was conducted that focused on under-
standing current nursing practice, today’s student mores’,
the school’s philosophy, and the class curriculum. An
optional 2-hour “refresher course” on physical assess-
ment also was offere d.
As the physicians needed to know exactly what they
were expected to do in the labs and the depth of assess-
ment skills needed to teach beginning nursing students,
they were asked to review learning objectives for each
laboratory and review the assessment skills demons-
tration videos before the laboratories. Weekly reminder
emails were sent to the physicians who would be teach-
ing the upcoming week with lab schedules, learning
objectives, links to review video, and details of skills
covered. The physicians were held accountable for their
attendance and for finding replacements when they had a
change of plans. To ensure consistency of content taught
to the students, each lab began with a demonstration
video, followed with a questions-and-answers session.
Initially, the students were then divided into pairs to
practice physical examination techniques on each other.
Later, the students used programmable manikins, and
live patients with specific scenarios. The physicians
would circulate around the laboratory space to supervise
the progress. One nursing faculty floated between four
laboratory areas. Following class, students were given
one week to finish their assessment write-ups and give
them to the faculty that taught that particular laboratory
Studies about physician retirement have indicated that
physicians desire meaningful work [8,9]. Indeed, phy-
sicians expressed their satisfaction in being able to pass
along their skills they had honed over decades of prac-
While the RPO’s leadership felt that the pilot project
was appropriate for their members, the members them-
selves, due to their many other activities, could not each
teach a whole course [8,9]. They did agree that a group
of physicians could each teach a single laboratory course
module, particularly in an area that matched their clinical
specialty interest. Initially, 22 physicians volunteered to
participate; another 11 joined the program later. Some
physicians volunteered for one laboratory session, some
for six.
As noted, all volunteer physicians participated in the
orientation. Of interest is that all also took part in the
optional refresher course on physical assessment. The
physicians were observed to be very conscientious in
their new role in requesting copies of student assign-
ments, both written materials as well as the online sub-
ject matter. They generally arrived early before the lab
started. There were no instances where the physicians
failed to either appear in person or find an alternative if
there was a change in their personal plans.
Student interviews also reflected very positive res-
ponses to the change in instruction. Besides developing
their clinical skills, they stated that working with the
retired physicians offered an invaluable introduction to a
mutually respectful physician/nurse interaction and made
them very comfortable talking with physicians.
Traditionally, students were given one week to finish
their written assessments. However, with a different
P. L. Starck et al. / Open Journal of Nursing 3 (2013) 481-484
Copyright © 2013 SciRes. OPEN ACCESS
physician teaching in every lab, students did not have the
advantage of seeing the same instructors every time they
returned to the laboratory. As a consequence, students
could not turn in their papers to the instructor who
supervised their practice in the content areas they were
writing about. It was suggested that the students com-
plete their write-ups within the laboratory session. How-
ever, the students had difficulties completing their review
of systems and physical examination within the three
hours available for the laboratory. While some retired
physicians offered their email addresses for students to
send their papers after laboratory hours, this was not
possible for all. In the latter case, nursing faculty graded
the assessments. This problem was solved the next se-
mester when a nursing faculty member was paired with
each laboratory section and the students gave their pa-
pers to the nurs i ng fa culty the next week.
In evaluating the experience, the physician questionnaire
responses showed that the physicians were very positive
in being given the opportunity to share the knowledge
and expertise acquired over 40 years with a younger
generation and thereby have a positive impact on future
patient care. While they admitted to a sense of unease
prior to their first teaching experience with nurses, their
comfort level immediately improved after seeing the
students’ obvious pleasure at having experienced, knowl-
edgeable physicians present at their earliest educational
experience. The questionnaire also reflected that the phy-
sicians were still somewhat uncertain as to exactly what
their role should be.
Evaluation focused on the two objectives of effective-
ness and cost savings. Evaluations of both the physicians
and students were performed. After the end of the course,
a questionnaire was mailed to the participating physi-
cians and interviews were conducted with the students.
The cost benefit analysis showed a financial benefit to
the School by using retired physicians as adjunct faculty.
The savings were calculated by determining the number
of nursing faculty replaced to conduct the laboratory
sessions minus the cost of the pilot program. Expenses
included compensated p arking, orientation packets, refresh -
ments, a luncheon given at the end of the semester and
appreciation gifts (mementos), and a small fee paid to the
project liaison for a total of less than $4000 . Not counted
were the costs associated with administrative time spent
in recruiting faculty or coord inating schedules.
The number of volunteer physicians (22) initially re-
sulted in an increased time commitment for the Nursing
School’s faculty to coordinate the different teachers with
the different students. This work load was greatly red uc ed
by using the project management liaison who took over
this aspect of the course.
In the laboratory component of the basic undergra-
duate adult and pediatric health assessment course, ge-
neral health assessment and physical examination tech-
niques are covered. Traditionally, students would have
the same instructor throughout the semester for the labs.
As most of the physician volunteers were specialists,
there was initial concern that the physicians would only
sign up for areas involving their specialty. The students
related that any disadvantage that this caused was more
than compensated by having a specialist for each topic.
The physicians’ ability to provide guidance in devel-
oping physical exam skills helped the students accom-
plish the examination with more self confidence and
awareness of the “real” world beyond school. Creating a
mutually respectful physician/nurse interaction is diffi-
cult to replicate in the actual hospital setting due to
accessibility and time constraints but is critically impor-
tant for appropriate team management. This was not
difficult in the described environment. Furthermore, the
students learned about the diseases and treatments from
the medical side as well as from the nursing perspective.
This allowed the student to fully integrate the concepts of
disease management.
Post pilot project, the specific role of the retired phy-
sicians in the educational process was evaluated by the
project team. Indicators of the project’s success were
demonstrated by the feedback from both the students and
physicians; 30 physicians volunteered to teach the fol-
lowing semester. The physicians have been integrated
into other aspects in the life of the school, including so-
cial events. Seminars have been held for physicians,
including one as “Understanding generational differ-
Another consideration for the future is to examine the
expectations of the nursing school faculty and the vol-
unteer physicians. Considerable time was spent by the
project management liaison contacting individual phy-
sicians, who had volunteered but wer e of town or out the
country, to determine when they were available for the
following semester. Further anticipatory development of
course curriculum will permit physicians to plan ahead
and facilitate their involvement. It should be noted that
once contacted the physicians enthusiastically expressed
a desire to continue their participation.
The program began in 2008 and has settled in to a
standard part of the BSN degree program. The class size
has grown to 120 students. There have been some at-
trition and change, including two deaths, but new volun-
teers have also joined.
The inclusion of retired physicians into the teaching
environment of the SON has been an extremely enrich-
ing experience for our students and faculty and utilizes
P. L. Starck et al. / Open Journal of Nursing 3 (2013) 481-484
Copyright © 2013 SciRes. OPEN ACCESS
an under realized resource. Although not without its chal-
lenges, such programs can serve to alleviate, at least in
part, the shortag e of nurse faculty in this country.
[1] Texas Nursing Education Capacity Team (2012). Texas
nursing: Our future depends on it. A strategic plan for the
state of Texas to meet nursing workforce needs of 2013.
[2] Texas Nurses Association (2010). RN supply & demand.
[3] Janiszewski, G.H. (2003) The nursing shortage in the
United States of America: An integrative review of the
literature. Journal of Advanced Nursing, 43, 335-343.
[4] Fitzpatrick, J. and Emerson, E.E. (2011) 201 careers in
nursing. Springer Publishing Company, New York.
[5] United States General Accounting Office (2012) Nursing
workforce: Emerging nurse shortages due to multiple fac-
tors. United States General Accounting Office Report to
the Chairman, Subcommittee on Health, Committee on
Ways and Means, House of Representatives.
[6] Reinert, J., Bigelow, A. and Kautz, D.D. (2012) Over-
coming nursing faculty shortages and bridging the gap
between education and practice. Journal for Nurses in
Staff Development, 28, 216-218.
[7] Tanner, C.A., Gubrud-Howe, P. and Shores, L. (2008) The
Oregon Consortium for nursing education: A response to
the nursing shortage. Policy Politics Nursing Practice, 9,
[8] Virshup, B. and Coombs, R.H. (1993) Physicians’ ad-
justment to retirement. Western Journal of Medicine, 158,
[9] Liss, S.E., Cohen, I.M. and Charalampous, K.D. (2001)
Insights into physician retirement. Texas Medicine, 97,