If you are a physician considering moving to a new hospital or accepting contract employment in another state, prepare for the daunting credentialing process. As a pediatric emergency medicine physician who frequently locum tenens, I am intimately familiar with the cumbersome, repetitive, and costly treasure hunt that accompanies accreditation at each new hospital. This process must be endured every time, in every hospital, without data sharing between institutions. The redundancy, repetition and waste of time and money is staggering.
Key accreditation requirements
1. Basic Demographics and Personal Information
- Simple but essential, this step involves submitting your basic demographic and personal information.
2. Medical education and training
- Hospitals contact each educational institution you attended to verify dates and attendance. A copy of your diploma is generally required.
- Includes verification of internships, residencies and scholarships.
3. Work history
- Verification involves contacting all previous places of employment to confirm your employment history and roles, hospital affiliations and any employment breaks with necessary explanations.
4. Peer References
- Three peer references are required, with each hospital carrying out its own investigations.
5. Professional career
- Detailed submission of board certifications and professional certificates, including current expiration dates. Each of them is paid.
- State professional medical licenses for each state in which you have practiced, along with proof of expiration. Each state may have different requirements for a new license, including continuing education, certifications, background checks, fingerprinting, and drug testing. Some states, such as Texas, require passing a state legal exam. There is also a fee for obtaining a compact license to expedite state licensing.
6. DEA License
- A new DEA number is required for each state, with current regulations requiring an 8-hour opioid course.
7. Insurance and Malpractice Claims
- You must provide proof of each malpractice insurance company with which you have been affiliated. Detailed histories of any claims, including terminations and the specifics of each case, are also necessary. Some hospitals may even request a copy of the termination or case history.
- Hospitals will also check the National Practitioner Data Bank.
8. Personal documents
- Submission of your CV, current photos, driver's license and social security card.
9. Request for privileges
Hospitals require documentation based on your training, which can vary. Additional certifications may be required, such as Pediatric Advanced Life Support (PALS), Trauma Life Support (ATLS), and hospital-specific training modules like my final requirement, “pre-eclampsia.”
10. Certification Questions
- Standard basic questions about prior criminal history, arrests, or limitations on hospital privileges.
The whole process ends with a long wait for a monthly meeting where your application is finally approved. Following this, you need to tackle the insurance packages.
Conclusion
Bureaucratic barriers to obtaining hospital credentials demonstrate not only the health system's inefficient practices, but also a significant drain on resources. Each accreditation exercise involves considerable duplication of effort, unnecessary expense, and significant time commitment, contributing to delays in patient care and physician burnout. There is a critical need for a streamlined, centralized system that can share accreditation data between hospitals, thereby reducing redundancy and facilitating transitions for healthcare providers moving between facilities.
The process is less about improving security and more about adding fees and tedious steps to what should be a simple process. Remember, you must keep up with license renewals and recertifications, as well as merit courses, maintenance of certification, state-specific training requirements, and most importantly, pay all fees on time to avoid penalties or the threat of losing your license.
The game is becoming more complex and expensive, but it is neither safer for patients nor better for the doctors trying to meet their needs.
Mick Connors is a pediatric emergency physician.