If you are a physician planning to move to a new hospital or take a contract job in another state, prepare yourself for the daunting process of credentialing. As a pediatric emergency physician who frequently provides locum coverage, I’m intimately familiar with the cumbersome, repetitive, and costly scavenger hunt that accompanies credentialing at each new hospital. This process must be endured every time, at every hospital, with no sharing of data between institutions. The redundancy, repetition, and waste of time and money are staggering.

Key credentialing requirements

1. Basic demographics and personal information

• Simple yet essential, this step involves submitting your basic demographic and personal details.

2. Medical education and training

• Hospitals contact every educational institution you’ve attended to verify dates and attendance. A copy of your diploma is usually required.
• Includes verification of internships, residencies, and fellowships.

3. Employment history

• Verification involves contacting all previous places of employment to confirm your work history and roles, hospital affiliations, and any gaps in employment with necessary explanations.

4. Peer references

• Three peer references are required, with each hospital making its own inquiries.

5. Professional background

• Detailed submission of board certifications and professional certificates, including current expiration dates. Each of these carries a fee.
• State professional medical licenses for every state you’ve practiced in, along with proof of expiration. Each state may have different requirements for a new license, including continuing education, certifications, background checks, fingerprinting, and drug screens. Some states, like Texas, require passing a state legal exam. There are also fees for obtaining a compact license to expedite state licenses.

6. DEA license

• A new DEA number is needed for each state, with current regulations requiring an 8-hour course on opioids.

7. Insurance and malpractice claims

• You must provide proof of every malpractice insurance carrier you’ve been affiliated with. Detailed histories of any claims, including dismissals and the specifics of each case, are also necessary. Some hospitals may even request a copy of the dismissal or case history.
• Hospitals will check the National Practitioner Data Bank as well.

8. Personal documentation

• Submission of your CV, current photos, driver’s license, and social security card.

9. Application for privileges

Hospitals require documentation based on your training, which can vary. Additional certifications may be necessary, such as Pediatric Advanced Life Support (PALS), Trauma Life Support (ATLS), and hospital-specific training modules like my latest requirement, “pre-eclampsia.”

10. Attestation questions

• Standard background questions about any criminal history, arrests, or limitations on previous hospital privileges.

The entire process culminates in a lengthy wait for a monthly meeting where your application is finally approved. Following this, you must tackle insurance packets.

Conclusion

The bureaucratic hurdles to obtaining hospital credentials are not only a testament to the inefficient practices in the health care system but also a significant drain on resources. Each credentialing exercise involves considerable duplication of efforts, unnecessary expenses, and a 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 credentialing data across hospitals, reducing redundancy and easing transitions for health care providers moving between institutions.

The process is less about improving safety and much more about adding fees and cumbersome steps to what should be a simple process. Don’t forget you have to keep up with license renewals and re-certifications, plus merit badge courses, maintenance of certification, state-specific educational requirements, and, most importantly, pay all the fees on time to avoid penalties or the threat of losing your license.

The game is becoming more complex and costly, but it is not safer for patients or better for physicians trying to meet their needs.

Mick Connors is a pediatric emergency physician.