Physician credentialing delays should carry a consequence

Physicians are taught to accommodate. A clinic runs behind. We stay late. A colleague calls out. We cover. Credentialing takes longer than expected. We send another document. An administrator needs another week. We wait.

Much of this is appropriate. Health care is complicated, and functioning organizations depend on people extending one another reasonable grace. But there is a point at which accommodation stops being professionalism and starts becoming an incentive.

I was reminded of this recently while arranging occasional oncology coverage for a cancer center. The discussions had been underway for months. There had been multiple conversations with recruitment. Compensation was negotiated. An agreement was executed. Credentialing began. Forms were completed, records supplied, verifications obtained, and payer enrollment initiated.

We discussed an anticipated start window. As that window approached, I heard little. So I asked for an update. Then I asked again.

Eventually, I gave the organization a simple deadline: Please provide reasonable clarity regarding where credentialing stands and the anticipated completion timeline, or I will release the dates I have been holding. The answer came quickly. The cancer center now wanted to delay my start by another couple of months because it preferred to reach a particular level of payer enrollment before I began seeing patients.

That was surprising, but not necessarily unreasonable. Organizations are entitled to make operational decisions.

What bothered me was something else. Nobody had called to discuss the change with me. I discovered it because I kept asking. And when the delay was finally communicated, it was presented essentially as an operational decision already made: This is now the timeline. We hope you understand.

I did understand. And because I understood, my decision changed too.

Understanding does not require accommodation

This is a distinction physicians frequently miss. When an institution tells us something has changed, our instinct is often to decide whether its explanation is reasonable. But that is only half the analysis. The second question should be: What does their decision change for me?

The cancer center was entitled to decide that waiting another two months better served its operational interests. But my calendar is an operational resource too. Those months represented clinical capacity that could be committed elsewhere. They represented uncertainty I would have to carry while the organization completed a process on its preferred timetable. Their decision therefore changed the economics of mine.

I released the dates. I also placed a defined time limit on the arrangement while leaving the door open for both sides to continue if the relationship became operational and remained mutually worthwhile. No accusations. No demands. No argument over whether their operational preference was correct.

They made a business decision. So did I.

Physicians routinely subsidize organizational uncertainty

There is a subtle asymmetry in many physician-institution relationships. An organization changes a schedule, delays credentialing, modifies staffing, postpones onboarding, or introduces another administrative requirement. The physician absorbs the variance. We rearrange the calendar. Complete another form. Send another email. Wait another month.

Each individual request may be reasonable. But systems learn. If a material change creates no consequence, there is little organizational incentive to prevent its recurrence. The delayed email becomes three delayed emails. The temporary workaround becomes workflow. The start date moves once, then moves again.

This does not require malicious administrators. Usually it involves reasonable people operating inside fragmented systems. Recruitment owns recruitment. Credentialing owns credentialing. Revenue cycle owns payer enrollment. Clinical operations owns staffing. Everyone owns a piece. Sometimes nobody owns the consequence.

Until there is one.

Beware the sunk-cost argument

Several physician colleagues might look at my situation differently. After months of recruitment, contracting, and credentialing, was another two-month delay really worth potentially losing the relationship? It is a fair question.

But the months already invested are sunk costs. The relevant question is not: How much have I already invested? It is: Given what I know today, is additional investment justified?

Indeed, the longer a process continues without convergence, the less persuasive “we have already come this far” should become. If months of effort have produced continuing uncertainty, another two months should not automatically be presumed to solve it. November can become January just as easily as September became November. At some point, time needs to acquire a price.

Accountability is not hostility

There is an opposite mistake physicians should avoid. Every inconvenience should not become a confrontation. Medicine would become impossible if every delayed credential, scheduling mistake, or administrative request triggered threats or contractual escalation.

A more useful hierarchy is:

• Small inconvenience: Accommodate it.
• Unexpected legitimate problem: Collaborate.
• Material change communicated early: Renegotiate.
• Repeated information asymmetry followed by a unilateral material change: Attach a proportionate consequence.

That consequence does not need to be punitive. Sometimes it means releasing dates. Sometimes it means declining additional responsibilities. Sometimes it means requiring a decision by a defined date. Sometimes it means allowing an arrangement to expire rather than preserving it indefinitely.

The purpose is not to punish the other party. It is to stop making dysfunction a one-sided equation.

Not every physician has the same leverage

There is an obvious objection to this argument. Not every physician can respond to institutional friction by walking away. An employed physician dependent on a single organization occupies a very different negotiating position from an independent physician with multiple opportunities. That is true.

But agency does not always require termination. It can mean documenting when assumptions change. Asking who owns the next decision. Establishing a deadline rather than sending a fourth follow-up email. Releasing dates that were never firmly committed. Declining an additional obligation when the resources required to perform it were never provided.

The consequence should fit both the problem and the physician’s actual leverage. The principle remains the same: Another party’s operational problem does not automatically become your unlimited obligation.

Consequences reveal priorities

Something interesting happens when uncertainty becomes costly. Before a consequence exists, everyone can sincerely say a project is important. Recruitment can say the physician is needed. Operations can say credentialing is progressing. Leadership can say they are excited about the relationship.

All of those statements may be true. But they are inexpensive statements. Introduce a real consequence and priorities become easier to see.

If the organization accelerates, the relationship mattered. If leadership finds another solution, perhaps the obstacle was more flexible than it appeared. If nothing happens, perhaps the need was never particularly urgent. And if the organization simply lets the relationship end, that is useful information too.

Not every relationship needs to be saved. Sometimes discovering that early is far more valuable than discovering it after several more months of emails, administrative work, and uncertainty.

Stop chasing: Change the default

There was one final reason I changed my approach. I noticed the relationship assuming a posture I disliked. I was repeatedly asking:

• Where does credentialing stand?
• When will you know?
• What dates do you need?
• When might I start?

Without intending to, I had become the party pulling an organization toward execution when the organization had originally recruited me. That was backwards. So I changed the default.

I no longer needed to chase an update. The organization had a defined period in which the relationship could become operational. If it wanted to proceed, it could come back when it was ready. If it did not, nothing further was required from me. Silence itself would eventually resolve the matter. There is enormous value in structuring professional relationships so that inertia resolves uncertainty rather than perpetuating it.

“I understand” can be a complete sentence

Physicians do not need to become combative to reclaim agency. We do not need to assume bad intentions. We do not need to win every disagreement. And we certainly should not threaten to leave every time an institution makes a decision we dislike.

But neither should professionalism mean unlimited accommodation. When another party changes the assumptions underlying a relationship, physicians are entitled to reconsider their own assumptions. Sometimes the institution’s decision will remain perfectly reasonable. So will ours.

The most useful response may therefore be neither anger nor acquiescence. It may simply be:

I understand your decision. Here is mine.

Sriman Swarup is a board-certified hematologist-oncologist and the cofounder of OncoNexus, an AI-driven oncology workflow platform focused on improving efficiency and care delivery. He also leads Swarup Medical PLLC, where he consults on clinical systems design, health equity, and digital health transformation. Practicing in rural Arizona, Dr. Swarup manages more than 3,000 patient encounters each year while advising startups and health systems on innovation and health care strategy. He writes about medicine, technology, and health care leadership at his website.