A recent post on Medscape eschews what has happened to the world of credentialling. Why ? About two decades ago there were many occurences of imposter physicians, and/or physicians who were sanctioned, or whose priveleges are suspended or revoked. Many of these physicians would move to other jurisdictions to practice without knowledge of their history. The crevasses and crannies have been sealed.
Delays in credentialing, often adding up to months, deprive patients of clinical care and physicians of the ability to earn a living. (Ask a few random physicians how long it took to get their hospital privileges, and watch them roll their eyes.)
For example, I recently requested an application for privileges from a hospital that shall remain unnamed. Despite numerous requests on my part, it has been more than 2 months, and I have not yet received the application. (The actual hospital privileges will take months after submitting the as yet unavailable application.) The hospital's response? They simply don't have the "resources" to put the form in the mail. They are too busy processing other applications to mail out new applications!*
In another case, the number of requests by a hospital for "additional information" was so numerous and protracted that by the time the application was complete, the institution had been sold to another hospital system, which had a different application. So the process had to be started all over again.
In yet another case, I was unable to begin a locum job (in a state where I was already licensed) because the hospital could not grant privileges with nearly a 2-month lead time! I lost a work opportunity, and I don't know whether the hospital ever got coverage for their patients.
Loss of Privacy
In our medical system, we agonize over every tidbit of a patient's privacy, even mandating secure email and fax systems that comply with the Health Insurance Portability and Accountability Act (HIPAA). However, the opposite is true regarding those who work in that system: Nearly every facet of a physician's life is exposed in these applications. The boilerplate disclosure states that these details can be shared with all necessary parties—which, if you read the fine print, includes almost everyone in the civilized world. The application process rivals that of applying for a security clearance when applying for a VA or military medical position
The current requirement for each and every hospital to individually credential their medical staff is time- and resource-consuming, and possibly the most inefficient way to achieve the purported goal of protecting the public. Certainly, physicians and other medical personnel should be vetted. However, physicians with active medical licenses should not be forced to provide countless professional and personal details to hospitals about their lives (details that in most cases have already been provided to state licensing authorities or other hospitals), and then be subjected to months of unproductive waiting until they can begin work.
Unlike many of the imperfections in our healthcare system, this one is easy to fix. Credentialing should be centralized, as it is in the military and veterans systems, so that it need be done only once. The same applies for state medical licenses; one federal medical license would suffice. Rather than cost money, this fix would save a bundle. Currently, there is an effort by the Federation of State Medical Boards to set up a system that would simplify applying for multiple state licenses, but it still needs approval by state legislatures before it goes into effect.
What Do You Think?
1. Does anyone else have the impression that the questions on hospital credentialing applications go beyond common sense?
2. Should the date of one's high school graduation be included in hospital privilege applications?
3. Is there a hope for a centralized hospital credentialing service that could save time and money, and expedite getting doctors to work?
Let us know your thoughts in the comments section.