Once upon a time a physician would be granted emergency credentials on very short notice if requested, or needed by the hospital or a member of the medical staff. A quick call to the chief of staff or medical director followed by a call to the institution in which the visiting doctor was already credentialled was all that was necessary.
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.
Andrew N. Wilner, MD, a neurologist who performs locum tenens at hospitals who would otherwise not provide his sevices. He reports what many physician experience when attempting to work at different hospitals.
The medical credentialling process has run amok !. The process itself is not overwhelming, however it may involve letters or corroboration from many hospitals and colleagues who are already overwhelmed with bureaucracy.Some of the information may be decades old. Medical staff offices and licensing bodies often take a month or more to find a request before acting upon them.
Hospitals and credentialling committees are suspicious about established physicians applyng for medical staff priveleges. When questioned why the intense historical day to day emplyment, vacations, and other time slots, I have heard a number of explanations. Such as time in prison for fraud and abuse, DUIs, that may have been ignored, or psychotic episodes, which applicants would be hesitant to disclose. Often the commission of a felony would eliminate the issuance of a new medical license, and a record of a psychotic episode would result in not granting privileges, even if the physician was treated successfuly or had served prison time with good behavior.
Interminable Delays
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
Conclusions
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.
