Physician credentialing is a critical part of modern healthcare. It allows for oversight in the healthcare industry and plays an essential role in maintaining the quality and integrity of healthcare delivery.
While credentialing is one of the first steps towards practicing as a physician, it’s an ongoing process required throughout a physician’s career. The primary goal of credentialing is to ensure a physician continues to possess the qualifications and competencies to safely practice medicine and provide the best care to their patients.
Credentialing can be confusing, so we’ve created a guide to help you understand it, including tips on how to help physician candidates navigate the process.
The terms “credentialing” and” privileging” are often used interchangeably, but they are two distinct steps in a three-step process:
- Credentialing. According to the National Library of Medicine, credentialing means qualifying and verifying a physician’s medical credentials using established guidelines that ensure patients receive the highest level of care from healthcare professionals.
- Privileging. Also known as hospital privileging, this gives physicians the authority to work at a specific facility and perform particular services based on credentials verified in step one. Depending on the job, most physicians must be credentialed and receive privileges at multiple facilities.
- Enrollment. This third and final step includes enrolling the physician for insurance payment so they can bill for their services. This step requires completed credentialing and privileging.
Who gathers and stores the information?
The National Practitioner Data Bank is required to gather and review medical data on each physician seeking medical credentials. For physician candidates, training, licenses, malpractice coverage, clinical judgment, and any certifications related to a physician’s specialties are verified. The process also involves data collection, source verification, and committee review.
The process can be time-consuming! According to CHG Healthcare, there’s no standard timeframe. Some facilities finish credentialing and privileging within a few weeks, while others may take up to six months – it all depends on the organization’s accreditation, requirements, and bylaws. Credentialing processes vary by state. We can’t list all of them here, but the Federation of State Medical Boards (FMS) provides a state-by-state list of credentialing requirements.
Can physician recruiters do anything to help move the process along?
You can’t speed up approvals or shorten the application, but you can do a few things to simplify the process. Here are four tips:
- Familiarize yourself with the requirements of the state where the physician candidate is going to work. Every state has slightly different requirements for obtaining credentials, so it’s crucial to check them first. Remind candidates to review their American Medical Association (AMA) profiles regularly, especially after a career milestone. The AMA maintains this comprehensive physician information, which can be updated and verified (here’s a sample physician profile). Keeping an up-to-date and accurate profile means it’s ready to go when you need to send it to a licensing board.
- If a physician candidate doesn’t know what’s on their AMA profile, they can request a self-inquiry profile through the AMA website. Here’s a sample of a physician inquiry. They can also have their profile sent to a specific licensing board. Processing fees apply to most requests; you can find full details on the AMA website. If a physician candidate is unsure whether to disclose something or provide additional documentation—the best answer is to do it. Incomplete applications are one of the most significant speed bumps in credentialing,
- Remind physicians to keep track of the procedures they perform throughout their medical careers. For a primary care physician, procedures might include abscess and cyst drainage, wound repair, skin biopsy of moles, steroid injection of joints, electrocardiograms (EKGs), etc. They should also document any issues they’ve experienced doing procedures.
- Advise physician candidates to store both digital and print copies of all the documents needed for credentialing purposes and store them in a safe place so they’re always ready.
As a physician recruiter, you know hospitals and health care organizations often prioritize physicians who are board-certified or board eligible when they hire. The AMA has provided a preparation guide for the physician credentialing process you may also find helpful. They also created a video that demystifies the physician credentialing process.
Helping physicians be more productive so they can provide better care to their patients is a top priority at Doximity. This includes helping physicians better manage their time and careers.
Have you ever wondered how health care organizations use Doximity Talent Finder to build great physician teams? We recently hosted a webinar featuring some of our top client users. You can view a recording of the webinar now.