Career Planning
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Starting With Your New Practice
Managing Your Credentials Process
Congratulations! You’ve got a “real job!” Time to tackle the credentialing process, which can seem quite tedious and somewhat confusing, but it is nonetheless a requirement of our field.
The significant amount of regulation, and the high-impact and risk in health care, has resulted in the current labyrinthine structure. Be organized and start early to ensure you don’t accidentally end up on an unintended unpaid vacation next July.
Congratulations! You’ve got a “real job!” Time to tackle the credentialing process, which can seem quite tedious and somewhat confusing, but it is nonetheless a requirement of our field.
The significant amount of regulation, and the high-impact and risk in health care has resulted in the current labyrinthine structure. Be organized and start early to ensure you don’t accidentally end up on an unintended unpaid vacation next July.
See our timeline for when to start. It is never too early to start this process, especially if your new position is other than where you completed your training.
Here is some helpful information as you begin your credentialing process:
How Much Time to Expect
This will vary by state, depending on their process and possible need for direct involvement of the board and any meeting cadences.
At the very least, you should plan to give yourself at least four to six months prior to your start date. The process is generally (somewhat) easier right out of training, as there is less work history to be verified by your new Medical Staff Office.
What is the Process?
In order to practice in any state and at any institution, your professional records must be verified. There is a legal responsibility for all insurance networks, healthcare organizations, and hospitals to complete a very detailed process to verify your identity, licenses, training, education, malpractice, and career history, and to complete all necessary background checks in order to grant your privileges so that you may treat patients.
At a minimum, the institution needs to ensure that you:
- are who you say you are
- have completed the requisite education and training
- have and maintain a current medical license
- meet the basic qualifications to care for and treat patients
- meet the requirements as outlined in their medical staff bylaws
- carry the appropriate malpractice coverage
- are an appropriately qualified provider
There are three main parts to the process:
- Credentialing: This is the verification process as outlined above and comprises the long, arduous process (aka: the waiting game) you will need to go through for each state in which you intend to practice. Hospital medical staff offices will manage this process on their side and you should be in close contact with a representative until you are certain this is completed. This is required to grant privileges.
- Enrollment: This is the process of ensuring you can participate in a health insurance or network as a practicing provider. Once the credentialing process is completed, the information needs to be submitted to insurance companies, other hospitals, and payers. This is required to be reimbursed for your services.
- Privileges: This is the authorization of a specific scope of practice based on your credentials and past performance. Depending on how many hospitals you will practice at, and therefore, the number of medical staffs you will encounter, you will need to be granted privileges to each hospital you intend cover. This is required to care for and treat patients and will need to be renewed every two years.
Documents to assemble:
- Completed Application
- Driver’s License
- Photo
- Curriculum Vitae (CV)
- Current Work Status
- Board Eligibility Status
- Education Diplomas
- Internship, Residency, and Fellowship Certificates
- Current State Medical License
- Drug Enforcement Administration (DEA) License
- Controlled Substances Registrations or Licenses
- Malpractice Insurance
- Vaccination Records
- References
Know Your Role
Yes, the actual review is out of your control, but you should be mindful of what steps are required of you. It is important that you understand the process well enough to ensure you are not the hang up or causing yourself any undue stress.
The credentials you manage include proof of your identity, completed training, and medical examinations. You should be checking on the state’s exact process and connecting immediately with the health system’s medical staff office to obtain checklists and timelines.
Take ownership for being informed on the specific steps, paperwork, and submission process. Ask what you need to do and by when to ensure you do not cause any snags on your end.
Where are the Common Pitfalls?
- getting a late start
- not planning ahead
- lack of appropriate documentation
- missing information
- incomplete applications
- not securing references
- not including all practice locations
Additional Resources
Provides an example of one hospital’s medical staff onboarding checklist for new physicians.
