The Disenfranchised Physician—Credentialing


By Bob Sweeney

January 27,  2020


Our blog examines aspects of clinical practice where doctors and other clinicians continuously face frustrating obstacles.  This essay looks at credentialing.   Probably no other area of interaction between the practice bureaucracy and its “clients”—that is, clinicians—creates more frustration, duplication, delays and wasted time.  Physician credentialing and licensing are among the most critical processes in healthcare: a physician can’t even see patients without the proper credentials.

There are many reasons why credentialing has become such a source of misery.  First, the process is seldom systematized in any predictable manner.  Each office or hospital has its own expectations, paperwork, standards and deadlines.    Even today, there are many locations that rely on a paper submission, filing and tracking process to keep track of compliance.  Notifications are often inaccurate, misaddressed or even missed entirely.  It is not uncommon for docs to be out of compliance and not even know it.  Since the system is fragmented in most cases, it is often impossible to verify the security of collected information.  Unsurprisingly, documentation can be lost or misplaced as well.  

Yet, failure to meet or maintain such credentialing requirements as licensure, certification and insurance plan deadlines, health care plan participation, CME mandates,  and reporting deadlines can threaten the individual’s practice life, and pose serious legal and financial risks.  The hospital or health care organization, as well, is exposed to these types of issues.  A particularly difficult and harrowing process often takes place when the hospital is trying to staff a service on short notice.  For example, the emergency department is often the site of high physician turnover rates, as well as the frequent engagement of backup and seasonal coverage or extenders. 

This environment cries out for consolidation and centralization of these functions, the introduction and use of digital technology, and the simplification, where possible, of submission and reporting procedures.   In fact, there are a few companies such as Modio Health, now a division of CHG Healthcare, that are diligently attacking the credentialing quagmire.   But for thousands of physicians and other providers, credentialing remains a source of irritation at best and practice burnout at worst. 

Bob Sweeney, Principal & Managing Partner
Global Health Impact Fund LLC