Physician credentialing is the process of verifying and recognizing that a physician is qualified to practice medicine. Credentialing is done by an organization such as a hospital or insurance company, and may occur many times over a physician's career. Credentialing protects the organization by ensuring that a physician working for them, or with them, is qualified for the position. Credentialing also helps the physicians by allowing them privileges in their organizations if they have done good work in the past.
Education and Training
Credentialing includes verifying medical school education and any residency work that the physician did after medical school. Grades are examined as well as references from instructors and colleagues. The organization that the physician is applying to work with determines the standards for these records.
License and Certification
Examining the physician's state board license and certification is another aspect of credentialing. All paperwork must be in order for the physician to receive privileges at their organization. Becoming licensed requires credentialing by the state medical board, which will ultimately award the physician licensure.
The experience the physician has had with patients is also evaluated during the credentialing process. This includes the following areas: bedside manner, scope of practice, patient care and experience with various clinical practices. This determines the areas of clinical work the physician will be privileged to work in at a particular organization.
Malpractice and Negative Clinical Occurrences
The credentialing process includes reviews of any past events in the physician's practice that led to negative clinical occurrences or malpractice suits. This may include harm to patients, harm to colleagues or legal issues during practice. It is the judgment of the credentialing body to determine whether the physician has had too many incidents of this type to justify providing him with privileges.
The physician's character is evaluated through observation in addition to recommendations from past employers and colleagues. Physicians are expected to work under the American Medical Association's code of ethics, which specifies behavior and practice that leads to good character. Protecting patients from harm is very important in physician character, as well as honesty, collaboration and confidentiality.
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