HOSPITAL CREDENTIALING NOT AUTOMATIC
To become a member of a hospital medical staff, a physician must undergo a thorough investigative process called credentialing. In this process, a prospective staff member presents his credentials to a committee for their evaluation and approval. The credentials committee is composed of 3-5 current staff members who are in good standing with the hospital and are revered by their peers. The committee members are chosen by the medical staff executive committee. It is this committee that decides if Dr. So-and-so is qualified to be a member of the hospital medical staff and admit and treat his patients in that facility.
I was on the credentials committee for two years mid-way through my 40 years of practice. The chairman of the committee was an intelligent and highly respected man who took the responsibility very seriously and went to extreme lengths to be certain the people we, the committee, chose for membership were worthy of acceptance. He actually did most of the work himself, corresponding with the applicant as well as verifying authenticity of the documents the applicant presented. He left no stone unturned to be sure we made good decisions.
An applicant had to present all pertinent information from his medical school, state licensing board, his residency program, and any other training activity in which he/she may have been involved. We wanted verification of completion of the program, a critique of the doctor’s performance in that program, and any behavioral or even criminal problems that arose during the physician’s tenure. If he had practiced in another city or state, we wanted specifics on why he/she relocated, and if the doctor voluntarily or involuntarily left. Also included were multiple letters of recommendation from program directors, former colleagues, or those in a supervisory role for the applicant. Credentialing was a rigorous process that could take weeks, or sometimes months, to complete.
The committee met once a month, or more frequently if demand required it. Most applicants were evaluated and accepted with little scrutiny because they had nothing in their records that was a “red flag” or a comment that drew attention to the doctor’s capability and/or character. No applicant that I can recall was ever requested to appear before the committee. The chairman managed all personal communications.
However, one physician stands out as one who barely “passed muster,” and who nearly did not receive approval to admit and treat patients. Our hospital desperately needed a well-trained, competent oncologist. We had none at the time. This young man was finishing his oncology fellowship at a prestigious cancer care institution in another state. Physicians trained at that institution were excellent and highly sought after. Not this man, however.
In the credentials from his oncology fellowship were several unflattering letters of recommendation. There were comments about his personality conflicting with patients and colleagues, that his communication skills were terrible, and the director of his fellowship program even went so far as to say he would be reluctant to hire him for any job.
As you might suspect, this doctor received maximum attention and scrutiny because no one had said he was incompetent. No one said he didn’t know what he was doing. No one questioned the care of his patients. The chair of our committee wrote letters, spoke personally to multiple people who had complained about him, and spoke to the doctor himself face-to-face, as well. It came down to him having a problem with interpersonal communications, not professional competence.
After several weeks of intense investigation, the committee, actually the chairman, decided to take a chance on this doctor and granted him hospital privileges. BUT he was required to agree to a period of probation and oversight of his practice dealings to be sure the committee had made the right decision.
This doctor, despite patients and colleagues having a very difficult time communicating with him, practiced at our hospital for 10 years, never refused to care for any patient, and had patients who complied with his treatment recommendations without hesitation. He provided a great service to the hospital and could be seen there 365 days a year. As new oncologists were granted privileges, he became less busy. That may be why he abruptly left for Florida with one of the hospital oncology nurses on his arm. I referred patients to him regularly, and received no complaints from them. He was almost refused privileges, but he provided a service to the hospital that previously had limited availability.
Credentialing is very important for quality hospital care. Doing it thoroughly and diligently makes a difference, and that is largely dictated by the attitude of the committee chair. Mistakes can be made, but not often if the process is done as it should be with careful, watchful, and thorough inspection.
