QUESTION: Our Hospitalists have been short-staffed for some time now. They desperately need several new doctors. We understand their predicament, but we are also frustrated that they keep presenting us with sub-par applicants. Then they get upset with us for asking so many questions and taking so long. What can we do? – Credentialing Coordinator
ANSWER: It sounds like you already have a keen appreciation for the importance of making the right decision at initial appointment. As one Credentials Committee Chair recently noted, “Good credentialing is the foundation of quality care.” Thus, while appointing a below average applicant may give the group some initial relief with their scheduling dilemma, that relief will be short?term, and predictable problems will follow.
There are a few steps that can be taken to help address the problem of a group recruiting applicants who are not likely to meet your credentialing expectations. First, you should consider strengthening your threshold eligibility criteria set forth in the Credentials Policy. Instead of just requiring that an applicant have a license, your criteria could require an unrestricted license and no previous licensure actions within the last seven years. You could also require no past disciplinary actions by any other hospital and no resignations during or in exchange for not conducting an investigation. Completion of an ACGME?approved residency program and board certification are also excellent standards to build into threshold eligibility criteria.
No one’s application gets processed if he or she does not satisfy the threshold criteria. Therefore, once the threshold criteria are built into your Credentials Policy, they will help filter out some of the “sub-par” applicants. (It’s important to remember that waivers to the threshold criteria should be limited to exceptional situations.)
Second, once the threshold eligibility criteria are adopted, they should be shared with all members of the Medical Staff, but you could make a special effort to call the criteria to the attention of the hospitalist group and other groups who may have a history of recruiting problems. Anyone who is recruiting new applicants should understand that all new applicants must satisfy the threshold eligibility criteria. It’s helpful to keep in mind, as noted in the Kohn case discussed in this week’s HLE, courts defer to threshold criteria adopted by hospitals.
Third, if the hospitalist group has a contract with the hospital (and it probably does), the hospital should build the threshold criteria into that contract. No employed or contracted physician should be appointed and granted clinical privileges unless the physician satisfies the basic threshold criteria.