QUESTION:        Two registrants at our recent Complete Course for Medical Staff Leaders in Las Vegas  asked similar questions:  An affiliated medical group extended an employment contract to a physician or PA — then asked the Medical Staff Office to send an application.  The group wants recruits to “shadow” a group physician until the application is approved.  Is such shadowing common? If the MSO discovers significant red flags — what can the MSO tell the group?

ANSWER:             “Shadowing” under these circumstances is not prohibited by regulatory or accreditation standards. However, it is not common, in our experience.  It may be wise to wait until an application is deemed complete.  What message would allowing shadowing — before a determination of completeness — send to a candidate who turns out to have red flags?  Would applicants and the group assume that credentialing is just a paperwork matter, and that appointment is likely?  Here are some best practices:

• The MSO and group recruiters should get together for Credentialing 101! (Of course, they’d be most welcome at our Credentialing Clinic!)  The MSO should develop a checklist or FAQ to help educate recruiters who lack credentialing experience on how to spot a reasonably discoverable problematic past.
• “Shadowing” should not take place until the application is complete (which means not only that the blanks are filled in, but also that all reference evaluations have been received, primary source verification is done and there are no red flags). Develop a policy if your organization wants to allow shadowing on a regular basis. Shadowing may be attractive if your hospital doesn’t have an expedited process.
• If reference evaluations reveal issues, the application should remain incomplete, and there should be no shadowing!
• The group may push for quick action; the MSO and Medical Staff Leaders may need to educate the group’s leaders about the risks of “negligent credentialing.”
• The evaluators most likely expect confidentiality. But it is appropriate to provide the substance to the recruited practitioner (without revealing identities of the evaluators).  The applicant’s side should be heard.
• Pursuant to a release, the substance can also be provided to the group’s CMO, who also should sign a peer review confidentiality agreement; and this is best accomplished by an information-sharing policy or agreement.
• Before allowing shadowing prior to appointment, even with a stellar candidate, provide basic orientation and get the candidate’s agreement to abide by all policies, including patient privacy, in advance of shadowing.
• The physician who is being shadowed should acknowledge responsibility for informing patients and for the conduct of the physician or PA doing the shadowing.