Anytime a physician changes employers or seeks new privileges, they are required to go through the credentialing process. For residents and fellows wrapping up their training, credentialing is one of the first steps to working as a practicing physician.

The process entails verification and assessment of a physician’s education, training and experience. It allows patients to trust that they’re in good hands and physicians to have trust in their peers. Credentialing also plays a part in physician health plan enrollment so that payment for services can be received. 

For residents, having a knowledge base about the process and how it can be used can go a long way. A video called "Physician Credentialing Demystified”—produced by FREIDA™, the AMA Residency & Fellowship Database^®—offers insight on the process.

“From a resident's perspective, the biggest thing is to know that this process exists—that you need to be prepared for it,” said Tammy Weaver, the AMA’s vice president of physician professional data. “Theres is a lot of information and documentation to pull together and fill out.” 

Upon accepting a new position, physicians are required to fill out extensive credentialing applications. For physicians who anticipate accepting a position in the near future, it’s a good idea to have that information and any supporting documents at the ready. 

That information includes:

• Your education, training and board eligibility or certification.
• Federal, state and professional licenses and registrations.
• Explanations of any gaps of 30 days or more in education, training or work history.
• Your work, medical staff and clinician privilege history.
• Names and emails of peers who can provide references.
• Clinical report cards and performance reviews.
• Your medical liability insurance carriers and any claims history.

It also is helpful to make sure all aspects of your AMA Physician Profile are accurate. The institution with which you are seeking employment or privileges may pull a copy of your profile through the AMA’s Credentialing Solutions to verify information provided on your application.

“The profile contains information that the AMA has obtained from authoritative primary sources such as state license boards, medical schools, training programs and others,” Weaver said. “We provide this information to expedite the verification process and eliminate redundancy. We also encourage every physician to download their free self-inquiry profile on AMA Profiles Hub because that is the information that a hospital or a payer is going to see when they are verifying your information.”

When should you start compiling your information? It is never too early, Weaver said.

“Many residents are exposed to the process while still in training,” she said. “But keeping track of your credentials isn’t a one-and-done thing. This really is an ongoing process, and physicians benefit from being able to quickly access their most up-to-date information and documentation.”

Dive deeper:

• Obtaining a medical license
• Licensing and board certification: What residents need to know
• Final-year residents: Are you up to speed with your job search?
• 4 keys for a physician’s first employment contract

Credentialing, which is the process of verifying credentials and assessing qualifications, is the first of three distinct phases. The second is privileging, which gives you permission to perform specific services at the institution based on your credentials. The third is enrollment with payers, such as Medicare, Medicaid and commercial insurance, which allows you to bill and be paid for those specific services.

Because these processes may take up to 180 days, it’s wise to get started as soon as possible. It’s also imperative that each facet of an application is filled out in full detail.

“You need to make sure you are disclosing everything that there is to disclose, and you need to make sure you're completing 100% of that application,” Weaver said. “That is the most common pitfall and the biggest complaint that we hear from hospitals and practices—that they get incomplete information. And they can't start their process until they get that completed application.”

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One of the reasons the credentialing process takes as long as it does is that credentialing offices are obligated to conduct primary-source verification of the information you have provided.

“They don't want to hear—from you—that you graduated from ABC Medical School in 2021; they need to hear from that medical school directly that you graduated in 2021,” said John Andrews, MD, vice president for graduate medical education innovations at the AMA.

The AMA has established a new tool, VeriCre™, that prefills physician applications with authoritative, primary source-verified data from AMA Physician Profiles, thereby eliminating redundancy and administrative burden for both physicians and medical staff offices.

“It makes the process more efficient for everyone,” Dr. Andrews said. “On the applicant side, you only have to reference your profile. On the credentialing side, they don't have to reach out to all these independent entities.”

For residents preparing to enter the job market or practicing physicians looking to make a change, the AMA provides many resources to help physicians understand employment contracts, such as the Annotated Model Physician-Group Practice Employment Agreement (PDF) and the AMA Physicians’ Guide to Hospital Employment Contracts (PDF), both free to AMA members.

Also, take time to learn about the “AMA Principles for Physician Employment” adopted by the AMA House of Delegates, which are designed to help physicians and employers address challenges such as contracting, conflicts of interest, payment agreements, and advocacy for patients and the profession.