Once you’ve completed your residency or fellowship training and accepted an employment offer, you might think most of the hard work of getting a job is done. But the process of getting your license, credentials and privileges is no simple formality. In fact, it can take months and require constant attention.

An episode of the “AMA STEPS Forward® Podcast” lays out the essential steps physicians must take to obtain licensure, credentials and hospital privileges, as well as to enroll with payers.

One thing to remember throughout: You’re dealing with multiple entities, each with its own application process and administrative limitations, so you should stay in touch with your human resources department to help smooth the process.

The podcast features an interview with Beckie Herron, director of credentials verification at Baptist Health, a health system with eight hospitals in Kentucky and Southern Indiana, and Brad Housman, MD, who is vice president and chief medical officer at Baptist Health Paducah. 

Baptist Health Medical Group is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Licensure is the first part of the process: It’s the state medical board’s verification of your education. 

Credentialing, on the other hand, is done by the hiring organization and qualifies a physician to work in a particular setting.

It is “the process of us proving you are who you say you are,” or that “you’ve done the training that you say you have done,” said Dr. Housman, a former ob-gyn.

Privileging is the part of the process where the employer—typically a hospital or surgery center—evaluates whether you are qualified for the type of medicine that you want to practice.

“It's up to each hospital's credentials committee to look at the application and look at the applicant and consider the privileges that are being requested [to] make sure those privileges are within the capability of that facility and make sure they're appropriate for that community,” Dr. Housman said. It’s all about knowing “you can do the things you say you can do.”

After all this, physicians sometimes forget about payer credentialing, he noted, but this is a hugely important part of the business of medicine. 

“That's the part where you get paid for the work that you do,” Dr Housman said, adding that this means applying to private insurers and government agencies so you can bill them for your work. “Think of it kind of like a three-legged stool—those are the three big areas or three big buckets.

Get tips on your transition to practice

Make your transition from resident to attending physician seamless with expert advice.

Subscribe Now

“For credentialing, the biggest roadblock is having all of the correct contact information entered on the application and everything entered thoroughly and completely,” Herron said. So the more information you have, such as PDFs of relevant documents, the better. 

The AMA has developed VeriCre™, an integrated credentialing solution that helps overcome one of the most consequential challenges in the credentialing process—receiving verified data in applications quickly and reliably. Learn more.

For privileging, Herron suggested reviewing the privilege form thoroughly so you know what you need to request and to have appropriate case logs gathered ahead of time.

Meanwhile, enrolling with insurance plans will require having a National Provider Identifier (NPI) number. To obtain your NPI, visit the National Plan and Provider Enumeration System website or call (800) 465-3203.

“They sometimes ask for more. An example is they'll ask for a Social Security card to get Kentucky Medicaid,” she said, noting that you might not want to provide this because of concerns about identity theft, “but in order to get a Kentucky Medicaid number, you're going to have to.”

Learn more with the AMA about what resident physicians need to know about credentialing.

“The best thing to do is apply as soon as possible,” Herron said of state licensure, adding that states often have differing processes and requirements, and while some boards meet monthly, others meet only quarterly. “Some organizations require a valid state license before you can even start the application process for privileges.”

Physicians coming out of training should “be thinking about applying for a state license by January of the year that they're going to finish,” Dr. Housman said, concurring that “you're a little bit at the mercy of when the boards meet.”

The podcast also goes in depth on the many documents and certificates required, as well as how to address medical liability claims, gaps in training and behavioral health issues.

The episode is part of an “AMA STEPS Forward Podcast” series that offers physicians transition to practice an introduction to the business of medicine. Other episodes cover the basics of medical liability insurance and information and technology in health care.