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The Association for Advancing Physician and Provider Recruitment (AAPPR) is redefining recruitment to retention and is the only professional organization where physician and provider recruitment leaders and others who influence recruitment, onboarding and retention can connect, learn and advance their careers.
Data in recent AAPPR reports has shown that physicians and clinicians feel more satisfied and confident with their job if they’ve undergone a formal onboarding process. An essential part of creating a formal onboarding experience is by helping physicians navigate the often complex and lengthy credentialing process.
Recruitment professionals can help provide clarity on what physicians can expect during the credentialing process and set them up with the proper support and materials they need to feel confident and energized as they take on their new role. Here are four ways credentialing support can enhance your organization’s onboarding process and reduce the risk of turnover:
In a recent AAPPR report, 94% of respondents said credentialing is a key part of their onboarding process and that assistance with licensing and credentialing processes made the onboarding experience a positive one.
Providing insight and setting expectations for the process can help physicians get certified faster. With the credentialing process taking as long as six months, making this as seamless as possible means that physicians can start their work treating and caring for patients more quickly.
A formal onboarding process that integrates credentialing support leads to happier physicians. In return, this helps healthcare organizations retain skilled professionals and can reduce turnover, contributing to long-term stability and a positive work environment.
Organizations that have effective onboarding processes and support physicians through the credentialing process often see improvements in patient satisfaction. A bottlenecked credentialing process not only hinders physicians from making a living, but also delays patients from receiving the care that they need, which can be damaging to an organization – especially during an ongoing national physician shortage.
Organizations that have taken the time to develop a positive onboarding experience that runs in conjunction with the credentialing process have reported happier patients and physicians, leading to higher retention rates and more satisfied employees.
To improve both onboarding and credentialing processes, organizations can adopt these best practices:
Interested in learning more? The complete AAPPR Physician Credentialing Survey Report is available for download here: aappr.org/research/physician-credentialing-report
While Mental Health Awareness Month is behind us, the importance of mental health and wellness is a year-round priority. When it comes to mental health in physician and provider recruitment, one of the main challenges is burnout, which can have extensive effects on everyone in the healthcare community, from clinical staff to recruitment professionals.
At AAPPR’s 2024 Annual Conference, Advancing Connections, members Jennifer Scherer, CPRP and Becky Trujillo, CPRP dove into “Navigating Burnout in Physician Recruitment” and the impact burnout has on the healthcare community. According to a recent American Medical Association survey, more than 50% of physicians across nearly all experience levels feel at least one symptom of burnout while those who are 6-10 years post-residency are the group most likely to feel burnt out. However, this is not only an issue among clinical staff. In physician and provider recruitment, more than 50% of professionals experience symptoms.
What Does Burnout Look Like?
Contrary to popular belief, burnout is not just stress. Stress is a response to a perceived threat, while burnout is a state of physical, mental and emotional exhaustion caused by prolonged and excessive stress and can occur both in the workplace and in personal lives. The causes and symptoms of burnout are wide ranging and can be difficult to pinpoint unless you are intentionally looking for them. If you’re experiencing lack of energy and trouble sleeping along with physical symptoms, such as stomach issues, muscle tension and headaches, you may need to ask yourself if you’re feeling burnt out.
Why is Burnout so Common in Recruitment?
The significant and continuing physician shortage in the United States is expected to increase in the coming years, placing high demand on recruitment professionals. Recruitment teams are pressured to do more with less and face a range of factors outside of their control, from organizational decision-making processes to candidates opting for competing positions. All that to say, it’s very likely these conditions can cause prolonged and excessive stress to the employees in the work environment, which can eventually lead to burnout.
How to Effectively Manage Burnout
Many healthcare organizations and recruitment departments stress how important their teams’ mental health is. While wellness programs can be a key component of a recruitment strategy for retention, recruitment professionals should also “practice what they preach” and prioritize their own wellness.
Recruitment professionals can do this by setting boundaries with their time. A 2023 study from Pew Research Center found that more than half of workers (55%) respond to work emails or other work-related messages outside of their normal hours. While there will always be work to do, it’s important to utilize weekend and evening time for rest and things that you enjoy. This will leave you more refreshed and effective when you return to the office.
In the presentation from Advancing Connections, Jennifer and Becky also suggest setting priorities and sticking to a schedule to better own your time. For instance, spend the morning hours prioritizing sourcing and answering emails, during the lunch hour set aside time to journal or walk and talk to colleagues, and be sure to find time in between work tasks to take a break, even if it’s just for five minutes.
When recruitment professionals prioritize their own mental wellbeing, they are more able to give their full attention and effort to developing and executing successful strategies for potential and current team members.
Recruitment professionals play a vital role in the healthcare community. They help improve access to care, attract and retain staff to improve their healthcare systems and provide opportunities for physicians that fit their needs. However, when we are burnt out, it’s almost impossible to perform to the best of our ability. Prioritizing your own mental health and organizing your time can help you bring your best self to work while helping others find the care and careers they need.
In healthcare, bias can ultimately affect life and death decisions for patients. While artificial intelligence (AI) can help recruitment professionals streamline hiring processes, it must be used responsibly and with health equity in mind. At the recent SHRM Inclusion conference, Tamiko Stanley, Chief Diversity officer & Managing Partner of Elite Executive Strategies and Liz Mahan, AAPPR Director of Professional Development & Solutions, shared their insights on recruitment professionals’ roles in advancing health equity and how they can find a balance between human connection and AI for a more equitable healthcare system.
A diverse workforce in healthcare institutions is essential for addressing the unique needs and experiences of different patient populations and promoting cultural competence in care delivery. Diverse organizations are better positioned to grow, innovate, and to advance along with ever-evolving healthcare demands and emerging medical conditions.
The impact of a representative clinical workforce is significant. In fact, the most diverse organizations are the most successful ones. According to McKinsey, companies in the top quartile for ethnic diversity show an average 27% financial advantage over others, and companies with representation of women exceeding 30% are significantly more likely to financially outperform those with 30% or fewer.
In healthcare, a diverse workforce can improve patient experiences and health outcomes and foster a culture of respect and collaboration. Data shows that there is a significant equity gap in both access to care and quality of care. For example, Black patients received lower quality care than White patients for about 40% of health equity measures in most recent studies. Recruitment professionals have a significant role to play in addressing these disparities by developing a diverse workforce within their organization.
Building a diverse healthcare system starts with recruitment professionals, their strategies and their processes. Technology can’t replace people, or the soft skills needed for healthcare. It’s up to recruitment professionals to find the right people with the soft skills needed to build a workforce that truly represents the diversity of their community.
Recruitment professionals can do this by providing clear paths for career advancement to all employees, establishing a reputation for genuinely supporting diversity as well as building strong connections – not only within the organization but in the broader community as well. Other powerful ways to attract diverse talent include developing diverse and inclusive sourcing and screening strategies, being an active advocate for proactive recruitment and retention strategies and understanding your candidate through active listening and asking the right questions.
Although AI comes with some challenges, it also has some benefits when used responsibly. It can help physician and provider recruitment professionals streamline the hiring process through resume screening, candidate matching, predictive analytics, automated scheduling and more.
To use AI responsibly and avoid bias, recruitment professionals should:
Teaching AI how to be human is an impossible task, so it’s essential you incorporate AI into your organization responsibly, using it to supplement, rather than to replace, human expertise and intentionality.
Effective DEI is heavily rooted in intentionality. As long as your organization prioritizes DEI in all aspects and incorporates AI in responsible ways, you are on the right path to ensuring equity for any patient that walks through your doors. Because after all, healthcare is all about humanity. To grow in your DEI journey and become aware of your own bias, check out AAPPR’s DEI Virtual Resource Center and DEI Micro-Certification. This topic will also be one of the sessions at the 2025 Annual Conference, Advancing Connections, in Phoenix, Arizona. Registration opens Dec. 3, so be sure to secure your spot for the opportunity to hear from and network with industry professionals.
Partnership. We use the word all the time, but how frequently do we take the time to dive into what that really means? Recruitment professionals are adept at building relationships with candidates, internal stakeholders, vendors, and our recruitment teams. But what does it take to turn those connections and relationships into true partnerships.
Recently AAPPR spoke with members, vendor partners, and leaders about what factors make for a good partnership. We’ve summarized our findings into the Eight Golden Rules for a Successful Partnership
1. Trust: Trust is essential in any partnership and can only be built over time through consistent actions and communication. Be honest about what is expected and share feedback regularly about what is going well and where there are opportunities for improvement.
2. Clear Communication: Partnerships require open and honest communication. Establishing a communication strategy that works for both parties will eliminate miscommunication and help ensure everyone has a voice in the project or process. Remember, not everyone communicates the same way – some prefer email, others a text, and some would rather a phone call. Clear communication will help to build trust and achieve shared goals.
3. Shared Vision and Goals: Partnerships should be formed with a shared vision and goals, so that both parties are working towards the same end result.
4. Complementary Skills and Strengths: Partners with different skills and strengths can complement each other and create a more effective and successful partnership. Taking the time to learn what the other partner can bring to the table is invaluable. Different perspectives and approaches to strategizing and problem solving will only create a stronger team.
5. Accountability: Once expectations are communicated and established, both partners should hold themselves accountable for their actions and responsibilities within the partnership. At the same time, both partners should also hold each other accountable and communicate with one another when expectations aren’t being met. Accountability may mean holding regular check-ins or sharing reports or status updates.
6. Mutual Respect: Each partner should respect the other’s contributions, opinions, and ideas. Some of the strongest partnerships involve people who approach or see things very differently; but with mutual respect and appreciation for what each brings to the table the partnerships thrive.
7. Flexibility: A willingness to adapt and change course as needed is important in any partnership, as circumstances and goals may shift over time. Recruitment is ever changing and both teams and individuals need to be able to adapt their strategies to a shifting landscape.
8. Mutually Assured Success: The recruitment ecosphere is small, and the market is competitive. At the end of the day, we are all working towards the same goal: attracting and retaining top provider talent to our communities. When a partnership is built on both parties winning success will follow.
The inner critic. Most of us have one. That little voice tells us we’re not good enough, not doing enough and don’t have anything of value to contribute. It can stop us from speaking up, pursuing a goal, or moving into a more influential job. The inner critic is a masterful storyteller who can influence every part of our lives.
The inner critic can be especially fierce in a niche profession like physician and provider recruitment. Professionals find themselves explaining what they do, why it matters, and how it differs from talent acquisition. We may struggle to stand out for our achievements within an organization where the need for new providers in a highly competitive market means one success is overshadowed by the pressing need to fill another requisition, where excitement about closing the deal with one provider is followed by another provider declining an offer.
A highly active inner critic can affect our emotions and self-esteem. It can trick us into thinking we don’t have the expertise to step forward and speak up in meetings. It can convince us we shouldn’t have a seat at the table during strategic planning. Worst of all, it can prevent us from moving forward professionally because we hear that little voice telling us we aren’t qualified.
Silencing the Inner Critic
Learning how to silence or diminish the inner critic’s power is incredibly important for our personal and professional well-being. However, it is much easier said than done for most of us. Here are a few ways to overcome our inner critics.
Awareness and Recognition: Work to recognize when your inner critic is active. Recognize the negative thoughts and self-judgments as they arise. Simply acknowledging their presence can be the first step towards managing them.
Practice Self-Compassion: Treat yourself with the kindness and understanding you would offer a friend. When negative thoughts arise, counter them with self-compassionate statements. Acknowledge that everyone makes mistakes and has flaws; these don’t define your worth.
Set Realistic Standards: Often, the inner critic emerges when you set impossibly high standards for yourself. Set achievable goals and recognize that perfection is not necessary.
Stop Comparing Yourself to Others: In a world and industry of intense competition, it’s easy to begin gauging our worth in relation to others. Engaging in comparisons only fosters the idea that we lack the capacity to achieve what others have accomplished. Remember that each person is distinct, possessing a unique set of abilities. Evaluating your skills through others is an injustice to your own potential.
Celebrate Achievements: Acknowledge your accomplishments, no matter how small they may seem. This can help boost your self-esteem and counteract the inner critic’s negativity. There is a saying that criticism and failure stick to us like glue, but praise and success bounce off us like Teflon. Challenge that and focus on making the successes and praise stick like glue!
Seek Support: Talk to friends, family, or a therapist about your struggles with your inner critic. Sometimes, sharing your thoughts with others can provide perspective and comfort. As a professional association, AAPPR is a wonderful resource to connect with other professionals who can relate to your successes and challenges. Consider finding a mentor or building a network of colleagues to help build you up when you have self-doubt.
Practice Self-Care: Engage in activities that bring you joy and relaxation. Taking care of your physical and mental well-being can help reduce the power of your inner critic.
Ensuring you take the time for yourself helps combat burnout and keep us at our best.
Learning From Mistakes and Putting Criticism to Good Use
Mistakes happen. Criticism will come our way. But don’t let mistakes and criticism define you or your worth – and don’t allow them to fuel the inner critic. It is important to remember that we all make mistakes and learn from them. Rather than seeing them as failures, view them as opportunities to improve and grow.
For high achievers or perfectionists’ mistakes can stick like glue. The very thought of them can be terrifying. Before giving in to the inner critic, consider this: You have the skills and ability to not only fix your mistakes but to learn and grow from them.
Some of the best progress the world has seen has come from a mistake – penicillin, the pacemaker, and even potato chips (yes, potato chips!) were the results of mistakes. And now we can’t imagine a world without them.
Like mistakes, criticism from others can send the inner critic into overdrive, seeming to confirm all those doubts about our abilities. Before you react to criticism, take a moment to acknowledge and reflect.
Reacting quickly can be a recipe for disaster! It is important to recognize that nine times out of ten, the person delivering the criticism has your best interest and well-being in mind, although admittedly, it can sometimes be delivered in a way that is less than constructive.
However, demonstrating that you are open to criticism can lead to success. It can show people that you care about what you are doing personally or professionally and seek to grow. Criticism can also help reduce mistakes or open our eyes to ways to do things differently. We may even be able to learn something new from it. At the root, criticism is a form of feedback. It can allow us to evaluate and find new solutions or identify ways to grow.
The Path to Growth
Silencing the inner critic doesn’t mean eliminating self-awareness or constructive self-reflection. Instead, it involves managing negative self-talk, challenging unrealistic expectations, and practicing self-compassion.
Silencing the inner critic can significantly impact your mental and emotional well-being, personal growth, and overall quality of life. It can increase self-esteem, reduce stress and burnout, increase productivity, and create resilience. Most importantly, overcoming the limitations imposed by the inner critic allows you to step out of your comfort zone, try new things, and embrace challenges. This leads to personal and professional growth and self-development.
The Association for Advancing Physician and Provider Recruitment (AAPPR)’s annual Internal Physician and Provider Recruitment Benchmarking Report is officially available. The report is packed with valuable insights designed to transform your recruitment and retention strategies. Most starkly, it highlights the effects of the increasing physician shortage in the United States and the impact it has had on health organizations’ in-house recruitment teams across the country.
As many of you likely know, as recruitment professionals it can be difficult to set tangible goals, productivity levels and benchmarks of success without access to relevant industry data. The benchmarking report provides that exact credible industry data, based on real recruitment professionals’ experience. This report is geared to help our members, their leaders, and the broader physician and provider recruitment industry prepare, plan and forecast to meet the challenges of the evolving healthcare landscape.
Key Takeaways for 2023
More than 150 member health organizations participated in the extensive research study, representing more than 19,000 searches (60% specific to physicians). The Bureau of Labor Statistics projects about 24,200 openings for physicians and surgeons each year, on average, over the decade, meaning the data from AAPPR’s Benchmarking Report represents close to half of all physician searches in the United States.
Some notable key findings from this year’s report include:
Over 24,000 Ways to Customize Data Outputs
Alongside the 70-page PDF report, recipients gain access to an array of valuable custom online resources. Dive into infographics highlighting nine key takeaways about recruiter data, offering concise yet impactful snapshots of crucial insights. Another infographic unveils 11 pivotal findings regarding search data, providing at-a-glance access to critical trends shaping the industry.
AAPPR’s commitment to empowering healthcare recruitment professionals goes beyond static reports. Our innovative reporting portal offers a dashboard that unlocks over 24,000 ways to customize data outputs. This dashboard lets you manipulate the data of over 19,000 searches in ways that precisely reflect your unique organization, sourcing needs, goals, and objectives. It also lets you filter compensation data on 600 recruitment professionals. Whether you’re fine-tuning strategies, making data-driven decisions, or seeking to optimize staffing solutions, the benchmarking report empowers you and your team to tailor the information to your needs. It’s more than data; it’s a blueprint for shaping recruitment strategies that drive excellence in healthcare staffing, putting the power of innovation firmly in your hands.
If your organization participated in the annual survey to collect this data, you can gain free access to the AAPPR benchmarking portal. The benchmarking portal includes days to fill and compensation calculators and give you the ability to compare a range of data, including organizational profiles, search information, recruiter profile data and recruiter compensation figures.
Utilizing the Reporting
Access to these customized reports is critical to making informed and strategic decisions around workforce planning, growth management, and target productivity levels. The ability to make these strategic decisions goes a long way towards implementing informed recruitment strategies that can ultimately help you better understand the market and fill searches more quickly.
To see how your organization stacks up and gain access to more valuable industry data, you can purchase the complete 2023 Benchmarking report at https://aappr.org/research/benchmarking/.
As the national physician shortage continues, demand for physician and provider talent is only expected to grow, giving physicians who are unsatisfied with their working conditions the opportunity to find a similar role with a competing organization.
In fact, AAPPR’s 2022 report on increased provider turnover shows one in three physicians and nearly one in two advanced practice providers (APPs) have departed their employer for a similar position elsewhere. Despite this trend, more than 75% of survey respondents say their organization does not have a formal retention program in place.
With ongoing physician shortages, a recruitment strategy isn’t enough to keep your organization staffed, and it’s critical that your workforce planning strategy prioritizes retaining the high-quality talent you already have. To ensure retention remains a top priority and minimize turnover, we recommend implementing a formal retention program. Here are five things to consider when launching your formal retention program:
Once your organization’s retention program is developed and in place, it’s important to measure its effectiveness and analyze if there is any room for improvement. One way you can measure this is by comparing your previous turnover rate to your present one. Surveying physicians on factors that often drive turnover, including burnout, level of work-life balance and overall job satisfaction, can also help guide the program and identify opportunities for improvement.
As competition for clinical talent continues to dramatically rise, investing in a formal retention program will bring your organization long-term benefits including reduced turnover and increased retention of top talent, while creating a work environment that demonstrates you are an employer of choice.
The marks of a good partnership are trust, transparency, and a desire to work together toward a common objective. Through AAPPR’s Corporate Partnership program, we seek organizations that provide these key aspects to our members and the physician and provider recruitment community.
Recently, Jackson Physician Search joined AAPPR as a Signature Partner, our highest Partner level, to support AAPPR’s mission of advancing and empowering physician and provider recruitment professionals with high-quality education, resources, and connections, so they can best serve their communities.
I spoke with Tony Stajduhar, President of Jackson Physician Search, to gain insight into what a partnership with AAPPR means to him and his organization. Tony shared how Jackson Physician Search is dedicated to supporting our members by partnering on original research, and with thought leadership and a knowledge base built on hundreds of years of collective experience to AAPPR members.
“At Jackson Physician Search, we support recruitment professionals based on our company’s values that include putting others first and doing the right thing,” said Stajduhar. “Recruitment is a long process, and it’s inevitable challenges will arise. We recognize that no two in-house recruitment teams are the same, and that every recruiting challenge is unique, so we work to understand the industry’s wide-ranging needs and to deliver support and solutions for each.”
Four decades into working with thousands of in-house recruitment professionals, Jackson Physician Search will provide AAPPR members with the resources, education, and expertise they need to improve recruitment efforts. From navigating the challenges of the ongoing physician shortage, to best practices for sourcing and recruiting, to gaining a seat at the table, Jackson Physician Search will share actionable insights on the most significant challenges facing our profession today.
“With the right tools, AAPPR members can drive real change in the healthcare systems they serve,” said Stajduhar. “We’re excited to collaborate with AAPPR and to be a resource for in-house recruitment professionals by listening, understanding their goals, and leveraging our knowledge from thousands of searches to share what we know – from trends and best practices that will improve their workforce strategies.”
As the largest, privately owned permanent physician recruitment firm specializing in physician, physician executive and advanced practice provider searches, Jackson Physician Search has dedicated significant resources to gathering data and insights that bring fresh thinking to the ongoing challenges in healthcare recruiting, and to the best practices that work today.
AAPPR is excited about the value this partnership will bring to our members and for the wide-ranging benefits it will have on our organizations and our communities.
In closing, Stajduhar said, “We’re here to support members in any way we can. We’re not just here to gain customers, but to be an extension of the team, a sounding board and a resource to serve our common goal of improving healthcare and ensuring communities around the country have access to the quality care they need.”
To learn more about Jackson Physician Search and their services for in-house recruitment teams, visit https://www.jacksonphysiciansearch.com. For more information on AAPPR’s Partner programs, visit https://aappr.org/partnerships/.
It’s no secret the market for physician and provider talent is more competitive than ever. Data from our 2022 benchmarking report shows physician shortages in many specialties are expected to continue climbing for the foreseeable future, making employee retention, burnout management, and well-being more important than ever. If not addressed, burnout and poor well-being of physicians, providers, and entire system staff has the potential to impact the quality of clinical operations and patient care.
To keep retention, mitigating burnout, and encouraging well-being top of mind for recruiters, HR staff, and leadership, we believe these three things are critical:
When constantly putting out fires and working to solve employee deficits, it’s difficult to prioritize intentional and thoughtful retention, burnout, and well-being initiatives. That’s why we always recommend engraining retention practices into everyday operations. Tactics like regular touchpoints can help identify issues and potential stressors, such as a lack of support or nursing staff before they’re full-blown crises. It’s also important to take a proactive approach to change management and look to involve physicians and their feedback in the decision-making process whenever possible.
Also critical to mitigating burnout and improving wellbeing and retention, is positioning physician and provider leaders at the forefront of retention activities. Just as physicians must personalize care to each patient, leadership and management need to personalize retention strategies to various teams, people and roles. Not every approach works for every physician or every healthcare system. Rather, empowering physician leaders to build a culture focused on connection will help leadership develop a deeper understanding of their teams wants, needs and concerns. This insight is critical in developing specific and individual strategies to ensure wellbeing, alleviate burnout and drive retention.
New technologies are essential to improving operations, efficiencies and even patient care, but AAPPR research also found new technologies and processes are a common cause of burnout, especially among older physicians and providers. In fact, our 2021 report on physician satisfaction and burnout found that over 33 percent of physicians cited burnout as the primary factor for early retirement, while 20 percent attributed an increasingly difficult technology and administrative workload as causes for early retirement.
The involvement of physicians in the roll out or development of new technologies and processes can help to ensure the technology works in a way that complements physicians and their roles, ultimately reducing day-to-day stress rather than introducing new stressors.
All of these things sound relatively simple in theory, but limited bandwidth amongst physician leaders can make it difficult to implement clinical-driven retention strategies. We recommend a few best practices to make this process a bit easier including allowing physicians to lead by example to promote the benefits of a physician-led recruitment program and providing physicians the tools and recourses they need to lead their own team programs. The most important thing leaders can do to support retention efforts is “know thy physician”. As recruitment professionals, we have a critical role in serving as the liaison between physician and leadership and can help nurture these important relationships and promote retention strategies.
Overall, proactively involving physician leadership in retention activities has the power to improve retention rates in clinical support staff. By giving physician leaders the resources needed to develop and engage with their team members, these leaders are empowered to meet with teams outside of the work environment and improve retention rates by understanding team concerns and challenges, as well as soliciting feedback on their own individual management styles. More than anything, an organizational commitment to the principle of “no decisions about me without me” may bey the key to avoiding administrative decision-making that doesn’t adequately account for physician needs.
Have you implemented any physician-led retention efforts at your organization? Share with us on social!
Facing unusually long wait times for credentialing and medical licenses in many states, physicians and advanced practice providers say it’s preventing them from making a living – and impeding patients from getting the care they need.
Physician and provider recruiters are well aware of the state medical licensing delays. For years, recruitment professionals have managed the challenges that prolonged state licensure delays have on new providers who are eagerly waiting to join an organization practice. In some cases, the unpredictable licensure timelines and unforeseen delays have resulted in organizations adjusting provider start dates multiple times. In turn, this can mean delaying appointments for patients who may have already been waiting to see a provider for quite some time.
The COVID-19 pandemic contributed to the backlog, adding to the physician shortage and other factors hampering healthcare recruiting – but does it affect patient care? Deborah Baker, Director of Legal and Regulatory Policy for the American Psychological Association,¹ believes it does. “If we don’t have efficient, consistent processing of these licensing applications, it’s just snowballing the overwhelming need,” said Baker. “This is more than just an administrative issue, this really is a public health issue.”
The length of time it takes to get a license in each state varies. Each state has its own licensing process, and although licensing requirements are very similar across the country, most states require physicians to be separately licensed in every state in which they practice. In addition to state-based licensure requirements, physicians performing services for multiple hospitals (like radiologists reading digital films via teleradiology) must be separately credentialed and privileged at each hospital.
The cause of the delays can vary, but state budgets and lack of staffing are common reasons. The processing speed can also vary by state and profession. Most states license numerous other professions and occupations, not just those in healthcare. Some states have independent medical boards that approve licenses, while others house their boards within a larger agency. Many states also use manual processing systems, requiring applicants to send forms, transcripts, and other records via fax or mail.
Physicians and providers need to be aware of the time it takes to get a license or risk being blindsided by licensure delays. Physicians are typically told it will take about sixty days, but in some states, the process can take six months or more. Prolonged delays have caused some physicians to pivot career plans or work in limbo in a location where they are licensed and credentialed until they can get a license to work in another state, practice, or hospital. All the while, patients await delivery of care.
Delayed licensing is not a new problem, either. In 2009, the California Medical Association2 filed a suit claiming that furloughs instituted by the state unacceptably slowed the state medical board’s processing of applicants for physician licenses. The state medical board had a backlog of applications well before California began its furlough program. In 2020, the healthcare system was already experiencing a physician shortage, impacting access to care, when the COVID-19 pandemic exacerbated the problem. It also revealed how ill-prepared state licensure and hospital credentialing procedures are when a crisis requires hiring more physicians to meet patient-care needs.
At the onset of the public health crisis, every licensing agency was forced to adapt. The Centers for Medicare and Medicaid Services (CMS) and almost every state in the country temporarily waived the requirement that physicians be licensed in the state where their patients are located.3 Many states waived or modified licensure requirements and renewal policies to ensure physicians with out-of-state licenses could practice in states with increased in-hospital demands. Did it help? NYC Health + Hospitals (at the epicenter of the crisis in the U.S.) was able to staff up to meet urgent needs during the pandemic,4 and there are numerous other examples.
The Interstate Medical Licensing Compact (IMLC)5 also provided much-needed flexibility to states that needed to license physicians to treat more patients quickly. The IMLC, an agreement between state boards of allopathic and osteopathic medicine, allows board-certified physicians in one of the member states to obtain expedited licensure in other member states. The Compact requires just one application for a physician to be licensed in multiple states where they intend to practice, which helps licensure to be completed faster and in fewer steps.
While the pandemic highlighted the need and the efficiency of the IMLC, it also changed how physicians used the compact. According to research from the American Academy of Dermatology Association,6 before 2020, a higher percentage of physicians used it for localized practice, with about 40% of physicians applying for licenses in a nearby state and an average of 1.6 licenses issued per application. However, after the pandemic began, locum tenens and telemedicine needs increased to account for 66% of applications.
What if physicians who get licenses in multiple states could also use the IMLC to maintain them? According to the American Academy of Dermatology Association,7 one of the biggest issues the IMLC hears from physicians is the difficulty in having multiple licenses with different renewal periods and continuing education requirements. In response, the IMLC is working to create a single source for physicians to log in to view all their licenses and track and control that information.
Virtual medical visits also dramatically increased during the pandemic. To prevent exposure to physicians and patients yet still serve patients, in-person visits were conducted by video. To address the critical need, some states also extended out-of-state licensing requirements for telehealth during the COVID crisis. For some specialties, telehealth has become a vital tool for physicians and patients alike, increasing and expanding access to care in communities. Under the revised licensure requirements, providers can deliver telehealth services across state lines, depending on rules set by state and federal policies. Interstate Compacts further simplify cross-state telehealth for specialists in participating states, according to the Federation of State Medical Licensing.8
Credentialing bottlenecks with organizations and payors can also affect patient care. Any physician opening a new practice, working across state lines, changing practice states, or joining a new hospital or healthcare organization must undergo the credentialing process within that practice or organization – regardless of how long they’ve been working as a qualified healthcare professional. The process requires extensive paperwork and multiple steps, and every state has slightly different requirements for obtaining credentials. Some states estimate traditional credentialing to be 30 to 60 days, while others warn credentialing can take anywhere from 90 to 150 days. Every day can impact a physician or provider’s ability to practice medicine legally, and patient care and access are hindered. The paperwork-filled processes can also increase stress on providers, drain physician enthusiasm, and affect their work-life balance.
Inefficient provider credentialing processes and mistakes can also increase costs. For many hospitals and health systems, 2022 was the most financially difficult year since the start of the pandemic. Research points to administrative waste as a critical driver of excess health spending. According to research from HealthAffairs,9 administrative spending accounts for 15 to 30 percent of healthcare spending, and at least half of that spending is wasteful due to a lack of standardization and coordination of administrative policies and procedures.
There’s no arguing that credentialing is a labor-intensive process. However, the industry is becoming more patient-centric, making it all the more important for physicians and providers to stay up to date with their credentials. That’s why many healthcare industry pundits believe automating the credentialing process can create efficiencies and substantially streamline the process. According to Physician and Practice,10 by importing information directly from primary sources like state licensing boards, a physician profile can be created and extended among health system locations. A physician could verify pre-filled data, supply any missing information, and spend 15-20 minutes versus three or four hours completing a lengthy document. Physicians also save the aggravation of refiling the same paperwork every time they move to a new state, a new hospital, or another practice. Automating and centralizing credentialing could also help healthcare organizations enhance provider satisfaction (think retention) and ultimately help deliver better patient care.
Healthcare staffing complications, exacerbated by the pandemic, put a spotlight on barriers that physician licensure and credentialing procedures have created for the delivery of healthcare. Understanding what the healthcare workforce needs to achieve desired patient outcomes and advocating for faster and easier licensing and credentialing processes is essential to patient care.
1. Building on the IMLC and expanding the Compact to all 50 states and four territories is an important step. It currently includes 37 states, the District of Columbia, and the Territory of Guam.
2. Having multiple licenses with different renewal periods and continuing education requirements is one of physicians’ biggest issues.
3. The proposed national physician license would strengthen our ability to respond to future crises, better allocate medical personnel to areas of need, and reduce administrative costs.
4. Automating the credentialing process can create efficiencies and substantially streamline the process.
5. Providing easier and faster credentialing can allow organizations to offer a unique benefit to the candidates with whom they work, build trust among patients, and deliver patient-focused care.
¹‘A real crisis’: License backlogs in some states are preventing health care workers from seeing patients https://www.nbcnews.com/health/health-care/-real-crisis-license-backlogs-states-prevent-health-care-workers-seein-rcna14740
²Fierce Healthcare: California Medical Association sues state over doctor licensing delays
https://www.fiercehealthcare.com/healthcare/california-medical-association-sues-state-over-doctor-licensing-delays
³Bipartisan Policy Center: What Eliminating Barriers to Interstate Telehealth Taught Us During the Pandemic
https://bipartisanpolicy.org/report/what-eliminating-barriers-to-interstate-telehealth-taught-us-during-the-pandemic
4JAMA Network | JAMA Internal Medicine: Modernize Medical Licensing, and Credentialing, Too—Lessons From the COVID-19 Pandemic, Donnie L. Bell, MD; Mitchell H. Katz, MD https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2775344
5 Interstate Medical Licensure Compact Commission, https://www.imlcc.org/³U.S. Department of Health and Human Resources: Telehealth licensing requirements and interstate compacts
https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/telehealth-licensing-requirements-and-interstate-compacts/
6,7American Academy of Dermatology Association (AAD), EXTENDING MEDICINE’S REACH: DermWorld takes a look at the Interstate Medical Licensure Compact, by Andrea Niermeier
https://www.aad.org/dw/monthly/2023/january/feature-extending-medicines-reach
8Federation of State Medical Licensing: U.S. States and Territories Modifying Requirements for Telehealth in Response to COVID-19
https://www.fsmb.org/siteassets/advocacy/pdf/states-waiving-licensure-requirements-for-telehealth-in-response-to-covid-19.pdf
9HealthAffairs Research Brief: The Role Of Administrative Waste In Excess US Health Spending
https://www.healthaffairs.org/do/10.1377/hpb20220909.830296/
10Physician and Practice: Streamlining credentialing to boost provider satisfaction, patient access by Grant Fields
https://www.physicianspractice.com/view/streamline-credentialing-to-boost-provider-satisfaction-and-patient-access
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