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.
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
³Bipartisan Policy Center: 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
6,7American Academy of Dermatology Association (AAD), EXTENDING MEDICINE’S REACH: DermWorld takes a look at the Interstate Medical Licensure Compact, by Andrea Niermeier
8Federation of State Medical Licensing: U.S. States and Territories Modifying Requirements for Telehealth in Response to COVID-19
9HealthAffairs Research Brief: The Role Of Administrative Waste In Excess US Health Spending
10Physician and Practice: Streamlining credentialing to boost provider satisfaction, patient access by Grant Fields
OKEMOS, MI – The Association for Advancing Physician and Provider Recruitment (AAPPR), the leading authority of physician recruitment and retention, is celebrating the first group of members to complete its Certified Physician/Provider Recruitment Professional Diversity, Equity and Inclusion (CPRP-DEI) certification. The certification program was launched during the AAPPR Annual Conference in April 2022.
The course, which has been peer reviewed by fellow physician and provider recruiters and approved by the AAPPR Board of Directors, provides an advanced certification for those already holding a current CPRP certification. Through this curriculum, AAPPR is working to give recruiters the tools they need to create a more diverse and inclusive environment in their organizations.
“We recognize the need for providing relevant and actionable learning opportunities to further the cause for social justice and equality in health care and our world,” said AAPPR CEO Carey Goryl, MSW, CAE. “After completing the program, participants can demonstrate skills and leadership proficiency in diversity recruitment, further fostering a new ability to influence effective DEI and diversity recruitment strategies to support and drive systemic change.”
The following AAPPR members received their CPRP-DEI certification after completing the program:
To earn this distinction requires members to complete 3.5 hours of self-guided learning along with other instruction and then passing an exam.
The next available course for certification will be held on November 16, 2022 in Indianapolis. For more information, visit https://aappr.org/news-events/fall-in-person-courses/.
The Association for Advancing Physician and Provider Recruitment (AAPPR) is a nationally recognized leader in health care provider recruitment, onboarding, and retention. For more than 30 years, AAPPR has empowered physician and advanced practice provider recruitment leaders to transform care delivery in their communities by providing best-in-class practices, up-to-date industry knowledge, and evolving innovative approaches for hiring, onboarding, and retaining exceptional clinical talent. To learn more or to become an organizational member of AAPPR, please visit https://aappr.org/join-now.
If you think you’ve been hearing more about taking care of yourself, you’re right. One indicator: according to Google Trends, the number of searches for “self-care” has more than doubled since 2015. As recruiters, we are expected to work long hours, answer calls at all times of day, and hit our metrics to be highly productive. As a board, we’ve talked about the constant pressure and stress and how it can lead to burnout, depression, and anxiety. We are not alone, and you are not alone. We are all less equipped to handle the stresses that come our way when we’re depleted physically and experience emotional exhaustion. But by taking some time out to engage in self-care, you can help manage your stress and reground yourself where productivity is once again maximized. According to Southern New Hampshire University, “engaging in a self-care routine has been clinically proven to reduce or eliminate anxiety and depression, reduce stress, improve concentration, minimize frustration and anger, increase happiness, improve energy, and more.”
I constantly hear people neglect self-care because they don’t have the time. There is enough time in the day for self-care if you are aware of how you choose to spend your time. Prioritizing self-care is an active choice. How many hours do you spend on Facebook, Instagram, LinkedIn, TikTok, or YouTube each day? Most smartphones have an app that tracks how long you spend on social media each day. Try checking the app every day for a week. You may be surprised to learn just how many hours each day you spend on social media. Or how about trading one hour of exercise or on a hobby for just one hour spent on social media?
Another self-care tip is to set your alarm for 30 minutes earlier than usual. Reach for a notepad and pen instead of your phone when you get up. Write whatever comes into your mind. This will help reduce worries or stress and focus on your day ahead. No time for breakfast in the mornings? If your mornings are very hectic, prepare breakfast the night before so that you can still eat a healthy meal in the morning. Exercise not your thing? How about spending 30 minutes in a hot bath reading a book. Self-care is known to improve your mental and physical health.
Learning how to take time for yourself might be the hardest choice you’ll ever make. In the long run, it will be the best decision you make, allowing you to be your best self and achieve all those goals you’ve been waiting to tackle. Get started on taking care of yourself today.
A new year brings a fresh start, setting new goals and thinking about the future. Now that 2022 has arrived, it also has me reflecting on the events of the past year. The resiliency we collectively have to endure and overcome is inspiring. Even in struggle, I recognize the opportunities for change & innovation that the year brought to our profession. Much of which inspired notable and historic accomplishments for AAPPR and our Members.
In 2021, knowing that our traditional in-person Conference was not going to be an option, AAPPR pivoted and stood up our first ever Virtual Conference, hosting over 600 attendees and offering a virtual translation of our much-beloved annual conference. We held the first ever Leaders Connect in-person event, with a focus for leaders and stakeholders in the provider recruitment space. Additionally, the launch of the AAPPR Academy brings all our tools and resources together for a one-stop, easy to navigate, virtual learning experience.
AAPPR published its very first White Paper – a collaborative effort between the Board and a panel of leaders within our own membership – calling out the alarming trends and shifts we’re seeing in our industry impacted by the pandemic. In complement, AAPPR published 3 research reports on COVID’s impact on physician career changes, recruitment, onboarding, and compensation structure and benefits. In addition, the Annual Benchmark Survey hit a record high number of participants and search data points – inclusive of nearly 170 member organizations and almost 17,000 searches – shattering our prior year record of 11,000 searches.
Being at the forefront of industry trends and shifting landscapes is critical to supporting AAPPR’s strategic imperative of elevating our profession and our members as the source of knowledge and truth when it comes to recruiting and retaining physicians and providers. It is critical to us as a Board in ensuring that we are not only supporting our Members with the tools and resources they need, but always thinking ahead with foresight to advance our profession along the recruitment to retention continuum.
So, in addition to reflecting, we also start to ask, ‘what comes next’?
In 2022, I will reach a milestone in my own career – 20 years working in the physician and provider recruitment. From coordinator to recruiter to consultant to leader, I’ve worked within a multitude of care models, from fee-for-service, multi-hospital integrated academic systems, to capital-backed, technology driven health startups out of Silicon Valley – and everything in between. Experiences like these shape us as professionals and how we see things. The diversity of my own experience has shown me how much variety exists within our profession when it comes to
• how we do our work,
• what drives it and
• who the key contributors are.
The evolution of our industry is remarkable to watch.
Our traditional “in-house” recruiter lines are a bit greyer – with movement of physician and provider recruiters back and forth across the employer vs agency models. We have recruitment teams now that operate purely on production models, particularly those in the VC, pre-IPO space as new care businesses emerge every day and stretch to meet aggressive growth & hiring goals. As leaders in our industry, we need to consistently ask
• What is changing and how can we proactively anticipate the needs that come along with that change?
As we think towards the future, I challenge us to consider what that looks like.
• How is our work evolving?
• Who are the people influencing that change?
• Where are the content experts, the thought-leaders and the experiences that shape how we do our work and touch the physicians, providers, and communities whose lives we impact?
• Are the influencers part of our conversation and, if not, how do we invite them to the table?
• How do we continue to embrace and welcome change in a way that only makes us better – creating opportunity for learning and collaboration across the spectrum of our profession?
AAPPR embraces the change that is occurring and is eager to see what the future holds.
It’s Friday, and you have a physician who starts Monday, and the medical staff office hasn’t cleared them for a start. Meanwhile, you have a recent hire who has questions about their offer letter. Oh wait, you have to work with the department for another physician for last-minute coverage? But hang on, you also have to post the internal medicine position your leader wanted two months ago for a start date in the next three months. Then, whoops, your email just notified you that another physician resigned, and a department lead just sent you a text message saying they need an advanced practitioner partner and asking when you can meet to discuss the recruitment strategy. And the list goes on and on. Sound familiar?
As if the day-to-day challenges of recruiting talented physicians and providers weren’t enough, many of us find ourselves asking how we are going to get the job done…in a timely way, under budget, without adding resources, and delivering what seemingly becomes an all-too-often quest to help educate and realign stakeholder expectations.
From becoming and staying a destination employer to having the selectivity of candidate-of-choice, today’s recruitment environment leaves little in the way of maintaining a competitive advantage to recruit exceptional talent.
Undoubtedly, the success you encounter is not easy, and the days of advocacy for your needs are few and far between. But there are ways to stage your best advocates for success — your C-Suite and leaders. Really! Despite the unrelenting question of ‘where’s my hire?’, instilling their needed trust and support for you and your ideas requires not only your knowledge to speak their language, but to do so in a meaningful and effective way to help remove recruitment barriers and level-set expectations for an increasingly competitive market.
The art and science behind the language of the C-Suite and leaders is fueled by none other than data — and, more importantly, the interpretation/translation of that data into action. After all, data points are meaningless numbers without the understanding and recommendations of physician and provider recruitment leaders like you. Data fueling a recruitment strategy yields greater value by the C-Suite and senior leaders for a more effective and efficient approach to recruitment with greater confidence that clinical workforce growth goals can be achieved. Without data and value analysis, the risk of losing millions of dollars in lost revenue, expensive position vacancies, and perhaps costly temporary staffing resources.
For key data and strategies to help your C-Suite and leaders become recruitment advocates, please download our Creating Advocates Among C-Suite and Leadership quick guide.
Ready for more C-Suite/leader language? Be on the lookout for the next blog post, Let the Numbers do the Talking: Developing Effective Executive Dashboards to Showcase Your Success!
AAPPR is seeking your participation at the 2022 Advancing Connections Annual Conference at the McCormick Place in Chicago on April 24-26, 2022.
To apply, click on the link below and review all the information needed to complete the form before starting your submission. It must be completed in its entirety at one time. If you close your browser before clicking the Submit button, your work will be lost. Each field marked with an asterisk is required (including attaching headshot(s) of the presenter(s).
All submissions will be reviewed and evaluated for content and learning methodologies that will assure balanced, high-level engagement from our participants.
Should you have questions, please send a message to firstname.lastname@example.org. Thank you for sharing your ideas and expertise!
As a member of the AAPPR Board of Directors, it’s important for members to know that as an organization we fully support all of the regional Affiliate groups and encourage you to become involved with one closest to you. In thinking back to the whirlwind of my first year as a new physician recruiter, I had so much to learn in a short time. Nobody goes to school to be a physician recruiter. What stands out from that first year was my predecessor insisting I immediately join the regional ISPR (Illinois Staff Physician Recruiters) and national AAPPR (formerly ASPR) recruiter groups. After joining, I was quickly welcomed to the industry, provided educational resources, and mentors I could call for help. I hope you could say the same when you joined.
As a solo physician recruiter, I quickly felt a sense of security and inclusion within both organizations. AAPPR provided me with instant access to a huge volume of education, technical tools, and other recruiters. I had a place to find the answers to my questions. Yet it was my affiliate group where I distinctly remember the sense of recruiter community to be unique and memorable. I found that I could easily connect with them personally, due to our geographic familiarity and convenience of meeting together. They knew where my little town was and we often had someone in common, like the Six Degrees of Kevin Bacon. Our meetings and conferences always left me feeling understood and a part of a bigger network.
Today, as a senior recruiter, my affiliate group and AAPPR synergistically allow me to continue grow as a professional. It has provided me with the opportunity to gain leadership experience that is not always available to physician recruiters within their healthcare organization. In my 18 years as a physician recruiter, my affiliate group colleagues are the people with whom I have shared many professional challenges and successes. When I need advice, they have my back and I have theirs.
The Board and I would like to thank all of the Affiliate group leaders for their time and contributions. They appreciate members who get involved so if you haven’t already engaged with your local group – please consider reaching out.
Memorial Healthcare System
Ascension St. Vincent’s
GoHealth Urgent Care
Holzer Health System
Anne Arundel Medical Group
Bon Secours Mercy Health
Bayhealth Medical Center
Sparrow Health System
Cooley Dickinson Health Care
Erlanger Health System
Franciscan Physician Network
Cleveland Clinic Health System
Davita Nephrology Practice Solutions
The University of Texas Rio Grande Valley
Surgical Affiliates Management Group
First Physicians Group/Sarasota Memorial Hospital
Schneck Medical Center
Einstein Healthcare Network
University of Minnesota Physicians
Rush University Medical Center
Indiana University Health
Geisinger Health System
Tenet Healthcare – DMC Medical Group
District Medical Group (DMG)
Sentara Medical Group
Cleveland Clinic Health System
VHA Healthcare Recruitment & Consulting Office
Bluestone Physican Services
Rush University Medical Center
The University of Texas Rio Grande Valley
KUMC Rural Health Education & Services
OSF Healthcare/OSF Medical Group
CHRISTUS Trinity Clinic
Keystone Healthcare Partners
OhioHealth Physician Recruiting
Inova Health System
Northeastern Vermont Regional Hospital
Henry Ford Health System
Methodist LeBonheur Healthcare
At the end of a successful campaign, we like to look back, evaluate and measure success. It is also a great opportunity to say thank you to those who participated and engaged. We are grateful that at the close of the #IamAAPPR campaign, we can do both things.
Throughout the three-month campaign, we saw an increase in website traffic to aappr.org and in followers across all AAPPR’s social media platforms – Facebook, LinkedIn, Twitter and Instagram. Not only was there a boost in our followers, but the overall user engagement was at levels we had not seen since March, before the COVID-19 pandemic. There was even an up-tick each month in both new AAPPR memberships and partnerships.
What does this tell us? That even during a global pandemic, when there is a high likelihood for social media burnout and general inbox exhaustion, with the health care community taxed, AAPPR members were continually inspired to respond, comment and share – to be an active part of the campaign. The key reason for this engagement and inspiration, without question, was all the great stories shared by our members and partners. Both in the number of stories told and in the depth of their individual expression, your IamAAPPR stories defined this campaign and is what made it so compelling.
Whether you liked a post or shared your story, it is our sincere hope that you found new value in your AAPPR membership. Your enthusiastic engagement and willingness to spread the word about AAPPR is the essential foundation for a successful campaign. After all, there is always a need for inspiration and we look forward to hearing the next great IamAAPPR story.