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Licensing and Credentialing Issues in Healthcare

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    We have discussed Universal healthcare and healthcare policy in general on this site, and what often comes up in the discussion is the issue of the physician or primary care provider shortage.

    As somebody who works in healthcare staffing, I have a front line view of that problem, and there are other factors that impact the issue outside of the lack of qualified labor, which I fully recognize as a problem.

    We have a byzantine, laborious, and duplicative licensing and credentialing problem for physicians and mid-level providers that want to work. These restraints prevent us from maximizing the existing labor force and accentuate the shortage of qualified providers.

    There is a reason that healthcare is highly regulated, and we need a system that protects the public from bad doctors and mid-levels.

    At the same time, we need a system that is not overly burdensome on all parties involved.

    1. We need to do away with state and territory licenses and just have one national medical license.

    This is legacy of our system of federalism. States and territories license and regulate the professional fields. The evidence in my opinion is that this system does not serve public purpose when it comes to physician and mid-levels.

    State medical boards are charged with protecting the public from bad doctors and mid-levels, and that costs dollars to do, and the licensing costs are a source of revenue for the state boards. That is not a good reason for state or territory based licensing.

    State medical boards should be charged with investigating physician practices when issues arise inside their jurisdiction, and they should be funded for that public purpose. Limiting or constraining the ability of good doctors and mid-levels to practice medicine and move about the country to do so with relative ease does not serve public purpose. There are numerous ways that state and territory medical boards could be funded for public purpose that do not involve licensing fees

    2. We need a system of nationalized credentialing.

    Every time a physician or mid-level gets credentialed to work at a new facility, all of their history, training, and certifications have to be verified. And not just by the facility where they are working, but the healthcare system they are working for and any management company for that system. There could be several layers of credentialing, all verifying the same information. The costs, diversion of resources, and lost man hours from this duplicative, repetitive system are enormous. On average it takes 3 months to credential a hospitalist or an emergency room doctor, and many times much longer. We do have a system called the Federation Credential Verification Service, and that does help with verifying education records of providers, but it does not contain work history information, nor procedure logs. In today’s information age, we ought to build a system that automates credentialing so that providers can easily get to work and facilities, management companies, and providers aren’t burden with a mountain of paperwork that adds to costs, deters providers, and creates confusion, delay, and stress that only accentuates the provider shortage.

    3. Facilities need to not require duplicative certifications.

    I work with ER physicians so I would like to discuss that from this from that vantage point:

    Board certified (BC) physicians under the American Board of Emergency Medicine are trained in all kinds of medical procedures to save lives. To maintain board certification they have to complete many hours of continuing medical education (CMEs) per year. On a daily basis ER physicians are doing intubations, dealing with trauma, performing CPR, etc. And yet many facilities require the same heavily trained BC ABEM physicians to go out and take classes with nurses, high school students, and life guards to get Basic Life Support (BLS) certifications. If our Emergency Room physicians do not understand CPR after 4 years in medical school, 3 years in residency, and however long they have been working, we have a major problem and god help you if you need to go to the Emergency Room. The reason for these certifications is liability. On paper, if something goes wrong, a facility and provider are better protected in front of a jury in a medical malpractice suit if providers have these certifications, such as BLS, Advanced Critical Life Support (ACLS), Advanced Trauma Life Support (ATLS), etc. The problem is we do not have enough instructors for these classes and they are not distributed in a way to make these certifications easy to get. We need to create a system that insures our providers are properly trained without the need for onerous certification courses that are short in supply and there are many ways to do this.

    In short, I will say that physician and mid-level providers are regulated to death and we are not maximizing their labor-time.

    This is a massive problem and public purpose is not being served by our current system of licensing and credentialing. There is much that could be done at the federal level to smooth out this process, reduce costs, and increase the capacity of our existing qualified labor supply to work and combat the labor-time shortage of physician and mid-levels. We need to have this discussion regardless of the payment mechanism we decide upon or ideology we have when it comes to health insurance. What I am talking about is the real world and how both private and public policy functions.

    As a trained economist and committed progressive Democrat working in the field of physician staffing, I implore you to start paying attention to these practical, front line issues in healthcare, and taking time to explore these issues with me. I believe that I speak for a vast super majority of doctors.

    We can make American healthcare great again. And there are practical issues that must be dealt with regardless of payment mechanism we decide upon.

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    Carlitos; good story. Again it shows how far the US is behind in these things; in Europe such has been in place for half a century. Amen