The History of Medical Credentialing

What is Medical Credentialing?

If you haven’t worked in the medical field before, you might be wondering what credentialing even is.

Credentialing is the process of establishing the qualifications of licensed medical professionals and assessing their background and legitimacy.

Credentialing is often seen as a necessary evil for clinicians. If a physician graduated from medical school, completed a residency and possibly a fellowship, was licensed by a medical board, and has years of experience - why do their credentials need to be scrutinized all over again to work somewhere else? Why is patient care being delayed until another set of eyes verifies their history and competency? 

What is Included in Credentialing?

Hospitals and clinics have a duty to their patients to thoroughly evaluate the experience and skills of their medical staff and can be held liable for patient injury or mistreatment if they fail to do so. They will typically review and collect documentation for:

  • Medical education
  • Postgraduate training
  • Medical licenses - active and historical
  • DEA registrations
  • Controlled substance registrations 
  • Continuing education credits and compliance
  • Board certifications
  • Employment history
  • Privileges/affiliations history
  • Professional liability insurance policies held
  • Malpractice claim history, including statements from the clinician and court documentation, if applicable
  • Peer reference evaluations
  • Federal and/or state background check, often completed via fingerprint collection
  • Health screenings - drug/alcohol test, general physical assessment, anything necessary for physical interaction with patients such as a TB test or flu shot
  • Online databases - the National Practitioner Data Bank, the Office of the Inspector General’s exclusion database, Medicare’s Opt Out Affidavits database, etc.
  • Personal identification - driver’s license, passport, social security card, etc.
  • Clinician’s personal attestation history
  • Disclosure of conflicting financial interests

The list goes on and can vary from facility to facility based on their bylaws and group accreditation requirements. The purpose is the same - to protect the population from medical negligence and malpractice. While it would seem that a physician “passing” the credentialing assessment from one facility would mean subsequent facilities should follow suit, history has proven that this assumption can be a dangerous one.

The Beginning of Medical Credentialing

The first instance of physician vetting was in 1000 BC. In Persia, followers of the ancient religion Zoroastrianism created a system for deciding whether or not a doctor was allowed to practice medicine. The doctor had to successfully treat at least three nonbelievers in medicine, and only if all three survived  were they eternally deemed qualified to practice medicine.

The beginnings of medical school appeared around the 13th century in Sicily, well before the concept of the medical license. Physician candidates had to meet certain qualifications in order to attend and pass an exam given by a surgeon so they could practice. Regulation and restriction around the practice of medicine has substantially evolved since then, but the notion that physicians must prove their worthiness has been around for centuries.

Historical Landmarks in Credentialing

Darling v. Charleston Community Memorial Hospital in 1956 was the landmark case identifying negligent credentialing. Dr. John Alexander set a cast on a broken leg, but he wrapped it too tightly, ultimately cutting off circulation in the leg. The patient was transferred to another hospital, underwent several surgeries by the head of orthopedic surgery, and eventually had the leg amputated due to necrosis caused by the restricted circulation. Dr. Alexander claimed he had set hundreds of legs in the past, but he had actually only set two ankle fractures since working at this hospital. He was not exposed to orthopedic material in medical school, had no subsequent training on how to set a broken leg, and did not bother to consult the board-certified orthopedic surgeons available at his hospital.

The patient sued the physician, but what makes the case memorable is that he also sued the hospital for letting Dr. Alexander set the leg with no orthopedic training. The hospital did not require him to consult a specialist on staff or provide proof of up-to-date continuing education around operative procedures during credentialing. He also sued the hospital for their unskilled nurses not identifying the lack of circulation earlier. Both Dr. Alexander and the hospital were found liable. 

This was the first time a hospital was held responsible for the negligence of an affiliated physician originating from a lack of credentialing. Physicians traditionally operated as independent contractors for hospitals and were not employees, but this court decision shifted a portion of the responsibility from the medical staff to the hospital itself. It confirmed that physicians are extensions or representatives of the hospital when they are practicing in the hospital, unlike a typical contractor role where the employer bears little responsibility. The uniqueness of this case is the hospital’s liability for the physician’s torts, as well as the hospital having an independent duty to provide safe, quality patient care.

In 1981, Johnson v. Misericordia Community Hospital found the hospital liable for Dr. Lester Salinsky’s malpractice due to a lack of thorough credentialing. After Dr. Salinsky paralyzed a patient during a hip surgery, it was discovered that he had lied on his application, stating he had never had previous privileges suspended, omitting any information on his malpractice insurance, and attesting that he was only requesting privileges for skills he was qualified to perform.  Many of the hospitals he listed as being affiliated with had never actually had him on staff. He was not board-certified in orthopedic surgery as he had claimed--or even board-eligible! There were seven cases of malpractice against him that he had failed to disclose to the hospital, and three more suits were filed against him during his appointment at Misericordia.

There was no organized credentialing committee at the time of Dr. Salinsky’s appointment; the executive committee took on those responsibilities at the time. The executive committee failed to actually contact his references or verify his past privileges. A medical staff coordinator thought Dr. Salinsky had already been on Misericordia’s medical staff before she began working with the executive committee, so she passed the file along. Her assumption that he had been credentialed once, so he was qualified to be credentialed again, led to a grossly incompetent surgeon being allowed to practice in an environment where he caused undue injury to a patient. The case was considered corporate negligence of the hospital because Misericordia did not adhere to the duty they owed their patients to protect them from foreseeable harm. It was the hospital’s responsibility to investigate and find the truth, despite Dr. Salinksy’s lies on his application for appointment. 

Credentialing is a Necessary Evil

That, ladies and gentlemen, is why credentialing and recredentialing are important. The repetitive and detailed nature of credentialing is designed to protect patients and ensure the legitimacy of that expensive piece of paper a physician walks out of medical school with. However, it is possible to improve the efficiency and speed of credentialing without compromising quality, and our team at Iris Telehealth does a fantastic job of that. Our main goal as a telemedicine company is to bridge the gap in the availability of psychiatric care across the country. We can only be successful in this goal if we prioritize quality care, making thorough, diligent, and efficient credentialing our priority.

About Iris Telehealth

Iris Telehealth is a telepsychiatry provider organization made up of the highest quality psychiatrists and psychiatric nurse practitioners. Our mission is to provide underserved communities with access to the best mental health specialists and prescribers. We are owned and operated by doctors who understand what patients need and have earned a reputation for providing outstanding customer service. Iris values building strong professional relationships with our partners and their staff. We are dedicated to understanding your organization’s needs and operational goals because we recognize that your success is critical to our own.

Iris Telehealth has helped countless hospitals and community health organizationsacross the country add telepsychiatry to their list of services. We believe everyone should have access to compassionate mental health care, and we have made it our mission to find innovative, affordable ways of making this possible!

Want to learn more?

Click here to download a free telepsychiatry guide.