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Part Three: Setting Expectations; Medical Staff Credentialing and the Locum Physician

Part Three: Setting Expectations; Medical Staff Credentialing and the Locum Physician

A couple years ago I heard a credentialer say, “Locum Tenens is a type of practitioner, and not a type of privilege.” Such an incredibly succinct statement considering how often the relationship is confused with a privilege type. The days of locum tenens physicians practicing with minimal verifications and on-boarding activities are dwindling. Each facility has its own categories of use for locum tenens, but by far the most common (and most logical,) is “temporary” since these providers truly are provisional by nature.

Locum tenens are interim physicians that are urgently needed due to anticipated necessity (i.e., vacation) or for unanticipated needs (i.e., health reasons or unfilled slots in a rotation). Even when expected, a replacement might only come together at the last moment with limited time to complete the credentialing process.

I have also heard credentialers say, “We can’t use temporary or expedited privileges because of the Joint Commission standards.” When reviewing The Joint Commission’s standards on temporary privileges, one would see that JCAHO officially recognizes only two circumstances in which provisional concessions may be granted that allows an abbreviated process; current licensure and current competency verification. Due to these circumstances, both the CEO and the medical staff president must ultimately approve a practitioner privileges, in part by making sure all proper (primary source) verification reference checks are completed to ensure patient safety.

In addition to the above, certain facilities may offer expedited or abbreviated privileges in the following circumstances:

  1. To fulfill an urgent patient care, treatment, and service need (due to an emergency.)
  2. When an applicant for new privileges (who has a complete application that raises no concerns) is awaiting final review and approval by the medical staff executive committee and the governing body.

There are times in which expedited or abbreviated privileges may be granted, but these situations are becoming less frequent.

Applications for locum tenens are by-and-large the same process as those for full staff privileges. The practitioner must have a “clean” file and if at any point in the process data is received which disqualifies the file as being such, a member of the Credentials Committee, Chief Medical Executive, Department Chair, or Division Chief may halt the processing of the application. Because of the time-sensitive nature of locum tenens processing, it does not always allow the normal credentialing time span which includes a thorough vetting of discrepancies and concerns. Therefore, do not expect a physician with pending malpractice claims, licensure issues, sanctions/suspensions, dismissal/reductions of privileges from medical staff, unsatisfactory references, etc. to be eligible for temporary privileges or make the needed start date.

Board Certification
Board certification in the practice specialty achieved within three to five years of the highest level of post-graduate training is the norm. However, many medical staff bylaws allow for board eligibility with proof from their respective board and a date the physician has registered to take the board exam. If the locum tenens provider has been boarded and allowed certification to lapse, the physician may be considered for special exemption for five years from the date of board expiration; based on experience and current verification of competency.

Prior to any patient care activities, orientation is a mandatory part of credentialing and will typically be coordinated by Medical Staff Services and the entity bringing the locum aboard. Timely completion of medical records is a requirement of maintaining medical staff privileges. This includes IT training and competency, IT access management and credentials, health assessment containing titers and often times drug screening, as well as specific training required to ensure safe and coordinated patient care. Additionally, most facilities will require coding and medical records compliance training as part of the orientation.

Renewals are required to begin an assignment with process and timing differing for each facility; although most are approved for a maximum of 120 days. A new Medicare attestation statement must be completed at each renewal, as well as verification for the National Practitioner Data Bank (NPDB), General Service Administration (GSA), Office of Inspector General (OIG), DEA, and State license.

In the event a locum tenens physician is going to be used continually for more than three months and/or episodically where there is time to process regular privileges, it would be appropriate to facilitate this request at the time of initial application or to convert to regular privileges over time.

Knowing the requirements and limitations for the specific facility will eliminate much stress and disappointment in obtaining privileges. Make sure to check with the medical staff coordinator even if you’ve had privileges there in the past, or previously worked with the same hospital representatives. By-laws are continually updated and may not be the same as what you are historically accustomed. Bottom line being, if you don’t make assumptions, you’re less likely to encounter unexpected surprises that could slow the process.

Arlene Macellaro is the VP of Business Development and Client Relations for All Star Recruiting. She can be reached at AMacellaro@allstarrecruiting.com.

"When I was initially contacted by All Star, I had already been approached by several companies and presented to quite a few opportunities so I didn't think I needed to speak to another firm. What I didn't count on was All Star having another eight positions which other agencies didn't have. Now I'm happily working at one of the options they offered. Thanks!"
- Bal A., M.D.

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