Curbside Consult with Dr. Jayne 9/23/24

I spent several hours this weekend fighting with healthcare technology systems that haven’t been adapted to play nice with the new ways that some of us work as physicians.

In the past, many physicians left training and took jobs with a private practice, an employed practice model, or with an academic medical center. If they saw patients at a hospital, they likely went through a credentialing process that involved voluminous paper forms and actual humans that read through the applications and resolved any questions or discrepancies. There was likely a designated person who managed physician credentialing with the insurance plans that the practice worked with. In my experience, they typically worked from the hospital’s credentialing forms, but may have had supplements of their own. Once again, there was someone you could contact who would be shepherding your applications through the system.

As healthcare organizations started to get squeezed in the 1990s and began participating with more insurance plans, organizations started turning to third-party credentialing services as a way of economizing. Rather than paying someone in the practice to run credentialing efforts, they could pay an outside company to do it, hopefully faster and cheaper. The better companies assigned a designated person or two to work with a specific practice, but others just assigned credentialing tasks to a pool of people who may not have any kind of ongoing relationship with a practice.

Still, most physicians had a primary practice location and a couple of hospitals, so it wasn’t that complicated. Some physicians might have done moonlighting work at other facilities, but that was an exception rather than a rule.

Fast forward a couple of decades. A significant proportion of physicians are not employed in the traditional sense. Hospitals and staffing organizations are doing everything possible to try to not have their workers classified as employees even though they probably should be. Many more 1099 jobs are out there.

Some physicians prefer the 1099 world. They enjoy working as locum tenens physicians for the flexibility in time and location of different contracts. In the telehealth world, the majority of physicians who are doing the work are 1099 contractors, and many work for multiple platforms in trying to cobble together enough work to support themselves. That means that the burden of managing credentialing across multiple organizations falls to the physicians themselves, often without any specific training for it.

I’m dealing with three credentialing systems. All assume that I have a traditional office practice and that they are my sole side gig. The systems ask for different documents, but don’t necessarily have a mechanism to upload multiples of the same document, such as copies of medical liability coverage.

They are relatively inflexible with managing employment date information. Many of my clinical positions have not specifically been employment, and positions overlap when you’re a gig worker. The systems don’t account for this, resulting in discrepancy flags. The systems sometimes don’t understand that your medical liability insurance policy is only in effect on the days you work and isn’t in force all the time when you’re working infrequently at an urgent care or emergency department.

These systems are technically part of the healthcare IT ecosystem because they are mandatory if you’re a physician who is going to see patients, but they make even the worst EHR look like a walk in the park. I’m sitting here wishing we could have the health information exchange equivalent for credentialing, with some kind of interoperability so I could port data from one system to another without having to do triple entry.

Maybe there could be just a single system that I interact with and that can route the information to the different provider systems. Who knows, maybe something like that is already out there and I just don’t know it. I’m just trying to stay active as a physician and I’m not a credentialing professional.

None of the systems offer online chat or resources outside of business hours. One of them allows you to send emails to a generic mailbox with the hopes that your question will get to the right person. The other two require questions to be submitted through a ticketing system, and I’m not even sure if I’m choosing the right descriptors or qualifiers to get my issues to the right person. Either way, there isn’t a single person at any of these organizations who knows me from anybody, so I’m not hopeful that my issues will be resolved.

I spend the majority of time in my clinical informatics work, but I felt that even as a part-time clinician, I could provide deliver solid care to patients and allow busy primary care physicians to offload some straightforward acute patient needs. But I’m coming to realize that it might be time to hang up my stethoscope. There’s a bit of an existential crisis that goes along with that, but I know plenty of clinical informaticists who no longer practice.

I’ve reached out to some of my colleagues about what it might mean to stop practicing and have heard interesting stories about their own decisions. One stopped practicing at a time when his certifying board still required a single-day examination in person. He knew that seeing patients sporadically in a niche practice probably wouldn’t allow him to pass the exam without significant burden. Since most insurance companies won’t allow physicians to be on their panels if they’re not board certified, that was the end of his practice.

Another CMIO friend stopped practicing when he relocated to join a new health system that didn’t feel that medical practice was important to the role and did not offer options for patient care. His subspecialty isn’t suitable for telehealth work, so that was the end.

A third colleague stopped practicing because he felt like he was always burning the candle at both ends with both his industry job and trying to keep up patient hours without feeling fulfilled in his clinical role.

I’d be interested to hear from readers involved in credentialing. Is there some secret code that I have yet to crack, or an easier way to manage being a roving part-time physician? For physician informaticists who have given up clinical care, what was your thought process? Were there any gotcha moments that you wish you would have been warned about?

Do you have advice about continuing work versus hanging up your stethoscope? Leave a comment or email me.

Email Dr. Jayne.