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Medical Credentialing’s Impact on Physicians and Healthcare

By July 24, 2023Providers

CME providers like American Medical Seminars play a small but important part in the nation’s medical credentialing system. Medical licenses, certifications, and registrations are administered by various medical and healthcare authorities tasked with ensuring clinicians are qualified to safely practice. Medical credentials are earned through a variety of avenues, including formal education such as medical school, postgraduate education, ongoing continuing medical education, and medical board exams. The process of medical credentialing is essential to maintaining your practice eligibility.

Why are Medical Credentials Important?

Professional organizations, healthcare organizations, and medical boards work to establish a network of credentials. Secondarily, credentials are used by medical insurance companies to reimburse physicians and healthcare organizations. Note that in this case, the term “credentialing” doesn’t only apply to the granting of hospital privileges and includes all forms of physician certification and qualification.

Healthcare credentials such as medical licenses expire periodically and must be renewed for clinicians to practice. CME credits are therefore not only necessary for building medical knowledge but are required on an annual or biannual basis by state medical boards to satisfy renewal criteria.

Patient Safety

Physician credentialing set through state medical boards, healthcare organizations, and professional associations plays a major role in patient safety. These entities work in concert to promote accountability among physicians at all levels of the healthcare system.

For instance, as a component of periodic license renewal, continuing education is an opportunity for physicians to reinforce fundamental skills while keeping up to date with best medical practices. This ensures patients remain at the center of care by providing access to the safest and most effective medical treatments available.

The credentialing system also provides patients and physicians with resources to report abuses and draw attention to systemic patient safety challenges. Transparent and effective systems of credentialing ultimately reduce medical errors. The system acts as a safety net for patients while incentivizing ethical and professional conduct. The data acquired through credentialing channels helps to quickly identify weaknesses that need to be addressed.

Quality Patient Care Standards

In addition to patient safety, delivering effective care is among the most important duties a physician must fulfill. The system of comprehensive and, in some cases, redundant skill development required by physician credentialing helps ensure the medicine is standardized and replicable across patients and cases. The ongoing system of rigorous examination, continuing education, and practical assessment provides opportunities for physicians to maintain high standards of practice.

Legal and Regulatory Compliance

The criteria and standards reflected in the medical credentialing process are in many cases codified in law or enforced by professional regulatory bodies. These legal criteria required to practice are set and administered by authorities such as The Joint Commission operating in all 50 US states. Medical organizations also play a role in the legal framework of the medical credentialing system by working with state and federal legislatures.

This helps foster a system of credentialing processes that reconcile changing healthcare landscapes and the real-world challenges experienced on front lines of care. This system also establishes requirements for documentation, record-keeping and physician self-accountability, and continuing education that supports improved care over the long term.

Credibility and Patient Trust

Credentialing systems also promote transparency and professional accountability among patients and their physicians. Patients rely on the expertise and judgment of healthcare providers for their well-being and should be confident this judgment is exercised throughout the care journey. Credentialing systems also foster accountability by creating objective criteria for determining medical standards violations, including misconduct or malpractice. Systems of physician discipline and accountability can remedy misconduct and help support trust in the healthcare system.

Medical Specialization

Medical credentials indicate a physician’s fitness and ability to practice their specialized area of medicine. Each indicates a different area of expertise, some of which must be demonstrated by all practicing physicians, while others are obtained and maintained only by those practicing in a medical specialty, such as neurology, cardiology, or oncology.

Gaining a License to Practice

Those entering the medical profession must meet predefined qualifications that include graduating from medical school, postgraduate training such as residencies and fellowships, and a comprehensive national medical licensing exam. Applicants must also issue information on their background including criminal history, health status, and work history in relation to their ability to practice competently and ethically.

After a physician is licensed through their state board, they must renew their credentials, including state licenses, periodically. This includes participating in accredited systems of continuing education and maintaining acceptable standards of medical practice and ethics.

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