The primary responsibility of providing appropriate clinical care to a patient rests with the doctor under whose care the patient is receiving treatment. Thus, the outcome of care in a patient, to a very large extent, depends upon the expertise of the treating doctor. A doctor who is inadequately qualified or competent to handle a patient’s case can in-fact do more harm than good. Hence, it is extremely important that the patients are being treated by the right doctor. When doctors are employed or contracted by hospitals, it is the responsibility of the hospital to ensure that their patients are being treated by the right doctor. Hence it is a must for a hospital committed to provide high quality clinical care to have a robust policy on credentialing and privileging of clinicians.
CREDENTIALING
Credentialing refers to the process of collection and verification of the evidences of credentials of a doctor who is to be given the responsibility of treating patients in the hospital. The process ensures the authenticity of the details provided by the doctor.
Collection of evidences of credentials: Documentary evidences of following credentials should be collected for a doctor
1. Education
a. Mandatory basic qualification to practice medicine, as per Medical Council of India (MCI) regulations
b. Post-graduation, Diploma, Fellowship etc. from recognized institution with details of the specialization
c. Trainings, workshops, certificate courses etc. undertaken by the doctor with details of the topics/skills covered
2. Past Experience
a. Total number of years/duration of clinical practice
b. Specialization practiced by the doctor with its duration
c. Type of medical intervention / surgeries performed by the doctor
d. Hospitals/Settings with which the doctor has been associated for medical practice
3. Continuing Medical Education
a. Number of CMEs attended with details of each
b. Other educational or training programme attended to maintain current competencies
4. Teaching and research activities
a. Teaching and training roles undertaken by the doctor, related to medical practice
b. Research in medical science, publications and papers presented
5. Others
a. Registration with requisite councils (Indian medical council and state medical council) with registration numbers
b. Details of two references who can confirm the credentials of the doctor
c. Proof of identity
d. Detailed curriculum Vitae
e. Equivalence and legal permit to practice in India, for a doctor with medical degree from a foreign country.
Verification of credentials: After collection of evidences of credentials, a verification of the key details should be undertaken. This include verification of medical qualifications, experience of clinical practice and registration to practice. Verification can be done in following ways
1. For verifying qualification, original medical degree should be verified. For further verification the university/institute from where the degree is obtained can be contacted and requested to confirm the authenticity of the doctor’s qualification claim.
2. For verifying the registration to practice, the registration number can be checked from Medical Council website and details can be cross-checked.
3. For verifying the experience, original experience certificates must be verified. For further verifications past organizations can be contacted to confirm the details.
4. Verification should also be done from references to confirm various other details provided by the doctor.
The verification should be documented and recorded with the identification of person who did the verification. As the work of doctor involves life of patient, verification of every necessary details should be done meticulously. In case of doubt, additional evidences should be collected. If possible services of a professional employee verification agency can also be availed.
Up-dation of credentials: Credentials once collected should be updated from time to time. A specific duration, such as annual or six monthly should be determined by the organization, after which the further credentials added by the doctor should be collected and included his/her file.
PRIVILEGING
Privileging refers to determining the scope of clinical practice that a doctor can be permitted for undertaking independently in the hospital. The scope of doctor’s permitted clinical practice is also called as ‘clinical privileges’ of the doctor and the process of granting the clinical privileges is called as ‘privileging’.
Decision of clinical privileges to be granted to a doctor should be undertaken by a ‘clinical committee’ or a ‘credentialing and privileging committee’ in consultation with the concerned doctor. For efficient privileging process, the hospital should classify the scope of clinical practice in two parts, ‘core clinical practices’ and ‘clinical practices with specific credentialing requirements’.
Core clinical practices – These are the aspects of clinical practice that can be allowed to be undertaken by all clinician having a particular qualification. The committee should determine the scope of core clinical practices for each type of medical qualification. These practices should be such that a doctor with specific qualification can reasonably be assumed to have the competency of undertaking them. For example, core clinical practice for a doctor with at-least MBBS degree can be
- Admitting a patient
- Providing medical consultation
- Physical assessment of patient
- Providing basic life support care
- Ordering routine investigations
- Prescribing medicines that are not in high risk category
- Teaching, training and supervising
The committee can modify the core clinical privileges from time to time as per the prevailing local situation. The purpose of defining core clinical practices is that, a doctor with requisite qualification can be readily granted these clinical privileges. This enables the committee to focus on those practices for which there are special credentialing requirements.
Clinical practices with specific credentialing requirements – Certain clinical procedures requires specific competency on part of the doctor over and above the requisite qualifications. These competency can be gained by doctor through additional training or experience. The committee should identify all such procedures and specific credentials required for the same.
Privileges for performing these should be given to doctors after evaluation of the fitment of their credentials, by the committee. For example, a general practitioner when provides evidence of credentials of handling obstetric cases or emergency medicine cases can be given privileges for handling these cases. Similarly a general surgeon with virtue of experience in operating specific kinds of tumors can be given privileges to operate upon such patients.
The criteria for assigning these privileges should be determined by the committee and should be carefully determined considering safety of patient and effectiveness of treatment.
Temporary and Permanent Privileges – As the process of privileging can take some time to complete a policy of granting temporary privileges can be made by the organization. With this the doctor will be able to practice as per the temporary privileges till the time credentialing and privileging process is completed and permanent privileges are granted. For safety reason, temporary privileges should be limited to ‘core clinical practices’ and if any additional clinical practice is assigned it should be supervised by a senior doctor with same privileges. Temporary privileges can also be given to a doctor who would want to associate with the hospital on a temporary basis.
Review of privileges – From time to time, the privileges of the doctor should be reviewed and additional privileges can be granted. In certain situation, where the doctor cease to have the required competency, clinical privileges can also be withdrawn.
PROCESS OF CREDENTIALING AND PRIVILEGING
The credentialing and privileging process can be undertaken in following steps
1. The concerned doctor should be requested to fill the credentialing and privileging form and submit a copy of documentary evidence of all stated credentials.
2. The doctor should also specify in the form all the clinical privileges that he/she would like to have
3. The form should be checked for completeness and appropriateness.
4. The information pertaining to the credentials in the form and submitted evidences should be verified through appropriate means
5. The form should be given to the committee responsible for credentialing and privileging, for review and determination of clinical privileges. Simultaneously the doctor should be given temporary privileges by the chairperson of the committee responsible for credentialing and privileging.
6. The committee after reviewing the form and the privileges being sought should take a decision on whether the same could be granted or any modification needs to be made.
7. The committee should also consult the doctor concerned before finalizing the privileges.
8. After finalization, the temporary privileges should be updated into permanent privileges.
9. All clinical departments head and in-charges should be informed about the clinical privileges of the doctor, to ensure that same gets practices. Periodic reviews and medical audit should assess the compliance to the assigned clinical privileges.
