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Background Checks: What Physicians Need to Know

March 2004

Editor’s Note: “Once reserved for those of questionable character or individuals engaged in security work, the background check has become a routine part of the hiring process for physicians. Despite significant academic achievement, and the almost constant scrutiny and surveillance by peers and/or senior clinicians during postgraduate training, it just does not seem logical that physicians would have their declarations of honesty and professional integrity challenged in such an intrusive way. This is compounded by the fact that while training in medical school we have had the distinct privilege of entering into doctor-patient relationships that demand the highest levels of ethics and professionalism. Perhaps the best way to accept the reality that employers use background checks to verify suitability for employment is to reframe the process as one of a reaffirmation of accomplishments, as opposed to one that is going to expose inherent flaws.”

— John A. Fromson, M.D., Chairman of the Department of Psychiatry at MetroWest Medical Center

The background check, now commonly conducted in advance of the job interview, is essentially a straightforward process that physicians needn’t be overly concerned about.

The final months of residency and the start of the job search can and should be an exhilarating time for young physicians. Yet, as the job search narrows and interview scheduling begins, physicians may be surprised to learn that they will have to undergo a background check prior to the interview.

While such checks were once conducted after an offer had been extended, times have changed. Today, most physicians should expect that a background check will occur before an offer is made and, in most cases, before an interview is set. The credentials verification process, on the other hand, typically starts soon after the employment offer has been accepted.

The reasons are multiple. For one, the hiring hospital or medical group often invests substantial time, resources, and money in the recruitment process, and the organization has a vested interest in ensuring that expenditures are used prudently to attract and evaluate only suitable candidates. In addition, medical organizations, and businesses in general, have become more aware of the importance of checking individuals’ backgrounds to protect themselves from possible future litigation should competence or character issues arise. And it goes without saying that hospitals and medical groups must use due diligence in hiring physicians to ensure that patients and the public are properly protected.

“In today’s climate of skepticism, physicians might feel unduly targeted, but that is not the case,” says Anna Jarecki, president of AccuCheck, Inc., a Wisconsin firm that conducts background checks for organizations that hire physicians and other professionals. “In any line of work involving higher-level professionals, [candidates] are being checked more thoroughly today.” Organizations also are taking a more guarded look at the recruiting process, Jarecki adds. Because they put so much time, energy, and money into it, they cannot afford to bring in someone who is not the individual they thought he or she was — or someone who turns out to be either a bad personality fit or who lacks the requisite skills or competency.

The prospect of signing an authorization and having an agency peer into one’s personal life and past history can be a little unsettling. But for the most part, it needn’t be, assures Jarecki. “It can be a little nerve-wracking for physicians to look at the wording of an authorization and wonder: ‘Where are they going to look? Will they be contacting my high-school buddies?’ ” she says.

In fact, the pre-employment background check is a fairly straightforward process, and it typically does not entail undercover tactics or digging in to the distant past. The background check generally starts with the candidate’s undergraduate years and involves verification of the following:

• A Social Security trace and validation
• State and federal court records and one’s driving history
• Employment credit profile
• Primary-source verification of one’s bachelor’s through professional degrees
• Training programs, if applicable including internship, residency, and fellowship
• Licensure, board certification, and hospital-privileges history
• Professional organization affiliations
• Reference are checked
• Drug Enforcement Agency (DEA) registration and history
• Possible Medicare or Medicaid program exclusions
• Malpractice coverage and claim history and National Practitioner Data Bank entries
• American Medical Association or American Osteopathic Association profile

While this degree of checking might sound like overkill when a physician is merely being considered for a position, it is commonplace now, says Steve Korinek, vice president of the Southwest region recruiting division of Merritt, Hawkins & Associates, a leading physician recruitment firm. “These days, certain checks — malpractice history, hospital privileges, licensing and DEA status, for example — occur prior to the interview. That’s a change from 10 years ago, when those [items] might have been checked at the conclusion of an interview,“ Korinek says.

In the case of malpractice history, the hospital or hiring entity is being more thorough today in light of rising malpractice premium costs and, in some regions, the scarcity of carriers or coverage. The credit-history check is conducted primarily to ensure that physicians, who often receive a loan or a net-income guarantee on hiring, are financially responsible. The credit profile, because of its detailed information, also helps the firm conducting the background check ensure that items such as addresses and former places of residence line up with the information provided on the curriculum vitae.

How the background check is conducted

Prior to the start of the background check, which typically takes 10 to 15 days, physicians will be asked to sign an authorization for the release of said information. The authorization is comprehensively written and typically broad in scope, and it requires that physicians provide their Social Security number and/or date of birth. Young physicians are understandably concerned about releasing their Social Security number, Jarecki says, because they have been warned about the possibility of becoming a victim of identity theft.

Although such concerns are valid in general, physicians needn’t worry about releasing this information to legitimate organizations. “Of course, we are governed by law, and once a physician releases the information to a hiring facility and to us as their agent, it’s a fairly easy paper trail to chase should something happen,” she says. “I advise physicians not to be too skeptical when they are dealing with legitimate organizations.”

Providing a date of birth helps the investigating agency ensure that it’s dealing with the correct individual and reduces the possibility that documents, such as court records, will be linked to the wrong individual. “It’s important to remember that civil [court] records don’t include identifiers such as Social Security numbers and date of birth. So when we conduct a civil-records search we need to be thorough, and sometimes we will order copies of documents,” Jarecki says, to ensure that court records either do or do not match up with the individual whose background is being investigated.

In any event, physicians whose backgrounds are straightforward and who don’t have any problematic areas in their past need not fear that an investigator will pry into their lives or interview friends and neighbors. “We don’t go down alleyways or go undercover, and we are not trying to dig up dirt on everyone,” Jarecki says. “The check is conducted primarily to ensure that the hospital or hiring organization feels comfortable moving forward.”

For the record, Jarecki also notes that physicians will not come into personal contact with the investigator, who refrains from such contact to maintain objectivity. Nor is there any “judgment call” involved. “It is strictly information acquisition and reporting,” she says. In addition, should the hiring organization decide not to proceed with an interview based on the findings of a background check, the law requires that the individual receive written documentation of the report items or issues that led to the decision.

When physicians protest that the pre-employment background check in unduly intrusive, Korinek urges them to take a more forward-thinking view — to a time when they themselves might be working with, or involved in hiring, a new physician. “I say, put yourself five years down the road. Wouldn’t you rather work in a medical community that is bringing in a physician who has had the same extensive background check you had, rather than one for whom the process has been haphazard?” Korinek says. “You don’t want to end up in the operating room with someone who hasn’t had that extensive check, so physicians should look at this [background check]as a positive.”

For the most part, physicians should not be overly concerned or worried about the background check, Korinek says. “If I were a resident coming out of school who had done well, and was well thought of by peers and the residency or fellowship director, I wouldn’t be too concerned about the background check,” he says. “Physicians need to remember that they’re not joining the CIA.”

NOTE: The author, Bonnie Darves, is an independent health care writer based in Lake Oswego, Oregon.

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