Post a Physician Job My Account Advertising Info Contact Ad Sales Recruiting Physicians Today Newsletter
NEJM Online NEJM Weekly CME Journal Watch Online AIDS Clinical Care

Background Investigations Versus Credentialing: How the First May Eliminate the Need for the Second

November - December 2002

By Rhonda Jackson

When considering whether or not to conduct background investigations on a candidate, one of the first things a recruiter may think is: “We don't need that service, our medical staff/credentialing office takes care of that.” There are many reasons why this statement can be detrimental to the hiring practices of a hospital.

The First Line of Defense

The two major differences between “background investigations” and “credentialing and/or privileging” is the timing of the information and the type of information obtained. Background investigations are conducted either prior to a site visit or after a site visit, pre-contract offer. Recruitment offices will generally conduct some type of background screening, which may include residency and licensure verification and referencing. Other information, including educational sources and hospital affiliations, is typically left up to the medical staff office.

The recruiter may believe this is not a problem because the information will be obtained when the candidate fills out the medical staff application, and privileges will not be granted if there have been any problems. The first point to remember is that a recruiter is relying upon the information provided on the Curriculum Vitae (CV). This information is sometimes sketchy, and it is provided entirely by either the candidate themselves or an outside entity such as a recruitment firm.

Background Checks Help Prevent Further Investment in Undesirable Candidates

The second point to make is this: By the time the candidate is in a position to apply for privileges, the hospital has invested in advertising for the position, paid for a site visit and sign-on bonuses, arranged for moving expenses for the candidate (and his or her family), assisted the candidate in locating new housing, and set up countless meetings, mentorship programs, and advertising for the candidate’s new practice. In the case of a candidate with an undesirable background, most, if not all, of these expenses could be eliminated by conducting an in-depth background investigation prior to the site visit, or at the very least prior to the contract offer.

If a facility makes a contract offer contingent upon a satisfactory background investigation, it must be clear as to what a “satisfactory” background entails. Once a candidate has completely uprooted his or her family, the individual tends to exhaust all avenues of appeal prior to accepting a denial of privileges or revocation of any other type of offer. At this point, the hospital has not only spent large sums of money and become a target for civil litigation, but the publicity generated can be devastating, especially in smaller communities. Additionally, by conducting background investigations over and above the required elements from either NCQA or JCAHO, the recruiter is contributing necessary information for documenting due diligence in hiring on the part of their facility.

Credentialing Reports Versus Background Investigations — An Overview

*Not all of this information is included in every credentialing/privileging report. Requirements vary from NCQA to JCAHO depending on accreditation of each facility.

As you can see, all of the credentialing and/or privileging information may be contained in a background investigation, but the reverse is not necessarily true. Additionally, only cursory information may be verified — degree confirmation, for example.

A case in point occurred when a Doctor of Osteopathy degree was awarded to an individual who had attended college during a four-year time span. After completing a more in-depth background investigation, it was determined that the student had sued the medical school in federal court. The school had suspended the student, and he was attempting to get the disciplinary action reversed and expunged from the records. The student did not win the federal lawsuit nor his subsequent appeal, but after a three-month suspension, he was allowed back into school and was awarded his degree. The reason for the suspension: inappropriate behavior toward a female student. This doctor would later become a physician practicing obstetrics and gynecology. This was just the beginning of several other areas of concern for this candidate.

Be Wary of Candidates Unwilling to Cooperate in the Process

In addition to obtaining other information, such as driving record histories and employment credit profiles, background investigations can provide a recruiter with more specific information than the general “credentialing” report.

The first step in the background investigation process begins with obtaining a comprehensive authorization and release form from the candidate. Information provided should include the candidate’s full name, any other names under which the candidate had attended schooling and/ or practiced, a date of birth, and a Social Security number. These pieces of information are critical in confirming the individual’s records and identity. If a candidate hesitates or refuses to sign such an authorization, this is the first “red flag” in the screening process.

From there, a Social Security trace and validation is obtained. This report will generally provide any alternate names utilized, current and past addresses, and the date and state of issuance. This information is key in determining if the candidate has practiced in any locations not noted on the CV. States listed on a Social Security trace that do not correspond to information on the CV should immediately be contacted for licensure information and may even be considered prime locations for a search of court records.

Be Sure to Obtain Both Criminal and Civil Court Records

This leads to the second largest difference between a credentialing report and a background investigation — the court records. While some medical staff offices are currently conducting criminal background searches, very few are taking the steps to conduct a comprehensive search of court records, including both criminal and civil records at the county and federal level. Criminal records are always of concern; however, when dealing with medical personnel, the civil records are just as, if not more, important than the criminal records. Civil records will contain suits involving medical malpractice, negligence, breach of contract, and antitrust litigation to name a few. Payout information may be obtained during the credentialing process, either through contact with the liability carrier or through the National Practitioner Data Bank. At this point, however, the facility has already invested a great deal of time and money in the candidate. Information such as pending and dismissed cases may never be located through either of those sources. Contact with the court systems, however, may lead to a pattern of behavior or litigation that may not otherwise be found.

The recruiter is the first line of defense in ensuring quality health care providers for hospitals, health systems, and communities. Background investigations provide more specific information than the general credentialing report. Each background investigation is geared toward the individual candidate, rather than just the required documentation, thus saving valuable time and financial resources.

This article was written by Rhonda Jackson, account executive/investigator at AccuCheck Investigations, which is located in New Berlin, Wisconsin. You may contact Ms. Jackson at (800) 874-9099 or visit their website at www.accucheckinvestigation.com.

Back to Top