I haven’t been able to blog as much lately due to my recent residency graduation and entry into private practice. I have learned many things while purchasing my practice and credentialing with insurance companies. Credentialing with insurance companies is certainly challenging but the main thing I wish to discuss is my battle to obtain hospital privileges. I will not name the specific facilities involved but I will be 100 percent honest with my experience in this process.
I purchased my residency director’s practice as of June 1 with a great gradual changeover. He is on staff at two separate hospitals within a 30-minute drive of each other. Both hospitals knew about the impending change after I graduated residency on June 12. I began my hospital credentialing applications in the middle of March and understood this would take some time.
Hospital #1 is a few minutes away from our ancillary clinic. We are at this hospital two half-days each week. We have a relatively small patient population here and see a few hospital consults as well as perform the occasional surgery at this hospital. After touching base with the human resources department in March, I received a packet of information including my application.
Completion of this application included providing standard demographic information, residency training verification forms and my surgical logs. This is all very standard. I turned in all of the requested documents in a relatively timely fashion. Approximately three weeks ago, I was a part of a conference call with the department chairs of the hospital. The phone call was very friendly. The call started off with the department chairs asking me to explain who I was, a little bit about myself and, lastly, how I would utilize their hospital in my practice.
It was a very lighthearted conversation. The department chairs introduced themselves and invited me to their respective sections to show how their facilities could help me in my practice and assist with my patient treatments. This entire conversation took approximately 10 minutes. One week later, I received my welcome packet in the mail, stating I was on staff and simply needed to schedule a time for computer training and to get my badge.
Hospital # 2 is where I completed my residency. I spent the better part of three years in this facility. Everyone knows me on a first name basis and expressed excitement for my transition into the residency director’s practice. I received similar application information at a similar time frame in the mail. I filled out the application and returned at the same time that I returned the application for the first hospital I mentioned. Again, the hospital requested my surgery logs and I furnished those as well. I received a phone call stating that there will be a 30-minute conference call with the department heads for the credentialing committee. I was greeted by all the individuals in the call. I have worked alongside all of them at some point. We are not strangers.
After a brief “hello,” they immediately shared that they had concerns about my credentialing. I was told that due to my lack of experience with ankle fractures, ankle scopes and total ankle replacements, I would not be granted privileges to perform these procedures at this hospital. I was told there is no minimum number of cases required but they like to see close to five of each of these for me to be granted the ability perform these procedures at the hospital without any additional training or a second physician scrubbing with me.
I did have this experience, which was was clearly illustrated in my logs. None of the committee members had my logs in front of them nor were they aware of what cases I had done. They then agreed to allow me to furnish proof of the ankle fracture logs and declined to grant me total ankle replacement privileges as they would like to see additional training for this procedure. I did see that as reasonable as many companies that have total ankle replacement systems require certification and a wet lab in order to use their implants anyway.
That said, I felt I was on the defensive the entire time, essentially defending my entire surgical residency for rearfoot cases.
The committee then informed me that they planned to set aside my application as I was not eligible for approval at this time due to the ankle case log issue.// There was no interest on the part of the board for me to become credentialed quickly to see hospital consults or perform other surgeries. I told the board I would submit the true numbers for my logs within the next hour.
Immediately following the phone call, I reviewed my surgical logs and found 10 ankle fractures and seven arthroscopic procedures. This just showed me that none of them took the time to actually review my cases. I believe they simply assumed that my being a podiatrist made me unqualified to perform rearfoot and ankle surgeries. This was my home hospital, my residency hospital. People I’ve worked with in the operating room just assumed that because I was a DPM and not an orthopedic surgeon, I did not have skills. I sent them an email with these cases itemized. I stated that I still planned to pursue those privileges as these numbers do show confidence in these procedures. I also made sure that they knew that the longer it took for approval of my privileges, the more cases I would take to my neighboring hospital down the street.
What I hope to illustrate here is that the orthopedic surgery department in many locations still calls the shots. I know that the staff and CEOs have no idea as to what an adequate amount of procedures is for each type of case. I know that the opinion of me was driven by the orthopedic surgeons in the hospital. Nobody else would care. Any podiatry case simply brings money into the system. But for orthopedic surgeons, every podiatry case is a potential loss of a patient on their end.
For all of us young practitioners, make sure you stand by your training. You worked hard. You went to those cases. You spent hours scrubbed in on various procedures. Fight for your qualifications.
The orthopedic versus DPM disagreement is apparently still real. These people have been nice to me and I have been nice to them. But, unbeknownst to me, the apparent perception was I am “less than” this entire time. As of today, I am still not on staff at my residency hospital. What a shame.
Dr. Bishop recently completed his residency at Alliance Community Hospital and is now in private practice in Alliance, Ohio.