VISTA Staffing Solutions | Locum Tenens

The last time we visited the wonderful world of hospital credentialing for locum tenens assignments, we focused on the ever important ‘documentation of procedures’ or procedure log. As I mentioned in my last blog, paperwork and more paperwork is the norm now when applying for hospital privileges—whether it’s for a permanent position or a locums job. Although not a recent or extraordinary request, I am seeing more and more hospitals require documentation of all physicians’ TB skin test or PPD taken within the past year.

As a physician you probably realize there are a lot of you out there with positive TB tests who have no symptoms. Hospitals realize this and are fine with those results as long as we can provide them with a copy of a chest x-ray as supporting documentation. In most cases copies of your TB test and the chest x-ray are all that are needed. However there are a handful of hospitals that may ask for additional documentation from the physician who performed the TB test, and in extreme cases they may require you to take a TB test during your locum tenens orientation process prior to seeing patients.

So….like the procedure log, it’s a good idea to keep a copy of a recent (within the past year) TB test and a chest x-ray if your result is positive in your locum tenens credentialing file. I’m certain that over the next few years it will be a requirement at every hospital and clinic regardless of location.

A lot has changed over the past three years in regards to getting physicians credentialed and ready for locum tenens assignments. Applications are longer, medical staff offices are understaffed and require more time to process applications, and the types of documents required have changed significantly.

In the past the focus was on the written word and the ability of your peers to express their ideas and opinions about their professional interaction with you in a simple reference letter. This “Letter of Reference” actually served two purposes: 1. As an introduction to a client. 2. As a professional reference to fulfill hospital by-laws.

Today the Letter of Reference has shed some of its responsibilities. Your locum tenens recruiter will still need it, along with your CV and any supporting documents, to assess your fit with locum tenens work. However, from a hospital credentialing point of view the letters are outdated. These days we find that medical staff offices prefer their own version of the Letter of Reference: A Reference Questionnaire or Evaluation that is specific to each facility. These are usually one to two pages and consist mainly of a handful of questions that rate your performance in a number of areas, followed by a few questions that allow your colleague can elaborate in a more general form. So far the response has been hit or miss, as it does alleviate the need to type out a letter and the forms usually only take a minute or two to complete by hand. However, it is another piece of correspondence in a physician’s busy schedule.

A good rule as you move forward as a locum tenens physician is to keep your references current. I suggest that new doctors gather up a few references prior to leaving their practice, residency or fellowship and current assignment. Basically keep a running list of their work address, phone, fax and email address. This way, you’ll give outdated references a bit of relief and improve the odd of getting the newer references to respond in a timely manner.

Another change that is just as significant as your references is the Procedure Log. Almost anyone who is going to work in a hospital setting or perform any type of procedures is going to be asked to provide a copy of their Procedure Log for the past 24 months when applying for privileges. This includes new residents and fellows. The Procedure Log is basically a running tally of specific procedures and the number of times you performed them. Most modern hospitals and clinics have these readily available and can usually print them out on request. Again, I would suggest asking for a copy of your Procedure Log before you leave your training program or current assignment. Hang on to them for at least two years. It will save you a lot of time and effort trying to track them down after you leave.

Lastly, the UPIN number and all the paperwork and headache it took to get this number are all but gone. The number still shows up on credentialing applications that have not been revised, but the focus is now on the NPI number. Instead of three months, the new NPI number application takes five to 10 minutes to complete online. You are emailed a confirmation letter with your NPI number that you will use for the rest of your career. But that’s not the end of it. Hospitals now require that confirmation letter as part of your credentialing, so please don’t delete that email. Keep a copy handy.

The good news in all of this is that when you work locum tenens assignments through VISTA, we help you make sense and keep track of all of this.

State medical license renewal applications are much simpler than initial applications and re-licensure applications. The vast majority of state medical boards now offer on-line renewal.

The process generally requires the following:

• Verifying personal data
• Answering questions regarding discipline, criminal matters and mental health conditions
• Certifying completion of mandatory CME for the prior one- or two-year registration period

CME requirements range from 12 hours per registration year in Alabama to 50 per registration year in Illinois, Maine, Washington, Massachusetts, Pennsylvania, New Hampshire, New Jersey, and North Carolina. Specific class content may be required such as risk management, palliative care, and ethics.

Additionally, a certain percentage of your CME must be designated Category I. Make sure to keep your CME certificates, because boards often conduct audits and may request proof of CME. You may also want to apply for the AMA Physician’s Recognition Award, which measures Category I CME content. This certificate is accepted as an equivalent for licensure renewal by more than 75 percent of state medical boards.

You will usually receive your renewed license certificate in 15 to 30 days after the application is submitted.

Your first step is understanding your eligibility, which varies by state, and is based on:
• Whether you are an American or international medical school graduate and, in some states whether your medical school is approved by the state. VISTA’s team will research a state medical board’s website or utilize the WHO Directory of Medical Schools or the ECFMG FAIMER Directory to determine if a school is acceptable.
• The length of post graduate training you have completed. International graduates are commonly required to complete three years of PGT; American grads may meet eligibility with one or two years of training after graduation.
• Limitations on licensure examination, e.g., some states do not accept a “state” exam—these were the norm prior to NBME, FLEX and USMLE.
• The status of your original license. Some states require that your first license remain active.
• When you took the USMLE; USMLE failure rate on each of the steps; weighted score of the exam.
• How long it’s been since you took a licensure exam along with ABMS certification. Some states invoke “The 10-year Rule,” which states that if a physician has not taken a licensure exam within 10 years of application and is NOT board certified, he or she may be required to take the SPEX Exam.

VISTA’s recruiters review all locum tenens candidates’ applications and work with our licensing specialists to determine whether these requirements will impact your ability to qualify for a new state license. This is an important step in assessing locum tenens opportunities.

Once we help you determine your eligibility, a Licensing Specialist will walk you through the steps required to apply for the license. It is important to decide if you can meet the requirements, especially if you may be required to take the SPEX or obtain ABME certification. It is also important to know up front if a state will require an on-site interview or exam.

Once you have worked through the above, you must complete and certify the application for licensure and an FCVS profile application, if required by the board. Additionally, for those states that require an associated controlled substance certificate, you must complete a separate application and meet specific requirements.

The VISTA Licensing Specialist then begins requesting primary source verification of your credentials, which always include:

• Medical Education- all schools attended
• Post Graduate Training
• Licensing Exam Scores
• All state licensure – active, inactive, and training
• Professional’s statement regarding history of malpractice experience, discipline, and mental health issues that could affect or limit his/her ability to provide competent medical care.
• ECFMG for all international graduates

These additional verifications and requirements are requested by most states and processed by the Licensing Specialist:

• AMA or AOA Profile
• Federation of State Medical Board Clearance
• NPDB
• Transcripts
• Practice experience – this varies by state in terms of how far back your work history needs to be verified.
• Liability insurance coverage
• Certified birth certificate
• Legal proof of name change, if applicable
• Fingerprinting and background checks
• CME required for licensure- FL
• Passport photos
• Referencing – many states have their own forms; others require a statement

The Licensing Specialist contacts primary sources and then follows up to assure a response to the board is completed.

Once the application and all requirements for verification and documents are received by the board, the Licensing Specialist will stay in contact with you and the board until a decision is made.

If at any time during the application, you experience an unusual negative experience, even something like a traffic ticket (yes, just for speeding) you must notify VISTA and fully disclose the circumstances to the board you are petitioning for licensure.

Tricky question. It’s tough to pin down processing time for a new state medical license because, although the requirements are the same for each applicant, a physician’s unique history and situation impact processing time.

For example, an American medical graduate with no malpractice claims or disciplinary issues, who has practiced in one location for the 10 years since completing training, will take much less time than an American medical graduate with the same length of time in practice, but who worked in five locations and had a significant malpractice settlement.

In VISTA’s experience the wait for a locums license has varied from three weeks in New Hampshire to two months in North Dakota. Temporary licenses, requested in conjunction with an application for a permanent license, can be issued in a month in Hawaii. It may take up to three months to get the same license in South Carolina. Full, permanent licensure can be processed in two months in Hawaii, but may take as long as one year in Texas.

There are also a host of variables that are essentially out of our hands—and yours. VISTA’s licensing specialists are very knowledgeable about most of these processes and calculate an expected delay into the overall time frame when discussing licenses with you. California, for example, has a 45-day waiting period once an application is at the board before any action is taken on an application. North Carolina has specific deadlines for application completion so an application can be reviewed at a scheduled board meeting. The deadline is usually six to eight weeks in advance of the meeting.

All medical boards experience heavy application volume from March through August because physicians are completing their post-graduate training programs and preparing for practice. We plan for an additional one-to- two week delay during this time.

At VISTA we help physicians apply for licenses in anticipation of locum tenens assignments, and for new permanent positions through our Physician Licensing Resources Division. One of our medical directors has had up to 19 active state medical licenses at one time, so don’t let the prospect intimidate you. Concentrate on the steps that follow, and VISTA will make the process as simple as possible.

• Keep very thorough records of practice experience dates, locations and addresses, especially when on locums assignments.
• Maintain a file of certificate and document copies. If any of these have been lost, obtain an official copy from the institution issuing the certificate.
• Be prepared to provide a detailed and thorough explanation for any or all disciplinary actions or malpractice cases.
• Do not discard court documents, even if very old, or letters from attorneys or from medical boards. Do not depend on attorneys to maintain your documents.
• Thoroughly read and understand every question asked of you on a medical application, especially those concerning malpractice, discipline, arrest/conviction history, substance abuse, and mental health. Be sure to answer correctly and provide a full explanation for each circumstance.

For more information about licensure in conjunction with a locum tenens position talk with your VISTA recruiter or scheduler. If you are interested in help obtaining a new state license independent of locum tenens work, contact our Physician Licensing Resources Division at 800-366-1884. Adventure awaits. We can get you there!

Forget travel, forget rental cars, forget apartment keys under the mat at midnight…Getting licenses in new states can actually be one of the most challenging aspects of locum tenens practice—or medical practice in general for that matter. But there is a glimmer of “standardize this process for the betterment of humankind” hope on the horizon.

A new, on-line application process called the CLAF, Common License Application Form, has been launched. Ohio was the first board in the country to implement it in 2007, followed by Kentucky and New Hampshire. The new on-line system application is linked from each board’s web site to the Federation of State Medical Boards. Physicians do need to have an FCVS Profile or apply for one to use the CLAF system.

As other licensing boards implement use of this system, physicians will be able complete one application using the CLAF. The common information that all boards require is integrated into the form used by the state board, leaving only state specific data requirements to complete.

This process will save physicians the tedium and time of entering the same information on different applications every time they apply for a license in a new state. I can’t imagine anyone appreciating this more than a seasoned locum tenens physician, or the agency supporting said physician.

Kudos to the Buckeye, Bluegrass, and Granite states for taking this leap into the information age.

• We are seeing an increase in the number of states that require FBI and state criminal background checks. This usually includes getting fingerprinted, which can take six to eight weeks. When you are working with a scheduler and considering locum tenens positions, please keep this in mind.
• Another trend we have seen is an increase in the number of boards requiring physicians to complete a profile. This can usually be done via the Internet, but some states (like Tennessee) have a paper Mandatory Physician Profile. It is very important to complete these profiles. Your locum tenens or permanent medical license in a state can be compromised if you do not complete or update your profile by a certain deadline. Please pay close attention to all correspondence you receive from medical boards so you don’t accidentally miss a deadline. Your VISTA licensing team will help with this when you work locum tenens assignment through us.
• Most boards are going to online applications. Some allow you more than one day to complete your permanent or locum tenens license application. Others, like Texas, require that you complete your application and submit it in one session.
• The National Practitioner Data Bank has been around now for a while; however, boards are adding this to their licensure requirements. North Carolina just added this to their licensure requirements this year.
• MOC – Maintenance of Certification is now the term used in place of recertification. Physicians becoming board certified in their specialty will no longer be granted a board certification for life. MOC is a more involved process then the old recertification. Physicians must still take a written exam and maintain current CME credits. Each board explains their MOC program on their website. It is important to brush up on this for your specialty because some boards have a “Ten Year Rule” requiring physicians who are board certified for life to either be recertified (MOC) or take the SPEX. (The Ten Year Rule: If it has been 10 years or more since you had a licensing exam (NBME, NBOME, FLEX, USMLE , State Exam or board certification exam, you will need to take the SPEX or recertify.) Not all states have the Ten Year Rule, so it pays to stay on top of the issue.)

When you are applying for medical licensure in the US for either a locum tenens or permanent license, remember that the majority of medical boards require a recent (within the last six months) photograph. The medical boards do not accept digital photos printed on regular paper. The photos MUST be passport quality of a physician’s head and shoulders. Some boards require this photo be black and white; others require color. It’s true, digital pictures are more convenient, quicker to obtain, easier to reproduce as needed and are cheaper to have shot. However, don’t submit your digital picture printed on regular copy paper, or the medical board will very likely ask for another photo that is of passport quality. Your application (and your locums assignment!) could be delayed.

Did you know that in 2008, 61 state licensing boards will require continuing medical education (CME) for licensure or licensure renewal? Some states also require specific courses such as HIV/AIDS, risk management, or preparedness for terrorism and mass casualty events.

The most common method for physicians to report that they have met their CME requirements to licensing boards is through the license application or renewal application. Generally you are not required to submit documentation; most licensing boards perform a random audit at which time you must supply proof of CME courses.

CME requirements vary from state to state and year to year; we recommend that you check with each state in which you are or plan to be licensed. The AMA maintains a comprehensive list of state requirements. Check it out as you make your licensing plans:
http://www.ama-assn.org/ama1/pub/upload/mm/40/table16-2008.pdf