The job search is finally over. It was a long and arduous process and if I could start all over, there would be many things I would do differently.
I settled. I chose the practice that made the most sense economically, financially, and legally. I forego my desires and most importantly a chance at a social life. I’m still trying to come to terms with this decision. This is not the job of my dreams; rather it feels like a second fellowship. I have no choice but to do it to be in a better place afterwards. Sacrifice and delayed gratification.
Last week, I journeyed over to what is to be my new home for the next three years that is, if I survive the length of my contract. In the weeks preceding, I filled out countless forms and applications, and photocopied everything from my birth certificate, to passport, to educational diplomas & training certificates etc to start the licensing and credentialing process. Countless I say!
Read. Sign. Fill out. Explain. Attach proof. Read. Sign. Read. Sign. Read. Explain. Attach proof. Oh but wait, they don’t want photocopies…they want originals from the original sources. This of course meant I had to enlist the help of my dad in Ghana to get a certified copy of my birth certificate sent from Ghana. If you know anything about African bureaucracy, you will agree with me that it was amazing it only took 3 months to achieve this feat…this with my dad on the ground using his connections! So what if I have copies of my USMLE score reports? Must shell out $50 so that the USMLE can send the reports directly. They ask for a photocopy of my residency training certificate, and then in the next section ask for my residency programs contact information so that they can verify I actually did a residency. Oh boy!
Page after page! I swear. This is torture!
The process of obtaining a medical license is quite complicated. Everyone agrees on that. Even for an initial licensure for a person like me with an uncomplicated medical history, things can go awry. I was lucky enough to have started the FCVS process in the winter which is why I had a head start on obtaining my birth certificate from Ghana. Luckier to have found a job in Pennsylvania, a state whose licensing board takes on average a short two months to check information and issue an unrestricted medical license. Fortunate for my application to be approved within 4 weeks. Apparently in Texas, it can take upwards of a year to get licensed. Yikes!
But that was only the beginning. Apparently graduating from medical school, completing a residency program, and owning a state board license to practice medicine MEANS NOTHING!!!!
I now had to apply for hospital privileges – providing more of the same information for permission to work at, see patients, and admit patients (if I so choose) at the hospital where I would be working. To top it off, there is a fee involved. Say what? After I have already shelled out a few hundred bucks to FCVS, and another few to the state medical board, and yet another few to the DEA? Thank goodness I accepted a hospital employed position at a single institution versus the group practice that rotated at eight hospitals. Imagine eight sets of paperwork…and 8 sets of credentialing fees!
I really don’t understand the point of the credentialing fee. I know the hospital has a credentialing office, but aren’t the employees there already paid? And aren’t I the one filing out my paperwork, and making a bazillion copies of everything? And didn’t I do my own HIPDB-NPDB query? Another thing I don’t get. Why ask for my CV which includes all my educational and training history as well as all my references, professional organizations, prior licenses, ACLS/BLS history etc. and then ask me to fill out all that information on your letterhead application form. Form after form?! Then what, pray tell, is the point of providing my CV?
But that’s not even all of it. Apparently as physicians we are not allowed to have any gaps in our professional lives from the minute we graduated medical school. Actually from the second we showed up at medical school orientation. Every “gap” needs to be explained. Since most medical schools graduate their students sometime in May and almost all internships begin orientation in mid-June and as late as July 1; why do I have to explain what I was up to between May – June 2004? Duh! I was transitioning from medical school to internship. I was not in a drug rehabilitation program nor was I incarcerated. So what if I wanted to drop off the face of the earth for a while, why can’t I? I have a friend who completed residency several years ago on June 30th, like everybody else does, but didn’t start a job until September 1st of that same year. She had the job, she just decided she wanted a break, and she wanted to study for the boards! Would you believe she has to explain that “gap” in her history from henceforth!
But that’s not even all of it. Next in line – the insurance companies. Each and every single one that I may come across. Medicare, Blue Cross, Aetna, Humana, Ameritas, Cigna, undsoweiter, wants their own forms filled. Lord, help me! I will admit that at least for these the credentialing office at my future hospital filled them out “to the best of their ability”. I just had the pleasure of sitting behind a stack of, oh, lets say about 500 sheets of paper, read, sign here, read, sign there, read, date, date, date, check off no, check off no, check off no, check off no, sign here, read, sign there… A good hour at least, I kid you not. At the end, I didn’t even know what I was signing my name to! The rights of ownership to my firstborn child?
And then they ask for your medical history. Where is HIPAA in all of this? Aren’t we also protected? All this to say that last week I journeyed over to what is to be my new home for the next three years (again that is, if I survive the length of my contract). They had asked for my medical records and last physical, evidence of immunizations, tuberculin skin testing, list of medications I take etc. prior to my even stepping foot there. Then they proceeded to take my height, my weight, my shoe size (ok kidding!), my vitals, date of last menstruation (how is this important to them?!), and then took my blood to check my vaccination titers. Hello?! Didn’t I just send you documents showing when I had the vaccinations, and documents showing my titers from the last hospital that decided a history of vaccinations alone was not enough! Oh my goodness! And to top it all off I was drug tested like a mere criminal. Next thing you know they will ask for our DNA profiles. At least I wasn’t fingerprinted. I have heard some hospitals requiring that. And this is only the beginning.
I swear I have shelled out a few thousand dollars for all these privileges. Dollars I do not have. This on top of the $2000.00 I shelled out for the infectious disease certification boards I will take in October. Ah, the process of becoming a doctor. Someone really needs to tally up all our out-of-pocket expenses from the day we decided to take the MCAT (or the prep course for the MCAT) to the day we walk into a hospital as freshly minted board certified physicians. Seriously. And I’m not even going to bother with all the expenses required for “Continuing Medical Education” and re-certification boards so that we can continue to prove to everyone that we are fit to do our jobs.
I understand that all of this has to be done to make sure that society at large is protected from unfit and unqualified physicians. But really? Nothing can be done to streamline this process? Like a central clearinghouse or something? Just a wild thought. Can’t we get “verified” at one central location and that bureaucratic agency be responsible for sending out our packet to all those various entities that claim they need it? I mean if the state medical board has reviewed my life history and finds me fit to practice medicine, what then do I need to prove to a single hospital or to a single insurance company? What?! Talk about burgeoning health care costs. What do you expect when every agency involved in the delivery of health care wants to verify the candidacy of a physician for themselves! Yet, I am amazed that even with all this; there are not only bad physicians but also quacks practicing out there!
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