Five Steps to Check Your Doctor’s Credentials

 In CHR Blog

I wish I could tell you that finding the perfect doctor online is easy.  It isn’t.  Reviews at social networking sites have become popular, although small numbers of random reviews are not necessarily fair nor representative of a physician’s full panel of patients.  Fortunately, there are a few simple and objective things consumers can do to help narrow the choices and lessen the chance they will select someone who is not qualified.  Here are five places online where consumers can check the qualifications of their doctors.

  1. State License records. Every doctor, nurse practitioner, physician assistant, podiatrist, chiropractor and dentist gets a license from the state where he or she will be practicing.  Checking your state’s official website – the medical board for your state – will provide basic information such as full name, address and license expiration date. The site may also provide useful background such as where physicians got their medical degrees.  The most important part, though, may be whether the provider has had any disciplinary actions.  In some states, such a discipline “action” will have a link to the actual summary report about that physician. If you know what state a physician practiced in before coming to your community, you might want to check that state’s website as well.  Nurse practitioners will be licensed through a state nursing board, even though they function as providers.  Similarly, other professions have their own state boards.
  2. Board Certification. A different type of “board” is a specialty board in a certain medical or surgical field.  Board certification means that the doctor has met additional standards beyond general licensure, in a certain specialty.  At last count, there were 24 separate boards at the American Board of Medical Specialties (ABMS).  Together, those boards granted certification in 150 specialties.  Instead of assuming your physician is Board-certified, verify it at ABMS and make sure it is in the specialty you expected.Sometimes a physician will be board-certified in one specialty (e.g. Family Medicine), but might be working in another setting (such as a full-time Emergency Room).  In a community hospital, that might be quite common, but in a sophisticated trauma center, it would be more common to expect the Emergency Department to be staffed with physicians certified in Emergency Medicine.  There is not a right-or-wrong answer to Board certification.  But over the years, I’ve found that when I’ve asked the doctor why s/he isn’t certified in the specialty they’re working in, some very interesting answers appear.  They usually have to do with skill (unable to pass the skills tests by the specialty board), or in some hospitals, Board certification wasn’t perceived as a priority.Not every community can have a full-time, Board-certified specialist in every field, so doctors often develop an interest in a certain sub-field that is useful.  Take, for instance, a family practitioner who develops an interest in dermatology.  S/he may learn quite a bit, and be helpful in diagnosing myriad skin conditions.  But it’s important to recognize that such physician is not Board-certified in Dermatology.  At some point, that physician will have a patient who needs a Board-certified specialist to review the case.  Does s/he have a well-established referral program?  If so, who does s/he use?
  3. American Medical Association. The third thing to do is to look up your physician at the American Medical Association at AMA Doctor Finder. Members have detailed profiles with training and board certification. Although non-members of AMA may also be listed, the amount of information is considerably less.
  4. Local Hospital Website. Check your doctor’s profile on the local hospital’s website.  If it’s not there, it could mean that your doctor doesn’t have privileges at that hospital.  Compare information you find to what the state, ABMS and AMA websites have said about the doctor.  Is the specialty information consistent?  Or are there differences that should be followed up?  Are there any discrepancies?  Ask more questions.A few years ago, I was shocked to find just such a discrepancy.  A very reputable medical system had listed a doctor’s profile on its website, saying the doctor was Board certified. I checked with ABMS online and could not verify it.  So, I contacted the hospital about the discrepancy, and shortly thereafter the profile was corrected.  Healthcare systems should be extremely careful about accurate public representation of their physician credentials, lest they be accused of false advertising.  Still, there’s a good chance that communication gaps are present between the credentialing office and the marketing department.  Consequently, consumers should do their research too.
  5. List of Excluded Individuals/Entities (LEIE). The LEIE is operated by the HHS Office of Inspector General. The website allows consumers to search for a specific name of a person or business to see if they have been excluded from receiving payment from Medicare and Medicaid, due to license revocation, suspension or surrender; program-related fraud; patient abuse or neglect, and other reasons such as default on Health Education Assistance Loans. The Exclusions database names thousands of individuals –  physicians, nurses, nurses’ aides, hospital employees, pharmacists, nursing home operators and more. It would be highly unlikely to find your physician on this list, but if you did, take notice.
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