Appointment application fee to work for hospital - WTF?

[Angry Birds]

I'm switching jobs, and just got sent an email with all the documents needed for being appointed staff, obtaining hospital privileges, yadda yadda...

They are asking me to fork over around $500 for an "appointment application fee." WTF? Is this normal? I feel like saying "F that," you pay me! This is especially bitter for me since I chose this job over another one that was offering a hefty sign-on bonus.

Is this just a normal part of business? I don't recall paying it for my first job out of residency... Can I ask to have the hospital pay for it, or is too late now? Will I look like an a-hole when I ask about this?

I'm so livid, haha. I'm debating sending everything else in except the $500 lol, and just seeing what happens. Am I overreacting over this?

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[Boatswain2PA]

I commonly see this (I'm locums, so work(ed) at many different hospitals). I think it is the fee that the credentialing service charges the hospital. I've never paid it yet, and never will. Few times I've just ignored it and sent in the mountain of paperwork, other times (jobs I realllly wanted) I called/emailed to confirm I wasn't going to pay it. Never been an issue yet. Good luck!

 

[The White Coat Investor]

I would try to get out of it as well. If it turned out it was pay it or take a job I liked less, well, I'd probably give in and pay. But $500 is a lot for something that is still free at many places.

Is that money going to the docs on the credentialing committee or just padding the CEO's bonus?

 

[deleted109597]

I've seen it everywhere I work.
I've never paid it though.
Not sure if the group/CMG is paying it, or if it just gets written off. Maybe it's there to scare people away from applying for credentials they won't use. Maybe they do stick it to the independent primary care docs trying to see their own patients. Don't know, don't care. (I'm on the credentialling committee at my current system, and it's never been brought up a single time in years).

 

[NinerNiner999]

Pay the fee - everyone else does and for a contract job (most likely) its definitely not worth $500 to make the new group you are joining look bad. Expect subsequent renewal fees every two years or so too. Its a (very) small cost to do business.

 

[Angry Birds]

I commonly see this (I'm locums, so work(ed) at many different hospitals). I think it is the fee that the credentialing service charges the hospital. I've never paid it yet, and never will. Few times I've just ignored it and sent in the mountain of paperwork, other times (jobs I realllly wanted) I called/emailed to confirm I wasn't going to pay it. Never been an issue yet. Good luck!

OK, so do you think I should email my new boss about this, and casually ask if the fee would be covered for me?

The only concern I have is that this would be one of the very first encounters with my new boss, and I don't want to come across as whiney/problematic.

I would try to get out of it as well. If it turned out it was pay it or take a job I liked less, well, I'd probably give in and pay. But $500 is a lot for something that is still free at many places.

So, you've never paid for it either?

Should I ignore it and turn in everything else, or should I inquire about it? Your thoughts?

Is that money going to the docs on the credentialing committee or just padding the CEO's bonus?

I don't know.

I've seen it everywhere I work.
I've never paid it though.

So, have you just ignored it and sent in everything else? Is that the best way to go?

Pay the fee - everyone else does and for a contract job (most likely) its definitely not worth $500 to make the new group you are joining look bad. Expect subsequent renewal fees every two years or so too. Its a (very) small cost to do business.

Thanks for your input.

It's like 4 against 1 now. Anyone else share the above view?

Thanks!

 

[emergentmd]

I been through this fight too at the board level. They don't charge this money b/c they want to make extra cash. They charge this so only people serious about working in the hospital will apply. Otherwise, you have 80% docs who ask for credential, never step foot in the hospital just in case they ever need to work there.

The amount of work the hospital/credentialing office puts in to every application is a large amount of work.

You have two options

1. Pay it, and not waste any more time.

2. Fight it, and I am sure they will not charge you b/c they know you are serious about working in the hospital. The group you are joining should pay for it.

 

[Daiphon]

My 1099 shop has a fee, but it comes back as a "loyalty bonus" or something (I forget the actual term) after 25 shifts worked... so agree with above that it really only serves as a deterrent from privileging without intent.

 

[southerndoc]

If you have a nice gig, then pay it. If it's just an average pay job, then skip it and go elsewhere.

 

[deleted109597]

So, have you just ignored it and sent in everything else? Is that the best way to go?

Unsure if it's the best way to go. However, I've never once heard anything about it from anyone at any of the hospitals I've credentialed at. I don't know if they go and ask the group, or if it is just left in there, or what.
I'm just saying what I've seen from the credentiallee and as the credentialer. Other than seeing it on the forms, nobody else has ever mentioned it.

 

[Angry Birds]

Unsure if it's the best way to go. However, I've never once heard anything about it from anyone at any of the hospitals I've credentialed at. I don't know if they go and ask the group, or if it is just left in there, or what.
I'm just saying what I've seen from the credentiallee and as the credentialer. Other than seeing it on the forms, nobody else has ever mentioned it.

Thank you, and thank you everyone else.

I've decided to just ignore it and see how it plays out.

 

[shookwell]

Thank you, and thank you everyone else.

I've decided to just ignore it and see how it plays out.

That's how I played it at the only place that asked for it. I filled out all the other paperwork and just left that one blank. When they were going through the paperwork to make sure it was all filled out they just threw that one away without saying anything.

 

[Doctor Bob]

I was told at one of my facilities that the money goes directly to pay for the food and drinks in the doctor's lounge.
I make sure to get my money's worth in donuts during my night shifts.

 

[Old_Mil]

Don't pay the fee. Any hospital that charges this doesn't really understand the hiring dynamic in medicine. The fact that they have instituted such a fee in the first place probably is a red flag for bigger problems later.

I actually turned down a job because they asked for one. This isn't a bunch of high school students applying to an ivy league school.

As for how hard the credentialing office works, let me find that small violin I have in the closet.

 

[emergentmd]

Thank you, and thank you everyone else.

I've decided to just ignore it and see how it plays out.

Don't ignore it. Just ask the people in your group and if they pay, just pay and move on. If no one pays it, then ignoring would be appropriate.

And many docs thinks that its petty and the the hospital should just suck up the cost to credential everyone but its a very time consuming process above the $$.

Imagine if you have an EM group in a 10 hospital system. Each hospital have to about 10 docs staffing for 100 docs.

Just for EM, if everyone gets credentialed in all of the hospitals, that is 1000 packets. And why a system does not just have one credential packet for all the hospital its beyond me

 

[dchristismi]

I'd ask the group's secretary/business manager. I just credentialled at a new shop and it was a $500 fee. When I asked, she told me that I'd be reimbursed by the group on my first paycheck.

At my other job, the group paid the fees.

 

[SoCuteMD]

I paid it to the hospital. My academic group reimbursed it when I started. It did not come out of my CME.

 

[gro2001]

I paid the application fee. You can ask your group coordinator if they will reimburse it. Mine said they would.

It just seems like a relatively small thing that could give people the wrong impression about you. What if everyone pays it and you are the only one who didn't? And then your boss gets an email about it from admin? Do you want to be that guy?

 

[NinerNiner999]

Some insight to the above posts:

Each hospital is required to have its own medical staff office, bylaws, MEC and board. They may be identical except for the hospital name. In some cases, hospital system boards may meet jointly, but medical staff must be hospital specific - hence the multiple applications needed for each hospital. There is a different quality office, committee structure, and senior leadership as well. These are basic JCAHO admin requirements. Working for a system has a common thread with many branching differences.

Medical staff dues are not only needed to help ensure intent. Often times, as noted above, they are used to pay for numerous things - physician food (as noted above), lab coats, embroidered scrubs, laundry service, and anything else deemed appropriate in the hospital bylaws. One of my hospitals actually pays a stipend to the department chairman from our dues.

Also, since each hospital has its own bylaws, make sure you read them carefully, since you are expected to follow the rules for that hospital. Some bylaws require application fee and renewal fees as a condition of medical staff membership, and may have procedures for suspension and discipline (including interest) if they are not paid. In short, you could be kicked off of the medical staff for not paying. Read your bylaws carefully.

Actually - this is a bunch of high school students applying to an ivy league school - The intent of privileges are implied in their name, and there is a clear difference between a right and a privilege. If you want to work in a hospital, you are expected to follow their rules. Everyone is a "guest" of the medical staff - including it's leaders.

I have been the boss who gets the phone call about the one provider who refused to pay dues. They are currently employed elsewhere.

 

[Old_Mil]

Some insight to the above posts:

Each hospital is required to have its own medical staff office, bylaws, MEC and board. They may be identical except for the hospital name. In some cases, hospital system boards may meet jointly, but medical staff must be hospital specific - hence the multiple applications needed for each hospital. There is a different quality office, committee structure, and senior leadership as well. These are basic JCAHO admin requirements. Working for a system has a common thread with many branching differences.

Medical staff dues are not only needed to help ensure intent. Often times, as noted above, they are used to pay for numerous things - physician food (as noted above), lab coats, embroidered scrubs, laundry service, and anything else deemed appropriate in the hospital bylaws. One of my hospitals actually pays a stipend to the department chairman from our dues.

Also, since each hospital has its own bylaws, make sure you read them carefully, since you are expected to follow the rules for that hospital. Some bylaws require application fee and renewal fees as a condition of medical staff membership, and may have procedures for suspension and discipline (including interest) if they are not paid. In short, you could be kicked off of the medical staff for not paying. Read your bylaws carefully.

Actually - this is a bunch of high school students applying to an ivy league school - The intent of privileges are implied in their name, and there is a clear difference between a right and a privilege. If you want to work in a hospital, you are expected to follow their rules. Everyone is a "guest" of the medical staff - including it's leaders.

I have been the boss who gets the phone call about the one provider who refused to pay dues. They are currently employed elsewhere.

Probably just as well given the entitled mindset this post conveys. In a market system when there are many warm bodies chasing few opportunities, those that run those opportunities cost shift to those seeking them.

In physician recruiting there are many opportunities chasing few warm bodies. It is up to the hospital and staff to prove to a prospective doctor why going to facility X will be a good career move. Trying to cost shift hospital credentialing fees to physicians is bad form.

Does your facility charge potential CEO xandidates for background checks?

 

[Janders]

We have a fee, much smaller, that does go to run the medical staff office (two employees) which is independent from the hospital. Our medical still has a fair amount of fierce independence. The medical staff office can be very helpful with keeping all your papers and licenses on file, and helping you out with paperwork and things when you need it. As such, I find it very intelligent to stay friendly with them. We pay the fees, something like $100-200. We take them out of our group budget so its pre-tax money, but we pay the fees.

All situations are unique, my last employee job did not ask for a fee as it was all hospital employees anyway...

 

[two guys]

I've worked for 3 different cmgs and been credentialed at a half dozen or so shops, the CMG payed the fee in each case.

I understand the spirit of niners post. But it is frustrating to pay $500 for what is often an inept staff that requires ppd's q 3 months or asks BCEM to do ATLS and is generally resistant to any policy change (ie not requiring ATLS updates for BCEM). I can't tell you how many times I've recieved an email stating "you never sent in X, we're going to cancel your privledges" only to find the exact thing they're requesting in my outbox with a reply sent confirming reciept from the person now threatening me. I consider it a privilege to take care of patients. I don't necessarily consider it a privilege to generate huge profits for my for profit health care system all while jumping thru meaningless hoops and merit badges deemed necessary by people who have never held a medical degree.

 

[NinerNiner999]

There is no entitled mindset in my post, and sadly your comment declares your ignorance of the current state of Emergency Medicine. Clearly, it is you who is entitled. Being an emergency physician in today's world of contracts and budget cuts is really no different than being the contracted janitor or dietary service in the mindset of hospital administration. Check yourself and realize that while there is a "title" after your name, it may buy you a cup of coffee or a pat on the back, but there is no mercy or protection because of the two letters after your name. There is no such thing as Job security in what we do, and as a contracted physician, you are guest of the medical staff in their house. We gave up our ability to be entitled a long time ago. Now Orthopods, CT surgeons, Cards, etc - they should be (and are) entitled because they pay the bills for the hospital.

Also, more often than not, the CEO/Admin are separate entities from the Medical Staff, and as such, have absolutely no bearing on their decision-making, bylaws, fees, etc. (although they can apply pressure based on their agenda). There is a clear separation between church and state.

Contract groups will likely pay your fee, and that is great if they do. If it's a deal breaker, and they won't, and $500 is enough for you to pickup your family, buy another state license, new house, etc, than that's your call. The point is, whether you pay, the local group pays, or the large CMG corporation pays, somebody has to pick up the tab so no waves in your contract are made.

WE ARE ALL GUESTS OF THE HOSPITAL WE WORK IN.

 

[Old_Mil]

The difference between a licensed, boarded EP and a janitor or a high school graduate is a matter of supply and demand. As far as not understanding the current state of emergency medicine, check out the back of the throwaways sometime. Finding another place to work is as simple as a phone call and in most cases won't involve much inconvenience at all...certainly not moving or getting another state license.

When I made plans to leave my previous practice a year ago I took a look at practicelink. There are open positions that were being advertised a year ago that are still being advertised.


As for who pays the cost of credentialing, that should be a hospital. What's next - charging physicians for parking and ID cards?

While I am I no way advocating a poor guest, reality has to intrude at some point.

 

[deleted547339]

There is no entitled mindset in my post, and sadly your comment declares your ignorance of the current state of Emergency Medicine. Clearly, it is you who is entitled. Being an emergency physician in today's world of contracts and budget cuts is really no different than being the contracted janitor or dietary service in the mindset of hospital administration. Check yourself and realize that while there is a "title" after your name, it may buy you a cup of coffee or a pat on the back, but there is no mercy or protection because of the two letters after your name. There is no such thing as Job security in what we do, and as a contracted physician, you are guest of the medical staff in their house. We gave up our ability to be entitled a long time ago. Now Orthopods, CT surgeons, Cards, etc - they should be (and are) entitled because they pay the bills for the hospital.

Also, more often than not, the CEO/Admin are separate entities from the Medical Staff, and as such, have absolutely no bearing on their decision-making, bylaws, fees, etc. (although they can apply pressure based on their agenda). There is a clear separation between church and state.

Contract groups will likely pay your fee, and that is great if they do. If it's a deal breaker, and they won't, and $500 is enough for you to pickup your family, buy another state license, new house, etc, than that's your call. The point is, whether you pay, the local group pays, or the large CMG corporation pays, somebody has to pick up the tab so no waves in your contract are made.

WE ARE ALL GUESTS OF THE HOSPITAL WE WORK IN.

Although I understand your mindset as someone higher up, this would be a big turnoff to me. I'm a PGY-3. I'm doing a fellowship, but I've flirted with the idea of working before fellowship and did a fair amount of looking around into different shops. It very much seems like a sellers marker currently. Given the fact that I (and everyone else on this board) gets countless daily emails for a stupid amount of money, I have a hard time thinking that a group willing to pay me between a quarter and half million dollars a year can't suck up a couple hundred dollars to process and maintain copies of my medical license, ppd status, etc.

I get that as an employer, you don't want people who make waves, that being said, I'm not going to pay to have the opportunity to work. My moonlighting gig requires a city license as well as a few other odd fees - they were all presented to me as "this will get re-imbursed in your first paycheck."

Further, I get that CV surgeons, orthopods, etc bring in big bucks for the hospital, but I know for a fact that my moonlighting gig is making money off me - they're not just employing me out of the goodness of their heart.

 

[Janders]

Apples and oranges and mangos and bananas.

Place in desperate need of moonlighters, typically staffed by randoms pulled in by a CMG, asking you to moonlight a couple shifts? Tell the CMG to pay your application fee, being ready to walk. You have the power.

Area of the county with barely any boarded EPs, desperate as hell to get you on board as an employee? Sure, tell them you aren't interested in paying the fee, and they'll likely cover it. Might cause a minimal amount of ill will, but you can weigh that in your head.

Joining a democratic group, who only hires a doc every couple years, in a desirable area, where you want to stay medium/long term? Ask the group what they do! If they say write a check, you write a check. Likely they'll cover it from group funds... WHICH IS YOUR MONEY ANYWAY!

And remember, the medical staff office doesn't make the rules! If they want you to have ATLS despite your board certification, its because that is how the medical staff bylaws and hospital policies are written. They just enforce them. If these things matter to you-- and they did to me-- get your group to modify the bylaws. We got rid of the ACLS/ATLS/PALS requirements for boarded EM docs, for example....