Credentialing: the hidden wall of reentry—and could a union help?
For physicians trying to reenter medicine after a career interruption, the biggest barrier often isn’t exams or CME. It’s credentialing.
In one group I participate in, the stories are heartbreaking. One doctor lost their third job offer—each one collapsing during the credentialing phase. Another got a call from a hospital telling them they were no longer moving forward with privileges, just days before the planned move. Four active state licenses. Zero jobs.
The fear is constant. Will this end up reported to the National Practitioner Data Bank? Should I withdraw my application before they do? What happens if I ask too many questions and “poke the bear”?
For those outside medicine, it’s hard to explain just how opaque this process feels. Credentialing committees hold enormous power with very little transparency. There is an old acronym used in medicine to describe a non-rigorous approach to so-called “evidence” in medical writing, and it applies to credentialling committees: BOGSAT (Bunch of Old Guys Sitting Around a Table). No real basis in fact, just a lot of opinions determining one’s fate. Declining to grant privileges isn’t the same as revoking them, but to the physician on the receiving end it feels just as devastating. And when you’ve already survived probation, exams, evaluations, and state board hurdles, to stumble here feels unbearable.
This is the part of reentry nobody sees: the wall after the wall. You can have a license in hand, and still no place to practice.
And it makes me wonder: would a physician union change this?
Pilots negotiated structured return-to-duty programs like HIMS through ALPA. Firefighters and law enforcement officers have collective bargaining agreements that spell out rehab and reintegration. Nurses have unions that helped shape diversion programs emphasizing recovery rather than permanent exclusion.
Physicians, though? We face credentialing committees alone.
A physician union could put pressure where it matters: on hospitals, malpractice insurers, and even third-party payers. With collective leverage, physicians could demand standardized credentialing criteria, written explanations for denials, appeal pathways, and legal support. Over time, unions might even influence state and federal regulators to clarify what’s reportable to the NPDB—and what isn’t.
Of course, a union wouldn’t erase every barrier. Credentialing is baked into hospital bylaws, and many physicians still resist collective action. But professions with unions have structured reentry. Professions without them have chaos.
Maybe credentialing is exactly the kind of problem that collective action was built to solve.
🧭 Today’s takeaway:
Credentialing may be the hardest hurdle in physician reentry. A union wouldn’t fix everything, but it could turn an opaque wall into a process with rules, protections, and support.
❤️ Ed