I thought the hardest part of my transition from resident to new-in-practice pathologist would be finding a job. So when I signed a contract with a group, I figured the hard work was over. However, I was surprised with the amount of paperwork and tasks that had to be completed before the end of my fellowship. While my transition to practice began as soon as I finished writing my signature, I had only 6 months to get everything together. There were licensing and credentialing hurdles, issues related to moving to a new city, and of course tying up all the loose ends at my current location. I’m writing this article in hopes of expediting this process for you, the incipient new-in-practice pathologist.
Richard Owings, MD, FCAP
For starters, you will need a lot of documents. I got everything together in a hard copy folder and made PDF copies of all my documents and stored them in the cloud for convenience and security. You’ll need a recent CV with explanations of any gaps longer than 3 months, copies of all medical diplomas, residency/fellowship certificates, results of board exams, passport, driver license, birth certificate, NPI number, DEA number, and any previous medical licenses. You’ll also need a list of 3 to 4 references with contact information and lists of previous educational institutions and prior hospitals, including dates of attendance, addresses, and phone numbers. You’ll also need prior vaccination history, TB skin test results, and your doctor's name and contract information.
I found the main kickoff for this process was receiving my new medical license. Unfortunately, the pace of processing a medical license was largely out of my hands. As such, it is really important to get started as quickly as possible. Many states require background checks with fingerprinting, which can take 6 to 8 weeks. Your current and previous training institutions will have to send in documentation as well, and you’ll need to get letters from program directors. I generally checked on my license every 4 weeks for any missing documentation and to see if I could get any documents expedited to the medical board. To put it simply, you should start working on getting your new license as soon as you sign a contract.
Once I had my license, I applied for privileges for various hospitals I would be covering and began enrolling in the various insurance plans and government programs. Luckily, most the paperwork you need to gather for the medical license also applies to these agencies so you don’t have to track anything new down. My group covers multiple hospitals, so there were numerous applications to fill out. Thankfully, my group had an employee who managed and filled the majority of the form beforehand, leaving me with only the responsibility of adding my signature. Even if you too have the added convenience of such support staff, it’s imperative to return everything quickly so hospital credentialing staff can start processing your applications. This can take up to 3 to 4 months and can vary notably according to hospital.
At 3 months before my start date, I began to arrange housing. I had to find an apartment over the telephone and make arrangements remotely. Most of the units required salary documentation, so I had to talk to the group’s practice manager to get a verification of income letter. If you have children, as many of my colleagues do, you’ll also need to arrange for daycare and schools, which can be especially time and labor intensive when you’re not yet living in the area.
I did a tissue-specific fellowship, but I knew that my new job included general signout responsibilities and performance of bone marrows. I talked with members of my new group to get a feel for what areas I should brush up on before starting my first day. Since I was doing bone marrows, I arranged to spend a couple of days shadowing the bone marrow service at the hospital that I was doing my fellowship. I also read up on neuropathology frozen sections since that seemed like a pretty daunting aspect. I had several friends who were going to be doing FNA clinics and therefore brushed up on FNA-specific skills before starting. Some people spent several weeks with other fellowships to prepare. It is important to get a feel for what your group does, not only to come in well prepared to start working, but also to identify the areas in which you may be less comfortable.
During the last several weeks of my fellowship, I exchanged contact information with co-fellows, attendings, and other colleagues I wanted to keep up with once I left. Unfortunately, a lot of the contacts that I imported to my cell phone were linked to the university email system, so when that account was deleted, my contacts were deleted as well. I can’t help but think this is a common oversight. Had I known beforehand, I would have downloaded the contact list into a spreadsheet and reloaded them to my phone. I also collected the wording of particular diagnoses and comments that I thought were good from my residency and fellowship so that I could use them in my own practice. I also saved all the presentations that I did during fellowship and residency and was able to use them as a skeleton for lectures I ended up giving at my new job. Finally, I made sure everyone had my personal email address and changed my contact information in all the medical society and organization web pages, so I would be able to keep up with all future notifications.
Although I thought I was operating ahead of the curve, there were still delays. I ultimately started a month late due to a delay in one insurance provider that look longer than anticipated with enrollment paperwork. Since I could not bill until the paperwork was completed, I spent my first month doing consults, QA, and presenting at tumor boards. Although my intention to be full-fledged at day one didn’t come to fruition, my extra preparation that started after I signed my contract was well worth it, and my group was understanding and appreciative once I was up and running.
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Dr. Richard Owings is a pathologist in Lafayette, Louisiana with the Delta Pathology Group. He works in a community practice and has a personal focus in breast pathology. He also serves as laboratory medical director for a regional medical center and several community hospitals.