Physician Credentials: How Can I Check Them?


Stephen Barrett, M.D.
November 19, 2009

Answer

Information about a doctor’s training and experience can usually be obtained from the doctor’s office, a local medical society (a the doctor is a member), a local hospital (if the doctor is on staff), or an HMO to which the doctor belongs. A few state licensing boards issue information about disciplinary actions, but getting it may be cumbersome. Several online organizations provide easy access to various amounts of information. Internet Health Pilot has a handy list of the medical and osteopathic licensing board Web sites.

The American Medical Association’s AMA Physician Select provides limited information on the training and certification status of all of the more than 690,000 medical and osteopathic physicians currently licensed in the United States. It does not list disciplinary actions. Searches can be done only one state at a time. This service is free of charge.

The American Board of Medical Specialties (ABMS) CertifiedDoctor Verification Service can be used to check whether a doctor is certified by one of the 24 recognized specialty boards. The searches yield no other information. All states can be searched simultaneously. This site is primarily useful for checking the certification status of a doctor whose location is unknown. Registration at the site is required, but this service is free of charge.

HealthGrades maintains a searchable database of medical and osteopathic physicians. Its reports cover education and training; specialties; board certification; disciplinary actions. and several other characteristics. Searching requires the physician’s last name, state of practice, and specialty. The resultant information includes whether the doctor has been sanctioned within the past few years, but no details are provided. The cost is $12.95 for the first search, no charge for a second one, and $9.95 for each additional one. Reports are also available for hospitals and nursing homes.

In addition to facts, HealthGrades provides a “recognized doctor” rating for doctors who are board-certified, have clean disciplinary records, and have never been sued, and a “five-star doctor” rating for doctors who meet these criteria and are on the staff of a hospital that HeathGrades rates highly. These designations are handy but should not be used as a sole basis for a decision because they do not consider whether the doctor engages in unscientific practices. That can be determined to some extent by comparing information in the doctor’s profile with our list of nonrecommended treatments and eliminating anyone who offers anything on the list.

Government Sources

Most states have Web sites with searchable databases, but the amount of information varies considerably from state to state. With respect to disciplinary actions, some provide brief summaries, some provide extensive documentation, and others simply say whether or not a disciplinary action has taken place. A few state boards provide information about malpractice suits and criminal convictions, but research at relevant courthouses is more likely to yield results. Searching Google may also yield such information. Internet Health Pilot provides a convenient list of the medical and osteopathic boards that maintain Web sites.

The U.S. Office of the Inspector General administers two databanks that collect adverse information about physicians and other healthcare providers. The information is not available to the general public but can be accessed by government agencies, credentialing organizations, and certain other parties.

  • The National Practitioner Data Bank (NPDB), which began operating in 1990, is intended to hinder the movement of “problem practitioners” from one facility or state to another. Licensing boards are required to report all actions that revoke, suspend, or restrict a license for reasons related to the practitioner’s professional competence or conduct. Professional societies must report all professional review actions that adversely affect the membership of a physician or dentist. Hospital administrators must report disciplinary actions that negatively affect a doctor’s clinical privileges for more than 30 days and must query the Data Bank when appointing or reappointing medical and dental staff. Malpractice insurance carriers are required to report all settlements against physicians, dentists, and other licensed health-care providers. The information is available to state licensing boards; hospitals and other health care entities; professional societies; certain federal agencies; and plaintiffs (or their attorneys) in a malpractice suit.
  • The Healthcare Integrity and Protection Data Bank (HIPDB), which became operational in 1999, is intended to combat fraud and abuse in health insurance and health-care delivery. It collects information about licensure and certification actions, criminal convictions, exclusions from federal and state health-care programs, civil judgments (other than malpractice actions) related to health care, and other adjudicated actions or decisions. The information can be accessed by health plans and federal and state agencies.

This article was revised on November 19, 2009.