A veteran plastic surgeon's manifesto: Organizing and documenting your professional life
As you move through medical training, many pieces of paper will cross your desk. They may be initially placed into folders with broad titles – e.g., undergraduate, medical school, residency. Once in residency, life gets more hectic; and documents may be randomly filed or piled, to be sorted at some later, "better" time.
A note of caution to all trainees: There is no better date, and life will never get less busy. It's important to know what to save and how to save it, in order to be more efficient when applying for state licenses, hospital privileges and other data-intense events. Creating a professional file will save hours of valuable time with little initial outlay of finances or time.
Not every piece of information will be needed for every license application, but it's easier to have it than not. All of the information I've noted here has been requested on an application.
Label file folders as suggested below and keep all of the folders in a fireproof, waterproof box. Considering how time-consuming it is to get some of the information from the source, it's a worthwhile investment. In the first folder, keep a running list summarizing all of the information. This is your master resource and allows you to look up facts without having to sift through each folder. Save a copy online in the cloud, or on a frequently backed-up drive. None of the information on the running list should ever be deleted.
All addresses, including past and present home addresses, should be saved. This includes the addresses of all institutions you have attended, from high school to medical school through Fellowship. Keep contact phone and fax numbers and web addresses, as well. It's helpful to call the sites before sending material to them, to ensure that the contact address or person is current.
Get one or more notarized copies of your birth certificate – and keep the address of the source of the certificate in case you need new copies. Check the data to make sure that it is correct in case you need to make changes. Copy your passport and social security card. Keep the passport up to date. Keep a file of immunizations. Most hospitals require annual TB tests. Others require documentation of Hepatitis A and B, tetanus, MMR, chickenpox and, depending on your age, smallpox. Keep reasonably current 2-by-3-inch photographs available in color and black-and-white. The widespread availability of digital photography makes this easy to achieve.
Similarly, and in a like fashion, note the precise dates of each of your educational experiences and activities. You may be asked to provide the month, day and year you began and completed high school, college, medical school, residency and Fellowship. Know the dates of all major exams (e.g., NBME, FLEX, ABPS exams); of hospital appointments; of state licensure; of your DEA license and renewals; and of conferences where CME credits were earned. If applicable, keep track of the expiration dates of memberships.
Keep copies of certificates earned for courses such as BLS, ACLS, ATLS, ABLS, PALS and LASER training. Residency programs generally provide certificates of completion for internship, residency and Fellowships. Save all certificates from the NBME, certifying boards and medical organizations. Make a note of your member number on the running list.
Have at least one notarized copy of each transcript from university to medical school.
Make copies of your diplomas and certificates before framing. Diplomas written in a foreign language will generally need to be translated into English; the granting institution can usually provide a certified translation. Record the address and phone number at your institution where copies can be obtained.
Update your CV frequently to avoid inadvertently omitting items (publications, presentations, committee activities, leadership roles, educational and mentorship activities). Include PMID numbers with publications. Consider using EndNote to allow for easy updates of your publications. Follow the guidelines of your organization in formatting your CV.
For those in academics, review the guidelines in order to see which activities are required for each academic level. When going up for promotion, it will be important for you to be able to demonstrate accomplishments in key areas.
Do not include CME credits on your CV – but keep them in a separate file, separated into Category I and II credits and patient safety, and enter them as soon after the event as possible. Many states now require you to get annual opioid education as well. Many professional organizations keep records of your credits (ASPS and ASSH are two); your hospital and certifying agencies may also require documentation of credits earned.
As an ASPS member, your CME credits earned at the annual meeting and other affiliated large meetings will automatically be entered onto your personal page. You can manually enter credits earned for smaller meetings or meetings not usually attended by plastic surgeons. When needed, the CME file can be transferred to the ABPS.
For residents, conferences and work hours ensure that adequate educational hours are being met. Once you finish residency, it's important to keep track of credits. Twenty-four states use the AMA's Physician Recognition Award (PRA) to document CME. To receive the award, the physician sends documentation of earned CME credits, and a fee, to the AMA. Taking annual specialty-specific In-Service exams is an inexpensive way to earn credit.
Use of the Federation Credentials Verification Service (FCVS) is required by some state medical boards for certification in that state. It's operated by the Federation of State Medical Boards of the United States and provides a "centralized, uniform process for medical licensing authorities to obtain a verified, primary source record of a physician's 'core' medical credentials." The first charge is about $300; subsequent requests cost $65-110. Not all institutions use this, and there may be significant duplication of effort on the applicant's part in completing both. No universal verifying system yet exists, and most hospitals and surgery centers have their own credentialing forms which must be completed, and fees which must be paid.
Do not underestimate the time it takes to get state licensure and hospital accreditation. In many states, it can take three-to-five months to get licensed. This shouldn't need to be said, but if you do call to check on the progress of your application, be polite. For hospital certification, the average time for a file to be completed is 60-90 days. The most-common reasons for prolongation of the hospital accreditation process are missing information and a file that isn't "clean."
For many systems, being named in a lawsuit, having a misdemeanor or other legal problems – however minor – turns the file from one which can be reviewed quickly to one which needs more data and which may need to be approved by the hospital board. This varies by institution and by state. If you think that you'll be practicing in a certain state (or states), start the accreditation process as early as possible.
Each hospital and surgery center at which you have an appointment outside of your residency needs to be documented. New institutions may only want information over the latest five years of practice – but to be safe, keep a running tally. Save the letter from the hospital documenting the initial date on which privileges were granted. This will also note the type of privilege (attending, consulting, courtesy, active, etc.) Keep a list of the addresses of contacts at each hospital, as state licensing agencies or hospitals may need to contact the hospitals directly. A valid state license is generally required to obtain hospital privileges in that state.
Keep separate files for each state in which you have had a medical license. Note the dates of initiation and expiration, the type of license, the license number and the address of the state medical board. State medical boards generally have well-designed websites. If you need to have license information sent between states, it has become relatively straightforward to pay a nominal fee ($20 or thereabouts) to have states transfer license information to other states or organizations.
Notify the DEA before you move to a new state. Though your number will not change, the DEA license does not automatically follow you. Keep track of expiration dates, save all DEA forms and make note of the drug categories on the permit. If you will practice in more than one state, you will need separate DEA forms for each state.
Keep a current list of at least three professional references. The ACS requires five Fellows as references for membership. Other boards and hospitals may require local or regional references within one's specialty.
Keep a record of membership in professional organizations, and save paperwork showing that you are or were a member. Note the dates of membership and the contact information for the organization.
For academic positions, it's important to keep a promotion/tenure file. The format varies with each institution, but the faculty member generally must keep track of lectures given, the audience, whether CME credits were given to attendees, publications, committee activity (local and national), advanced education courses taken and taught, grants applied for and awarded (including dates, amounts, publications and presentations resulting from the grant) and graduate students mentored.
Malpractice, missing time, other issues
Necessary malpractice information includes the amount of coverage, the type of insurance (claims made or occurrence), the name and address of the insurer, the dates of coverage and information on lawsuits in which you were named (even if the case was eventually settled out of court or dropped). If you were involved in a lawsuit, you may need to get – from the courthouse or attorney involved – notarized statements regarding the details. You don't need to keep a record of 180-day letters that did not go further than the exploratory phase.
Explanations of "missing" time must be provided. Vacation time (summer/holidays) while in school doesn't count, but deferring time for any reason from undergraduate onward must be explained. You don't have to list each vacation, but if formal leaves of absence were taken, they must be accounted for. Hospitals and state medical boards need to know if the time was spent in rehabilitation, jail, etc. Documentation must also be provided for felony convictions, jail time, mental or physical disorders that impair ability to practice, or addictions.
If you've ever been put on academic probation; if your license to practice has ever been revoked or refused; if you've lost your DEA due to practice violations; or if your hospital appointment has been rescinded; it must be documented. Hospitals and state boards want to know why you've given up hospital appointments for even benign reasons (e.g., deciding not to moonlight, not using the site for any reason). Recently, a few forms have asked for explanation only if hospital privileges were rescinded.
Most institutions will reimburse new physicians for costs incurred during the application process. Save your receipts for this reason, as well as for documentation that fees have been paid.
Dr. Kalliainen is an associate professor of plastic surgery in the Brown University (Providence, R.I.) Department of Surgery.