Fellow Credentialed as Attending? (I.e. through Medical Staff Office not GME)

[unsung]

Hi guys,

Are most fellows credentialed through the GME?

I'm completing a fellowship and was NOT credentialed through GME. In my reappointment letter, one of my titles is "Assistant Attending."

Is there any functional difference to being an "attending" while in fellowship (credentialed through medical staff), as compared to being credentialed through the GME?

I do know that fellows in other divisions are entitled to certain benefits including a meal card, etc., which I do not have. But are there any other differences? And how common is it for fellows to NOT be credentialed via GME?

Just curious!

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[kchan99]

I don't know about how credentialing is handled by GME vs. medical staff office for fellows. As a fellow, the medical staff office handled credentialing and privileging. I had privileges through the medical staff office for procedures that I could perform without supervision. I think privileging for procedures with supervision was handled through the GME office, but I'm not sure.

 

[typhoonegator]

Our fellows are credentialed as clinical fellows through GME and the department and cannot bill or perform procedures independently because they are in training. From my experience, the procedures the fellow is allowed to do are dependent on the procedural privileges of their supervising attending. This is how an ICU fellow can place a central line on their first day in the unit -- they're supervised by an attending who is credentialed to do it.

Some of our graduates who have completed fellowship and are sticking around to work in a lab, or do another fellowship for a finite period of time, can get credentialed through the department as a Graduate Medical Assistant, which is a staff position that allows procedures and billing, but does not come with admitting privileges. So they can do consults and bill for them, but they can't staff the inpatient service because patients can't be admitted to them. But this is a really intended as a temporary position and only for a small amount of the calendar year, allowing junior staff members to maintain their clinical proficiency while completing another fellowship so they don't enter practice after training with a huge gap. Because patients see all "attendings" as at the same level, you obviously have to be very careful about which people you allow to do this. And you have to be very clear with the junior attending that it comes with no promises about the future.

I would hazard to guess that these policies and procedures vary greatly between institutions.