How to obtain credentials and privileges
Get the access you need to care for patients in every clinical setting.
Credentialing and privileging ensure you can care for patients across all clinical settings. Learn what documents you’ll need and what to expect throughout the process.
Featured resources for obstetrics privileges
Applying for obstetrics privileges
Presentation: Education on family medicine and obstetrics
Why this matters
Your credentials and privileges determine whether you can provide care in hospitals, emergency departments and other specialized settings. These approvals are essential for practicing to the full extent of your training. Decisions are typically made by a hospital’s governing board in accordance with its medical bylaws. Having a family physician on the privileging committee can help protect and advocate for the scope of family medicine.
The American Academy of Family Physicians (AAFP) offers guidance and resources to help you prepare and advocate for the access you need.
Required documentation
To apply for credentials and privileges, you’ll need documentation that verifies your education, training, experience and licensure. Be sure to review the hospital’s medical staff bylaws before requesting an application.
Documents to prepare
Education, training and experience records
Letters of recommendation from past instructors or supervisors
Board certification
State medical license(s)
Malpractice liability certificate
Curriculum vitae (CV) in the hospital’s required format
Government-issued photo ID
Internal Revenue Service (IRS) Form W-9
Drug Enforcement Administration (DEA) certificate
Controlled and Dangerous Substances (CDS) certificate (if applicable)
National Provider Identifier (NPI) and other identification numbers (e.g., Unique Physician Identification Number [UPIN], Medicare, Medicaid)
Step 1: Apply for credentials
Once you request and receive an application packet, read all instructions carefully. Submit all required documents and privilege request forms. If anything is missing or unclear, you’ll typically receive a request for additional information with a submission deadline. Failure to respond by the deadline may result in the withdrawal of your application.
When you submit your application, any inaccuracy, omission or misrepresentation, even unintentional, may be grounds for terminating the process. The applicant does not have the right to a fair hearing or appeal.
By submitting your application, you:
Confirm all documents are accurate and complete
Allow the hospital to verify your information
Authorize consultation with references about your competence, character and ethical and professional qualifications
The credentialing committee reviews your materials to determine whether you meet the requirements for privileging. If you qualify, your application is verified and may proceed to an interview. If not, the committee will notify you.
Note: Some medical staff bylaws limit specific privileges to contracted groups. Even if you meet the qualifications, this may restrict access to certain services (e.g., anesthesia or pain management procedures).
Step 2: Secure your privileges
If your application is approved, the hospital will grant you privileges to provide specific types of care. These privileges are initially subject to a focused professional practice evaluation (FPPE) to confirm your current competence.
Performance monitoring during this period may include:
Retrospective or concurrent proctoring
Chart review
Performance metrics tracking
External peer review
Morbidity and mortality reviews
Input from other physicians or care team members
Once this process is complete, your privileges may be continued or adjusted based on the outcomes.
Procedural privileges for full-scope family medicine
With appropriate training, family physicians can safely provide the following procedures with high-quality outcomes at reduced costs. This list is not exhaustive, but it demonstrates the value and benefit of care provided to communities when family physicians practice at their full scope.
Note: If you are seeking privileges in a specific procedure, some hospitals may require a department other than the family medicine department to recommend and approve privileges.
The scope of family medicine includes many office- and hospital-based procedures, with many family physicians gaining advanced procedural skills during residency.1 Through this training, family physicians deliver safe and effective procedural care with patient outcomes comparable to many other specialists. When family physicians perform certain procedures, health care costs are reduced and health systems experience a return on investment.2
Therefore, maintaining the full scope of practice for family physicians is essential to ensuring access to cost-effective and quality care in rural and other areas. This is especially true for specific procedures in cardiology, dermatology, emergency care, obstetrics and pediatrics.3
1. Newman AR, Heidelbaugh JJ, Klemenhagen K, et al. Current procedural practices of family medicine teaching physicians. Fam Med. 2024;56(3):156-162.
2. Nelligan I, Montacute T, Browne M-A, et al. Impact of a family medicine minor procedure service on cost of care for a health plan. Fam Med. 2020;52(6):417-421.
3. Barreto T, Jetty A, Eden AR, et al. Distribution of physician specialties by rurality. J Rural Health. 2021;37(4):714-722.
- When properly trained, family physicians can perform colonoscopies safely and competently with a high degree of patient satisfaction.4
- The quality, safety and efficacy of colonoscopies performed by primary care physicians are comparable to those performed by gastroenterologists and are in accordance with expert guidelines.5-7
- Family physicians perform nearly one-third of colonoscopies in rural areas.8
- In one study, 99% of patients reported they would be willing to have a repeat colonoscopy performed by their primary care physician.9
- Primary care physicians who performed flexible sigmoidoscopies and colonoscopies were more likely to comply with colorectal cancer screening recommendations than those who did not perform the screening.10
The AAFP supports privileging for colonoscopy based on an individual’s education, training, experience and current competence, as outlined in the AAFP's policy, Privileges, colonoscopy. Other valuable resources on the topic include the AAFP’s Colonoscopy (position paper) and the American Association of Primary Care Endoscopy’s website.
4. Newman RJ, Nichols DB, Cummings DM. Outpatient colonoscopy by rural family physicians. Ann Fam Med. 2005;3(2):122-125.
5. Wilkins T, LeClair B, Smolkin M, et al. Screening colonoscopies by primary care physicians: a meta-analysis. Ann Fam Med. 2009;7(1):56-62.
6. McClellan DA, Ojinnaka CO, Pope R, et al. Expanding access to colorectal cancer screening: benchmarking quality indicators in a primary care colonoscopy program. J Am Board Fam Med. 2015;28(6):713-721.
7. Berry E, Hostetter J, Bachtold J, et al. Evaluating colonoscopy quality by performing provider type. J Natl Cancer Inst. 2024;116(8):1264-1269.
8. Komaravolu SS, Kim JJ, Singh S, et al. Colonoscopy utilization in rural areas by general surgeons: an analysis of the National Ambulatory Medical Care Survey. Am J Surg. 2019;218(2):281-287.
9. Kolber MR, Wong CK, Fedorak RN, et al. Prospective study of the quality of colonoscopies performed by primary care physicians: the Alberta Primary Care Endoscopy (APC-Endo) Study. PLoS One. 2013;8(6):e67017.
10.Levy BT, Dawson J, Hartz AJ, et al. Colorectal cancer testing among patients cared for by Iowa family physicians. Am J Prev Med. 2006;31(3):193-201.
- A variety of skin biopsies can be performed by family physicians, enabling early detection of malignant lesions.11
- Incorporating dermoscopy, with adequate training, along with a clinical exam, improves the accuracy of diagnosing pigmented lesions.12
- Facilities report savings and improved efficiency when general practice physicians perform minor surgery on sebaceous cysts.13
- Family physicians achieved significant cost savings for health systems when performing the following procedures: drainage of skin abscesses, hematomas, bullae or cysts; biopsy and removal of skin lesions; excision of soft tissue masses; and removal of nail plates.14
- Patients have shorter wait times for dermatological surgical procedures when performed by family physicians.15
11. Lin AJ, Ferris LK, Maier J, et al. Skin biopsies and diagnostic outcomes at a multisite family medicine residency network. South Med J. 2024;117(10):609-611.
12. Secker LJ, Buis PA, Bergman W, et al. Effect of a dermoscopy training course on the accuracy of primary care physicians in diagnosing pigmented lesions. Acta Derm Venereol. 2017;97(2):263-265.
13. van Dijk CE, Verheij RA, Spreeuwenberg P, et al. Minor surgery in general practice and effects on referrals to hospital care: observational study. BMC Health Serv Res. 2011;11(1):2.
14. Nelligan I, Montacute T, Browne MA, et al. Impact of a family medicine minor procedure service on cost of care for a health plan. Fam Med. 2020;52(6):417-421.
15. Arribas Blanco JM, Gil Sanz ME, Sanz Rodrigo C, et al. Effectiveness of dermatologic minor surgery in the office of the family physician and patient satisfaction in relation with ambulatory surgery. Med Clin (Barc). 1996;107(20):772-775.
The AAFP supports privileging for endoscopy based on an individual’s education, training, experience and current competence, as outlined in the AAFP’s position paper, EGD, training and credentialing of family physicians in (position paper).
Allowing family physicians to work in hospital settings ensures better continuity of care for patients, professional growth for physicians and access to better resources for communities that may not be available in traditional family physician practices.16
16. Garrison GM, Meunier MR, Boswell CL, et al. Continuity of care: a primer for family medicine residents. Fam Med. 2023;56(2):76-83.
- Family physicians who perform injections around the knee (joint and bursa), shoulder (joint and bursa) and hip (trochanteric bursa) had similar patient outcomes (i.e., reduced pain and a better physical quality of life) compared with internal medicine physicians.17
- Training family physicians to perform musculoskeletal injection therapy can be cost-effective for health systems.18
- Primary care physicians can see patients needing musculoskeletal injections much sooner than other specialists.14
14. Nelligan I, Montacute T, Browne MA, et al. Impact of a family medicine minor procedure service on cost of care for a health plan. Fam Med. 2020;52(6):417-421.
17. Bhagra A, Syed H, Reed DA, et al. Efficacy of musculoskeletal injections by primary care providers in the office: a retrospective cohort study. Int J Gen Med. 2013;6:237-243.
18. Nelson RE, Battistone MJ, Ashworth WD, et al. Cost effectiveness of training rural providers to perform joint injections. Arthritis Care Res (Hoboken). 2014;66(4):559-566.
- All family physicians are trained and competent to “provide care for low-risk patients who are pregnant, to include management of early pregnancy, medical problems during pregnancy, prenatal care, postpartum care and breastfeeding.”19
- Many family physicians pursue additional training within residency to provide intrapartum care for low-risk pregnancies and some moderate-risk pregnancies, including vaginal deliveries. Some family physicians pursue further training to include managing high-risk pregnancies and cesarean deliveries.
- Family physicians deliver safe, effective and cost-efficient pregnancy care with health outcomes comparable to obstetricians-gynecologists (OB-GYNs), especially for low-risk pregnancies and in rural settings.20,21,22,23,24,25
- Family physicians are essential for maintaining access to maternity care, especially in underserved areas. In some places, they are the only clinicians delivering babies.25.26
- The AAFP and the American College of Obstetricians and Gynecologists (ACOG) support privileging for maternity care based on an individual’s education, training, and demonstrated current competence, as outlined in the AAFP-ACOG Joint Statement on Cooperative Practice and Hospital Privileges.
Self-advocacy guide: Applying for obstetrics privileges
Presentation: Education on family medicine and obstetrics
19. Society of Teachers of Family Medicine. Core outcomes, competencies, subcompetencies, and milestones. Accessed October 30, 2025. www.stfm.org/teachingresources/resources/cbme-toolkit/epascompetenciesmilestones/overview/
20. Avery DM, Graettinger KR, Waits S, et al. Comparison of delivery-related complications among obstetrician-gynecologists and family physicians practicing obstetrics. Am J Clin Med. 2014;10(1):16-19.
21. Aubrey-Bassler K, Cullen RM, Simms A, et al. Outcomes of deliveries by family physicians or obstetricians: a population-based cohort study using an instrumental variable. CMAJ. 2015;187(15):1125-1132.
22. Avery DM, Burgess K, McDonald JT, et al. Neonatal outcomes of 26,331 infants delivered by obstetrics fellowship trained family physicians and OB/GYNs. J Fam Med Dis Prev. 2015:1-3.
23. VanGompel EW, Singh L, Carlock F, et al. Family medicine presence on labor and delivery: effect on safety culture and cesarean delivery. Ann Fam Med. 2024;22(5):375-382.
24. Coffman M, Wilkinson E, Jabbarpour Y. Despite adequate training, only half of family physicians provide women's health care services. J Am Board Fam Med. 2020;33(2):186-188.
25. Walters D, Gupta A, Nam AE, et al. A cost-effectiveness analysis of low-risk deliveries: a comparison of midwives, family physicians and obstetricians. Health Policy. 2015;11(1):61-75.
26. Quinlan JD. The role of the family physician in rural maternity care. Clin Obstet Gynecol. 2022;65(4):801-807.
- Point-of-care ultrasound reduces the cost of care by identifying the need for more advanced imaging.27
- A systematic review found that general performed ultrasonography with satisfactory accuracy.28
27. Bornemann P, Barreto T. Point-of-care ultrasonography in family medicine. Am Fam Physician. 2018;98(4):200-202.
28. Andersen CA, Holden S, Vela J, et al. Point-of-care ultrasound in general practice: a systematic review. Ann Fam Med. 2019;17(1):61-69.
- No differences in vasectomy outcomes were observed among family physicians, urologists and general surgeons.29
- In some areas, family physicians are the only physicians performing vasectomies.30 Therefore, it is essential that they continue to be trained on evidence-based recommendations.
29. New A, Chiles L, Bird E, et al. 1238 outcomes of vasectomies based on provider type and review of timing and sperm cell counts from post-vasectomy semen analysis. J Urol. 2013;189(4S):e507.
30. Posielski NM, Shapiro DD, Wang X, et al. Do I need to see a urologist for my vasectomy? A comparison of practice patterns between urologists and family medicine physicians. Asian J Androl. 2019;21(6):540-543.
Credentials and privileges FAQs
What is credentialing?
Physicians who work in a practice that contracts with federal or private insurers must undergo credentialing. Credentialing is the process of verifying a physician’s education, training, experience, current competence and licensure to provide services.
Hospitals and other health care employers and payers have credentialing processes to complete. Credentialing is closely tied with privileging and is frequently a first step for physicians seeking hospital privileges.
What is privileging?
Privileging is the process of authorizing a specific scope of practice at a health care organization based on credentials and performance. Hospital governing boards grant privileges based on the recommendations from a physician's department and the credentialing committee. The hospital governing board should consider all recommendations, including to deny, accept or referral back for further consideration. At least every 24 months or more frequently if required by state law, physicians will need an ongoing professional practice evaluation (OPPE) for continued or revised hospital privileges.
Are there different types of hospital privileges for a family physician?
Yes, typically there are active and courtesy privileges. Some hospitals may have more categories of medical staff membership that may qualify for privileges. Review the medical staff bylaws for a statement of duties and privileges in each category of medical staff.
- Active privileges (may be referred to as admitting privileges) signify you will be eligible for appointment as medical staff. As part of the medical staff, you may admit patients to that hospital or medical center.
- Courtesy privilege means you may either admit patients occasionally or may act as a consultant. You will be ineligible to participate in medical staff activities.
How do I get credentialed with payers?
Most insurers use the Council for Affordable Quality Healthcare (CAQH) Provider Data Portal https://proview.caqh.org. There is no cost for health care providers to enter and maintain their professional and practice information.
Medicare Credentialing and Enrollment is managed through the Medicare Provider Enrollment, Chain, and Ownership System (PECOS).
How do I handle a privileging dispute?
The purpose of credentialing and privileging is to ensure qualified, well-trained physicians are providing quality care to patients. Although the steps are clear, credentialing and privileges are unique from location to location and challenges can arise, including stressful privilege disputes. Practices may use different services for obtaining credentials and for privileges to be secured, you’ll need to understand your hospital’s individual bylaws. These resources can help you in the event of an anticipated or actual privileging dispute:
- Privilege dispute tips
- AAFP policies on privileges that can be submitted to a hospital governing board
- Privilege support protocol
What are medical staff bylaws?
Medical staff bylaws stem from various regulatory sources, including state hospital licensing laws, federal conditions of hospital participation in Medicare and rules from accrediting organizations, such as the Joint Commission. These bylaws describe a hospital’s organizational structure, the medical staff‘s organizational responsibility, rules for self-governance and outline privileges of all licensed physicians and non-physician practitioners. Bylaws are created and approved by medical staff with final approval from the hospital governing board. Revisions to medical staff bylaws must be approved by the governing board.
How can I advocate for family physicians to secure privileges?
Because decisions about granting privilege are made locally, it's important for family physicians to participate in the medical staff meetings at their hospital and serve on the privileging committee.
Legal opinion: Privileges
AAFP policies to support your privileges
Support your pursuit of privileges with help from the AAFP. These policies can help you advocate for the practice scope that fits your training. You can provide them as documentation in support of your request.