Why clinician start dates slip, and where the days go

The short answer

On average, 112 days pass between a physician signing a contract and the first day of work, and 70% of organizations say credentialing and privileging alone take three to four months¹. The most common single cause is medical staff waiting on items from the physician, reported by 42% of organizations¹.

Key takeaways.

The wait holds two kinds of days: external turnaround and internal work. Complete submissions, early requests and committee cutoffs affect how long a file waits.
Waiting on items from the physician is the top reported cause of delay (42%), ahead of state licensing (38%) and verifications or references (30%)¹.
Start credentialing the day the offer is accepted, and run it alongside HR, IT and department onboarding.
Time each hire from accepted offer to first day worked, split by segment, before you change anything.

What delays a physician start?

The AAPPR asked organizations what held up their physician starts¹. A start can have more than one cause, so the shares don’t add up to 100%.

Causes of delay between a signed contract and a physician’s first day, by share of organizations reporting each. AAPPR, reported by the AMA, 23 Dec 2025.
Cause	Organizations reporting it	Who can act on it
Medical staff waiting on items from the physician	42%	Your team and the physician
State licensing delay	38%	The state board
Waiting on verifications or references	30%	Outside sources; your team can follow up
Internal credentialing delays	22%	Your team
Drug Enforcement Administration (DEA) delay	15%	The DEA
Not enough staff to support hiring	11%	Your team
Physician asked for a later start	10%	The physician
Poor communication among the people involved	8%	Everyone involved
Immigration delay	7%	Outside agencies

How long does each part take?

Published ranges for each segment, with their sources. Each one measures a different stretch, so they aren’t added together.
Segment	Published range	Source
Signed contract to first day worked	112 days on average; in about one case in seven, up to six months¹	AAPPR, via the AMA
Credentialing and privileging	Three to four months, for 70% of organizations¹	AAPPR, via the AMA
Submitted application to completed verification	90 to 180 days²	MGMA
Payer enrollment	Up to five or six months²	MGMA

These are physician figures. Most nurses don’t go through medical staff privileging, but their license, health and background checks have the same split between waiting and chasing.

Which days can your team win back?

A board, payer or committee controls its own process. Your team controls the completeness and timing of its requests, its follow-ups and any rework. That chase work is where a team can win back time, with one owner for each item and a date for the next follow-up.

Rōvn is built to carry that chase work: one record that each team works from, with agents built to follow up on missing items while people make every decision.

How do you tell if a change gets clinicians working sooner?

Pick one group of roles and time each hire from accepted offer to first day worked.
Record each requirement, owner, complete submission, response and next action. Separate outside turnaround from internal rework; overlapping intervals must not be added together.
Record planned start, authorized start and first day actually worked separately. Compare cohorts with similar roles, jurisdictions and requirements over a defined observation window.
Report cohort size, elapsed-time distribution, unfinished cases and withdrawals. Explain changes in case mix or external turnaround; a before-and-after difference alone does not prove causation.

Keep de-identified references in your tracking sheet and sensitive evidence in its authorized system.

To put a cost on the wait, use the start-delay cost calculator with your own numbers.

Questions.

How long does physician credentialing take?

Most organizations report three to four months for credentialing and privileging, and an average of 112 days from signed contract to first day worked¹. Payer enrollment can take up to five or six months².

What is the most common cause of a delayed start?

Waiting on items from the physician, reported by 42% of organizations, followed by state licensing delays (38%) and waiting on verifications or references (30%)¹.

When should credentialing start?

The day the offer is accepted. It’s usually the longest track, so it shouldn’t wait for HR paperwork to finish.

Can our team shorten the wait?

Your team can improve request completeness, submission timing, follow-up and rework. Outside institutions retain their own turnaround and decisions. Track both and confirm whether the change affects the actual start, rather than assuming fewer follow-ups means an earlier start.

Do these numbers apply to nurses?

They come from physician surveys. Most nurses don’t go through medical staff privileging, but the same split between waiting and chasing applies to their license, health and background checks. See the clinician onboarding checklist.

Sources

1
American Medical Association, “What might delay the start of your first physician job,” 23 Dec 2025
Reports AAPPR’s physician credentialing and onboarding research.
Accessed Oct 15, 2026
2
MGMA, “Navigating the credentialing gauntlet,” 14 Dec 2021
Accessed Oct 15, 2026

Not Rōvn results

These are published survey figures, not Rōvn’s results. Each measures a different stretch of the process, so none are added together.

Keep reading

Also: primary source verification, NPDB checks, nurse license verification, physician license verification and locum tenens credentialing.