Noncompete agreements get most of the attention when physicians consider leaving employment. For Travis Doering, MD, the bigger obstacle was months of waiting for insurers to let him in.
Dr. Doering, an Austin, Texas-based hand, upper extremity and peripheral nerve surgeon, left a large orthopedic group this spring to launch two independent practices: Upper Extremity ATX and Regen ATX. He applied to payers in February. Nearly eight months later, he is still waiting on at least one.
“That probably in some ways was the most frustrating, just because it’s something that you have almost no control over,” Dr. Doering told Becker’s. “You can have all your CAQH data all set, and it still just doesn’t [move].”
Relief may be coming. UnitedHealthcare, Cigna and Centene have signed on as initial participants in a new national shared credentialing program from CertifyOS, which aims to standardize verification and eliminate duplicative submissions. Providers submit an average of 17 credentialing applications a year to different payers, according to CertifyOS. The program is scheduled to go live this fall.
Months without revenue
For a new practice, credentialing starts before a physician sees a single patient. A practice first needs a physical location, often secured about six months ahead, before it can even apply.
“After you go through the whole credentialing and contracting process, that’s six months for a small independent physician. You’re not getting a salary,” Dr. Doering said. “You’re not sure even if the insurance companies will contract with you for whatever reason.”
His timelines varied by payer. Medicare took about 30 days, with some retroactive coverage, and Blue Cross Blue Shield took about 45 days. Aetna followed. UnitedHealthcare took about six months. He signed his final paperwork with MultiPlan, now Claritev, only recently, nearly eight months after applying. He still is not credentialed with TriWest, which he said represents a large share of potential patients in a state with a major VA system and military presence, particularly for his peripheral nerve work.
“That’s not income. That’s not anything,” he said.
Why it matters more than a noncompete
Dr. Doering argues credentialing now does more to keep physicians in employed roles than noncompetes do. Texas tightened its physician noncompete law in September 2025, limiting new or renewed agreements to one year and a five-mile radius from a physician’s primary practice site. The state followed others that have restricted or eliminated noncompetes.
“Noncompetes are still an issue, but they are just not nearly as big of a deal as the process to start a medical practice,” he said.
The imbalance also favors payers, he said. Insurers have the staff and experience to wait out a small practice, and little incentive to hurry.
“It’s that David and Goliath situation,” he said. “They can wait you out, and they don’t care if you join their network or not, even if you offer a specialized procedure or skill set.”
How he planned around it
Dr. Doering said foresight kept the delays from sinking his practice. He started applying to payers in February, before leaving his previous job in mid-April, and secured office space early. He opened June 1, giving himself a runway to ramp up.
Still, he has had to turn patients away or ask them to come back in six weeks. He also learned to see some patients out of network, which many patients do not realize is possible, by sending good faith cost estimates.
The complications multiply with secondary plans, he said. A physician can be in network with Medicare but not with a patient’s specific Medicare Advantage plan.
What should change
Dr. Doering said fixing the process will take regulators and payers alike. He pointed to Curative, a newer insurer, as an example of what a faster process could look like. He negotiated his contract with the company entirely through AI: His AI tool and the insurer’s went back and forth for about two weeks, using payers’ machine-readable price files to compare his offer against what local providers in his specialty were being paid.
“We settled on a number, and we signed, and it was great,” he said. “To me, that kind of feels like the future. It should feel like a straightforward process.”
His advice for physicians considering independence: Start credentialing well before leaving.
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