top of page
Fellowship in Medical Staff Development Credential
$170
Name
Enter your text
Title
Enter your text
Mailing Address
Enter your text
Phone
Enter your text
Email
Enter your text
Website
Enter your text
REFERENCES 1: Name
Enter your text
REFERENCES 1: Title
Enter your text
REFERENCES 1: Organization
Enter your text
REFERENCES 1: Address
Enter your text
REFERENCES 1: Phone
Enter your text
REFERENCES 2: Name
Enter your text
REFERENCES 2: Title
Enter your text
REFERENCES 2: Organization
Enter your text
REFERENCES 2: Address
Enter your text
REFERENCES 2: Phone
Enter your text
REFERENCES 3: Name
Enter your text
REFERENCES 3: Title
Enter your text
REFERENCES 3: Organization
Enter your text
REFERENCES 3: Address
Enter your text
REFERENCES 3: Phone
Enter your text
EXPERIENCE: Current Title/Responsibility
Enter your text
EXPERIENCE: Description of Responsibility
Enter your text
EXPERIENCE: Percentage of time spent in these medical staff development area(s)
Enter your text
EXPERIENCE: Organization
Enter your text
EXPERIENCE: Address
Enter your text
EXPERIENCE: Start of Employment
Please choose a date
EXPERIENCE: Total years in current position
Enter your text
EXPERIENCE: Previous Title/Responsibility
Enter your text
EXPERIENCE: Description of Previous Responsibility
Enter your text
EXPERIENCE: Percentage of time spent in previous medical staff development area(s)
Enter your text
EXPERIENCE: Previous Organization
Enter your text
EXPERIENCE: Previous Organization Address
Enter your text
EXPERIENCE: Previous Employment Start Date
Please choose a date
EXPERIENCE: Total Years Spent at Previous Employent
Enter your text
EXPERIENCE: Upload Your Current Resume
CONTINUING EDUCATION 1: Name of Program
Enter your text
CONTINUING EDUCATION 1: Sponsor
Enter your text
CONTINUING EDUCATION 1: Date
Please choose a date
CONTINUING EDUCATION 1: Location
Enter your text
CONTINUING EDUCATION 1: Contact Hours
Enter your text
CONTINUING EDUCATION 1: Type of Program
Enter your text
CONTINUING EDUCATION 1: Upload Corresponding Documentation
CONTINUING EDUCATION 2: Name of Program
Enter your text
CONTINUING EDUCATION 2: Sponsor
Enter your text
CONTINUING EDUCATION 2: Date
Please choose a date
CONTINUING EDUCATION 2: Location
Enter your text
CONTINUING EDUCATION 2: Contact Hours
Enter your text
CONTINUING EDUCATION 2: Type of Program
Enter your text
CONTINUING EDUCATION 2: Upload Corresponding Documentation
CONTINUING EDUCATION 3: Name of Program
Enter your text
CONTINUING EDUCATION 3: Sponsor
Enter your text
CONTINUING EDUCATION 3: Date
Please choose a date
CONTINUING EDUCATION 3: Location
Enter your text
CONTINUING EDUCATION 3: Contact Hours
Enter your text
CONTINUING EDUCATION 3: Type of Program
Enter your text
CONTINUING EDUCATION 3: Upload Corresponding Documentation
CONTINUING EDUCATION 4: Name of Program
Enter your text
CONTINUING EDUCATION 4: Sponsor
Enter your text
CONTINUING EDUCATION 4: Date
Please choose a date
CONTINUING EDUCATION 4: Location
Enter your text
CONTINUING EDUCATION 4: Contact Hours
Enter your text
CONTINUING EDUCATION 4: Type of Program
Enter your text
CONTINUING EDUCATION 4: Upload Corresponding Documentation
PROFESSIONAL CONTRIBUTIONS 1: Program or Publication
Enter your text
PROFESSIONAL CONTRIBUTIONS 1: Title of Course Publication
Enter your text
PROFESSIONAL CONTRIBUTIONS 1: Sponsoring Organization
Enter your text
PROFESSIONAL CONTRIBUTIONS 1: Meeting or Publishing Date
Please choose a date
PROFESSIONAL CONTRIBUTIONS 1: Location of Meeting
Enter your text
PROFESSIONAL CONTRIBUTIONS 1: Your Specific Session or Article Length
Enter your text
PROFESSIONAL CONTRIBUTIONS 1: Speaking Assignment
PROFESSIONAL CONTRIBUTION 1: Upload Corresponding Documentation
PROFESSIONAL CONTRIBUTIONS 2: Program or Publication
Enter your text
PROFESSIONAL CONTRIBUTIONS 2: Title of Course or Publication
Enter your text
PROFESSIONAL CONTRIBUTIONS 2: Sponsoring Organization
Enter your text
PROFESSIONAL CONTRIBUTIONS 2: Meeting or Publishing Date
Please choose a date
PROFESSIONAL CONTRIBUTIONS 2: Location of Meeting
Enter your text
PROFESSIONAL CONTRIBUTIONS 2: Your Specific Session or Article Length
Enter your text
PROFESSIONAL CONTRIBUTIONS 2: Speaking Assignment
PROFESSIONAL CONTRIBUTION 2: Upload Corresponding Documentation
PROFESSIONAL CONTRIBUTIONS 3: Program or Publication
Enter your text
PROFESSIONAL CONTRIBUTIONS 3: Title of Course or Publication
Enter your text
PROFESSIONAL CONTRIBUTIONS 3: Sponsoring Organization
Enter your text
PROFESSIONAL CONTRIBUTIONS 3: Meeting or Publishing Date
Please choose a date
PROFESSIONAL CONTRIBUTIONS 3: Location of Meeting
Enter your text
PROFESSIONAL CONTRIBUTIONS 3: Your Specific Session or Article Length
Enter your text
PROFESSIONAL CONTRIBUTIONS 3: Speaking Assignment
PROFESSIONAL CONTRIBUTION 3: Upload Corresponding Documentation
AWARDS & PROFESSIONAL DESIGNATIONS 1: Please list all relevant information including name, purpose, sponsoring organization, date, and qualifications.
Enter your text
AWARDS & PROFESSIONAL DESIGNATIONS 1: Date Received
Enter your text
AWARDS & PROFESSIONAL DESIGNATIONS 1: Upload Corresponding Documentation
AWARDS & PROFESSIONAL DESIGNATIONS 2: Please list all relevant information including name, purpose, sponsoring organization, date, and qualifications.
Enter your text
AWARDS & PROFESSIONAL DESIGNATIONS 2: Date Received
Enter your text
AWARDS & PROFESSIONAL DESIGNATIONS 2: Upload Corresponding Documentation
ASSOCIATION MEMBERSHIP 1: Are you a member of the American Academy of Medical Management?
ASSOCIATION MEMBERSHIP 1: Actual Years of Membership
Enter your text
ASSOCIATION MEMBERSHIP 1: Upload Corresponding Documentation
ASSOCIATION MEMBERSHIP 2: Name of Association
Enter your text
ASSOCIATION MEMBERSHIP 2: Actual Years of Membership
Enter your text
ASSOCIATION MEMBERSHIP 2: Upload Corresponding Documentation
ASSOCIATION MEMBERSHIP 3: Name of Association
Enter your text
ASSOCIATION MEMBERSHIP 3: Actual Years of Membership
Enter your text
ASSOCIATION MEMBERSHIP 3: Upload Corresponding Documentation
I certify that all the information contained in this application is accurate. I understand that all of the information I have provided herein may be verified, and I authorize such verification. I also agree, if awarded Fellowship status, to abide by the rules and regulations set forth by The American Academy of Medical Management.
Product Details
This FMSD Credential covers the myriad Medical Staff Development areas dealing with the physician practice. Display this credential proudly. Learn more...
Fellowship in Medical Staff Development (FMSD Credential)
Medical Staff Development is a broad ranging term, which covers myriad areas dealing with physicians. To apply for Fellowship status in Medical Staff Development (FMSD) you must meet the following qualifications:
Fellowship Requirements
- Current employment in one or more areas of medical staff development.
- At least two years experience in medical staff development, whether full or part-time.
- Over the past two years any combination of experience and continuing education units (CEU), professional contributions, awards and professional designations totaling 16 units.
Units are measured as follows:
- Experience Units: One unit for each quarter year full-time equivalent.
- Continuing Education Units: One unit for each accepted 6 hours of instruction (no limit on the number of units).
- Professional Contributions: One unit for each hour taught or each full page published (up to 2 total units).
- Awards & Professional Designations: Up to 2 units.
- Association Membership: Up to 2 units.
- Current membership in the American Academy of Medical Management.
Note: Medical Staff Development is a term broadly used for non-clinical activities. It is primarily the “business side of medicine”, but does cover some related areas, such as working with physicians and or other medical providers in providing medical education, medical records, etc. However, the term is not defined to include true clinical areas, such as patient treatment.
Please follow these instructions when completing the form to the right:
EXPERIENCE IN MEDICAL STAFF RECRUITMENT
Unit credit: During the past three years, one unit for each quarter full-time equivalent (up to 12 total units).
This section seeks information about the number of years and percentage of time spent in medical staff recruitment over the past three years. This recognizes that a professional often has various recruitment responsibilities. Please provide appropriate employment data beginning with your current position, and describe your professional experiences. Attach a separate sheet if more space is needed. Please forward a letter from each employer to verify this information.
CONTINUING EDUCATION INFORMATION
Unit Credit: During the past three years, one unit for each six contact hours of approved instruction. No limit on number of units.
Contact hours are the actual number of hours spent in classroom educational activity, excluding breaks. For each, please provide 1. verification of attendance, 2. course outline.
PROFESSIONAL CONTRIBUTIONS IN THE FIELD OF MEDICAL STAFF DEVELOPMENT (OPTIONAL) (May apply If the applicant does not have 21 units)
Unit Credit: Up to 2 total units. One unit for each hour taught or each full page published during the past three years.
This can be accomplished through publishing articles, teaching at continuing education programs or universities or serving in leadership capacities in Medical Staff Recruitment related associations.
All of the contributions listed below should be substantially related to the profession of Medical Staff Recruitment in the past three years.
A. Authoring or Publishing an Article
In order to receive credit, attach a reprint of the article(s) in one or more Medical Staff Recruitment areas that you have authored and published in recognized national or regional publications. A quote attributed to you in an article does not apply.
B. Teaching and Speaking at Programs and Meetings
Please list teaching or speaking assignments at meeting and educational programs on Medical Staff Recruitment. Please attach verification of your speaking, with a copy of the promotional brochure and course outline. (Serving as a panelist will count as half credit.)
AWARDS & PROFESSIONAL DESIGNATION
Up to two total units, one for each qualifying award and professional designation. During the past three years, any individual awards recognizing your medical staff recruitment expertise or professional designations, such as related certification or fellowship credentials.
Please provide complete information on the name, purpose, sponsoring organization, date, qualifications and any other data relevant to the award/recognition that you have earned.
ASSOCIATION MEMBERSHIPS
Up to two total units. One unit for each full-year membership of a national association or one-half unit for a local or state association during the past three years which is directly within the realm of medical staff recruitment.
Membership in professional associations related to the field of recruitment is strongly encouraged. Such membership exposes the member to industry trends as well as opportunities for professional enhancement.
NOTE: You will be notified of your application results via e-mail within 4 to 6 weeks.
Fellowship in Medical Staff Development Credential
Display prices in:
USD
bottom of page