Clearance: The Invisible Handcuffs Binding Healthcare Providers

Let's get straight to it. This post is going to stir the pot. And while I know it won't make me popular with everyone in the locums industry, I believe it's a conversation we need to have.

Today, let's talk about clearance, an industry norm that quietly limits providers far more than most realize. In many ways, clearance functions like a non-compete agreement, but without the legal framework or transparency that typically comes with such restrictions.

What Is Clearance, Really?

Before we dive in, let's clarify what we're dealing with. Clearance has two parts, and understanding the distinction is key.

Healthcare Organization Clearance: The Reasonable Part

First, there's clearance from the healthcare organization's perspective. This part, I'll admit, makes sense when applied appropriately. When an agency presents your name to work at a facility, that organization wants to verify that you're not already:

• In active discussions with their internal recruiters
• Currently working there
• Recently worked there (typically within the last 12-24 months)

This protects organizations from double-paying for the same provider and prevents confusion in their recruitment process. So far, so good.

Agency Clearance: Where Things Get Problematic

Here's where the waters get muddy. If you’ve ever worked within a health system through any agency, sometimes years ago, sometimes at an entirely different facility, you may be locked into that agency.

Imagine this: You find a better-paying opportunity with a new agency. But because you worked a single shift eight months ago through another agency in the same health system, you’re told you can’t clear. That’s it, no choice, no flexibility.

This is fundamentally anticompetitive. Imagine if Uber drivers could only work for Uber, or Lyft drivers could only work for Lyft, never both. As independent contractors, these restrictions would be unthinkable in the rideshare industry.

The Hidden Problem: Unknowing Submissions

Perhaps most concerning is that many providers don't even know their names are being submitted to organizations. This creates real downstream consequences, missed opportunities, delayed placements, and reduced earning potential that providers often can’t trace back to the root cause. The only party that wins in that stratagem is the Agency who loads the healthcare organizations with “cleared” providers to box-out competitors and cash in on massive margins and buy-outs.

The Bigger Picture

Let me be clear: I'm not trying to vilify anyone in this industry. Most people are good people operating within a system that has evolved in ways that don't always serve providers or healthcare organizations well.

The current clearance system creates unnecessary overhead, limits provider flexibility, and restricts healthy competition, all without meaningful benefit to healthcare organizations or providers. It's a practice that exists primarily to protect agency relationships, not to improve patient care or provider satisfaction.

Moving Forward

I recognize that changing established practices isn't easy, and I understand the business rationale behind current clearance policies. But as an industry, we can do better. We can create systems that protect legitimate business interests while preserving provider autonomy and fostering healthy competition.

Independent contractors should have the freedom to choose who they work with, especially when they haven't signed exclusive agreements or received specific benefits that would justify restrictions on their practice. The healthcare industry is facing unprecedented staffing challenges. Now, more than ever, we need systems that empower providers to work where they're needed most, with the agencies that serve them best.

At Sendit, we believe transparency and provider choice aren't just good business—they're the right thing to do. And while this approach may ruffle some feathers, I'm confident it will ultimately benefit everyone involved: providers, healthcare organizations, and yes, even agencies willing to compete on value rather than restrictions.

Our Commitment to Change

We won’t point out a problem without offering solutions. Here’s what Sendit commits to, and what we believe should be industry standard:

1. Documented Consent Always: We will never submit your name to any healthcare organization without your explicit, documented consent.
2. Full Transparency on Compensation: You'll know exactly what you'll earn before you commit to any opportunity and begin the credentialing process.
3. Provider Choice: If you're presented to an organization through multiple agencies, you should have the right to choose which one you'd prefer to contract through.

These aren’t radical ideas; they’re common sense. And they’re long overdue.

Facing a Clearance Issue Now?

If you or a loved one has been exposed to clearance-related nonsense, please know help is available.

Common symptoms include:

• Confusion: You don’t recall ever authorizing your name or CV to be submitted.
• Anger: You chose locums for freedom… yet somehow feel more restricted than ever.
• Whiplash: Being “locked” to an agency because of one shift years ago.

If these symptoms occur, follow this treatment plan:

1. Request documentation from the agency or organization that denied your clearance.
2. If they “don’t have it,” ask for the person who does and request evidence of why you are not eligible.
3. Challenge inconsistencies and demand accountability.
4. Don’t give up if it’s a facility you want—it’s worth fighting for. Remember, it is in you and the hospital's best interest that you get across the finish line. You want the gig, they need your help.
5. And for long-term prevention: Join Sendit, where transparency is standard and no one thrives on restrictions or opacity.