Abstract: Economic forces have created a revolution in health care. Traditional models of practice are changing. The care of the patient is being split between the hospitalist and the primary care physician in the ambulatory setting. Increasingly there are physicians that no longer come to the hospital except to attend meetings, yet Departmental Chairpersons must credential and privilege these physicians and vouch for their competence. This article discusses ways to be able to credential and privilege ambulatory physicians or physicians that rarely see patients in the hospital (low volume admitters) by using the core competencies designed by ACGME that are currently used to evaluate residents.