ObjectiveTo assess credentialing practices for critical care admissions and procedures in smaller hospitals within the United States.MethodsA questionnaire was sent to credentialing coordinators of 500 randomly selected American Hospital Association hospitals with fewer than 300 beds.Measurements and Main ResultsMost hospitals validate qualifications for intensive care unit (ICU) admitting and procedural privileges through recommendations only. Fewer (16%) require a specified prior number of procedures to have been performed, and 9% require prospective supervision before privileges are granted. Critical care subspecialists are present in 57% of these hospitals and tend to be in the larger facilities with more critical care beds. Criteria for ICU admission and procedure privileges appear to be inclusive, because family medicine, obstetrics-gynecology, orthopedic surgery, and neurology specialists are often credentialed. The presence of a critical care subspecialist is associated with fewer hospitals credentialing family medicine specialists for ICU admission and procedures but not obstetrician-gynecologists, orthopedic surgeons, or neurologists.ConclusionsThis is a brief descriptive report of hospital policies that define which physicians are permitted to care for critically ill/injured patients in small U.S. hospitals. The presence of a critical care specialist appears to influence only slightly the ICU credentialing processes for other selected specialists.