Determining initial competence for low- and no-volume practitioners

Organizations should identify proactively how they will address low- or no-volume practitioners both at initial appointment and reappointment to ensure that as organizations they are extending privileges only to individuals who can demonstrate current clinical competence.

If an applicant has little to no recent clinical activity and is therefore unable to demonstrate current clinical competence, the organization must determine what options best fit the applicant. Some options for low- and no-volume practitioners at the time of initial appointment include:

• Discuss the practitioner’s intent to utilize the privileges requested. Perhaps a different category of privileges, such as refer-and-follow or consult-and-assist privileges, would better fit the applicant’s practice. These privilege categories allow the practitioner options to interact with the care team but not serve as the primary care medical services professional practitioner during a patient’s hospital stay. Or, if the applicant anticipates participating only in membership activities, then he or she may not need clinical privileges and may be interested in only applying for staff membership.
   
• If a practitioner has been out of practice for a significant amount of time or in a private or office-based practice for many years and has no current inpatient experience, the organization may want to consider requiring the practitioner to participate in a refresher course or remedial course. The Federation of State Medical Boards keeps an up-to-date list of these types of courses that are offered across the country, many of which customize training based on need. Many times, if the organization is willing to invest in the practitioner (for example, if a hospital has hired him or her as a hospitalist), it will pay for the course(s).
   
• The organization could also elect to require precepting to afford the practitioner the option to receive additional training before granting him or her privileges to provide patient care independently.

Source: The Medical Staff's Guide to Overcoming Competence Assessment Challenges