Granting privileges to low-volume/no-volume practitioners

Whatever the reason, a large number of physicians who have low or no volume of clinical care will nevertheless want to reapply for membership and privileges. They may not meet your criteria for current competency for that set of privileges, and therein lies the conundrum: How can an organization grant privileges to a practitioner who does not meet its criteria and when it cannot determine his or her current clinical competency?

The first decision is whether you wish to have this practitioner remain a part of your medical staff. Why would a facility have physicians on staff when they are not doing enough work on-site to meet the basic membership criteria? There are two major reasons:

• Some medical staffs recognize that many practitioners do not primarily practice inpatient medicine and will always be physicians on staff when they are not doing enough work on-site to meet the basic membership criteria providers, but the organization would like them to continue to be part of the medical staff because of their use of the hospital ancillary services.
• The physician may participate in continuity of care programs that extend outside the hospital’s four walls, or in a community group of physicians.

An organization that wants these physicians on its medical staff will have membership criteria that enable low-volume or no-volume providers to be members. This is likely an organization with an inclusive medical staff.

This decision is best made via a thorough medical staff policy so that everyone is treated equally, rather than through a committee’s individual decisions. It’s probably easier for a credentials committee to enforce a policy than to make ad hoc, case-by-case decisions.

If the hospital determines that it wants a particular practitioner to remain on the medical staff, then it proceeds to the next determination. If not, then the medical staff leadership may choose to tell the low-volume practitioner that they cannot process his or her application because he or she does not meet the criteria for competency. However, this process should be outlined in a policy.

Note that such a decision would not be a denial of privileges and therefore would not give rise to fair hearing rights. A medical staff making these kinds of determinations might be seen as an exclusive medical staff.

Source: The Credentials Committee Manual