Medical staff members on governing boards: Critical expertise or conflict of interest?

I just finished reading Errol L. Biggs’ The Governance Factor: 33 Keys to Success in Healthcare (Health Administration Press, 2004) in which the author states:

“The president of the medical staff, by virtue of the position, is usually an ex officio member of the board. This individual basically serves one purpose and that is to represent the entire medical staff, a role that is generally understood by everyone involved…..It is expected that the president of the medical staff will represent the view of the medical staff first.” He then goes on to state, “Although exceptions exist, the board nominating committee should eliminate all hospital based physicians from consideration” (p. 103).

I couldn’t disagree more. Thoughtful medical staff presidents understand that they wear two hats. One is to represent the interests of the medical staff as a whole through an advocacy role; the other is to fulfill his or her board-delegated function to oversee and improve the quality of care performed by licensed independent practitioners.

When a president of the medical staff votes as a member of the medical executive committee, he or she represents of the interests of the entire medical staff; when he or she votes as a member of the board, that individual represents the interests of the hospital at large. If there is a conflict between the two opposing interests, the medical staff president discloses the conflict to the board and allows the body as a whole to decide a reasonable course of action.

A medical staff president on the governing board represents no more of a conflict than other individuals on the governing board, such as:

• A contractor who serves as a board officer and receives $2 million per year from the hospital for providing contracted services
• A board treasurer who manages the hospital’s endowment fund
• A board chair who receives tens of thousands of dollars a year in marketing fees
• A CEO who provides critical managerial input to his or her employer

All of these conflicts must be appropriately managed through a conflict of interest policy that outlines proper disclosure and determines the level at which the medical staff president should be involved in issues that pose a conflict of interest. Hospitals may wish to consult legal counsel as well to define conflict from a statutory or regulatory standpoint.

The president of the medical staff serves on the board as an ex-officio member to provide critical clinical expertise and to represent the interests and perspectives of the medical staff at large. A non-ex officio member of the medical staff serves on the board as a citizen of the community the hospital serves who happens to bring clinical expertise to the table. In both cases, their primary role is to serve the interests of the hospital at large and not the medical staff.

Boards are largely made up of successful and dedicated individuals from the community, who often have little—if any—healthcare experience or background. With the increasing necessity for the board to oversee quality performance with the same degree of rigor as its traditional financial oversight, individuals with clinical expertise should be on the board to deepen the board’s understanding of strategic and regulatory quality issues. Chief medical and nursing officers may assist in this regard; however, they may or may not have current, first-hand clinical expertise of a practitioner in active clinical practice.

Medical staff members have an essential role to play on the board. After all, potential conflicts may be appropriately managed, but a lack of essential expertise cannot.

Best regards,

Jon Burroughs, MD, MBA, CMSL
Senior Consultant,
The Greeley Company