A new look at medical staff categories

Several questions have come to my attention recently that involve defining categories of the medical staff.  In many medical staff organizations, physician leaders are finding that old categories don't fit new realities of how physicians and other practitioners relate to the hospital and participate in medical staff organization activities.

An important principle is to clearly separate membership issues from privileging issues.  This is a Joint Commission requirement. The overview to the 2007 Medical Staff Standards states: "Membership on the medical staff is not synonymous with privileges.  The medical staff may create categories of membership, as in active member, courtesy member, and so forth.  These categories may be helpful in defining the roles and expectations for the various members of the medical staff."  In the section of the standards that provides information about the structure of the organized medical staff, the Joint Commission states that, "applicants for privileges need not necessarily be members of the medical staff."

So, it is clear that these issues should be separated.  Why, then, do so many medical staff bylaws mix membership and privileging issues?  For example, many bylaws, in defining the "active" category of the medical staff, state that, "members of the active category have the privilege to admit."  The reality is, of course, that there may be members of the active category that would never be expected to admit (pathologists, emergency department physicians, etc.).  Admission of patients is a privileging issue that should be dealt with in that venue, not through an assignment to a category of the medical staff.

Membership is a political issue: Who can vote, attend meetings, chair a committee, serve as an officer, etc.  Your organization has the opportunity to define medical staff categories in the way that will be most useful to the medical staff.  Some organizations have two categories - voting and non-voting.  Others have active, courtesy and honorary categories (or active, affiliate and emeritus).  It is up to your organization to determine what is appropriate for your medical staff.

The second issue is, what parameters might be useful to determine when/if a practitioner is eligible for advancement, if your organization does have a "holding" category (such as provisional) that is used for new physicians who then subsequently are determined to be eligible for advancement to active, courtesy, consulting, etc. categories.

Most medical staff organizations link advancement to a length of time served on the medical staff (the usual range is from six months to one to two years) in a "holding" category.  A practitioner may be eligible to move from provisional to active, for example, if he or she has a specific amount of clinical activity during the provisional period of time.  The same practitioner may be eligible to move to courtesy if his or her clinical activity has been minimal or low. 

It is perfectly acceptable to move a practitioner into the "active" or "voting" category based on clinical activity (which shows a commitment to the organization), rather than based on an arbitrary length of time. 

Medical staffs all over the country are rethinking some of the established rules that have been in place for many years.  And it is always beneficial to question the status quo to determine if the categories that served an organization in the past continue to be effective.  If those categories aren't effective anymore, change them.

We'd love to hear from any of you who have come up with some innovative and successful ways to deal with medical staff categories.  We'll share your success stories in future columns.

Vicki Searcy, CPMSM