Responding to requests for additional medical staff departments

Dear Medical Staff Leader:

This week's mail brought a number of questions concerning the addition of departments to the medical staff structure. For example, one medical staff leader asked how he should respond to pediatricians' request to form a department to gain influence and increase the number of patient beds allocated to pediatric patients. Another physician leader sought help dealing with neurosurgeons who wanted to form a new department but did not want to take on the responsibility for peer review, emergency department call, and formal meetings.

When faced with such requests, I recommend that you first determine what is really motivating the group of specialists to departmentalize. Generally, most physicians don't care to form "their own" department. However, these same physicians will often agree that forming their own department is preferable to remaining part of a larger department. Often this agreement is tied to the physicians' desire to secure a medical executive committee (MEC) seat.

However, departmentalization requires the chairs of newly formed departments to carry out the approximately 15 leadership functions detailed in the JCAHO's standards--including peer review. Keep in mind that no regulation exists that prohibits a group of specialists from meeting as often as desired for purposes of grand rounds, education, general discussion, and drafting recommendations to the MEC (through their respective chair).

If members of your medical staff request the creation of a new department simply to gain a seat on the MEC, you should consider this issue separately from the issue of departmentalization. Determine whether this specialty should be represented on the MEC. Does the specialty conduct significant clinical activity? Will the addition of this specialty to the MEC spur additional such requests that interfere with the efficient operation of the MEC?

Remember, allowing pediatricians to create a medical staff department does not automatically create more patient beds for pediatric patients, eliminate the need to provide emergency services, or increase the practitioners' influence over medical staff and hospital operations. It's true that a seat on the MEC allows practitioners both a voice and a vote, which may lead to greater influence. However, a specialty does not need to form its own department to gain a set on the MEC.

For more discussion on this issue, stay tuned for the March issue of "Medical Staff Briefing," published by HCPro, Inc.

That's all for this week.

All the best,

Hugh Greeley