Credentialing and privileging of hospitalists

The hospitalist profession has taken the healthcare industry by storm over the past 20 years as the fastest-growing specialty in the history of American medicine. The role of the hospitalist continues to emerge through different specialties, including family medicine, internal medicine, pediatrics, OB-GYN, and cardiology. The Society of Hospital Medicine (SHM) recommends that organizations build maximum flexibility into the process of credentialing and privileging hospitalists. This process should recognize the ongoing evolution of hospitalists' roles and address the following principles:

• Hospitalists should demonstrate competency in those areas where evidence of proficiency will enhance the delivery of patient care and promote the safest outcomes for patients. SHM recommends that individual medical staffs ensure provider competency in those areas.
• SHM supports the recognition of a hospitalist's primary specialty credential, be that certification from the American Board of Internal Medicine, American Board of Pediatrics, American Board of Family Medicine, or other appropriate certification organization.
• SHM supports the movement of general specialty boards to recognize hospitalists within their constituencies as site-defined specialists with unique competencies. The focused practice in hospital medicine (FPHM) credentials offered by the American Board of Internal Medicine and American Board of Family Medicine represent the first step toward recognizing hospital medicine as a distinct specialty. SHM endorses the FPHM credential, but recognizes that, as in any specialty, a credential alone is not sufficient to guarantee proficiency in the various skills required to practice hospital medicine.
• SHM supports the Fellowship in Hospital Medicine, Senior Fellow in Hospital Medicine, and Master in Hospital Medicine designations and recognizes that while these credentials represent an individual's commitment to and accomplishments in a career in hospital medicine, they do not indicate the attainment of specific clinical competencies.
• Germane to the practice of hospital medicine is proficiency in bedside procedures and practices such as ACLS, PALS, vascular access, paracentesis, lumbar puncture, and thoracentesis. While proficiency in these areas is not a requirement for American Board of Internal Medicine or other specialty board certification, SHM supports granting these privileges to hospitalists who demonstrate these competencies as defined on a local level by their medical staff governance.
• Although they may not be board certified in critical care medicine, hospitalists who provide critical care should demonstrate competency in key areas to ensure best practice and outcomes. Ventilator management, ACLS, airway management, treatment of shock, and performance of emergent bedside vascular access are examples of proficiencies that should be regularly evaluated in a hospitalist who delivers critical care services.
• Competency-based training and assessment is the optimal way to ensure the highest level of quality care and patient safety. In the absence of specific restrictions, SHM recommends that hospitalists be privileged to practice medicine within their scope of practice as defined by their training, experience, and specialty board. These privileges should be supported by demonstrable and measurable competency. SHM's “The Core Competencies in Hospital Medicine: A Framework for Curriculum Development” (2006) is a useful resource for hospital medicine groups and medical staffs working on developing appropriate privileging criteria for hospitalists. It can be accessed at www.hospitalmedicine.org/Content/NavigationMenu/Education/CoreCurriculum/Core_Competencies.htm.
• SHM acknowledges a growing trend of specialists (general surgeons, neurologists, psychiatrists, obstetricians, etc.) practicing within the broader field of hospital medicine. SHM supports credentialing and privileging of these specialty hospitalists based on the competencies defined by their primary specialty and with demonstration of competency focused on the needs of hospitalized patients.

Source: News and Analysis

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