Membership vs. Privileges-Part2

Dear medical staff leader:

In last week's edition of this newsletter, I discussed the privileging challenges presented by low- and no-volume providers. As an increasing number of family medicine and internal medicine physicians begin to use hospitalists and spend less time in the hospital, medical staffs struggle to assess these physicians' competency at reappointment. How do you reappoint a physician with limited or no clinical activity in the hospital over the past two years? Can these physicians remain on the active staff? Last week we answered the first question. In this week's column, I'll address the question of which medical staff category best suits such practitioners.
 
As discussed last week, membership is separate from, and does not determine, privileges. Use categories to delineate the citizenship status of various members of the medical staff. A member's category indicates whether he or she can vote in general medical staff elections or on bylaws amendments, serve as an officer, sit and vote on committees, and so forth. A medical staff that wants to streamline its categories might consider establishing an active category and an associate category. Members in the active category can vote, chair committees, and hold office. Some medical staffs also establish an honorary category for clinicians who have been on staff previously but no longer actively practice (e.g. retired physicians).

When reappointing family practice physicians and general internists who concentrate on office-based practice while admitting their acutely ill patients to hospitalists, your decision into which category to place them depends on whether you want to be inclusive or exclusive. Remember that "form follows function." So once you decide how you want to function (whether to be inclusive or exclusive), write corresponding bylaws language.

If you want to be inclusive and feel that these physicians are supporting the mission of the hospital by referring patients to their colleagues for inpatient admissions and/or outpatient surgery and sending ancillary services to the hospital, you can certainly make them eligible for the active status category. If your bylaws define a number of contacts a physician must have to be eligible for active staff category, you could consider admissions, inpatient/outpatient surgeries, consults, or referrals for inpatient admission and/or inpatient/outpatient surgery as contacts. If you want to be exclusive and feel that only those physicians who work in the hospital regularly should be eligible for active category, place low- and no-volume physicians in the associate medical staff category.
 
In today's ever changing health care environment we need to recognize that low- and no-volume physicians remain highly qualified members of the medical community and should be welcomed members of the medical staff.

All the best,

Joseph Cooper, MD
The Greeley Company