Medical Staff Operational Issues: Departments vs. Clinical Services

Medical staffs today are, more than ever before, challenged by the time constraints of their members. More administrative physicians are taking on roles that alleviate some of the time burden on medical staff leaders, whose primary responsibility is the care of their own patients. Moreover, more medical staffs are redesigning their medical staff operations to alleviate some of the burden placed on their members by, for example, adopting clinical services instead of departments or streamlining the medical staff committee structure and process.

The Joint Commission does not mandate any medical staff departments. As a result, many medical staffs are now eliminating departments and are instead forming clinical services that have no departmental obligations. According to The Joint Commission, the medical executive committee (MEC) has the authority to recognize any group of practitioners who wish to organize themselves into a clinical service. Physicians who are organized into clinical services are not required to hold regularly scheduled meetings, attend any meetings that are held, or take meeting minutes. The clinical service is only required to submit a written report to the MEC only when the clinical service is making a formal recommendation. When a clinical service makes a formal recommendation, it should submit a report to the MEC documenting the specific position of the clinical service. Clinical services, although not required to meet regularly, can hold educational meetings, morbidity and mortality conferences, and business meetings. The clinical service’s representation and participation on the MEC is always of concern whenever medical staffs consider eliminating departments in favor of clinical services.

The medical staff can determine what functions it wishes the clinical service to perform, such as educational meetings, morbidity and mortality conferences, or operational meetings. The medical staff can also determine which of the 15 mandated duties of department chairs (as defined by The Joint Commission) they wish the clinical service chair to perform. It is a prerogative of department chairs to recommend a practitioner for membership and/or privileges; however, clinical service chairs review candidates and give input to the credentials committee.

Finally, the medical staff can also determine whether it wants the clinical service chairs to have voting ex officio positions on the MEC or if the MEC will be constituted in some other manner.

Thus, the switch from departments to clinical services can offer many benefits so chosen by the medical staff without some of the mandated regulatory burden. Some organizations wish to maintain clinical departments, but they have a limited number of departments. Others have restructured the medical staff in such a way that certain functions, such as peer review and other mandated Joint Commission functions, are centralized within the organization. Many departments no longer require practitioners to attend any meetings.

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