What are core privileges?
There are several ways to delineate privileges. How an organization delineates privileges will affect the information that the medical staff office will require to process privilege requests.
In a core privileging environment, appropriate members of the medical staff identify the cognitive and procedural skills that are part of the general (core) competency of a given specialty or subspecialty treatment area. Any practitioner who meets the requirements for education, training, and experience can perform the core privileges. Practitioners who apply for special (non-core) procedure privileges must document additional training, experience, and competency for the procedures requested. The medical staff develops specific diagnostic and invasive procedure skills for each set of core privileges.
Core privileges include those taught in the majority of Accreditation Council for Graduate Medical Education– or American Osteopathic Association–approved residency training programs. This means the vast majority of applicants who completed this training have documented experience in the privileges included in the “core.” The core privilege approach recognizes that the basis for determining competence is formed by the combination of:
- Completion of an approved residency training program
- Recent direct or indirect experience
- References from physicians who have observed the applicant’s practice
An organization cannot assume that every applicant can perform every procedure or activity listed in the core. The organization must clearly define the process for requesting or not requesting specific procedures or activities that an organization may include in the core. Applicants must be instructed to delete or strike through procedures or activities for which they do not wish to apply. In addition, there must be a mechanism in place to modify the core appropriately if the organization deems the applicant not qualified or not competent to perform specific procedures or activities included in the core.
Successful core privileging systems include:
- Predefined criteria that outline specific education, training, and experience requirements for each specialty
- Clinical privilege descriptions that are up-to-date, accurate, detailed, comprehensive, and specific
- Clearly stated minimums for the education, training, and experience necessary to apply for clinical privileges
The medical staff or an appropriate subcommittee should determine the core set of clinical activities for each specialty that any appropriately trained physician with good references would be competent to perform. In addition to defining this core set, the medical staff or subcommittee should outline special requests that require individual criteria. Special requests nearly always reflect advances in technology, high-risk or volume-sensitive privileges not automatically incorporated within the core, and privilege areas that occasionally cross specialty lines.