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Don't process 'doomed' privilege requests

Credentialing Resource Center Connection, March 12, 2003

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Dear Credentialing Colleague:

The following is a conversation that's heard all too often in the medical staff office (MSO) today.

MSSP: "Dr. Fuentes, you are the chair of the credentials committee. I just got a letter from Dr. Smith, our neurologist. He's asking for privileges to interpret his own CT scans. What should I do? I thought our radiologists did all of the CTs."

Dr. Fuentes: "Physicians can ask for any privileges that they want. Just process the request and we'll sort it out at the next credentials committee meeting. After all, Dr. Smith is a great neurologist."

Even though Dr. Fuentes' answer sounds like a sensible course of action, it is not.

Do not allow practitioners to request a privilege that the hospital will not grant because of an exclusive contract arrangement, administrative tradition, or other institutional policy. The MSO should have a policy that clearly indicates which clinical privileges are "off limits" to applicants and reapplicants. Include this policy (or a summary of it) in your application and reapplication packets.

Processing a physician's "doomed" application often leads to irrelevant discussions at department, credentials committee, and medical executive committee meetings. In worst-case scenarios, such processing leads to a denial, a fair hearing, and in certain instances, a report to the National Practitioner Data Bank.

In addition to the conversation above, consider the following real-life scenarios involving practitioners who shouldn't be permitted to request privileges:

1. The qualified general surgeon who requests privileges to perform bariatric surgery (a procedure not offered by the hospital).
2. The anesthesiologist employed by a multispecialty group who seeks inpatient anesthesia privileges when the hospital already contracts with an anesthesia group
3. The "misinformed" internist or family physician who requests privileges to "consult" on cardiac cases (no physician needs privileges to "consult," as any physician may request a consult from any other physician on staff if they so choose)
4. The podiatrist who would like class intravenous podiatric privileges, even though she has not completed an ankle fellowship program (hospital policy requires completion of such a fellowship)

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