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Military service and leaves of absence

Credentialing Resource Center Connection, March 1, 2003

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Dear Credentialing Colleague:

Whether you work in a hospital or managed care setting, you possibly could face two situations arising from the military commitments of your medical staff or provider panel members. Both involve the practitioner to request a leave of absence (LOA).

While requests for LOAs should cause no problems whatsoever, hospitals sometimes make more out of them than necessary. No law or accreditation standard requires the medical executive committee (MEC) to act upon LOA requests, or for the governing board to review them for final approval. Medical staffs may instead develop a policy that permits the vice president of medical affairs, chief of staff, or chief executive officer (CEO) to review and approve an LOA request under extenuating circumstances such as when a practitioner leaves for active military duty. Bringing this issue to the MEC or board adds no value.

Credentialing policy language should require practitioners to request an LOA in writing, state the reason for the leave, and indicate the estimated start and ending dates. Bylaws should outline the procedure to use upon the practitioner's return from leave.

While it is preferable to receive notice and information in advance of a practitioner's return, it is not always practical, especially when the leave involves military service. Practitioners often forget to send in a request for return ("30 days in advance" as many bylaws require), so your policies should be flexible enough so practitioners returning from an easily verifiable tour of duty can simply provide a summary of activities and be considered for "return" by the chief medical officer, applicable department chair, and CEO (or his/her designee) in a timely manner.

Once again, it is not necessary for the MEC or board to consider the request for return unless the situation is unusual or complex.

LOAs are slightly more complex when the leave period extends beyond the physician's regular appointment period. Under these circumstances, the board could extend the practitioner's appointment until the physician returns. When the practitioner actually returns, your institution could also immediately begin to process his or her full reappointment using the reappointment process outlined in your documents. Alternatively, your policies might dictate that membership and privileges have lapsed, but those membership and privileges will be restored using the reappointment process rather than the more complicated initial appointment process.

But the main issue that you must handle upon a practitioner's return any LOA is the verification of his or her qualifications and current clinical competence. This step requires confirmation of all legally required credentials and a review of the practitioner's activities during the leave. Often the greatest dilemma pertains to the potential loss of skill during the leave. Medical staff leaders should be able to assess this issue using common sense and existing policies.

In short, make "leave taking" and returning from leave as easy and effective as possible. Design documents that give the hospital flexibility when necessary to avoid making the process overly bureaucratic.

That's all for this week.

All the best,

Hugh Greeley
www.greeley.com/seminars/

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