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When OB/GYNs don't want OB privileges

Credentialing Resource Center Connection, July 22, 2005

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Dear credentialing colleague:

What options do a medical staff and board have when faced with an OB/GYN who is genuinely not interested in practicing the full scope of his or her specialty? The fact is that this scenario is more the norm than the exception. Most physicians choose not to practice within the full scope of their medical or surgical specialty training: orthopedic surgeons often specialize in shoulders, backs, or knees; some pediatricians work exclusively on infants; some internists specialize only in cardiology or geriatrics; and most family physicians restrict themselves to a fraction of the skills they learned during their residency.

The staff and board, however, do have options that they may employ to ensure adequate provision of care to patients in their community. For example:

 The board could adopt a policy that it will appoint to the staff only those OB/GYNs who commit to providing both obstetrics and gynecological services for a defined period

 Medical staff leadership could report to OB/GYNs that they are free to refrain from practicing obstetrics but that this has absolutely no impact on their responsibility to back up the emergency physicians on a certain schedule. (If they encounter a patient in need of delivery services, it is their responsibility to immediately contact a colleague to assist, just as an orthopedic surgeon would call a colleague outside his or her own area of specialization.)

 Most existing bylaws have provisions authorizing provision of emergency care regardless of granted privileges.

Medical staffs and board members should recognize that they cannot command a physician to request certain privileges, nor should they attempt to grant privileges that have not been requested. The hospital also cannot force a physician on its medical staff to provide care that the physician does not feel qualified to provide or does not desire to provide, for whatever reason. (Exceptions to this rule would include dire emergencies in which medical staff leadership can certainly request assistance from any physician on staff).

Once again, it is important to recognize that the staff should separate the issue of on-call emergency department backup from the clinical privileging issue. Allowing the two to become intertwined will cause medical staff paralysis. Providing appropriate backup to the emergency physicians is a critical responsibility of the hospital and its medical staff. This issue will not be resolved by simply requiring that physicians maintain "full privileges."

That's it for this week.

All the best,
Hugh Greeley
http://www.greeley.com/seminars/

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