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Membership without privileges

Credentialing Resource Center Connection, July 1, 2005

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Dear credentialing colleague:

As physicians in many specialties decide to concentrate on ambulatory practice and refer their acutely ill patients to colleagues in the hospital, many no longer need, or qualify for, inpatient privileges. The vast majority of these physicians would, however, like to retain membership on the medical staff. The benefits of membership include opportunities for continuing medical education, collegiality, medical staff leadership, participation in certain managed care programs, and the ability to tell patients that they are part of a medical staff. This situation has given rise to a critical review of existing medical staff bylaws. These documents often require that a practitioner be active "in the hospital" to maintain active staff status. While appointment to the courtesy or affiliate category may fall within the bylaws, many of the affected physicians would consider such placement a demotion.

As the hospital environment changes, medical staff leaders should review and update these policies and procedures. Increasingly, medical staffs are amending their bylaws to allow physicians who are genuinely interested in assisting the medical staff and hospital with its mission to be appointed to the active staff category. These practitioners are active within the community and their referrals to colleagues and the institution constitute activity.

Granting these individuals membership to the staff with no privileges is perfectly acceptable. In the event that some privileges are necessary, it is easy for the credentials and medical executive committees to craft privileges authorizing the practitioner to admit and treat in conjunction with a practitioner with independent privileges.

Note: Credentials and bylaws committees should take great care in distancing this issue from the issue of on-call coverage in the emergency department. Allowing the two to become intertwined will most assuredly result in medical staff paralysis.

That's it for this week.

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

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