Credentialing & Privileging

How would you handle this application: The readers respond

Credentialing Resource Center Connection, April 28, 2005

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Dear credentialing colleague:

In the April 15 edition of Credentialing Connection, I asked how you would handle a medical staff application from a 54-year-old who, for the past 15 years, was the sole general surgeon at a very small hospital in rural America, and has excellent references from the administrator of his past hospital, a family physician, and an internist. I received a great response to this challenge, including the following comments submitted by readers.

"We would not process this application if the doctor has not kept his recertification current. If that is not a factor, we would probably, after having checked all primary sources possible, grant limited privileges with precepting (teaching) or proctoring (observing) for a certain number of cases. We would certainly expect the hospital that the doctor practiced at to give us a report of the number of cases he had performed and what type. That would also help us to fit the privileges to his experience."

"Since the practitioner has been the sole general surgeon at the small rural hospital for 15 years and provided peer references only from a family practitioner and internist, this does not give enough information regarding his surgical competence in my opinion. What I'd require in this case would be a list of the number of, and types of surgical procedures, performed in the last two years, at a minimum. Our credentials committee would also ask the applicant to come before them and to visit with the surgery department chief, and I would anticipate that the applicant would definitely have a preceptor assigned for surgical procedures."

"Additional information would be requested from the surgeon including additional references from general surgery colleagues who have knowledge of his skills, a copy of current privileges, and a summary of surgical case activity, by type and volume, for at least the past two years (five years if two-year volume is limited as may be the case in a small, rural hospital). Additional proctoring may be required. Non-core privileges would not be granted without evidence of specific training and current competency."

"I would contact the administrator of his current hospital for a more extensive background check as well as the chief of medicine and department of nursing. I would even go so far as to tailor my form for this particular situation. I would ask for verification of all continuing medical education attended within the last five years to assure continuing education as it relates to his current job and for the position at our facility. I would suggest that if approved, he be mentored by one of our long-standing surgeons for quality indicators and his appointment would be provisional based on his performance the first six to 12 months."

"We would process the application with primary source verification of training and licensure, board certification, health status, etc. In addition, we would request references including information from individuals who had provided anesthesia for the applicant. We would also compare his privilege delineation requests with his surgical logs and finally, we would have him in for a personal interview before his application went to the credentials committee."


For all of you who suggested that you steadfastly follow your hospital's policies; you are correct. However, since the applicant has no references from any general surgeons and no available quality data from his last practice you will not be able to fulfill the requirements of the competency equation (performance + evidence of acceptable quality = current competence).

To properly process this file, you should consider obtaining references from anesthesia providers and conducting an external evaluation of a selected sample of the physician's records, performed by a certified general surgeon. He has no obvious problems in his file, but there is no evidence of current clinical competence as reported by individuals knowledgeable in the area of surgery. The issue of who will pay for the external review is up to the hospital.

Remember this rule: In the absence of evidence of clinical competency, you should not grant privileges to practice independently.

Another suggestion, mentioned by several readers, is to grant dependent privileges permitting the applicant to practice with another fully qualified surgeon at the table, scrubbed in, and actually involved in the case. This condition would continue until the medical executive committee was convinced that his skills and judgment were at the generally recognized level.

Thanks to everyone who responded to this query, and please continue to send in your questions or comments.

That's it for this week.

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



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