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Octogenarian applicants

Credentialing Resource Center Connection, March 17, 2005

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Dear credentialing colleague:

Your medical staff bylaws, like those of most hospitals throughout the United States, probably indicate that your hiring practices do not discriminate based on age, sex, religion, national origin, or any other characteristics unrelated to clinical competence, or safe, effective practice.

What then is a medical staff to do when it receives an application from a physician in his or her seventies or eighties? Clearly, if this individual were a new applicant to the staff the application would cause considerable consternation for medical staff and hospital leaders. It is possible that hospital management might attempt to dissuade the individual from proceeding with the application and may even contact qualified legal professionals for assistance.

However, if the physician was making his twenty-seventh biannual application to the medical staff (signifying more than 50 years on the staff) a completely different set of conversations might ensue.

In truth, these two situations are virtually identical, and there is no easy solution for this dilemma short of a board policy addressing the issue of age.

Absent such a policy, the only tools available to medical staff and administrative leaders in dealing with this scenario are their powers of persuasion and existing rules. These rules would most likely indicate that the applicant or re-applicant may be qualified for appointment to the staff, although the issue of clinical privileges could be completely different. If the applicant had not practiced recently, had not completed a recent refresher training program, and would not agree to co-admit with another competent colleague, his or her request for clinical privileges could certainly be deflected.

If the applicant was in "semi-active practice" or had completed a recent refresher training program it would be difficult for the medical staff to draft an ideal solution.

It is perhaps time for medical staffs to consider adding the ability to grant dependent clinical privileges to practitioners in their advanced years to their credentialing tool kit. The elderly physician could only exercise such privileges along with another qualified and competent practitioner on staff. Dependent clinical privileges, however, should not be confused with proctored privileges. Dependent privileges should require that all patients be co-managed by the applicant and another qualified individual.

Through this mechanism, elderly physicians could certainly be allowed to remain on staff with clinical privileges (although dependent) thus allowing them to retire gracefully. Without a proper understanding by medical staff leaders of the "dependent privilege," staffs are often faced with the ugly realities of medical staff bylaws that never contemplated the octogenarian applicant and a legal system that is occasionally at odds with safe and effective patient care.

That's it for this week.

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

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