Credentialing & Privileging

Don't bend on your bylaws

Credentialing Resource Center Connection, February 24, 2005

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Dear credentialing colleague:

Recently, I received the following scenario from a newly installed chief of staff:

His medical staff had just received an application from a physician who had not completed a general surgical residency program. The physician had left his residency program some eight years earlier and developed a very successful surgical practice at a hospital out of state. However, the chief of staff's medical staff bylaws require the completion of an approved residency for processing medical staff applications. This rule had been in place for some time and the hospital was not interested in changing it. The in-house attorney suggested that the hospital should process this application giving great consideration to the physician's successful surgical practice and his excellent references. He also suggested that if after an extensive review the physician was found to be competent but not technically qualified (based on lack of residency completion), they could then deny him, offer a hearing, and be subject to the protections of the Healthcare Quality Improvement Act.

The question posed by the chief of staff was: "Is this sound advice?"

In my opinion, the answer here is no. Your medical staff and board have adopted a standard that applicants to the staff complete an approved residency training program. This is much the same as the common requirements that physicians must have an unrestricted license in the state, have successfully completed medical or osteopathic school, and be board admissible or board certified.

There is no reason to place your medical executive committee or board in the position of denying this individual's request for appointment. Instead, the physician should simply be informed that his application for appointment to the staff will not be processed because the minimum threshold requirements have not been met (under these circumstances, failure to demonstrate that he has completed an approved residency training program). This hospital's medical staff and board have a perfectly acceptable minimum threshold requirement, and there is no logic to the suggestion that this application be processed thus leading to a denial. Most medical staffs clearly understand that denials are to be avoided whenever possible. The best way to avoid unnecessary denials is to establish firm but reasonable threshold requirements. Physicians or other health care practitioners not meeting minimum requirements should be firmly but politely informed that their application will not be processed until such minimums have been met.

That's it for this week.

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



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