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Working with the 'what ifs'

Credentialing Resource Center Connection, February 15, 2007

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When I work with medical staff leaders to create privileging criteria, there are a number of specific questions often raised that deal with what I call the "what ifs."

What if:

-          We would like to offer a position to a very well-trained and qualified physician who is not certified by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)? Instead he/she is certified by the Royal College of Physicians and Surgeons in Canada, but our medical staff bylaws and privileging documents say you must have ABMS or AOA boards.

-          An initial applicant has been on a leave of absence and does not meet the defined volume criteria for requesting the core privileges in his/her specialty?

-          At reappointment the practitioner requesting a particular privilege doesn't meet the defined volume criteria for that particular privilege?

One of the guiding principles of credentialing is that excellent credentialing requires clear criteria consistently applied. With this principle as a guide, it is important to remember that criteria are not created for the exception. hen an exception to the rule occurs, there needs to be a method to manage that exception appropriately. 

Each one of the above scenarios can be managed appropriately in a variety of ways.  However, the point for our purposes here is that in order to have the ability to manage the exceptions, it is important to have waiver language within your medical staff bylaws that allows the governing board to make exceptions based upon recommendations from the medical executive committee (MEC).

An example of such language might be:

Only the board may create exceptions to the qualifications for membership and/or privileges after consultation with the MEC.

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