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When a physician is on a leave of absence, is he or she still required to go through the reappointment process? I have come across different procedures at various hospitals.

Medical Staff Legal Advisor, May 26, 2005

Yes, otherwise the appointment should lapse.

Editor's note: The JCAHO recently clarified its position on how to handle practitioners who are on an extended leave of absence and come up for reappointment and reprivileging.

The JCAHO, in its January issue of its newsletter Perspectives, outlined three options that hospitals can follow if a practitioner is on a leave of absence for reasons such as medical, legal, personal, or military obligations, when the time of the two-year reappointment and reprivileging comes up. According to Perspectives:

1. Hospitals can reappoint/reprivilege the practitioner prior to the start of the leave of absence, even if the two-year reappointment date is months away.
2. Hospitals can allow the appointment or privileges to lapse. Upon the practitioner's return, it can implement the process to grant temporary privileges for new applicants for up to 120 days. As outlined in the
Comprehensive Accreditation Manual for Hospitals, organizations can grant temporary privileges based on the verified credentials information in the practitioner's existing file, along with an updated query of the National Practitioner Data Bank and verification of current licensure with the ability to perform the privileges granted. Before those temporary privileges expire, the hospital should fully recredential, reprivilege, and reappoint the practitioner "with the expectation that all the information from the previous two years of activity be the basis of the decisions."
3. Hospitals can reappoint/reprivilege the practitioner during the leave of absence based on information gathered to date, on the condition that the practitioner submit evidence of his or her ability to perform the privileges granted on his or her return.

"The Joint Commission does not allow organizations to extend the reappointment or privileges beyond the two-year date until the practitioner returns, or suspend and reinstate the reappointment or privileges for the reminder of the unused term after the two-year date," the JCAHO wrote in Perspectives.

The two-year calendar cycle is the maximum amount of time that privileges may stay in effect prior to reappointment, the JCAHO wrote. The organization may elect to reprivilege a practitioner before the two years is up in anticipation of a leave of absence.

The JCAHO cautioned organizations to use the procedure only to handle a planned leave of absence and not as an alternative method to handle situations where two-year reprivileging does not occur because an applicant fails to submit an application in time or committees delay approving that application.