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Clinical privilege myth #2: Clinical privileges are defined, determined, and granted by the clinical departments

Medical Staff Leader Connection, February 7, 2008

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A medical staff member wishes to apply for new privileges to perform carotid artery stenting. The vascular surgeons at your hospital feel that it is their responsibility to determine who in the organization can perform this procedure. However, the departments of interventional radiology, cardiology, neurology, and neurosurgery, strongly disagree with any claim of ownership the vascular surgery department might make on the privilege.
 
The above scenario is an example of the many "turf disputes" medical staff leaders across the country must mitigate.  In many cases, a turf battle is the result of:

• Evolving technology blurring the traditional lines between specialties
• Declining physician reimbursement per procedure
• Increasing number of physicians performing a particular procedure
• Escalating competition between hospitals and physicians to provide services

In light of these factors, medical staffs must adopt clear, consistent policies that detail how the organization develops criteria for privileging. The policy should state that the medical staff will not grant a practitioner privileges until after it has developed criteria for granting that privilege. 

Criteria should be specific to the specialty or procedure requested, not the department. The medical staff must put the burden on the applicant to provide information about training, experience, indications, and ways to assess current competence in granting and renewing the clinical privilege. The medical staff should follow the policy when determining cross-specialty criteria.
 
The adoption of a step-by-step policy to prevent and resolve privileging dilemmas will help the medical staff tremendously when navigating the waters of department/practitioner/specialty disputes.
 
Stay well and be the best you can be.

William K. Cors, M.D., MMM
Senior Consultant
The Greeley Company

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