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Clinical Privilege Myth #3: A physician is entitled to all requested clinical privileges unless not sufficiently trained or qualified

Medical Staff Leader Connection, February 13, 2008

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Although some physicians may argue otherwise, a competent and appropriately trained physician is not entitled to all clinical privileges he or she requests.

For example, a physician may request privileges to perform a new technology procedure for which he or she is competent to perform. However, the hospital lacks the requisite equipment and staff to support the procedure. The medical staff and hospital must implement a clearly defined policy and process to handle such privileging requests before they arise.

Additional privileging challenges arise when a specialty group within the hospital creates an exclusive contract that allows only physicians in that specialty to perform certain privileges. Exclusive contracts may cover specialists including radiologists, cardiac surgeons, pain management specialists, hospitalists, intensivists, neonatologists, and interventional cardiologists. Hospitals may also create exclusive contracts for a panel of physicians, making them responsible for the performance and/or interpretation of 64-slice cardiac CT scans, EMG/NCV, EEG, EKG, or other related services.

Exclusive contracts are independent of a physician's competency. For example, a radiology-exclusive contract to read brain CTs and MRIs would prohibit even the most competent neurologist from applying for those privileges. No amount of competence trumps the protection of an exclusive contract.

Departments must notify the medical staff office about these exclusive contracts, particularly since the medical staff office carries out the privileging process. Unfortunately, some hospitals and medical staffs do not understand the importance of communicating this information to medical staff leaders and MSPs. Communicating the details of exclusive contract arrangements to all potential applicants is also imperative. By stating restrictions upfront, preferably on the privilege form, hospitals can alleviate any embarrassment for a practitioner who may not be privy to the details of the exclusive contract and is told only after applying for the privilege that he or she is ineligible. 

The hospital simply should not accept applications for clinical privileges that are exclusive to practitioners named in the exclusive contract. Likewise, a practitioner who is part of the contract arrangement should not automatically receive privileges. The practitioner must request the privilege and meet the qualifications defined by the hospital.

In the next issue, Myth #4 will deal with "textbook criteria" for privileges. Until then, stay well and be the best you can be.

William K. Cors, MD, MMM, CMSL
Vice President Medical Staff Services
The Greeley Company

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