Medical Staff

Manage the two primary sources of conflicts of interest

Medical Staff Leader Connection, April 8, 2010

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Two types of conflict of interest come to mind with regard to physicians on the medical staff. One is the conflict of interest that may occur when one physician reviews another practitioner’s file for peer review and credentialing purposes. The other is the conflict of interest that arises when a physician’s outside business interests intersect with the business interests of the hospital. Let’s take a moment to look at those two types on conflicts of interest and what medical staffs should do when confronted with each. 

Conflict of interest pertaining to peer review and credentialing: This is when one medical staff member has a personal or business conflict with another medical staff or potential medical staff member.  Sometimes people just don’t like each other; at other times they are each other’s economic competitors. 

One of the most obvious conflicts of interest occurs when the person that the peer review or credentials committee is discussing sits on the committee. In such a case, the individual must recuse him- or herself from any discussion or decision making. Some medical staffs also feel that spouses or first-degree relatives (parent, sibling, or child) of the person being discussed represents too close of a relationship, and that person is unable to render an unbiased decision. These scenarios are considered absolute conflicts of interest.

Potential conflicts of interest occur when a physician is involved in the peer review or credentialing of a partner, competitor, friend, or foe. However, if medical staffs exclude everyone who is a partner, competitor, friend, or foe, there would be no one left on the medical staff to do these important jobs.  Plus, most physicians, when put into these situations of potential conflict, usually take the high road and do what is right. Physicians who find themselves in such a situation should disclose the conflict and let the chair or other members of the committee decide whether the physician should take part in the discussions or the decision-making.

Conflicts of interest pertaining to business relationships. The other kind of conflict occurs when there the business goals of individual physicians and the interests of the organization (either the medical staff or the hospital) do not align. For example, a physician may conduct research for a device manufacturer and advocate that the hospital start doing a procedure that requires one of the devices that the physician helped develop. The physician may feel that the procedure would financially benefit the hospital and increase the quality of care the hospital provides to its patients, but the hospital would need to weigh the physician’s relationship with the manufacturer when deciding whether to adopt the procedure.

Medical staffs and hospitals can deal with this type of conflict of interest similarly to how they would deal with conflicts between competitors, partners, friends, and enemies. Physician leaders who are exposed to confidential information or are in decision-making positions need to declare what their outside conflicts are and let the body discussing the issue determine whether these conflicts are significant enough to exclude someone from hearing or taking part in the decisions on these specific issues.

It is important to note that at times physicians can be partners, competitors and collaborators, but this should not necessarily exclude them from important roles in the medical staff organization. However, it is their obligation to disclose potential conflicts of interest so that they can be dealt with openly and honestly. 

Mary Hoppa, MD, MBA, CMSL is a senior consultant with The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.



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