Medical Staff

When a Hospital Joins a System What Changes in Credentialing?

Medical Staff Leader Insider, February 23, 2012

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Another day, another headline. One more hospital joins a healthcare system. What will change for the physicians when it comes to credentialing? Maybe nothing. Maybe everything. Choices will need to be made. Physicians know it and care, but can also be afraid of what lies ahead because decisions about credentialing, and especially about privileging, have the potential to support or threaten each physician’s chance to succeed. Let’s look at two cases that demonstrate the two sides of this coin.


In Case 1, Memorial Hospital, a community hospital, joins a system with a tertiary teaching hospital. At Memorial, general surgeons have been performing vascular surgery procedures for years. At the tertiary hospital, only fellowship-trained vascular surgeons perform vascular procedures. The general surgeons at the community hospital suddenly fear two things:

·         The ambition of the tertiary hospital to create a loud sucking sound, pulling all but the most basic vascular procedures into their hospital and into the care of the current tertiary surgeons.

·         The bar will be raised going forward. At a system level, decisions may be made for the sake of improving quality and reducing liability, so only fellowship-trained vascular surgeons will be eligible to apply for vascular surgery privileges. The general surgeons fear losing the income from these procedures as well as loss of professional satisfaction.


In Case 2, Saints Hospital, also a community hospital, joins a system that includes a pediatric hospital. The general surgeons at the community hospital perform surgery on children down to the age of two. Seen from the perspective of the pediatric surgeons working at the children’s hospital, this is a travesty. To allow adult general surgeons to operate on children places those children at risk of adverse outcomes, whether from inexperienced or inadequately trained surgeons or the anesthesiologists also caring for their patients. By working in a pediatric hospital, pediatric surgeons feel as though they commit their careers to ensuring the highest level of care for children.


In both cases, decisions will need to be made on what some physicians hold dear. In both cases, the issues are grayer than black and white. They pose questions like, “How much will the system adopt a single standard of care vs. how much will they allow local autonomy, variation, and control across the hospitals in the same system?” Or, “How high will we set the bar for quality vs. protecting the ability of physicians to earn a living practicing as they choose?” There is no absolute answer to each of these questions. They cannot be “solved” in any direct way. They must be managed over time as new challenges arise. Barry Johnson, Ph.D. has developed the tools of Polarity ManagementTM to help diagnose and manage such thorny problems he refers to as polarities.


The take home message from these cases is that when a hospital joins a system, such challenges will inevitably arise and must be managed. Doing so requires open dialogue, flexibility, and good leadership. Physicians have reason to care, yes even fear, when their hospital joins a system. The best approach is to encourage level heads to discuss the issues on all sides openly and seek balance and fairness at every turn. No easy answers will come, but hard work and good leadership can lead to wisdom.


All the best,


Rick Sheff, MD

Principal and Chief Medical Officer

The Greeley Company


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