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June 25, 2014 |
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Several questions have recently come to my attention that involve defining categories of the medical staff organization. In many medical staff organizations, physician leaders and MSPs (medical staff professionals) find that traditional categories don’t fit the new realities of how physicians and other practitioners relate to the hospital and participate in medical staff organization activities. An important principle is to clearly separate membership requirements from privileging criteria. As we know, all practitioners granted privileges are not necessarily members of the medical staff. It is becoming more common these days to have physicians with clinical privileges who do not have medical staff membership (for example, physicians with temporary/locum tenens privileges need not be members of the medical staff — and telemedicine practitioners also do not need medical staff membership). Why, then, do so many medical staff bylaws mix membership and privileging issues? For example, many bylaws, in defining the “active” category of the medical staff, state that, “members of the active category have the privilege to admit…” The reality is, of course, that there may be members of the active category that would never be expected to admit (pathologists, emergency department physicians, etc.). Admission of patients is a privileging issue that should be dealt with in that venue — not through an assignment to a category of the medical staff. Make sure that your bylaws clearly separate the issues of membership and privileges. Membership is an organizational issue — who can vote, attend meetings, chair a committee, serve as an officer, etc. Your organization has the opportunity to define medical staff categories in the way that will be most useful to the medical staff. Some organizations have two categories — voting and non-voting. Others have active, courtesy and honorary — or active, affiliate and emeritus. It is up to your organization to determine what is appropriate for your medical staff. I would highly recommend that you keep the number of categories to a minimum — and do not use a medical staff category to describe a group of practitioners who are not even members of the medical staff category (for example, in bylaws I often see the section that describes medical staff categories — the list often includes “Allied Health Professionals” and “Residents and Fellows” — and these practitioners are typically NOT members of the medical staff organization). The second issue is — if your organization does have a category (such as provisional) that is used for new physicians who then subsequently are determined to be eligible for advancement to active, courtesy, consulting, etc. categories, what parameters might be useful to determine when/if a practitioner is eligible for advancement? Most medical staff organizations link advancement to a length of time served on the medical staff (the usual range is from six months to one to two years). Another parameter is successful completion of the FPPE process (focused professional practice evaluation). A practitioner may be eligible to move from provisional to active, for example, if he/she has a specific amount of clinical activity during the provisional period of time and has successfully completed FPPE requirements. The same practitioner may be eligible to move to courtesy if his/her clinical activity has been minimal or low. It is perfectly acceptable to move a practitioner into the “active” or “voting” category based on clinical activity (which shows a commitment to the organization) rather than based on an arbitrary length of time. Medical staffs all over the country are re-thinking some of the established “rules” and traditions that have been in place for many years. And it is always beneficial to question the status quo to determine if the categories that served an organization in the past continue to be effective. If those categories aren’t effective anymore — change them. Just make sure that your medical staff organization keeps membership and privileging issues separated. Thanks for reading! 
Vicki L. Searcy
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