The privilege process: How doctors get privileges at hospitals

Patients, naturally, want good, qualified doctors. But so do hospitals.

That means that simply being a licensed physician does not guarantee doctors will be granted hospital privileges, area hospital executives say. Hospital privileges are the "prescriptions" that allow physicians to perform certain procedures or operations, or even to admit a patient.

Without them, a doctor is not considered qualified.

Regulatory bodies that license hospitals -- such as the national Joint Commission on Accreditation of Healthcare Organizations and Medicare and the Missouri Department of Health and Senior Services -- hold hospitals responsible for appropriately privileging every physician before he or she can practice in a hospital.

Obtaining hospital privileges is a detailed and tedious process. But it is necessary to ensure patients are getting the best care possible, said Kay Bolin, manager of Medical Staff Services at Southeast Missouri Hospital.

Doctors go through similar processes at all hospitals where they want to practice, she said, and each hospital makes an independent decision regarding privileges.

Before a physician, dentist, oral surgeon, or podiatrist can treat patients at a hospital, they must submit an application requesting permission to practice at the hospital, said Bolin. They also must request permission to treat patients and carry out specific procedures at the hospital, she said.

"All of their credentials -- education, residencies, fellowships and practice experience-- are reviewed for appropriateness of training and competency," Bolin said.

Dr. David Cope, vice president of medical affairs at Southeast Missouri Hospital, said this information is verified by medical staff services in most hospitals and reviewed by physicians in medical staff leadership positions.

Recommendations regarding appointment to the staff and granting of specific privileges are made by the medical department's chairman and forwarded to the Credentials Committee for consideration, he said. Their recommendations are considered by the Medical Executive Committee and resulting recommendations are forwarded to the Board of Trustees, who takes the action approve -- or not.

"If they meet all the guidelines, they are awarded privileges that they appear to be appropriately trained to carry out," said Cope, adding that doctors can obtain privileges to work at more than one hospital, although some doctors just want privileges at one hospital.

Privileges can be denied if it's determined doctors have a lack of training and cannot demonstrate competency. Also, loss of medical license in another state, exclusion from Medicare or Medicaid, or having previously found guilty of fraud or abuse are reasons for denying hospital privileges. Privileges can be suspended if a physician does not perform enough of the specified procedure or treat enough of a patient type to stay proficient.

At Saint Francis Medical Center, Dr. Mark Valliere, vice president of medical affairs, said the privilege process is started by a physician contacting the hospital. In the application process, detailed information regarding the physician's training, practice experience, licenses, malpractice insurance and references is submitted.

Valliere said the physician states which specialty he or she wants to practice, and the application materials are sent to that specialty. A thorough verification process is undertaken. After verification, the application is reviewed by the appropriate department chair, sent to the Credentials Committee, discussed by the Medical Executive Committee then sent to the board of directors.

"The physician committees make recommendations regarding membership and privileges," said Valliere. "However, the board is the final authority and grants privileges."

A physician can join multiple medical staffs, unless there is an employment contract preventing it. Valliere said the more narrow the specialty, the more likely the physician is needed at more than one hospital to have the patient base necessary to make a living and maintain clinical skills. He said most physicians in Cape Girardeau are on staff at both hospitals.

"Many insurance companies require a physician to maintain hospital privileges in order to participate as a provider in their provider panels," said Valliere, adding that hospitals also benefit by having physicians with privileges on staff. He said hospitals must have certain patients and perform specific procedures to generate revenue to cover employee wages and benefits, building and grounds maintenance, maintain and improve medical equipment and technology.

Valliere said more physicians on staff often translates into more hospital patients; however, there is a movement where many physicians are choosing not to join hospital staffs. More often, they are seeing patients in their offices or performing procedures in outpatient centers. Valliere said this trend is intended to improve the physician's quality of life and/or improve their efficiency.

"Some procedures can only be performed in a hospital setting and certain patient types are only treated on an inpatient basis," said Valliere. "If a physician wishes to perform those procedures or treat such patients, he or she must belong to a hospital staff and meet the criteria for that hospital."