A key component to the success of a physician’s practice is to be granted staff privileges at a hospital. In fact, physicians are typically not allowed to practice in a hospital, or perform any type of medical procedure, without the acquisition and maintenance of staff privileges at that hospital. Like most patients, hospitals want to seek out the best-qualified physicians, as they will potentially generate business and establish the hospital as a leader in the health care community. If a physician loses his or her privileges for any reason, it can be difficult obtaining staff privileges anywhere else.
The process of granting a physician staff privileges involves inquiries into the physician’s education, residencies, fellowships and practice experience, as well as a proctoring period where the medical staff observes the physician and evaluates his or her technical competence. In addition, the physician must disclose any previous instances wherein his or her privileges were denied or modified.
A Credentials Committee reviews this information and makes a recommendation, which is considered by the Medical Executive Committee and, ultimately the Board of Trustee, who will approve – or not approve – the physician’s privileges. A physician’s privileges may be denied if the committee feels that there is a lack of training or competency in his or her area of expertise. Other reasons for denied privileges include the loss of a medical license in another state, exclusion from Medicare or Medicaid or being found guilty of fraud or abuse.
The rise of managed care has had a significant effect on the relationships between physicians, hospitals and health insurance companies. Many managed care organizations have been known to exclude a physician based on personality or his or her ability to generate income, and not necessarily their competence as a medical professional. This can make obtaining staff privileges that much more difficult.
Another issue is determining whether or not a physician with staff privileges is an employee of the hospital or an independent contractor, which can impact whether a physician may state a claim of employment discrimination against a hospital for refusing to grant privileges. A large number of courts hold that a physician with staff privileges is not considered an employee of the hospital, which precludes a physician from being able to make a discrimination claim. However, physicians have fought back on this issue and with some success. Two recent federal court cases that address this issue ruled in favor of the physicians, permitting them to maintain an action under Title IV.
When deciding whether to deny a physician staff privileges, a hospital must be careful to ensure that their decision is not discriminatory in any way, as they could face litigation by physicians who believe that they were not granted privileges for discriminatory reasons.
Philadelphia Health Care Lawyers at Sidney L. Gold & Associates Help Physicians Maintain Staff Privileges
If you are at risk of losing your staff privileges or have been denied membership, our Philadelphia healthcare lawyers at Sidney L. Gold & Associates will protect your legal rights and guide you through every step of the appeals process. Our offices are conveniently located in Center City, Philadelphia where we serve clients throughout Pennsylvania, New Jersey and New York. Call us today at 215-569-1999 or contact us online for a confidential consultation.