A Fresh Look at How We Give Surgical Privileges
Abstract & Commentary
By Frank W. Ling, MD, Clinical Professor, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, is Associate Editor for OB/GYN Clinical Alert.
Dr. Ling reports no financial relationship to this field of study.
Synopsis: The principles and problems in the process of surgical privileging are presented for thought, discussion, and possible action.
Source: Bass BI, et al. Surgical privileging and credentialing; A Report of a Discussion and Study Group of the American Surgical Association. J Am Coll Surg 2009;209:396-407.
In 2006, a study group was established by the council of the American Surgical Association to study the role and responsibility of the surgical profession in defining competence of the practicing surgeon. The identified events of focus included initial hospital privileges, periodic reprivileging, and the times when privileges for an established clinician are requested relating to a new technique or technology. The group set out the following principles of surgical privileging:
- Should be based on training, ABMS surgical board certification, and ongoing practice experience.
- Elective surgery privileges should match the surgeon's practice and be based on actual practice data.
- Elective and emergency surgical privileges may differ.
- Privileges should be time-limited.
- New privileges should be based on new training and education and technical proficiency in a proctored teaching environment with appropriate post-privileging follow-up.
- Privileging should be the responsibility of the surgeons practicing at a specific facility within the medical staff structure.
- Privileging should factor in integrity, citizenship, and a commitment to professional growth/improvement.
- A new infrastructure for surgical training and technical retooling is needed.
Commentary
I am aware that this is from the general surgery literature, with no co-authors from the gynecologic surgery field. That's OK, really. The principles involved are the same in all of the surgical fields. We each face the challenge, whether we realize it or not, of being responsible not only for how we practice individually, but how our surgical field is conducted around us, i.e., on our respective hospital staffs. There is no question that surgeons are being scrutinized by insurers, lawyers, and patient advocacy groups, just to name a few. We should relish the attention and demonstrate that we are acting and operating responsibly.
Gone are the days when organized medicine was perceived to be watching out for itself as a primary mode of operation. Clearly, the patient's welfare and safety should always be at the top of the priority list. Who operates and what they do ideally should be determined on a continuous basis by the people and organizations that can evaluate with the greatest insight and expertise. This report's authors come down firmly on the side of appropriate credentialing and recredentialing by the surgeons themselves, functioning within the context of a hospital staff, which is charged with quality of care.
There is little to be argued with in this article. If nothing else, it should serve as the starting point for every reader's hospital staff to begin looking at what it can do to improve the surgical privilege-granting process. Who will disagree that only the qualified should operate? Who can quibble with the idea that surgeons should only be allowed to do what they have shown to be within their area of expertise? How can anyone deem inappropriate efforts to make sure that new procedures are introduced with an eye on quality?
As they say, "The devil is in the details." Even without universally accepted measurements for the critical areas that we would need to monitor, should not every hospital staff make sure that it is doing what it can now? Are new practitioners being monitored when they first arrive? Is every surgeon, regardless of how long they have been on staff, doing only those procedures that they truly can perform safely?
So, I encourage you to print out the entire article, sit down on your favorite sofa. Maybe relax outside under a shade tree or near a quiet stream. Get a cup of latte or a glass of fine wine. Read the entire report and think "What if?" Make copies and send them to others in your group or on the medical staff. Have them ask the same "What if?" question. What tweaking can be done to improve the surgery privileging process where you practice?
Some might argue that we're stepping on toes, that we're not trusting the surgeon to know his/her own limits, that we're compromising the right to practice as an independent clinician. If feelings are bruised, so be it. As long as the process is fair and has good intentions, it should at least be considered. Are lawsuits possible? Maybe. Better that the surgeons who know quality of care determine the rules relating to who gets privileges than governmental agencies or others with less knowledge and insight. Each hospital has its own agendas. Each surgeon has his/her own agenda. When it comes to patient welfare, I can't imagine that it isn't first on both.
Excuse me now, while I get off this soapbox.
In 2006, a study group was established by the council of the American Surgical Association to study the role and responsibility of the surgical profession in defining competence of the practicing surgeon.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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