Hospital Appointment and Surgical Privileges Simplified
By Dr. James Stavosky
As a residency director and ABPM Board member, I have noticed some confusion among residents and new practitioners when applying for staff appointment and hospital and/or surgical privileges. The primary purpose of credentialing and privileging is to ensure that a practitioner is competent and meets the education, training and experience required by governing bodies such as the Joint Commission of the Accreditation of Healthcare Organizations (JCAHO) and the Center for Medicare and Medicaid Services (CMS) . While the application process can be complex, sometimes even inconsistent, below, is a general summary of hospital requirements and what ABPM’s certification means to this process.
To work for, or provide services at, a hospital you will need to provide the medical staff office with your education, training and experience including primary source verification of your DPM degree, state license, DEA registration, residency training and board certification, as part of the credentialing process. Once the medical staff verifies this information, it typically goes to the Medical Executive Committee who reviews the material and approves you r appointment to the medical staff of the hospital.
There are various levels applied to the medical staff. You may begin as “provisional staff” until you’ve been at the hospital and attended medical staff meetings for a defined period (6 months or a year); then, depending on your level of activity at the hospital you may be promoted to “active staff”. Hospitals also have a “courtesy staff” designation for individuals who are not regular providers of services in the hospital. As a member of the medical staff, you may be required to pay annual dues and attend meetings.
Once on staff, you apply for privileges. While every podiatrist completes similar education (podiatric medical school and three years of residency training), experience is the differentiating factor for privileging.
Case logs will be used to determine your level of privileges. During residency you may have met minimum case requirements for the Council on Podiatric Medical Education (CPME) but some residents will have experience beyond minimums in, e.g. trauma, diabetic foot and/or reconstruction. Privileges for podiatric surgery vary from hospital to hospital because of state law regarding scope-of-practice, as well as how the hospital bylaws are written. Some podiatry privileging forms are more simplified, granting core privileges (hospital admissions, consults, basic surgeries) and then privileges for advanced procedures in groups. Other processes for privileging may require that each procedure be individually requested (e.g. 15 different types of bunions). If you don’t have the case volume to receive privileges for a particular procedure, the department may require proctoring of a certain number of cases before those privileges are granted. This is also true if you already have privileges and request to do a newly learned procedure.
Podiatry or another department?
Podiatry may be in its own hospital department or under another department such as surgery, vascular, plastics or orthopedics. The department chair runs the privileging process.
ABPM Board Certification
Board certification is only one component of hospital credentialing and privileging. The Council on Podiatric Medical Education (CPME), through the Joint Committee on Recognition of Specialty Boards (JCRSB) recognizes two certifying boards: The American Board of Podiatric Medicine (ABPM) and the American Board of Foot and Ankle Surgery (ABFAS).
ABPM’s primary duty is to protect the public by ensuring the competence of those applying to become board certified. Podiatrists completing a 3-year, CPME-approved residency, may take both the ABPM qualification and certification examination the year they complete their residency. We encourage you to maintain well-documented, thorough logs so you can show your experience and provide these when applying for credentialing and privileges, but they are not required for ABPM certification. This requirement was lifted a few years ago after extensive correlation analysis on the pass rate by those with appropriate case documentation, making submission unnecessary. Since hospital bylaws generally require you to become certified within 5 years of residency training or lose your staff appointment, we encourage all podiatrists to take both the ABPM qualification and certification examinations in the year they complete their residency. .
Yet remember, your surgical privileges are not based on your certification alone, but on your education, training and experience; This is why ongoing case documentation and logs remain important. Hospital departments that specifically require ABFAS certification for surgical privileges may have included this at a time when podiatric education was not standardized and did not include the level of education and residency required of today’s podiatrists. These may require updating. ABPM can assist hospital credentialing and medical staff offices with privileging language that is compliant with the requirements of the medical governing bodies.
If you have experienced any challenges in obtaining privileges or have any further questions, please contact Dr. Marc A. Benard, ABPM’s Executive Director, who will initiate a review of the situation to assist you however possible.