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starting a new practice FAQ:

Family Medicine Privileges

Having a realistic sense of the typical scope of family medicine is an essential part of choosing the right community for your practice. Family physicians who want to maintain a full-scope family practice should conduct a careful evaluation of scope of practice issues in any community they're considering. The ability to provide maternity care, deliver babies, admit patients to the hospital, and perform GI procedures like colonoscopy are just a few of the "hot button" issues in family physician privileging across California.

To learn more, spend time talking to family physicians, specialists, hospital administrators, patients, and community leaders. Some of the things you should consider include:
- Does the hospital have an established Department of Family Medicine?
- Do family physicians approve the privileges of other family physicians?
- How many "admits" per year are required for active medical staff membership?
- Will you be able to form close, collegial relationships with other family physicians? Specialists?
- Are you willing to get involved with the medical staff leadership and/or serve on a committee?
- Do you have the training, experience, and competence to meet the community's standard of care?
- Are your residency training experiences well documented?
- Who will be your backup, especially for maternity services?
- If a clinic or hospital is recruiting you, is it contingent on a broad scope of practice?
- What will you do/what will happen if you aren't approved for certain privileges?
- How hard are you willing to fight for full scope of practice, should you run into problems?
- If you would like to do deliveries, will you be able to find OB back-up?
CAFP's policy states that hospital privileges should be determined based on your training, experience, and demonstrated competence. In theory, your residency training and your track record of procedures and patient care should earn you the right to be proctored, to determine your current competence. In practice, however, it can be quite difficult to get the privileges to which you are entitled. Take a two-pronged approach, education and politics, if you are anticipating a struggle for privileges.

The California and American Academies of Family Physicians have a number of resources to assist you with privileges. These include:
- AAFP Protocol for Handling Privileging Problems, a step by step guide to the process.
- Family Practice in Health Care Organizations, a thorough examination of privileging.
- Family Physicians: The Logical Resource for Our Changing Health Care Environment, a meta-analysis of literature examining family physicians' quality of care.
- An AAFP-commissioned legal opinion about specialty-related privileging disputes.

CAFP will also write a letter of support outlining our policy. It can be addressed either to you or to the medical staff leadership, as you choose. To request a letter, contact Susan Hogeland.

It's been said that all politics are local, and this holds especially true for privileging disputes. Hospital medical staffs are democratic, independent decision making groups and, the movement towards evidence-based guidelines notwithstanding, defining quality of care still happens one hospital community at a time.

An often overlooked component of privileging is the need for political engagement. Making sure that others are on your side is essential to your success. The first step is getting to know other physicians, both family physicians and specialists, on the medical staff. Building a solid relationship and understanding other peoples' issues and concerns is the key to being an effective politician. Your communications should be clear, respectful, and use a blend of inquiry and advocacy at all times. Use the information that you've gathered and stay calm and upbeat when pressing your case.
No. The CAFP policy is that privileges should be determined based on training, experience, and demonstrated competence. Numbers of procedures are neither grounded in science nor adequate proxies for quality of care. If a hospital is putting forth numbers-based privileging guidelines, ask to see the literature that supports those numbers as evidence of quality of care. The Illinois Academy of Family Physicians has made available a sample privileging list. To request a copy, send your mailing address to Susan Hogeland.
CAFP does have a policy memo that you can share with hospital staff. The memo outlines CAFP's recommendation that prospective and new parents should be given equal access to selecting a family physician at the level of registration or nursing in a hospital, as a member of a health system, or at any other point in the continuum of care. It also includes the Academy's strong recommendation that the parent be asked, "Who is or will be your baby's doctor," to ensure that patients understand that they may choose a family physician as their child's doctor.