What would keep an MD from having privileges?
What would keep an MD from having privileges?
Just curious...what would keep a physician from having privileges at all local hospitals in the city of their practice. Do they choose to allow the hospitalists to care for their patients? Do they make more money staying in the office seeing patients? Or, is it deeper than that?
I personally would want my PCP coming to see me in the hospital, but a lot of PCP's don't and let the hospitalist groups manage the inpatient care.
I personally would want my PCP coming to see me in the hospital, but a lot of PCP's don't and let the hospitalist groups manage the inpatient care.
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Re: What would keep an MD from having privileges?
Privileges are necessary but frequently not sufficient to work at a particular hospital. They are completely separate from the right to practice there. Those rights can and are contracted out by hospital administrators.
Re: What would keep an MD from having privileges?
In my area a family MD group of about 5 physicians do not see their patients in the hospital anymore. They let the hospitalists treat them in the hospital. This MD group can still make rounds and are in good standing with hospital administration. They choose to let hospitalists see their patients in the hospital.Die Hard wrote:Do they choose to allow the hospitalists to care for their patients?
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Re: What would keep an MD from having privileges?
I can't comment on PCPs but for specialists, it is more financially advantageous for them to see patients in the office versus consult at the hospital. Seeing patients in the clinic nets more revenue than surgery, also.
Re: What would keep an MD from having privileges?
The burden of call is a huge reason for primary care physicians now having hospitalists take care of the hospitalized patients. Years ago, all primary care physicians with hospital privileges shared call not just for their patients but for those patients in practices of their call group partners. This involved heading into the ER to admit patients in the middle of the night, and then rounding on these patients on nights and weekends. You can imagine how much fun a full office schedule would be the day after a busy call night with little sleep.
Enter the hospitalist model. Primary care physicians now have the hospitalists take care of the night/weekend in hospital work. Lifestyle becomes much better. Many (?most) hospitalists are former private practice docs themselves, who now longer have the hassles of running an office and often now work in shifts. Result - lifestyle now better for them as well. So both groups of physicians benefit from this system of taking care of hospitalized patients.
Whether patients receive better treatment (ie- more standardized) of acute illness requiring hospitalization when in the care of a hospitalist I do not know, but that would be plausible and my guess is there have been studies that have looked at that.
Enter the hospitalist model. Primary care physicians now have the hospitalists take care of the night/weekend in hospital work. Lifestyle becomes much better. Many (?most) hospitalists are former private practice docs themselves, who now longer have the hassles of running an office and often now work in shifts. Result - lifestyle now better for them as well. So both groups of physicians benefit from this system of taking care of hospitalized patients.
Whether patients receive better treatment (ie- more standardized) of acute illness requiring hospitalization when in the care of a hospitalist I do not know, but that would be plausible and my guess is there have been studies that have looked at that.
Re: What would keep an MD from having privileges?
Last edited by norookie on Thu May 17, 2012 12:16 pm, edited 2 times in total.
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Re: What would keep an MD from having privileges?
Maintaining privileges/credentials is a huge pain in the rear. Dozens of pages of paperwork updated every 2 years. Having had to do it at multiple hospitals before I don't know why anyone would maintain privileges at every hospital in town. Our group has a full-time employee whose only job is credentialing/privileging the doctors in our group. The hospitals also have an employee or two and this is their only job.
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Re: What would keep an MD from having privileges?
There are physicians who choose not to make rounds on their patients nor have privileges at a hospital for a vriety of reasons such as poor remuneration and low efficiency of such activities (e.g. primary care physicians). There is another group of physicians who could be either primary care or specialists who are not able to get privileges (or have been kicked off the staff) for poor performance and/or poor credentials.Die Hard wrote:Just curious...what would keep a physician from having privileges at all local hospitals in the city of their practice. Do they choose to allow the hospitalists to care for their patients? Do they make more money staying in the office seeing patients? Or, is it deeper than that?
I personally would want my PCP coming to see me in the hospital, but a lot of PCP's don't and let the hospitalist groups manage the inpatient care.
Two completely different groups, and you need to investigate to which group your own physician belongs before you can do an accurate evaluation of that doctor.
Re: What would keep an MD from having privileges?
As a retired Fam. physician I agree. Many family physicians, and other primary care physicians, no longer admit but refer out to speciliast or hospitalists when their patients need to be admitted. Many keep their privileges and see their patients when hospitalized but turn inpatient care over to a specilist. I'd want my personal physician to see me if hospitalized but not necessarily every day. I'd be very careful of a specilist who didn't have hospital priveleges. There may be valid reasons but I'd ask why.Munir wrote:There are physicians who choose not to make rounds on their patients nor have privileges at a hospital for a vriety of reasons such as poor remuneration and low efficiency of such activities (e.g. primary care physicians). There is another group of physicians who could be either primary care or specialists who are not able to get privileges (or have been kicked off the staff) for poor performance and/or poor credentials.Die Hard wrote:Just curious...what would keep a physician from having privileges at all local hospitals in the city of their practice. Do they choose to allow the hospitalists to care for their patients? Do they make more money staying in the office seeing patients? Or, is it deeper than that?
I personally would want my PCP coming to see me in the hospital, but a lot of PCP's don't and let the hospitalist groups manage the inpatient care.
Two completely different groups, and you need to investigate to which group your own physician belongs before you can do an accurate evaluation of that doctor.
Re: What would keep an MD from having privileges?
I would think that the biggest reason is not having unassigned call. About 12 yrs ago we went to the Hospitalist model, ie, the Hospitalist takes the unassigned (patients that do not have a primary care dr, or there pcp does not have privaleges at our hospital). Prior to that, all the primary physicians had to take turns being on call. In the beginning, the private physicians kept admitting their personal patients, but gradually over the years most of the groups stopped admitting their patients and the patients started going to the hospitalist. Now there are only a handful of drs that admit their own patients, and only 2 doctors that have elected to stay on the unassigned call schedule.
I would guess that the doctors did this to avoid the hassle (IE, you have to go to the hospital either before or after office hours to take care of your admitted patients, plus fend off phone calls throughout the day and night to take care of the patients), leading to a very long work day and poor sleep. With the continued decrease in Medicare reimbursement, they found they could have a nicer life style without much (or even any) of a decrease in their bottom line.
As to the patients care, most articles seem to suggest that hospitalist care results in better quality and faster dishcarges. Check out The Happy Hospitalist blog, he often talks about such things. http://thehappyhospitalist.blogspot.com/
Mike
I would guess that the doctors did this to avoid the hassle (IE, you have to go to the hospital either before or after office hours to take care of your admitted patients, plus fend off phone calls throughout the day and night to take care of the patients), leading to a very long work day and poor sleep. With the continued decrease in Medicare reimbursement, they found they could have a nicer life style without much (or even any) of a decrease in their bottom line.
As to the patients care, most articles seem to suggest that hospitalist care results in better quality and faster dishcarges. Check out The Happy Hospitalist blog, he often talks about such things. http://thehappyhospitalist.blogspot.com/
Mike
Re: What would keep an MD from having privileges?
I have a relative who is in private practice and although he very rarely sees patients anymore in the hospital, he goes to some hospital meetings and retains privileges.
It probably depends hospital to hospital and can change at a given time.
It probably depends hospital to hospital and can change at a given time.
Re: What would keep an MD from having privileges?
Another thing I might mention is that there are different types of privaleges. The first is general admitting privaleges, ie you can admit a patient to the hospital any floor, any time as much as you want. Next is consulation privaleges, where you see the patient in consultation but don't actually admit the patient. Most consultans (subspeciallists such as infectious disease, gastroenterology etc have these.) They will sometimes have "courtesy" privaliges, which allows them to admit a certain number of patients a month or a year. Some hospitals are now limiting icu or ccu privaleges, so that only certain doctors can admit patients there.
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Re: What would keep an MD from having privileges?
In my area there are cat fights going on among local hospitals owned by competing interests, and the physician practices have become part of it. So, one of my specialists, who was in a stand-alone group practice with privileges at several hospitals but not economically affiliated with any of them, joined a practice established by Hospital A, after which Hospital B (which was actually closer to his office and whose facilities he had used for many years) canceled his privileges. And I believe the same has been happening in the opposite direction: doctors/entire practices who affiliate with Hospital B are then denied or limited in their privileges at Hospital A.
In other words, as I understand this situation, it has almost everything to do with business turf wars and almost nothing to do with the care of patients. And from my own point of view as a patient it's also a damned inconvenience, because Hospital B is within walking distance of my home, and this specialist's office is within a couple minutes drive, but if I need to have a procedure (even if completely outpatient) that can't be done right there in his office, I now have to travel about 8 miles to meet him at Hospital A.
I find all of this quite disgusting. Care has become the servant of money instead of the other way around.
In other words, as I understand this situation, it has almost everything to do with business turf wars and almost nothing to do with the care of patients. And from my own point of view as a patient it's also a damned inconvenience, because Hospital B is within walking distance of my home, and this specialist's office is within a couple minutes drive, but if I need to have a procedure (even if completely outpatient) that can't be done right there in his office, I now have to travel about 8 miles to meet him at Hospital A.
I find all of this quite disgusting. Care has become the servant of money instead of the other way around.
Re: What would keep an MD from having privileges?
I agree with pretty much all of the reasons and explanations given above.
While there is probably the uncommon situation where a physician has training or personal issues that keeps him/her off of a hospital staff, in the vast majority of cases, it is a decision made by the physician involving a better lifestyle, and probably more importantly, economic survival.
With reimbursements crashing, no way one can afford the "luxury" of spending your time driving thru traffic to various hospitals, and even worse being pulled away from your office schedule to see patients in the ER.
While there is probably the uncommon situation where a physician has training or personal issues that keeps him/her off of a hospital staff, in the vast majority of cases, it is a decision made by the physician involving a better lifestyle, and probably more importantly, economic survival.
With reimbursements crashing, no way one can afford the "luxury" of spending your time driving thru traffic to various hospitals, and even worse being pulled away from your office schedule to see patients in the ER.
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