Does a FP really have these privileges?

Discussion in 'Family Medicine' started by hotobhaga, May 9, 2008.

  1. hotobhaga

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    According to the AAFP site the following procedures can be performed by a FP. Does anybody know if any FP really does all these?

    Privilege List for Family Practice Departments in Hospitals
    The AAFP believes that the use of a Privilege List in conjunction with the categorization approach is the most comprehensive method for delineation of privileges. The addition of a listing of specific privilege requests will give the Credentials Committee, and ultimately the Board of Trustees, a better understanding of the scope of family practice training and experience.

    Since it is impossible to make a completely comprehensive list of all possible diagnoses and procedural needs which would be applicable across the country, the AAFP recommends that the following Privilege List be used as an outline and reference material for a form which is adapted to meet local needs. The Privilege List is separated by systems rather than the usual "specialty" categories (e.g., pediatrics), which the AAFP considers as arbitrary and not applicable to the continuum of care provided in family practice. The format lists, in alphabetic order, both cognitive and procedural skills involved with the medical care of each system.

    Example:
    ALIMENTARY

    I. Cognitive
    A: general medical diagnosis and treatment
    R R/C T E C M G D
    [] [] [] [] [] [] [] []




    II. Procedural
    A: anoscopy
    R R/C T E C M G D
    [] [] [] [] [] [] [] []


    The number of items listed under a specific system should also be tailored to meet local needs. Department committees should be aware of the political climate in their community as well as the attitudes of other types of specialists so that the list will include all items which may become problematic if not specifically listed. This is especially true regarding procedural skills.

    In utilizing the categorization format in conjunction with the Privilege List, the department may wish to assign certain skills to a specific categorical level. An example would be any disease process considered acutely life threatening or requiring care in the Intensive Care Unit which the department may wish to designate as Category II and III. This, again, will need to be evaluated locally and based on local needs.


    APPLICANT SECTION


    R: privilege requested: indicates you believe you can properly diagnose and treat this problem
    R/C: requested with consultation: indicates you can properly diagnose and treat this problem with consultative assistance and would not manage without such consultation
    T: indicates your training background is sufficient to justify granting the requested privilege
    E: indicates your experience with the problem is sufficient to justify granting the requested privilege


    HOSPITAL SECTION


    C: category this privilege is considered at your hospital
    M: monitoring required before privilege granted independently
    G: privilege granted
    D: privilege denied



    R R/C T E C M G D
    ALIMENTARY SYSTEM
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: anoscopy
    B: appendectomy
    C: biopsy: simple oral lesion
    D: cholecystectomy: open
    E: cholecystectomy: laparoscopic
    F: colonoscopy:
    with biopsy
    without biopsy
    with polypectomy
    without polypectomy
    G: endoscopy of peritoneal cavity
    H: esophagus: dilation of
    I: esophagogastroduodenoscopy:
    with biopsy
    without biopsy
    with PEG placement
    J: fissurectomy: anal
    K: fistulectomy
    L: gastric lavage
    M: hemorrhoidectomy: surgical
    N: hemorrhoidectomy: banding or infrared
    O: hernia: ventral
    P: hernia: umbilical
    Q: hernia: inguinal
    R: hernia: femoral
    S: hyperalimentation
    T: lips: full thickness laceration repair
    U: liver biopsy: fine needle
    V: NG tube placement
    W: paracentesis: abdominal
    X: peritonsillar abscess drainage
    Y: pilonidal cyst i/d or excision
    Z: polypectomy: rectal
    AA: proctosigmoidoscopy:
    rigid with biopsy
    rigid without biopsy
    flexible with biopsy
    flexible without biopsy

    R R/C T E C M G D
    CARDIOVASCULAR SYSTEM
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: arterial line placement
    B: arterial puncture/cannulation
    C: cardioversion: medical
    D: cardioversion: electrical
    E: central venous placement & monitoring
    F: CPR
    G: EKG interpretation
    H: myocardial infarction: uncomplicated
    I: myocardial infarction: complicated
    J: pacemaker: venous/temporary
    K: pacemaker: venous/permanent
    L: pericardiocentesis
    M: stress testing: exercise treadmill
    N: stress testing: chemical/nuclear
    O: Swan Ganz placement and monitoring
    P: temporal artery biopsy
    Q: thoracentesis: needle/catheter
    R: venipuncture
    S: venous cutdown and cannulation


    R R/C T E C M G D
    CONNECTIVE TISSUE DISEASES
    I: Cognitive
    A: general medical diagnosis and treatment

    R R/C T E C M G D
    EAR NOSE AND THROAT
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: abscess of auricle: drainage
    B: adenoidectomy
    C: cricothyroidotomy
    D: epistaxis: anterior/posterior pack
    E: endoscopy: with foreign body removal
    F: endotracheal: intubation
    G: foreign body: ear, nose, throat
    H: frenulum release lingual or labial
    I: laryngoscopy: direct
    J: laryngoscopy: indirect
    K: myringotomy and aspiration
    L: myringotomy and tube placement
    M: nasal fracture: undisplaced
    N: oral lesions: biopsy and excision: simple
    O: rhinolaryngoscopy: fiberoptic
    P: tonsillectomy:
    with adenoidectomy
    Q: trachael puncture: transcutaneous
    R: tracheostomy: elective or emergency
    closure of

    R R/C T E C M G D
    ENDOMETABOLIC SYSTEMS
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: fine needle biopsy: superficial

    lymph node or thyroid


    R R/C T E C M G D
    EYE
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: foreign body removal
    B: slit lamp exam
    C: tonometry
    D: tumors of lid or orbit: biopsy
    E: tumors of lid or orbit: excision

    R R/C T E C M G D
    GENITAL SYSTEM: FEMALE
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: bartholin’s cyst: drainage or marsupialization
    B: biopsy: vulva and vagina
    C: cervix: biopsy and polypectomy
    D: cervix: cryosurgery
    E: culdocentesis
    F: colposcopy and biopsy
    G: conization of cervix
    H: dilatation and curettage
    I: endometrial bx/aspiration curettage
    J: hymenotomy
    K: hysterectomy:
    vaginal
    abdominal
    L: hysterosalpingogram
    M. hysteroscopy
    N: IUD: insertion/removal
    O: laparoscopy
    P: LEEP
    Q: sub-cutaneous contraceptive device:
    insertion/removal
    insertion/removal
    R: tubal ligation:
    laparoscopic
    open
    S: veneral warts: treatment
    T: vulvar abscess: treatment

    R R/C T E C M G D
    GENITAL SYSTEM: MALE
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: androscopy
    B: circumcision: non-infant
    C: epididymitis: drainage of abscess/hematoma
    D: epididymitis: aspiration of spermatocele
    E: hydrocelectomy & spermatocelectomy
    F: meatotomy
    G: testis: needle biopsy
    H: tunica vaginalis: needle aspiration of hydrocele
    hydrocele
    I: varicocelectomy
    J: vasectomy
    K: veneral warts: treatment


    R R/C T E C M G D
    HEMATOLOGIC SYSTEM
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: bone marrow aspiration
    B: bone marrow: biopsy
    C: lymph node: superficial biopsy or excision

    R R/C T E C M G D
    HEREDOFAMILIAL DISEASES
    I: Cognitive
    A: general medical diagnosis and treatment

    R R/C T E C M G D
    IMMUNE SYSTEM
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: dermal skin testing

    R R/C T E C M G D
    MUSCULOSKELETAL SYSTEM
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: arthrocentesis
    B: carpel tunnel release
    C: dislocations: simple/closed reduction
    D: dislocations: open reduction
    E: extensor tendon repair: simple/primary
    F: fracture care: non-operative/non-displaced
    G: fracture care: closed reduction
    H: fracture care: operative
    I: ganglionectomy
    J: ganglion: aspiration/drainage
    K: hip dislocation: reduction
    L: hip fractures: open reduction and treatment
    M: i/d abscess
    N: injection joint, tendon, or bursa
    O: morton’s neuroma: removal or injection
    P: muscle biopsy
    Q: nail matrix destruction
    R: nail plate removal


    R R/C T E C M G D
    NERVOUS SYSTEM
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: burr hole trephination
    B: lumbar puncture

    R R/C T E C M G D
    RENAL SYSTEM
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: aspiration of bladder: suprapubic
    B: bladder catheterization
    C: circumcision: adult
    D: circumcision: infant
    E: cystourethroscopy
    F: peritoneal dialysis
    G: prostate biopsy
    H: urethra: dilation of female
    dilation of male

    R R/C T E C M G D
    RESPIRATORY SYSTEM
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: biopsy of lung: needle
    B: biopsy of pleura: needle
    C: bronchoscopy: flexible
    D: bronchoscopy: rigid
    E: pulmonary function interpretation
    F: respirator management
    G: surgical assisting
    H: thoracentesis: needle
    I: tracheostomy: needle
    J: tube thoracostomy (chest tube)

    R R/C T E C M G D
    SKIN, APPENDAGES, SUBCUTANEOUS TISSUES
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: biopsy skin and subcutaneous
    B: breast:oops:pen biopsy
    C: breast: needle aspiration of cyst
    D: burns: partial; full thickness
    E: i/d abscess
    F: laceration: simple repair
    G: laceration: intermediate repair
    H: lymph node excision or biopsy
    I: neoplasia of skin: thermal or surgical treatment
    J: sebaceous cyst treatment or excision
    K: skin biopsy: shave, punch, incisional or excisional
    excisional
    L: skin graft: minor pinch graft
    M: varicose vein surgery


    R R/C T E C M G D
    SPECIAL PROBLEMS AND SPECIAL POPULATIONS: CHILD
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: alimentary:
    appendectomy
    EGD
    hernia repair
    nasogastric intubation
    paracentesis: abdomen
    proctosigmoidoscopy
    pyloric stenosis repair
    B: cardiovascular:
    CPR
    EKG interpretation
    exchange transfusion
    internal jugular venipuncture
    intravenous therapy: neonate
    intravenous therapy: infant
    intravenous therapy: child
    venipuncture, including scalp vein
    venous cutdown
    C: genito-urinary:
    circumcision
    orchiopexy
    suprapubic bladder tap
    D: musculoskeletal:
    arthrocentesis
    fracture care: simple
    E: neonatal care:
    full term: uncomplicated
    preterm: uncomplicated
    full term: complicated
    preterm: complicated
    attend infant at cesarean section
    exchange transfusion
    infant intubation
    neonatal resuscitation
    umbilical artery or vein catheterization
    F: nervous system:
    lumbar puncture
    phototherapy of hyperbilirubinemia
    subdural tap
    G: respiratory:
    chest tube placement
    endotracheal intubation
    thoracentesis
    tracheotomy, tracheostomy
    tympanocentesis
    H: skin, soft tissue, appendages:
    i/d abscess
    laceration repair: simple
    skin biopsy: punch, shave, incisional, or excisional
    I: surgical assist:
    cesarean section
    surgical assist non-c/s; infant
    surgical assist non-c/s; child

    R R/C T E C M G D
    POISONING
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: poisoning: resuscitation and management

    R R/C T E C M G D
    VIOLENCE AND DOMESTIC ABUSE
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: sexual assault evaluation

    R R/C T E C M G D
    EMOTIONAL AND BEHAVIORAL DISORDERS
    I: Cognitive
    A: general medical diagnosis and treatment


    R R/C T E C M G D
    OCCUPATIONAL AND ENVIRONMENTAL PROBLEMS
    I: Cognitive
    A: general medical diagnosis and treatment

    R R/C T E C M G D
    PREGNANCY, CHILDBIRTH, AND PUERPERIUM
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: abortion: surgical interruption of pregnancy up to 12 weeks
    B: abortion: chemical interruption of pregnancy up to 12 weeks
    C: amniocentesis
    D: cervical laceration repair
    E: cesarean section
    F: delivery:
    uncomplicated; normal cephalic; term
    with outlet forceps
    normal cephalic; preterm
    complicated: breech
    complicated; abnormal/compound presentation
    multiple delivery
    G: dilatation and curettage
    H: ectopic pregnancy: medical management
    surgical management
    I: episiotomy repair: 1st and 2nd degree
    J: episiotomy repair: 3rd and 4th degree
    K: fetal monitoring
    L: fetal scalp pH
    M: induction of labor
    N: intrauterine demise; management
    O: labor: augmentation
    P: labor: inhibition of
    Q: placenta: abruption
    placenta: manual removal
    placenta: previa
    R: paracervical block
    S: pre-eclampsia or eclampsia: management
    T: pudendal block
    U: regional anesthesia: epidural, spinal or saddle block
    V: ultrasound assessment
    W: vacuum curettage: incomplete abortion
    X: vacuum delivery

    R R/C T E C M G D
    SPORTS AND RECREATIONAL MEDICINE
    I: Cognitive
    A: general medical diagnosis and treatment
    II: Procedural
    A: casting, splinting, and bracing

    R R/C T E C M G D
    OTHER
    I: Cognitive: (specify)
    II: Procedural
    A: surgical assist
    B: other: (specify)

    Copyright © 2008 American Academy of Family Physicians
     
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  3. EdibleEgg

    EdibleEgg Member

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    Can you narrow this down a little? What's your real question?

    I doubt there are many people out there that perform every procedure on the list. It would be tough to find the desire, patient population, and the time to do it all. Could you learn every procedure on the list? Sure, but you have to find some time to actually take care of patients. I don't personally know anyone currently doing laprotomies and cholecystectomies, although I do know a couple of FP's that once did. In most places it would be incredibly difficult to get hospital credentials, but I'm sure there are some out there. For most of the other procedures, I either perform them myself, or I know an FP well who does.
     
  4. hotobhaga

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    hi,
    i am a surgeon in my home country and am due to start residency in family practice in the US this july and eventually emigrate to the USA.
    what i wanted to know is whether it will be feasable to do procedures like GI endoscopies; surgeries like hernia/piles/appendectomies after this FP residency. will the skills i have already acquired in surgrey help me in my FP practice...i have semi-rural environment in mind.
     
  5. NuMD97

    NuMD97 Senior Member

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    It is my understanding that the more rural the better for an FM doc to do procedures. I think you have the right idea in mind, when you are considering a "semi-rural environment", as you describe.
     
  6. cfdavid

    cfdavid Banned
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    I know EM docs will do temporary pacemaker placements. I just can't see FM's doing permanent pacemaker placements. That just doesn't seem like it would be in the patients best interests, unless it's easier than it seems.
     
  7. sophiejane

    sophiejane Exhausted
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    It depends on the hospital, and your residency. Hospitals require a certain number of each procedure before they will grant privileges, and most people get those procedures in residency. I suppose if you were trained as a surgeon in your home country, as long as you can document you have done x number of appys, lap choles, etc. you could appeal to the hospital where you are hired for privileges for those procedures. Just know that a bitter turf battle between you and the local surgeon(s) will likely ensue.
     
  8. herpmed

    herpmed Third Defense to Meds

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    In most US hospitals, you would have to document (by provision of certifying cards) that you performed a certain minimun number of procedures of interest during residency. In other words, very rarely are procedures performed in another country recognized by privilege-granting hospital boards. One usually must perform these under specialist supervision during US residency and receive a card documenting each procedure performed. The card is signed by the supervising physician/surgeon who must be certified in the procedure. After obtaining the number of cards required (this number is dependent on the procedure; for colonoscopies it is anywhere from 50-100 depending on the state and hospital and whether the respective hospital follows guidelines form the AAFP or from the American College of Gastroenterology, etc). With your previous experience it should be reasonably uncomplicated to certify in many procedures. You could use elective time as well as scheduled rotations in disciplines contaning the procedures of interest in order to obtain the described cards and experience.
     
  9. DDuncan

    DDuncan Senior Member

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    Your list above contains a few that I would guess very few FPs do. If you are interested in full spectrum FP+OB+surgical - I hope that you have found a program that teaches them well.

    Suggested reading from me:
    Read the entire web site at
    http://www.psot.com/
    http://psotblog.typepad.com/

    Dr Rodney is a pioneer in the field of full spectrum FP. He runs the above web site, as well as a fellowship in rural/ob/fp in Tennnesse. (he probably does most of the procedures you mention.)
    read his "oscar list" at www.psot.com/Documents/Oscars.doc for his commentary on residencies.

    If you want stats on FPs doing those procedures check here: http://www.aafp.org/online/en/home/aboutus/specialty/facts.html

    Your background in surgery will serve you well if you go to a small town. Priveleging is HIGHLY variable from hospital to hospital.





     

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