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What are "hospital privileges?"

Discussion in 'Family Medicine' started by Mike59, Jan 24, 2004.

  1. Mike59

    Mike59 Sweatshop FP in Ontario 7+ Year Member

    Nov 19, 2001
    The inner-net
    I'm a first year med student interested in primary care and am confused about what these "priviliges" mean for an FP?
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  3. lowbudget

    lowbudget Senior Member 7+ Year Member

    Aug 4, 2003
    Correct me out there if I'm wrong.

    When hospitals grant privileges, they permit an outside doctor to work in their hospital, which includes allowing docs to admit patients (put them in the hospital), order labs and treatment, perform procedures, etc. If, for example, an Dr. X doesn't have privileges at Hospital A, Dr. X would have to send the patient to Hospital B or refer the patient to Dr. Y who has privileges at Hospital A.

    Maybe someone who knows more can tell us how doctors get privileges. I've heard that in some places, an FP would have to demonstrate that they do X# of vaginal deliveries in order to have privileges at a hospital while other places force FPs to refer to Ob/Gyn to deliver babies. I've also heard that getting privileges is a combination of your ability in medicine, your economic ability to generate hospital revenue, economic environment of the area and who your competition is, and local hospital politics.

    Some FP's have said, screw it all, and focus only on outpatient while referring hospital patients to Ob/Gyn and Hospitalists.
  4. PACtoDOC

    PACtoDOC 1K Member 7+ Year Member

    Aug 2, 2002
    In my humbled opinion, I find it undesirable to be one of those PCP's that refers everything out and functions basically like a midlevel provider (which I was am and was before I went to medical school). It is dangerous for an FP to either give up hospital privileges because once you do it it can be nearly impossible to get them back. Right out of residency is the best time to show that you have the numbers to get approved, but if you have been doing FP for years without hospital work, a hospital will probably make you work under another "evaluating" physician for a period of months to get signed off. What makes an FP doc special should be their ability to do so many things proficiently, not their ability to have someone else do all that for them. That is called being a gatekeeper and can be done by a medical assistant with an insurance directory. Go for privileges, and keep them! FP's fought a long battle to get them in the first place!
  5. Shoushu

    Shoushu 5+ Year Member

    Jan 24, 2010
    I'm a bit confused about hospital privileges or praticing priviledges.

    FPs see mostly outpatient in the doctor's office, and if there are serious problems, I assume they of course can admit to hospitals and order tests and using hospital equipment, if they got privilege. Do doctors have to pay for these privileges? Who gets the income, doctor or hospital?

    I'm more interested in surgery, as I hope to be a general surgeon someday. Do most surgeons maintain offices or are they hired directly by hospitals and surgerical center? B/c a solo surgeon can't afford to have an OR, if he has office, practicing privilege is needed right?
  6. Blue Dog

    Blue Dog Fides et ratio. Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

    Jan 21, 2006
    I'm not sure what you mean about "practicing privileges," unless you're referring to the ability to perform a given procedure. If you do this in your office, no specific "privileges" are needed, but you need to be able to demonstrate competency in order to avoid legal trouble in the event of poor outcomes. Hospitals will generally expect you to be able to document competency in any procedures that you will perform in their facility.

    Generally, no. Most hospitals want physicians on staff in order to generate revenue. Charging a fee would not encourage this.

    Most (if not all) surgeons maintain offices. Whether these are on hospital premises and how the overhead is covered can vary. Most surgeons do not have their own OR, plastic surgery being the exception. Most do have minor procedure rooms in their office, and many buy into outpatient surgical centers. You might want to ask about this stuff in the surgery forum.
    Last edited: Jan 26, 2010
  7. cabinbuilder

    cabinbuilder Urgent Care Physician Physician 10+ Year Member

    Nov 21, 2005
    When you apply for priviliges the hospital gives you a big packet of procedures that is broken down by specialty. You as the physician check off what you are trained to do. I am FP so most of what I checked was taking care of basic internal medicine type cases, central lines, reading plain films, etc. Then what you checked off is reviewed by some board at the hospital and you are granted/not granted. If there is a question about something that is out of the usual scope of practice, i.e. scopes as an FP then you would have to show proficiency in that procedure and/or be proctored by another doc for a certain number of cases.
  8. michaelrack

    michaelrack All In at the wrong time Physician SDN Advisor 10+ Year Member

    Dec 22, 2007
    Memphis TN
    Some hospitals do charge an application fee of anywhere from $50 to $300 when you are applying for privileges. This covers the cost of them checking out your background, veryifying that you have a medical license and malpract insurance, etc.
  9. Blue Dog

    Blue Dog Fides et ratio. Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

    Jan 21, 2006
    Interesting. I only have privileges at two, but neither charged anything.

    Do they charge you every year when you have to renew your privileges?
  10. DaveinDallas

    DaveinDallas 10+ Year Member

    Jan 23, 2004
    Blue Dog ---

    Some of my FP mentors have sworn off of hospital work after many years of doing it. Many have also sworn off OB work due to high malpractice costs. Note that these are in semi-rural areas where they were one of 3 or 4 docs as the town 'grew up'.

    Yet another FP that's a former professor of mine regularly includes some in-patient work as part of his practice (he likes the variety).......

    Would you mind articulating if you do the hospital work because it's a service you provide for your patients, a relative idea of cost effectiveness to maintain the insurance/whatnot and typically when you round on your patients, etc.? I'm interested in seeing my patients that require inpatient work (I really need variety also or I go stir crazy) but didn't know how viable that option was in the current environment for someone who intends to practice in the 'burbs or right on the edge of the 'burbs....
  11. Blue Dog

    Blue Dog Fides et ratio. Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

    Jan 21, 2006
    I don't actually do any inpatient work. I have "courtesy" privileges. Same process, but no requirement to admit patients.
  12. michaelrack

    michaelrack All In at the wrong time Physician SDN Advisor 10+ Year Member

    Dec 22, 2007
    Memphis TN
    No, they don't charge at renewal. One hospital does charge me $25 every year for the services of its medical library (whether I use it or not).

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