What does it mean to have privileges to practice?

Your Credentials

The process of credentialing can be quite a daunting one, especially if you are new to the healthcare or hospital medical staff approval process. In essence, your credentials are a verification of who you are – both academically and clinically. In addition, your credentials include your medical malpractice history, board certifications, training certificates, disciplinary actions, and other state-specific requirements that the state licensing board determines make you safe to practice. Think of your credentials as a portfolio allowing anyone who wants to know about you read a file and see what you bring to the table, and how well trained you are.

Likewise, credentials are equally important to the hospital or practice where you work, because they need to know that they are hiring a safe, certified provider that will not put them at risk. Anyone who has read stories about imposters treating patients while faking their titles as physicians can understand this. For this reason, the credentialing process is very serious, can be lengthy, but ultimately adds to your credibility for the rest of your career.

Providers in hospital settings must first be credentialed in order to have privileges to practice at that institution. In order to get privileges, you need to apply through the medical staff office of the hospital. The privileges you are asking for are often standardized based on the specialty you are applying to get privileges for. Often times, specialties  have core privileges that encompass the skills and procedures unique to that speciality. Invariably, you will have the ability to request additional privileges based on your training and ability to prove you were trained.

Hospital Bylaws

Of course, this is all based on the hospital bylaws where you are applying to work. You should be given a copy of those bylaws before you are reviewed by the credentialing committee. Read them carefully, because they vary from hospital to hospital, and define your credentialing process and approval process.  Almost uniformly, you will be approved for credentials by the credentials committee, approved by the medical executive committee, and ultimately approved by the hospital board of directors. Usually, unless there are unique circumstances, an approval by the credentials committee will be accepted by all parties.

Privileges should be thought of as skills and procedures you are asking the hospital for permission to perform in their hospital. Just like asking your parents for the keys to borrow the car, the medical staff credentialing committee must review your requests and determine if you have the skills and are able to perform procedures in their hospital in a safe manner. Often times they will ask for a log of your procedures to demonstrate your competency. If you don’t have a log, they will ask for verification of your skills either by written letter of reference, training certificate, additional certification, or other standardized means to document your proficiency. Sometimes, they are able to approve you without these documents if you have a sponsoring provider who has the privileges you are requesting to serve as a proctor, and verify that you are competent to perform the procedures you request.

Denied Privileges?

Despite all of the formality of this process, and the hoops that you need to jump through, it is highly unlikely that you will be denied privileges based on inexperience – especially if your training program has given you a degree with a standard curriculum that details procedures they deem you can perform! Bad outcomes are often the major area of concern.  In the end, the hospital risks litigation from you if you are denied privileges because that action must be reported to the state medical board. For this reason, they have to have a very strong reason to deny your request for privileges. Just as you don’t want to report being denied privileges to the state medical board, the credentials committee does not want to risk action against them, by you, for tarnishing your record simply because you lack experience.

Privileges are permission to practice, and your duty as a provider is to practice safely. There is truly no limit to the procedures you could be permitted to perform, so long as they are within your scope of practice. If you ask for privileges to perform lumbar punctures, and they are granted, you aren’t going to immediately begin putting 20g needles in everyone’s back because you can!  In fact, you may perform the first several procedures with supervision until you are able to do them comfortably on your own. That’s the way proctoring and supervision works! In fact, that’s how the practice of medicine works.

At Provider Practice Essentials, we can help you get your foot in the door by validating your abilities to a credentialing committee. As an added bonus of our program, you may take an optional certification exam. Passing this test will demonstrate your knowledge and skills base, and earn you a letter of reference to bolster your application for privileges- signed by a licensed, practicing, board-certified physician!  You have worked hard to master your skills and earn your degree. You owe it to yourself and your patients to practice to the maximum level of your ability!

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