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R. Dean White, DDS, MS, has been involved in medical staff governance for the last 33 years. He has served on every medical staff committee including chairing the credentials and bylaws committees. He also served as chief of the medical staff in 1999 and 2000 at Texas Health Harris Methodist HEB Hospital in the Dallas Fort Worth Metroplex. He served on the board of trustees of the same hospital for six years.

Holy Moly, He Wants to Come Back!

Okay, here are the questions:

  • What do you do when the physician requests his privileges be restored after he returns from rehab for his cocaine and sexual addictions?
  • What do you do when the 67-year-old internist, who retired five years ago, has just been hired by administration to be your new hospitalist?
  • What do you do when your favorite cardiologist returns from a medical leave of absence after suffering a significant stroke?

Of course, these scenarios cause more questions than answers. You suddenly wish you had declined the invitation to be chief of staff of your medical staff. The fact remains that demographics apply to physicians as well as the general public.

Alcohol and substance abuse is 12-14% in the general population and is the same or somewhat higher in the physician population. (P Hughes, Prevalence of Substance Abuse Among US physicians, JAMA, 1992) Sexual addiction, especially cyber addiction to pornography, is present in 6-8% of the general population and one out of five are women. (Carnes, Am J Prev Psychology Neurology, 1991, 3:16-23) Dementia is present in 13.9% of individuals 71 and older and 9.7% of these have Alzheimer’s disease. (Plassman, et al, Neuroepid, 2007) Stroke recovery is possible, but of course, varies widely depending on age, severity of the injury, rehabilitation efforts, and support to name a few. None of us are immune from these possibilities.

Okay, now a few answers. Patients are more important than physicians. Don’t get caught in the trap of treating physicians as “special people.” First and foremost, you should have a concrete policy for dealing with all of the above possibilities. It must be iron clad, fair and equitable, be consistent with HIPPA and the American Disability Act, should be patient-safety focused but also allow for the physician to return to your medical staff. This begins with a viable and credible Physician Health Committee, an engaged credentials committee, OPPE and FPPE plans on steroids, legal advice, and a “Fitness to Work” evaluation from an objective and independent physician.

Want more from Dr. White? R Dean White DDS, MS, of Dean White Consulting, will be speaking about how to create a physician re-entry process at the 15th Annual Credentialing Resource Center Symposium, May 10-11. For more information, click here. 

Medical staff advisor: Advocate for MSPs

One of the most valuable duties of the medical staff advisor is the working alliance with the medical staff professionals. As a group, MSPs are probably the most unappreciated employees of the hospital. They serve as the gatekeepers of safety in their credentialing and recredentialing roles and assist the medical staff as it performs its primary duty of governing itself. Many times, administrators and other hospital departments do not understand the depth and breadth of knowledge these dedicated professionals possess or their passion for keeping patients safe.

The medical staff advisor can serve as a senior advisor to MSPs, as well as provide a buffer between the medical staff officers and administration. They can help the MSPs as they seek to implement change by explaining, introducing, and adopting new Joint Commission standards, CMS directives, and other regulations.

This relationship is a two-way street, and the medical staff advisor is continuously educated by the professionals on current rules and regulations and what is needed to maintain good medical staff governance.

Over the past few weeks, I have described just some of the ways medical staffs and hospitals can leverage seasoned physicians for the common good of the hospital, the medical staff, and–most importantly–the patient. Given the opportunity, the medical staff advisor can leave the place a little better than he or she found it.

The medical staff advisor as mediator

Peer review activities and credentialing committee deliberations and recommendations are arguably the main reason the organized medical staff exists. Traditionally medical staff members sought these committee appointments. However, for whatever reason, the number of physicians that are willing to perform these duties is diminishing. Medical staff advisors can serve on these committees. Particularly if he or she is retired, the partner or competitor conflict goes away and the medical staff advisor can become a statesman and not a “turf warrior.”

The medical staff advisor can also provide the cultural history of how the medical staff has approached similar problems or questions in the past, such as interviews, longer provisional periods, proctoring arrangements, and referrals to the physician health committee to name just a few. Many times, practicing physicians are hesitant to evaluate a fellow physician’s clinical competence, but the medical staff advisor can be the catalyst to aim the discussion in the right direction. Instead of looking for reasons not to investigate or discipline a physician, the medical staff advisor many times is in the unique position to describe  how similar behavior in the past has resulted in less-than-desirable outcomes.


The medical staff advisor: Not just another administrator

The orientation of new medical staff members usually falls to the medical staff professionals, but leveraging the medical staff advisor, a seasoned physician who is cutting back on his or her practice or retiring, sends the message that orientation is important. That a fellow physician has taken the time to explain not only where the parking lot is located and where to get a free lunch, but also how to use the electronic medical record, starts the new physician’s tenure on the right foot. The medical staff advisor can explain various topics and provide useful information, including:

  • The culture of peer review
  • Steps for accessing medical staff leadership and administration
  • The use of clinical care coordinators and coding specialists
  • Financial contract information (what contracts the hospital has in place)
  • Current formulary information and staff rosters can all be given to the new physician
  • A tour of the facility, including introductions to both nursing and medical staff

Another valuable duty of the medical staff advisor is to assist the medical staff during behavioral incidents. A seasoned veteran should have the time, experience, and empathy to interview the medical staff member whose behavior is questionable to get his or her side of the story. Physicians understand physicians (for the most part) and they will relate better to someone who has stood in the same shoes and faced the same stresses and frustrations. With this mutual understanding, the medical staff advisor and the physician are more likely to find a solution to the problem that caused the behavior.  


The role of the medical staff advisor

The alignment between hospitals and their medical staffs continues to be one of the challenges that demands attention, particularly as we move into the unchartered territory called healthcare reform. Two factors continue to pose barriers. First, physicians must continue to be involved in medical staff governance to ensure quality of care and patient safety, but few are interested. Second, hospitals must often operate with decreased monetary resources. 

There is a group of physicians that could potentially pave the way for physician-hospital alignment: the seasoned physician who is scaling back his or her practice or retiring from clinical medicine. This group is made up of a large pool of talent, experience, and passion that is largely untapped by those charged with the governance of the medical staff. Historically, medical staffs have granted these physicians emeritus or honorary status, given them a reception with cake and punch, and wished them well as they exited stage left.