iProtean—The Medical Staff

The medical staff, though it has evolved over the last several years, faces additional pressures to accommodate the changing healthcare delivery environment.


The American Health Lawyers Association recently sponsored an in-depth discussion of the hospital medical staff and how and why it is evolving; contemporary challenges to the traditional role including declining physician participation, the friction between employed and independent physician members of staff . . . and the possible impact of health system reform on existing regulatory standards; the role of the medical staff of the future as leaders and drivers of change and in the maintenance of traditional duties such as credentialing and privileging, and oversight of quality.  (AHLA, The Hospital Medical Staff of the Future Webinar Series, Part I: The Role of the Medical Staff in an Era of Healthcare Consolidation, Health System Reform, and Increased Physician Employment, March 27, 2012)


These topics are covered in the iProtean video course The Medical Staff, featuring Monte Dube, Esq., Proskauer, Todd Sagin, M.D. J.D., Sagin Healthcare Consulting, and Brian Wong, M.D., The Bedside Trust.  The course provides both an historical review of the medical staff as well as the changing dynamics today. It covers the evolution of the medical staff, employing physicians and the tension between employed and independent members of the medical staff, an overview of credentialing and privileging as they relate to quality in today’s environment, and  the importance of physician leaders .


Todd Sagin, M.D., J.D., Sagin Healthcare Consulting

As we enter the 21st century we find that our medical staffs are bureaucratic and very complex organizations that are structured today much as they began to be structured 50 years ago.  It is not entirely clear that this framework is efficacious or functional for the new era of medicine.  Many medical staffs are starting to think out of the box and question whether they can be designed more efficiently and more effectively.


Monte Dube, Esq., Proskauer

There is an accelerated trend towards hospitals directly employing physicians.  This is not a new concept.  Throughout the 1980s and 1990s, many hospitals and health systems decided that it would be in the best interests of the hospitals and, ultimately, patient care to try to better align physicians and hospitals; that is, better alignment from a clinical care perspective, from a financial perspective and, quite frankly, from a competitive perspective.


Todd Sagin, M.D., J.D., Sagin Healthcare Consulting

One of the things that board members need to keep in mind is that as the medical staff becomes more diverse and, particularly, as there begins to be a divide between those who are in private practice and those who are employed, this creates tensions among members of the medical staff.  Those in private practice often become concerned that their interests will become subordinated to the interests of the employed physicians and that the hospital will not be as supportive of their private practices as they were in the past.


The other thing the board member needs to be aware of is that the medical staff now speaks with many voices and has many different interests.  Those of the employed physicians obviously are highly aligned with the needs and interests of the hospital.  The interest of private physicians may be less so.


Monte Dube, Esq., Proskauer

While credentialing and privileging have always been important, in light of health reform and the fact that government is only going to pay for quality measures that are substantially satisfied, there is heightened responsibility on the part of board to ensure that privileges afforded to physicians are earned, appropriate and, ultimately, will enhance the quality of your hospital.


Brian Wong, M.D., The Bedside Trust

One thing I have observed in many community hospitals across the country is how sloppy we have gotten in identifying, selecting and electing our medical staff leaders.  The medical staff organization is the engine that you as a board must rely on to fulfill your quality agenda.  You don’t have quite the expertise in quality; you are delegating this to your medical staff organization.  Wouldn’t you like to know that the leaders of that medical staff organization, namely the chief of staff, the chief elect, the secretary, the treasurer, the chairs of the departments are the best physicians with an aligned agenda, and who are as interested in quality, safety, satisfaction and cost reduction as you are?  That is typically not the case, and that begins with how physicians tend to be identified, selected and self-selected for leadership positions.


For a complete list of iProtean courses, click here.


iProtean Symposium & Workshop

Mark the Date!! October 10 – 12, 2012 at The Lodge at Torrey Pines, La Jolla, CA. Faculty: Barry Bader, Dan Grauman, Marian Jennings and Brian Wong, M.D. For more information, click here.


For more information about iProtean, click here.