The American Academy of Family Physicians has developed two privilege delineation forms for family physicians: a Categorization Form and a Privilege List. These forms are intended to serve as guidelines only; family physicians are strongly encouraged to review these forms carefully and adapt them to meet local needs.
The following instructions are provided to assist Academy members to use the form(s) in the most effective manner possible.
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How to Use the AAFP Privilege Delineation Forms
General
The information in this section pertains to all types of privilege delineation forms.
- Privilege delineation forms are designed to identify which clinical privileges are requested by the applicant, whether the applicant meets the qualifications for those privileges, and to indicate to the credentials committee whether those privileges are recommended for the applicant. Thus, "delineation of privileges" refers to the process by which privileges are requested, recommended and, ultimately, granted. This term should not be confused with "credentialing," which refers to the items that one examines when looking into a physician's background; e.g., letters of reference, evidence of training and experience, documentation, etc.
- The delineation of privileges should be based on each individual physician's documented training and/or experience, demonstrated abilities and current competence.
- It is important to note that the criteria used to assess qualifications for privileges may be weighted; e.g., experience may outweigh training or vice versa. Those responsible for delineating hospital privileges for a physician should look at the total picture of the physician's qualifications.\
- In assessing criteria for privileges, family physicians should try to avoid the "numbers game;" e.g., requiring a certain number of procedures in order to be considered qualified. There is little or no scientific data to support numbers.
- Whatever form is used, the Academy strongly recommends that, in hospitals with a family practice department, the form should include all areas and procedures which the family practice department may recommend for its own members directly to the appropriate credentials committee. Therefore, the form should be as comprehensive as possible. The form should not be used to limit or restrict a physician's privileges. For any privileges not listed on the family practice form, the family physician should be encouraged to apply through other involved departments/committees.
Privilege List
- The AAFP Privilege List has been designed to be a fairly comprehensive document. It includes those privileges for which family physicians are likely to request privileges. However, the AAFP Privilege List should not be considered as a complete list of privileges.
- Family physicians should realize that they may apply for any privilege even if the privilege does not appear on the Privilege List form. The applicant should be prepared to provide appropriate educational and/or experience-based documentation of skill and competency for these privileges.
- The AAFP Privilege List may be unique from other such forms since it is designed specifically for family physicians and is organized by systems rather than by specialty areas.
- Whether the Privilege List is used exclusively or in conjunction with the Categorization Form, family physicians should review the form line-by-line to ensure its local applicability.
- Once the final form is reviewed, revised and approved on the local level, the final form should be retyped and printed.
- Applicants should be instructed to check off the appropriate boxes on the left. The boxes on the right are reserved for the family practice department's credentials committee.
- Applicants may request some privileges as Requested with Consultation (R/C). It is assumed that in these cases, the family physician will diagnose and manage the patient and will request symptom or diagnosis appropriate consultative assistance.
Categorization Form
- The AAFP Categorization Form may be used exclusively, or in conjunction with the AAFP Privilege List. In either case, the form should be reviewed carefully by family physicians on the medical staff to ensure its local applicability.
- Applicants should be informed that they may apply for any privilege, i.e., they may apply for certain privileges even if the privilege is considered to be in a higher category than they have been assigned or of a higher degree of complexity than other privileges they have requested. The applicant should be prepared to provide appropriate educational and/or experience-based documentation of skill and competency for these privileges.
Combination: Privilege List & Categorization Form
- This system is most strongly recommended by the Academy.
- In order to combine these forms, it is first necessary to review the Privilege List line by line and assign Category I, II, or III to the boxes under "C" in the right-hand column.
- Then, when the document is retyped, it can be organized by category under each system heading.
- The Academy recommends that as many items be assigned to Category II as is honestly possible.
- Items on the Privilege List which are assigned to each category may vary according to local differences.
- Such determinations are hospital or department specific, not regionally specific.
- The category which is assigned to each item may depend on the hospital, type of facility, etc. For example, vaginal deliveries could be considered to be Category I, II, or III. Another example would be that gastritis may be considered as Category I at a particular hospital, while GI hemorrhage may be either Category II or Category III.
Hospital Privilege Delineation Forms
