It is the policy of the American Academy of Family Physicians, the American Medical Association and the Joint Commission on Accreditation of Healthcare Organizations that privileges should be assigned on the basis of each individual physician's documented training and/or experience, demonstrated abilities and current competence. Therefore, the privileges assigned to each family physician should be based on his/her respective qualifications.
The privilege delineation form should be regarded as an administrative tool to assist the applicant's department and/or the credentials/executive committee to determine which privileges the applicant is qualified to obtain. In non-departmentalized hospitals, medical staff members normally use one form for the entire staff. In departmentalized hospitals, however, it is common for specialty departments to use their own forms. Many associations have developed their own privilege delineation forms.
Hospital Privilege Delineation Forms for Family Physicians
The Need for a Delineation of Privileges Form for Family Physicians
The AAFP strongly believes that, in hospitals which utilize separate privilege delineation forms for each specialty, family practice also should have its own form. Members have reported that when family physicians do not have their own forms, family physicians have experienced difficulties in obtaining privileges since other specialties' forms often list inappropriate criteria for privileging family physicians. It has also been reported that when family practice departments do not have their own forms, they often have trouble obtaining the right to recommend privileges for their own members.
For these reasons, the Academy believes that family practice should have its own privilege delineation form in departmentalized hospitals which have a family practice department. In nondepartmentalized hospitals, family physicians should have input in the design of the privilege delineation form which is used by the medical staff.
For these reasons, the Academy believes that family practice should have its own privilege delineation form in departmentalized hospitals which have a family practice department. In nondepartmentalized hospitals, family physicians should have input in the design of the privilege delineation form which is used by the medical staff.
Types of Privilege Delineation Forms
The selection of privilege delineation forms should be a local decision. However, there are usually four systems used by hospitals to delineate hospital privileges. Although each of the systems listed below is acceptable, none of the systems is perfect:
1. Privilege list: This term is used to describe a detailed checklist of procedures or conditions. The Joint Commission on Accreditation of Healthcare Organizations believes it is not necessary that each hospital use a complicated list of procedures to delineate clinical privileges, however, the "privilege list" approach (or a modified form of this approach) may be an effective method for delineating clinical privileges as long as it is flexible.
2. Categorization: In this system, treatment areas or procedures are classified either by the degree of complexity of the procedures, or illnesses treated, or the level of the physician's training and experience. In any case, categories usually are levels I, II and III; or I, II, III and IV. The Joint Commission believes that when a hospital uses this system in delineation of privileges, the categories must be well-defined and the standards that must be met by the applicant should be clearly stated for each category.
3. Core Privileging: This alternative method of establishing privileges creates a general description of each specialty and the conditions and procedures commonly addressed by its physicians. This "core" for a specialty is what an appropriately trained physician with good clinical references should be competent to perform. Such a core for family medicine might read:
Family Medicine Core Privileges:
Admit, evaluate, diagnose and treat newborns, childrens and adults for most illnesses and injuries. Privileges include but are not limited to; pre-and post-operative care, suture simple lacerations, I&D abscess, perform simple skin biopsy or excision, remove non-penetrating corneal foreign body, and manage uncomplicated minor closed fractures and uncomplicated dislocations.
4. Descriptive: This term refers to a format in which the applicant "paints a word picture" of the privileges requested. Rather than a checklist or categorical system, this method requires applicants to describe what they can and cannot do in their own words; e.g., all abdominal surgery, no kidney surgery. This system may be modified by exceptions or by additional/special privileges. The Academy is not aware of any hospitals which use this system exclusively.
5. Combination: This system may combine features of the systems listed above, and is most commonly in use.
1. Privilege list: This term is used to describe a detailed checklist of procedures or conditions. The Joint Commission on Accreditation of Healthcare Organizations believes it is not necessary that each hospital use a complicated list of procedures to delineate clinical privileges, however, the "privilege list" approach (or a modified form of this approach) may be an effective method for delineating clinical privileges as long as it is flexible.
2. Categorization: In this system, treatment areas or procedures are classified either by the degree of complexity of the procedures, or illnesses treated, or the level of the physician's training and experience. In any case, categories usually are levels I, II and III; or I, II, III and IV. The Joint Commission believes that when a hospital uses this system in delineation of privileges, the categories must be well-defined and the standards that must be met by the applicant should be clearly stated for each category.
3. Core Privileging: This alternative method of establishing privileges creates a general description of each specialty and the conditions and procedures commonly addressed by its physicians. This "core" for a specialty is what an appropriately trained physician with good clinical references should be competent to perform. Such a core for family medicine might read:
Family Medicine Core Privileges:
Admit, evaluate, diagnose and treat newborns, childrens and adults for most illnesses and injuries. Privileges include but are not limited to; pre-and post-operative care, suture simple lacerations, I&D abscess, perform simple skin biopsy or excision, remove non-penetrating corneal foreign body, and manage uncomplicated minor closed fractures and uncomplicated dislocations.
4. Descriptive: This term refers to a format in which the applicant "paints a word picture" of the privileges requested. Rather than a checklist or categorical system, this method requires applicants to describe what they can and cannot do in their own words; e.g., all abdominal surgery, no kidney surgery. This system may be modified by exceptions or by additional/special privileges. The Academy is not aware of any hospitals which use this system exclusively.
5. Combination: This system may combine features of the systems listed above, and is most commonly in use.
AAFP Recommended Privilege Delineation Forms for Family Physicians
This document should be considered as a guideline and should be adapted to meet local needs. Further, the Academy decided to offer two types of forms: a privilege list and categorization form. In developing both types of forms, the Academy believes members will have an option of using either form or a combination of each.
Hospital Privilege Delineation Forms
