Protocol for Establishing a Department of Family Medicine

The American Academy of Family Physicians strongly supports the establishment of clinical departments of family medicine in departmentalized hospitals. A full clinical department of family medicine is one which possesses all the rights, duties and responsibilities afforded any other specialty department. Most particularly these responsibilities would include the recommendation of clinical privileges for department members, the authority to review the quality of care of department members, the representation of family physicians on various hospital bodies, and the review of the credentials of applicants of the department.

In order to assist those family physicians encountering difficulties in establishing a family medicine department, the AAFP Commission on Practice Enhancement has developed this protocol. The commission believes that by following the steps outlined here, family physicians can help themselves obtain the privileges needed to care for their patients in hospitals.

This publication considers the role and function of family medicine departments in hospitals. The second chapter discusses the reasons for establishing a family medicine department or upgrading an administrative unit to a full clinical department, the process necessary to establish such a department, membership in and functions of a department. A model set of department rules and regulations is included.

Review the hospital and the medical staff bylaws which pertain to clinical departments within the hospital. They may contain provisions which prohibit or restrict the establishment of a full department of family medicine. List any provisions which require amending in order to allow the establishment of a family medicine department. Proposed changes will need to be presented to the appropriate bodies of the medical staff.

If not found in the bylaws, request in writing from the hospital administrator a description of the process for requesting approval of a family medicine department. Be certain that an appeals process is delineated in the event your request for the establishment of a family medicine department is denied at any stage of the process.

This position paper should enumerate the benefits a family medicine department would accrue to the community, the hospital, the medical staff and patients in your region. (See benefits outlined in Family Medicine in Hospitals, Chapter Two.) Include such information as potential improvements to patient care, as well as economic benefits and possible public relations benefits for the hospital. Be sure to detail how the department would function, including the proposed internal organization and its interaction with other departments and bodies within the hospital. Address the issues of privileges and credentials, mentioning the fact that peers are the best judge of a physician's competence and that you, as family physicians, have a vested interest in ensuring the competency of your peers. Emphasize that as a department, family physicians are in the best position to assure quality among the department's members. Demonstrate in the position paper the important role the department can play in the hospital's continuing medical and nursing education efforts.

Your constituent chapter may be in a position to provide you with considerable assistance. The chapter may be able to supply a letter of support, provide you with advice and counsel, and may have a specific committee to deal with hospital and medical staff issues. In some cases, the chapter may be able to send an official to discuss the proposed new department with a representative of the hospital.

Present your arguments for a family medicine department at each level of the approval process. Should you encounter any difficult problems pertaining to the establishment of a family medicine department, seek assistance from the constituent chapter and/or national headquarters of the AAFP. Keep your constituent chapter informed of your progress or problems.

Some advocate that one should engage legal counsel if it appears that the proposal for the establishment of a family medicine department will be rejected or if you do not understand the due process outlined in the bylaws. This is a decision to be made by the family physician involved since the AAFP is not in a position to advise for or against the retention of an attorney. Remember, lawsuits are expensive and may produce bad feelings; however, there may be situations in which legal action could be the appropriate course of action. As a word of caution, do not be overly influenced by an attorney's encouragement to litigate. In general, courts are hesitant to substitute their judgment for the judgment of hospital boards.

If you decide that legal action is necessary, you may wish to seek constituent chapter support. The chapter will review the situation to ensure that the prescribed process has been followed and that this is a case which will advance the cause of family medicine in the state. The chapter's Board of Directors will decide whether and to what extent it will support the case.

Note: The constituent chapter is under no obligation to provide legal support for its members.

If all attempts to resolve the problem at the local and constituent chapter levels have failed, the constituent chapter's Board of Directors may wish to seek the support of the AAFP.

The constituent chapter must submit its request for assistance to the AAFP Commission on Practice Enhancement. The chapter should submit:

The official request for support then will be considered by the AAFP Board of Directors. Conditions for AAFP financial support of legal action include, but are not limited to, the following conditions. The AAFP Board of Directors must receive the official request to support the case from the constituent chapter's Board of Directors along with a recommendation from the AAFP Commission on Practice Enhancement. Requests for financial support will be considered only when the constituent chapter has committed its own funds to the case and only if you and the chapter each have obtained legal opinions as described above. The AAFP Board of Directors will consider the merits of the request, the procedure followed, and the impact of the case on the family medicine movement in making its determination.

The Board Chair or his/her designee will contact the President of the chapter immediately following the Board meeting to notify the chapter of the Board's action. A letter reiterating this conversation will follow with a copy of the letter to the member(s) whose case has been considered.


Note: The AAFP is under no obligation to provide financial support for such cases.