AAFP Counters Threat to Endoscopy Privileges

A recent mailing from the American College of Gastroenterology to hospital administrators has the Academy fighting mad. The ACG is "attempting to scare hospitals and peer review participants into denying qualified physicians privileges," said AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif., in a Dec. 12 letter to those same administrators.

Earlier this year, ACG sent a letter, legal opinion and brochure to hospital administrators about "potential litigation exposure" for granting endoscopy privileges to physicians who lack board certification in gastroenterology or eligibility for such certification.

ACG's legal opinion said courts and accreditation agencies "have moved away from reliance on board certification alone as a badge for competence." But the opinion also noted, "the burden upon the hospital to establish absence of negligence in credentialing is almost certainly greater when it cannot point to the physician's having attained board certification in the appropriate specialty for the procedure being performed."

"It is unfortunate that the ACG has apparently chosen to subordinate the health and welfare of the public to its own self-interest by preventing competent physicians from performing potentially life-saving procedures for their patients," Frank wrote hospital administrators and chairs of family medicine departments in her mailing, which included AAFP's response to ACG's legal opinion.

"The impression that the ACG seeks to convey from the correspondence is that endoscopy privileges should only be granted to board-certified gastroenterologists," said AAFP's legal opinion. "In fact, contrary to that impression, the law is straightforward and clear that credentialing decisions and granting of privileges may lawfully be based only on the demonstrated competency, experience and training of the practitioner."

Physicians who join together -- through medical staff decisions or otherwise -- to refuse to provide surgical or other backup to FPs or to exclude FPs from conducting procedures "may be engaged in a group boycott constituting a violation of the antitrust laws," said AAFP's legal opinion.

"It is highly risky for hospitals, managed care companies and others to refuse to credential competent, well-trained physicians simply because they are not certified," concluded AAFP's legal opinion.

John Popp Jr., M.D., past president of ACG and one of two leaders who signed ACG's letter to hospital administrators this summer, said in a recent interview, "This (ACG's legal opinion) is not meant to be exclusive. It is not meant to be an in-your-face document. I don't see how you can stonewall somebody who's gone to a good program -- perhaps to a family practice residency with training in endoscopy -- I think you work with the person. But we've had increasing feedback from our members about endoscopy being performed by people who have not had traditional training."

ACG's legal opinion is part of a 36-page report, Ensuring Competence in Endoscopy, (PDF file: 36 pages / 4.3 MB. More about PDFs.) by ACG and the American Society of Gastrointestinal Endoscopy.