Privileging, Family Medicine

The American Academy of Family Physicians (AAFP) believes the full spectrum of family physician education and training supports a broad range of procedures and care settings, including ambulatory, in-patient, emergency, and critical care. For privileging purposes, the AAFP recommends family physicians document significant training and experience (e.g., procedural skills, deliveries, intensive/critical care, and treatment of major illnesses). Family physicians have the training, education, and experience to perform common medical, diagnostic, and surgical procedures (e.g., dermatologic, outpatient musculoskeletal, interpretation of electrocardiogram). Family physicians may have additional training and experience in specific care or procedures (e.g., colonoscopy, obstetrical deliveries). Where family physicians meet an institution’s privileging criteria for a procedure or service, they should be granted this privilege.

Privileging decisions and criteria should:

be based on training, experience and demonstrated current competence;
hold all physicians to the same standards when granting privileges, regardless of specialty, in order to assure the provision of high-quality patient care.
be evidence-based, whenever possible; and when insufficient data exists, represent a consensus opinion of experts from within the specialty until such time as an evidence-based recommendation is available;
allow for any and all combinations of competencies in adult, pediatric, special/critical care, emergency and obstetric care in both the inpatient and outpatient settings;
support continuity in the patient-physician relationship, allowing family physicians access to their patients in all areas of a health care facility, including emergency care, labor and delivery, and special/critical care units;
consider the availability of facilities and the overall medical needs of patients, the community, and the hospital or health system;
recognize that overlap exists between many specialties and no one department "owns" or has exclusive rights to any particular privileges; and
in departmentalized hospitals, be recommended by the department of family medicine, and
not limit medical staff participation and privileges based on a physician (or a partner, family member, associate or employee of the physician) having privileges, a position of leadership or influence, or a financial relationship with a second or competing hospital or health system.

Non-physician clinicians are not the clinical equivalent of residency-trained, board-certified family physicians. Therefore, the AAFP opposes non-physician clinicians independently making privileging decisions regarding family physicians.

Emerging technology has allowed for new equipment (e.g., point-of-care ultrasound), procedures, and techniques to aid family physicians in the care of patients. Educational opportunities to learn new procedures and techniques should be available to all physicians, regardless of specialty. In the event of low or no volume experience, the hospital or health system should provide a method of determining competency that is consistent with Joint Commission standards. This competency assessment method must be applied equally and fairly to all medical staff so any physician applying for privileges, regardless of specialty, can prove competency.

All hospitals and ambulatory care settings should have a standing process for establishing the privileging criteria for a service or procedure new to that organization and for which no privileging criteria currently exist. The purpose for establishing this process is to assure that eligibility is determined fairly, and to rigorously ascertain competence, rather than promoting or limiting access to any specialty.

There are aspects of practice where family physicians face challenges in maintaining privileges that acknowledge the capabilities of full-scope family medicine. AAFP maintains the following policies on specific areas of importance:

(October 2023 BOD)