Obtaining Hospital Privileges: A Guide for Procedural Family Physicians

Many family physicians complete training with the skills their communities urgently need. They are competent, having trained under excellent attendings, and have diligently developed procedural expertise. They are confident and ready to deliver care safely and effectively — yet often find themselves unable to obtain hospital privileges.

For more than a decade, starting during my time on the American Academy of Family Physicians’ (AAFP) Board of Directors, I have worked closely with family physicians struggling with this issue, particularly in obstetrics (including cesarean sections), emergency medicine, and endoscopy. Many of them met or exceeded procedural numbers required for other specialties — only to find the goalposts moved when they applied for privileges. Some were even promised privileges by administrators but later blocked by the hospital medical staff, leaving them contractually obligated but professionally sidelined.

I also observed that many family physicians had unrealistic expectations about how privileges are granted, while others missed opportunities to advocate effectively for themselves and their patients. Unfortunately, current U.S. case law grants significant power to local hospital medical staff in defining and granting privileges. This legal framework is precedent-based and could have evolved differently.

In 1994, Eric Runte, MD, a family physician, relocated to Sonora, Calif., to serve as medical director for a pregnancy care clinic operated by Tuolumne General Hospital (TGH). The hospital had closed its labor and delivery unit in 1982 but continued its obstetric services through a contract with a private obstetrics/gynecology (OB/GYN) group. Physicians in this group were members of the OB/GYN department at the other hospital operating in Sonora at that time, Sonora Community Hospital (SCH). After the OB/GYN group lost its contract with TGH, Dr. Runte was hired and applied for cesarean section privileges at SCH. He had performed more than 110 primary cesarean sections during residency and was deemed competent by his preceptors, who provided supportive testimony and letters. There was clear patient need. However, the SCH medical staff — particularly the OB/GYN department — changed the privileging criteria to require OB/GYN residency training, effectively disqualifying Dr. Runte. Despite following due process through the medical staff bylaws, his application was denied.