Ten strategies to secure hospital privileges as a family physician

As I’ve pursued privileges for those procedures, I’ve broadened my network, been more active and learned persistence and strategic engagement. My efforts to obtain procedural privileges opened the door for my patients to benefit from comprehensive, continuous care delivered by their preferred doctor while connecting me more deeply to my profession and letting me take care of the whole patient.

Having privileges to provide the procedures that were important to my patients allows me to practice to the full extent of my training: a recipe for professional fulfillment, whether you’re employed or own your own practice.  

I want to share 10 strategies to get you from “How do I get privileges” to “I’m doing everything I want to do.”

1. Perseverance pays off

My most consistent message to my peers needing privileges is simple: Don’t give up.

This is a process that sometimes takes repeated, professional advocacy. Some hospitals approved my privileges immediately; others took years. One system held me off for five years before finally granting the scope I was trained for. During that time, I referred my patients to hospitals where I already had privileges—persistence that ultimately helped shift attitudes.

2. Build credibility by showing up in the hospital

Regular rounding and visible, efficient inpatient care build trust. When I managed my own inpatients, I consistently saw that care was more efficient and costs were lower: concrete evidence that reinforced my requests for broader privileges.

3. Claim a seat at the table by serving on medical staff committees

Committee work was a turning point for me. By serving on a medical executive committee and related groups—assemblies that often need more people than they’re able to marshal—I gained a voice in privileging decisions, challenged restrictive policies and helped colleagues understand my training.

At one hospital, a new chair happened to have a brother practicing family medicine and so immediately understood our scope and supported fair criteria.

4. Build your network and call on it

Cultivate allies who are willing to document your competence.

Letters from specialists who trained me or worked with me, as well as from residency faculty, were invaluable when I was seeking privileges. When needed, I even invited department chairs to observe procedures so they could sign off from firsthand experience.

5. Be ready to have eyes on you

Observation is routine and necessary, and I have always welcomed it. Even when I was nervous, demonstrating skills directly often accelerated approvals. Confidence plus transparency is a formula for advancing your progress.

6. Apply to more than one hospital to generate leverage

The majority of my career has been as an independent physician. My patients are served by multiple hospitals in different health systems. I applied for privileges at several hospitals, which worked to my advantage. One hospital withheld hysteroscopy privileges until I showed that I had approvals elsewhere. Once other institutions granted them, that domino fell.

Parallel applications for privileges, when you have these other pieces in place, help you generate momentum and leverage.

7. Negotiation is a practical path to “yes,” not a retreat

Those times when I wasn’t at first offered full approval for privileges, I negotiated, setting reasonable criteria that centered safety while reflecting my training and skills. For example, I successfully advocated for family physicians to be able to conduct open breast biopsies less than or equal to 3 centimeters.

I also worked to make sure that privileges for some procedures could be maintained, sometimes under monitoring, even when recent case numbers were low. That was a meaningful bylaws victory, one that all specialties embraced and that was especially beneficial for new physicians. Another way to allow family physicians to obtain or maintain privileges with a low number of a specific procedure is to group related procedures for privileging purposes. Family medicine is so broad that a specific tally of procedures doesn’t necessarily reflect our mastery.  

8. Challenge restrictive policies—constructively

When you see policy that defines scope for family physicians rather than proficiency, you have some room to push back. Some rules are outdated.

For instance, I’ve seen at least one case in which a family physician with substantial C-section experience was denied that privilege solely due to a hospital policy favoring obstetricians. On the other hand, one hospital mandated that all EKGs—even outpatient studies—be read only by cardiology. I pointed out that EKG interpretation is a core family medicine competency, an argument that helped restore that scope.

Remember: You can confidently advocate for yourself and family medicine colleagues by leaning on AAFP policy, which says privileging decisions and criteria should be based on training, experience and demonstrated current competence, and should hold all physicians to the same standards when granting privileges, regardless of specialty.

Rely on evidence, your training documentation, your documented procedure log, and other AAFP resources on credentials and privileges to build a case for obtaining the privileges you want.