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.