Fam Pract Manag. 2026;33(2):7-10
The publication of this supplement is funded by the American Academy of Family Physicians. Journal editors were not involved in the development of this content.
The scope of practice for family medicine is under pressure. The trend towards increased specialization in medicine and the compartmentalization of care has led other specialists, hospital credentialing committees and insurers to exclude specific procedures from family physicians' scope of practice. The lack of support from administrators, closure of rural hospitals, health system consolidations and private equity takeovers have exacerbated this issue, putting access to quality health care at risk in the United States.1–6 Family physicians can bridge this gap when equipped with self-advocacy tools.
The American Academy of Family Physicians (AAFP) asserts that privileges should be granted based on training, experience and demonstrated current competence, regardless of specialty.7 The AAFP seeks to empower family physicians to advocate for their right to provide full-scope care to improve patient care and health outcomes.
The AAFP and the American Board of Family Medicine (ABFM) recently partnered to create an updated suite of educational materials and other resources to assist family physicians at risk of losing the ability to practice the scope of care they desire and are qualified to provide. The partnership collaborated on these materials and resources with physicians from the Council of Academic Family Medicine, the AAFP Commission on Quality and Practice and three AAFP Member Interest Groups (Obstetrics, Reproductive Health Care and Rural Health) to address issues related to credentialing and privileging.
Family Physician Training and Effectiveness
Family physicians train to care for patients of all ages at all life stages and to diagnose, manage and integrate care in outpatient and inpatient settings.8 Family medicine residents are taught procedures and skills commonly associated with pregnancy, hospital and office-based care across a broad spectrum of medical specialties.9 Additionally, the family medicine residency curriculum emphasizes compassion, respect for diversity and responsiveness to patient needs within the context of medical knowledge and skills.
Through their training and acquired skills, research has shown that family physicians achieve similar or better patient outcomes compared to other specialists when providing and performing the following care and procedures: maternity care,10–13 colonoscopies,14–17 musculoskeletal injections,18,19 dermatological procedures20 and point-of-care ultrasound.21
Physicians trained in other specialties or subspecialties may not fully understand family medicine training and the specialty's full scope of care, which may be problematic during privileging decision-making. The ABFM has implemented a set of 15 core outcomes for all residency graduates, for which program directors attest to their competency for independent practice.22 These core outcomes include the stipulation that all residency graduates are able to provide care for children and adults in hospital-based settings, for pregnant patients and to perform a number of procedures.23 In addition to the core outcomes, many programs train residents in additional areas and procedures to meet anticipated community needs. Using a competency-based medical education framework, these programs design flexible curricula with frequent assessments to ensure competency. The move away from set numbers and time requirements can be challenging for medical staff and credentialing committees that are unaware of changes in medical education.
The Accreditation Council for Graduate Medical Education (ACGME) has also made progress in its most recent update to the family medicine residency requirements, providing a standardized curriculum for pregnant patients.8 The ACGME created a two-tiered set of criteria: one for the basic care of pregnant patients and the other for advanced but non-surgical care. It lays out expectations that others can use to assess a family physician's ability to provide pregnancy-related care.
AAFP Resources on Privileging
To support family physicians in privileging and credentialing, the AAFP has created an extensive collection of educational materials and other resources. They include information about obtaining credentials and privileges, frequently asked questions, handling hospital privileging disputes and member-exclusive access to a 2017 legal opinion on privileging. Through a recent collaboration, the AAFP created a CME course with faculty, Shani Muhammad, MD, FAAFP, and John Cullen, MD, FAAFP. The course is designed to help family physicians understand the complex privileging and credentialing processes within institutions and to advocate for themselves, their patients and our profession.
We've also recently developed a self-advocacy guide for family physicians seeking obstetrics privileges that contains information about AAFP policies, family medicine training and a list of common gynecology, obstetrics and newborn care privileges for family medicine, as well as common privileges for family physicians with advanced training. The guide helps you advocate for privileges by providing information on the positive health outcomes patients experience when family physicians provide maternity care, as well as talking points about the training and workforce of family physicians in obstetrics care. It also contains a link to two sample letters, one for community partners or patients to provide evidence of the need for family physicians to provide pregnancy care and the other for you to send to a privileging committee outlining the AAFP's privileging policies. Lastly, to further help you advocate for obstetrics privileges, we developed a PowerPoint presentation to accompany the guide, intended to educate hospital and health system leaders and administrators about the value of family physicians providing obstetrics care.
AAFP Policies, Position Papers and Joint Statements on Privileging
To further advocate and make your case for privileges for many other common procedures and skills within the scope of family medicine, visit our webpages on the following topics:
Common Issues That Delay Credentialing Applications
Physicians who have served on credentialing committees have provided the AAFP with insights into the issues that may delay or prevent family physicians from gaining privileges. We've summarized their tips below to ensure your application is complete, accurate and on time.
Keep a procedure log after you graduate from residency. While many health systems can gather procedure logs from an EHR, many physicians have found it challenging to get these records.
Start the privileging and/or credentialing process at least 3–6 months before your start date and be aware of submission deadlines. Committees may meet infrequently, and if your application and support materials are not all accounted for by the deadline, the next review opportunity may be months later.
Be honest in your applications and disclose any gaps in clinical care or past issues, such as malpractice case(s) and/or disciplinary action(s).
Thoroughly review the application and ensure your application is complete before submitting. Omissions or errors can cause significant delays.
Choose colleagues who know you well to write letters of recommendation. They can provide a thorough, up-to-date evaluation of your skills and competencies. If there are any parts of a form for recommendation writers to fill out that include your name, credentials, contact information, etc., fill them out in advance for your colleagues before sending it to them.
Understand your institution's procedural standards. If you haven't met the number of procedures, you may be required to undergo clinical supervision or proctoring before full privileges are granted.
Increase Support for Family Physicians Within Your Organization
Your family medicine department, family physician colleagues and future family physicians can benefit when you create strong working relationships with other specialists within health systems. Cultivating relationships creates buy-in and confidence in our specialty and for other family physicians who perform procedures. These relationships can be instrumental when family physicians in your organization need to advocate at the institutional level. The following are suggestions to help strengthen interdisciplinary relationships:
Spend time in the unit where procedures are performed and get to know the physicians and staff who work there. For example, newborn privileges can often be more straightforward and get you assigned to the unit providing clinical care. Likewise, if you wish to perform colonoscopies, visit the gastrointestinal lab and introduce yourself to the gastroenterologists.
Host an interdisciplinary journal club and conduct case reviews (e.g., family medicine obstetricians can invite perinatal physicians from departments such as OB/GYN, family medicine, pediatrics and anesthesia).
Teach Advanced Life Support in Obstetrics and Basic Life Support in Obstetrics courses in your health system and encourage clinicians from other disciplines to obtain training and assist in teaching courses.
Develop collaborative agreements (e.g., offer to be on standby for deliveries when the primary physician is pending).
Serve on other interdisciplinary committees or work groups, including quality committees, peer review and credentialing groups.
Share workspace, triage, rounding and call with physicians from other specialties.
Showcase the value of family medicine by looking at institutional, community or national data (e.g., examine workforce shortage data and make a case for how family medicine is filling the gaps). Other data sources that might reveal the need for and value of family medicine include the number of ER visits, unassigned OB cases (due to lack of prenatal care), and quality metrics and patient satisfaction data.
Represent Family Medicine to Your Institution's Leadership and Administrative Committees
Physicians who have served on credentialing committees consistently note that having a representative from the family medicine department on the credentialing and medical executive committees is extremely valuable for maintaining the scope of family medicine. Without a family physician at the table, there is no advocate to ensure that committee members understand the depth and breadth of care that family physicians provide. Serving on these committees allows family physicians and other specialists to interact and appreciate each other's processes, skills, contributions and unique challenges. While many of these roles are voluntary, serving can be professionally revealing and rewarding.
“When family physicians serve in these roles, we have the opportunity to shape the conversation around privileges rather than letting others do it for us.”
- Simon Griesbach, MD
The resources, strategies and tips we've outlined in this article can empower family physicians not only to navigate the complexities of privileging and credentialing for themselves but also to become influential leaders who shape their institutions for their generation and future family physicians. Protecting and expanding the scope of family medicine is an imperative for all of us. It is vital to safeguard access, equity and quality in health care.
The AAFP would like to thank the following members for their guidance, tips and expertise through conversations and other correspondences: Gary L. LeRoy, MD, FAAFP; Stacey Bartell, MD; Bernard Birnbaum, MD; Simon Griesbach, MD; John J. Saxer, III, MD, FAAFP; Danielle Carter, MD, FAAFP; Erick Skaff, MD; Varshaben M. Songara, MD, MHPE; Elizabeth A. Davis, MD, MBA; Rebecca Pfaff, MD; Bindusri Paruchuri, MD, FAAFP; Wendy B. Barr, MD, MPH, MSCE, FAAFP; Nicholas Schenk, MD, FAAFP; Tyler Barreto, MD, MPH, FAAFP; Kelsie A. Kelly, MD, MPHC; Peony Khoo, MD, FAAFP; Renee Crichlow, MD, FAAFP; John Cullen, MD, FAAFP; Shani Muhammad, MD, FAAFP; Mark Loafman, MD, MPH; Divya Reddy, MD, MPH; Karen Mitchell, MD, FAAFP; Janet Hurley, MD, MBA, FAAFP; and Samantha Elwood.
