Hospital admitting privileges are the formal permissions granted by a specific medical facility that allow a physician to practice medicine within that institution. These privileges are distinct from the state-issued medical license, which only grants a general right to practice medicine within a geographic jurisdiction. The hospital essentially authorizes the doctor to use its resources, equipment, and staff to provide patient care. Without these specific permissions, a licensed physician cannot admit patients or perform procedures at that particular hospital.
Defining Admitting Privileges
A physician’s state medical license is the initial, foundational authority, certifying that they meet the minimum requirements for practicing medicine in the state. Hospital privileges, in contrast, are an internal, facility-specific authorization that determines the scope of a doctor’s practice within that hospital’s walls. This is a contractual relationship established between the physician and the hospital’s governing board.
The hospital’s medical staff bylaws set out the specific criteria a doctor must meet to receive privileges and maintain them over time. Granting privileges allows the hospital to maintain control over the quality of care provided by every practitioner who treats patients in the facility. The scope of practice is precisely defined, ensuring a neurosurgeon is only authorized for neurosurgical procedures, and a cardiologist for cardiac care.
The hospital’s governing board holds the ultimate responsibility for granting, limiting, or denying privileges based on recommendations from the medical staff. This system ensures that every practitioner using the hospital’s resources has been individually vetted for competence.
The Credentialing and Review Process
The process of obtaining hospital privileges is known as credentialing, a rigorous review that verifies a physician’s qualifications and professional history. The initial application requires extensive documentation, including medical education, residency training, board certifications, and a detailed work history.
A Medical Staff Executive Committee, composed of senior physicians, oversees the review of the application and peer-review process. This committee assesses the applicant’s clinical competence and professional conduct. They often require professional references from colleagues and supervisors and look for any history of adverse actions or concerns about patient care.
A mandatory component of the review involves querying the National Practitioner Data Bank (NPDB), a federal information clearinghouse. The NPDB contains reports on medical malpractice payments and adverse actions taken against a physician’s license or privileges. This background check prevents practitioners who have had issues in one location from moving to another without disclosure.
Federal law supports this review process through the Health Care Quality Improvement Act (HCQIA) of 1986, which grants a degree of immunity to hospitals and physicians participating in peer review activities. This protection encourages candid feedback and rigorous evaluation of a doctor’s performance without fear of legal retaliation. Privileges are not permanent; re-credentialing is typically required every two years to ensure ongoing compliance and continued competence.
Impact on Patient Care and Physician Practice
Admitting privileges directly determine a physician’s ability to provide continuous care for their patients when hospitalization is required. If a primary care physician has privileges at a local hospital, they can admit their patient directly and serve as the attending physician, overseeing the patient’s entire course of treatment. This allows for seamless continuity from the outpatient clinic to the inpatient setting.
When a patient is admitted to a hospital where their personal physician lacks privileges, that doctor cannot legally manage the patient’s care. In these cases, the patient’s care is transferred to a hospitalist, a physician specializing in inpatient medicine who is on staff at the hospital. The hospitalist manages the patient’s daily care, while the primary care doctor is simply notified of the admission and discharge.
This scenario is common in emergency situations; if a patient arrives at an emergency department, they will be admitted by a physician who is on the hospital’s medical staff, regardless of who their personal doctor is. The absence of privileges means the patient’s primary physician cannot write orders, conduct daily rounds, or manage the patient’s medical plan.
The rise of the hospitalist model has reduced the necessity for all primary care physicians to maintain admitting privileges, particularly in large urban areas. However, for specialists like surgeons, who must be able to perform procedures and manage post-operative care within the facility, full privileges remain a necessity.
Levels and Limitations of Privileges
Privileges are not a single, all-or-nothing status; rather, they are structured into different classifications that define a physician’s responsibilities and rights. The most comprehensive status is typically Active Staff, granting full admitting privileges, voting rights within the medical staff, and often requiring specific service commitments.
Types of Staff Privileges
Other classifications exist to accommodate various practice needs:
- Provisional Staff: A temporary status for new practitioners under peer observation.
- Courtesy Staff: Permits a physician to admit or consult on a limited number of patients per year, generally excluding voting rights or mandatory service requirements.
- Consulting Staff: Granted to specialists who only need to see patients for specific consultations.
Beyond staff classification, privileges are also highly procedure-specific, based on the physician’s documented training and experience. For example, a cardiac surgeon may have general surgical privileges but be limited to only specific, complex procedures, such as transcatheter aortic valve replacement, based on their case logs and volume.