Many patients assume their personal physician can treat them wherever they are hospitalized. The relationship between a doctor and a hospital is governed by formal agreements called admitting privileges. Understanding these privileges is important because their presence or absence directly impacts a patient’s care during an inpatient stay. This article clarifies what admitting privileges mean and provides practical steps for patients to navigate care transitions if their doctor is not affiliated with a hospital.
Defining Hospital Admitting Privileges
Admitting privileges represent the formal permission granted by a hospital’s governing board to a physician. This authorization allows the doctor to use the hospital’s facilities, equipment, and resources to admit and manage the treatment of their patients. It essentially grants them the authority to practice medicine within that specific institutional setting.
These privileges are distinct from a physician’s medical license, which is granted by a state medical board. A license confirms the physician is legally able to practice medicine within the state, while privileges are an institutional approval process confirming they meet the hospital’s internal standards. The process involves a thorough review of the doctor’s credentials, training, and professional history.
Hospitals may grant different levels of privileges, such as “full” for complete patient management, or “courtesy” for doctors who rarely need to admit patients. The granting of privileges is a rigorous process designed to ensure high standards of patient safety and quality of care. The absence of privileges is often a logistical matter concerning institutional access, not necessarily a reflection of the doctor’s clinical skill level.
Reasons a Doctor Might Not Have Them
The most common reason a physician lacks privileges is that their practice is exclusively focused on outpatient care, such as preventative medicine or routine office visits. Many primary care providers and specialists operate solely from private offices or clinics, meaning they do not routinely need to admit patients. For these doctors, obtaining and maintaining hospital privileges is often unnecessary and time-consuming.
In some cases, the physician may be new to the geographic area or recently finished their training and has not yet completed the extensive credentialing process required by the hospital. This application and review period can take several months, creating a temporary gap in their official hospital affiliations.
Structural changes in healthcare delivery often play a role, as some hospital systems require physicians to be full-time, employed staff to receive privileges. An independent physician, or one utilizing a specialized model like concierge medicine, might intentionally choose not to pursue privileges to maintain autonomy or focus on their chosen scope of practice.
The Process During Hospitalization
When a patient requires admission to a hospital where their personal physician lacks admitting privileges, care management immediately transitions to a hospitalist. A hospitalist is a physician whose professional focus is entirely dedicated to the care of hospitalized patients. They are specifically trained to manage the complex environment of inpatient care.
The hospitalist takes over the responsibilities of ordering necessary diagnostic tests, interpreting results, prescribing medications, and coordinating specialty consultations while the patient is admitted. This model ensures that a dedicated physician is physically present within the facility throughout the day to monitor changes in the patient’s condition and respond rapidly to any emergencies.
This transfer of care does not mean the patient’s regular doctor is entirely excluded from the process. While the hospitalist holds the official responsibility for writing orders and directing daily treatment, they frequently communicate with the patient’s primary care physician or specialist. This communication provides the hospitalist with necessary background information, including the patient’s medical history and baseline health status.
The personal doctor acts as a consultant, offering insights and context that help the hospitalist formulate an appropriate treatment plan. Once the patient is ready for discharge, the hospitalist prepares a comprehensive summary and communicates the final treatment details back to the personal physician. This ensures a smooth transition back to the care of the primary doctor for post-hospital follow-up.
Patient Action Steps and Planning
Patients can proactively manage this scenario by initiating a direct conversation with their doctor about hospital affiliations before an emergency arises. It is prudent to ask which specific hospitals the physician has full admitting privileges with and which hospitals they have established consulting relationships. Knowing this information allows the patient to express a preference for a facility where their doctor can actively participate in their care.
Understanding the doctor’s network also involves inquiring about the specific hospitalist groups they typically work with and trust for inpatient management. This preparation helps to minimize anxiety during an unexpected admission by making the patient familiar with the expected care team structure.
Another important planning step is ensuring all current medical records, including up-to-date medication lists and recent test results, are digitized and easily accessible. Facilitating the quick transfer of this detailed information significantly aids the hospitalist in making informed decisions immediately upon admission.
For patients who place a high value on having their personal physician oversee their care during an inpatient stay, a long-term strategy involves choosing a primary care provider or specialist who is fully employed or affiliated with a major local hospital system. This choice provides the highest assurance of continuous care from a familiar provider, should hospitalization become necessary.