Doctors Clash Over NP, PA Say in Physician Privileges

Marcia Frellick

September 27, 2019

PHILADELPHIA — A debate about whether nonphysicians should have a say in decisions about credentialing and hospital privileges for physicians pitted proponents of the idea, especially those from small hospitals, against critics who say nonphysician participation infringes on the scope of a physician's practice.

Nurse practitioners (NPs) and physician assistants (PAs) would be welcome to weigh in on the decisions, but only if they are part of a physician-led credentialing team, some delegates said here at the American Academy of Family Physicians (AAFP) 2019 Congress of Delegates. Others suggested that NPs and PAs should not be part of the discussions, regardless of whether or not they practice independently.

Put simply, "docs should be credentialing docs," said Doug Curran, MD, a delegate from Texas.

The delegates voted on Wednesday to adopt a resolution that opposes credentialing and privileging decisions made solely by nonphysician clinicians.

Daron Gersch, MD, a delegate from Minnesota, said that he worked in a hospital with a medical staff of three for 22 years, and pointed out that many small hospitals have only a couple of physicians and two or three advanced practice providers.

"To have a good credentialing process, you sometimes have to involve the PA or the nurse practitioner," he told Medscape Medical News. "Not that they would solely credential physicians; I think that would be completely wrong."

Gersch said he would also be against credentialing decisions being made by a group in which nonphysicians are the majority. However, rather than having one or two physicians credential a hospital physician, the NP or PA can serve as another set of eyes on the supporting documents and help guard against bias, he explained.

Another Set of Eyes

"Let's say Dr Smith comes into my hospital and I am one of two doctors and I just don't like Dr Smith." Having more people on the team to add opinions can help keep someone from not getting credentialed because of one or two doctors' opinions, he said.

It is important that opposition to the resolution be focused on nonphysicians who practice independently and not those who are part of a credentialing team, said Brian Bacak, MD, a delegate from Colorado, during his testimony on behalf of his delegation.

"NPs and PAs are members of our medical staff," he said. "They are voting members of our medical staff. We sit as a team on a credentials committee."

Doug Gruenbacher, MD, a delegate from Kansas, echoed that thought and said that having NPs and PAs weigh in on credentialing decisions is important to rural hospitals, although he added that they should not be the sole decision-makers.

"We actually credential, in our hospital, cardiologists, orthopedists, urologists, and neurologists," he said. "Do I know what they know? No. Having our nonphysician providers help us in our credentialing is important. They are a vital part of our team."

David Hagan, MD, an Illinois delegate and one of the authors of the resolution, countered that advanced practice providers should not be involved at all in such decisions.

"I, too, practice at a small rural critical-access hospital. We have advanced practice providers on our medical staff but they are not involved in credentialing," he reported.

The impetus for the resolution, he explained, came when he served on a statewide managed care credentialing committee and, "at one meeting, a nurse practitioner was on the call."

"It seemed wrong for a nurse practitioner to be making credentialing decisions regarding physicians. I feel strongly they shouldn't be judging our credentials. They shouldn't be judging our privileges and defining our scope of practice," Hagan said.

"Not Peers"

Bryan Picou, MD, a delegate from Louisiana, agreed, and said he does not believe practice status is important.

"I don't care about independent or not independent, they shouldn't be credentialing doctors. They are not our peers," he said.

Curran, Gersch, Bacak, Gruenbacher, Hagan, and Picou have disclosed no relevant financial relationships.

American Academy of Family Physicians (AAFP) 2019 Congress of Delegates.

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