Clinical Privileges

Family Medicine/General Practice

Clinical Privileges

Name: ______

Effective from ______/______/______to ______/______/______

❏ Initial privileges (initial appointment) ❏ Renewal of privileges (reappointment)

All new applicants must meet the following requirements as approved by the Health Authority, effective: ____/____/____.

Applicant: Check the “Requested” box for each privilege requested. Applicants have the burden of producing information deemed adequate by the Health Authority for a proper evaluation of current clinical activity, and other qualifications and for resolving any doubts related to qualifications for requested privileges.

[Department chair/chief]: Check the appropriate box for recommendation on the last page of this form and include your recommendation for focused professional practice evaluation. If recommended with conditions or not recommended, provide the condition or explanation on the last page of this form.

Other requirements

Note that privileges granted may only be exercised at the site(s) and/or setting(s) that have sufficient space, equipment, staffing, and other resources required to support the privilege.

This document is focused on defining qualifications related to clinical privileges. The applicant must also adhere to any additional organizational, regulatory, or accreditation requirements that the organization is obligated to meet.

DEFINITION: The family physician/general practitioner is a skilled clinician who, serving a defined population, is competent in the person-centred clinical method; integrates a sensitive, skillful, and appropriate search for disease; acknowledges uncertainty; utilizes the cure/attenuation/comfort spectrum of treatment and addresses community health status indices.

As a generalist, the FP/GP, works collaboratively with the patient, their family and the health care team to optimize care, willand provides comprehensive care throughout the continuum of a person’s illness experience, and lifespan. The FP/GP understands the central role of the person-physician relationship and competently applies the concepts of evidence-informed care, advocacy and stewardship to improve the person’s bio-psycho-social-spiritual health, regardless of the clinical setting.

With reflection and self- and peer-assessment, the FP/GP undertakes continual professional self-improvement.

The FP/GP undertakes to mentor and teach colleagues to the best of his/her ability.

Qualifications for family medicine

Initial privileges: To be eligible to apply for privileges in family medicine, the applicant must meet the following criteria:

Current certification in Family Medicine by the College of Family Physicians of Canada or possession of equivalent credentials acceptable to both the College of Physicians and Surgeons of British Columbia and the governing body (organization name).

AND

Maintains an office practice and has either been the most responsible physician for twelve admitted patients in the past two years OR has been a member of an assigned inpatient care network in the past two years OR has successfully completed a residency in family medicine in the past two years OR is willing to work under the supervision of a mentor while on the provisional medical staff.A measure of current experience to be determined

Core privileges: Family medicine

❑ Requested Admit, evaluate, diagnose, treat, and provide consultation to patients of all ages, with a wide variety of illnesses, diseases, injuries, and functional disorders of all body systems. Provides comprehensive, coordinated, and longitudinal care of patients, families, and communities in collaboration with other professional colleagues. May provide care to patients in the intensive care setting in conformance with unit policies. Assess, stabilize, and determine disposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultative call services. The core privileges in this specialty include the management of conditions using procedures on the attached procedures list and such other procedures that are extensions of the same techniques, cognitive and manual skills. A very important skill is the cognitive ability of the physician to understand his/her skill set and the clinical situation surrounding the management of the patient.

Renewal of privileges: be a member of an assigned inpatient care network or act as the most responsible physician for 6 patients a year averaged over three years.a measure of current experience to be determined.

Return to practice: Work under the supervision of a member of the medical staff holding core privileges in family medicine and audit of hospital practice by department head or chief of staff after six months.

Core privileges: Refer and follow

❑ Requested: order outpatient diagnostic tests and services, visit patients in the hospital, review medical records, consult with the attending physician, and observe/assist diagnostic or surgical procedures with the approval of the attending physician or surgeon.

Initial privileges: Education and training, as for family medicine core privileges, current experience in MRP inpatient care not required.

Renewal of privileges: continued membership in good standing on the medical staff.

Core privileges: Obstetrical

❑ Requested Admit, evaluate, manage the care of pregnant women, labor and delivery, procedures related to delivery, postpartum care, and care of the newborn, which includes medical and psychiatric conditions that are complicating factors. Assess, stabilize, and determine the disposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultative services and transfer to another facility. Consult with other members of the medical staff as appropriate. The core privileges include the procedures on the attached procedures list and such other procedures that are extensions of the same techniques and skills.

Initial privileges: To be eligible to apply for privileges in family medicine obstetrics, current certification in family medicine or licensure as a family physician by the CPSBC by virtue of credentials acceptable to both the College and the governing body, plus:

· Neonatal Resuscitation Program (NRP) or equivalent certification within 2 years.

· participation in a simulated emergency skills workshops that should include the following conditions: shoulder dystocia, post-partum hemorrhage, emergent assisted vaginal delivery, unexpected breech delivery and identification and management of abnormal fetal health assessment. Simulation should include multidisciplinary members of staff providing maternity care. Programs that emphasize team-based delivery of care are preferable.

· Documentation from the FP residency director, or a facility-designated physician leader (e.g. chief of staff) that the applicant has skill in obstetrics.

and

Required current experience:

The safe, skilled, and peer reviewed management of five labours and five births over the previous 36 months. The foundation for quality outcomes is a rigorous Continuous Quality Improvement process from a committed maternity care team.

Graduation from a family medicine residency, which included obstetrics within the past 24 months.

Renewal Of Privileges:

· NRP or CARE recertification within 2 years

· The safe, skilled, and peer reviewed management of five labours and five births over the previous 36 months. The foundation for quality outcomes is rigorous Continuous Quality Improvement process from a committed maternity care team.

Return to Practice

· Return to the practice of obstetrics after 3 or more years: a preceptorship acceptable to the Health Authority designated physician lead with supervision of core procedures relevant to the intended scope of practice.

Core Obstetrical Procedure List

This is not intended to be an all-encompassing list. It defines the types of activities/procedures/privileges that the majority of practitioners would skillfully perform, and inherent activities/procedures/privileges requiring similar skill sets and techniques

· Spontaneous vaginal delivery of a fetus in vertex presentation

· Induction of labor

· Augmentation of labor

· Induction of labor

· Management of Vaginal Birth after Caesarian Delivery for singleton pregnancy with one prior uterine scar

· Vacuum assisted delivery at low/outlet

· Surgical assist at Caesarean Delivery

· Manual removal of placenta

Non-core Obstetrical Procedures:

· Dilatation and curettage

· Surgical management of abortion

· Caesarian delivery with tubal ligation (if requested)

· US for management of abortion: spontaneous and therapeutic

· Point of care ultrasound for assessment of amniotic volume, placental location

· Repair of third and fourth degree perineal tear.

· Repair of cervical laceration

· Pudendal anesthesia

Special Non-core Privileges (See Specific Criteria)

Non-core privileges are requested individually in addition to requesting the core. Each individual requesting non-core privileges must meet the specific threshold criteria as applicable to the applicant.

Non-core privileges Obstetrics

Non-core privileges: Low/Outlet Forceps of a fetus in vertex presentation

❑ Requested

Initial privileges:

held this privilege prior to [initiation date of dictionary]

and/or

documentation of successful completion of residency in family medicine that included training in low/outlet forceps delivery

and/or

completion of hands-on training under the supervision of a qualified physician preceptor

and

Required current experience: Documentation from the FP residency director, or a health authority designated physician leader (e.g. chief of staff) that the applicant has skill in this procedure, and has performed the procedure acceptably three times in the past 36 months

Renewal of privileges: demonstrated current competence based on results of ongoing professional practice evaluation and outcomes and performance one procedure per year averaged over the past 36 months

Return to practice: Physician will create an individualized learning plan and complete requirements in collaboration with the agency designated physician leader.

Non-core privilege: Repair of third degree perineal tear

❑ Requested

Initial privileges: held this privilege prior to [initiation date of dictionary]

Successful completion of residency in family medicine that included training in repair of third degree perineal tear

completion of hands-on training under the supervision of a qualified physician preceptor

AND

Required current experience: Documentation from the FP residency director, or health authority designated physician leader (e.g. chief of staff) that the applicant has skill in this procedure, and has performed the procedure acceptably in the past 24 months

Renewal of privileges: discussion with lead physician as to level of comfort with the procedure.

Return to practice: Physician will create an individualized learning plan and complete requirements in collaboration with the agency designated physician leader.

Non-core privilege: Repair of fourth degree perineal tear

❑ Requested

Initial privileges:

held this privilege prior to [initiation date of dictionary]

Successful completion of residency in family medicine that included training in repair of fourth degree perineal tear

completion of hands-on training under the supervision of a qualified physician preceptor

AND

Required current experience: Documentation from the FP residency director, or a facility-designated physician leader (e.g. chief of staff) that the applicant has skill in this procedure, and has performed the procedure acceptably in the past 36 months

Renewal of privileges: demonstrated current skill based on results of ongoing professional practice evaluation and outcomes and performance one procedure per year averaged over the past 36 months

Return to practice: Physician will create an individualized learning plan and complete requirements in collaboration with the agency designated physician leader.

Non-core privilege: Pudendal anesthesia

❑ Requested

Initial privileges:

held this privilege prior to [initiation date of dictionary]

Successful completion of residency in family medicine that included training in pudendal anesthesia

completion of hands-on training under the supervision of a qualified physician preceptor

AND

Renewal of privileges: demonstrated current skill based on results of ongoing professional practice evaluation and outcomes and performance of one procedure per year averaged over the past 36 months, or demonstration of skill in simulation.

Return to practice: Physician will create an individualized learning plan and complete requirements in collaboration with the agency designated physician leader.

Non-core privileges Circumcision

❑ Requested

Initial privileges: Successful completion of residency in family medicine that included training in circumcision or completion of hands-on training under the supervision of a qualified physician preceptor.

AND

Required current experience: Selena to research

Renewal of privilege:

Non-core privileges Vasectomy

❑ Requested

Initial privileges: Successful completion of residency in family medicine that included training in vasectomy or completion of hands-on training under the supervision of a qualified physician preceptor.

AND

Required current experience: performance of the procedure in the past 36 months.

Renewal of privilege: performance of the procedure in the past 36 months.

Non-core privileges: Point of care ultrasound[1]

❑ Requested

Initial privileges: Successful completion of an accredited postgraduate training program that included training in ultrasound OR completion of the practice-based pathway and training that meets currently available locally determined standards.

AND

Required current experience: Demonstrated current skill and evidence of the performance of regular ultrasound interpretations, reflective of the scope of privileges requested, in the past 36 months.

Renewal of privilege: To be eligible to renew privileges in point of care ultrasound, the applicant must meet the following criteria:

Demonstrated current skill and evidence of the performance of regular ultrasound interpretations, reflective of the scope of privileges requested, in the past 36 months based on results of ongoing professional practice evaluation and outcomes.

Return to practice: Demonstrated ongoing skill through a practical demonstration or by repeating an acceptable ultrasound course.

Non-Core Privileges: ultrasound in the context of delivering abortion services

❑ Requested

Initial privileges: Completion of 50 supervised ultrasounds in patients seeking therapeutic abortion privileges.

AND

Required current experience: Demonstrated current skill and evidence of the performance of regular ultrasound interpretations, reflective of the scope of privileges requested, in the past 36 months.

Renewal of privilege: To be eligible to renew privileges in therapeutic abortion related ultrasound, the applicant must meet the following criteria: