AMA aims to boost medical staff autonomy

At a time of growing animosity between staffs and hospitals, the Association calls for laws to guarantee physician independence.

By Victoria Stagg Elliott — Posted July 12, 2004

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Chicago -- Legislation is needed to bolster the ability of hospital medical staffs to govern themselves, according to policy adopted at the American Medical Association's Annual Meeting in June.

"We strongly support physician autonomy and self-governance because it has implications for patient advocacy and quality practice," said LaMar McGinnis, MD, from the American College of Surgeons. "It's very important for us to be on guard and take measures to preserve this very important aspect of physician function within the hospital."

The relationship between hospitals and physicians has a long tradition of uneasiness and tension. The growing acrimony, in part driven by financial pressures on both parties and involving the courts more and more, led the AMA to adopt several new polices.

"It's exciting and sort of sad to see such a string of resolutions related to self-governance," said Joseph L. Murphy, MD, an Organized Medical Staff Section delegate. "I sure hope this works for all of our doctors who are having problems all over this country."

To that end, the AMA also wants to work with the Joint Commission on Accreditation of Healthcare Organizations to lengthen the appointments of medical staff from every two years to every four years. Physicians complained that the process was too time-consuming to happen so frequently.

The Association also plans to develop a third edition of the Physician's Guide to Medical Staff Organization Bylaws. The second edition was published in September 2002, and members felt an update was necessary to help staff working at hospitals better navigate the rules that govern them.

The AMA is also studying whether staff bylaws should be considered contracts. In some situations this has proven to be legally advantageous, but the Association wants to study possible ramifications before taking action.

"We're concerned about what that would bind us into. It could have a backlash of making us less autonomous," said Chris Unrein, DO, an internist and delegate from Denver.

If the AMA cannot stop the fighting, it is hoping that at least it can establish some rules of engagement. It plans to support legislation guaranteeing that doctors involved in disputes will have full access to any related medical records.

"Imagine if you had two or three patients that questioned your skills in a hospital setting." Dr. Murphy said. "They were threatening discipline to you, and you could not even have a copy of records. I can't believe that anyone would not be shaken by that."

Also, in response to reports of doctors being forced to resign if they lack liability insurance tail coverage, the AMA plans to study alternatives.

In related action, the organization also announced its opposition to forced subspecialty consultation. This action came in response to complaints that patients were being forced to see specialists based on their disease state to bump up revenue for the hospital and other doctors even though the primary care physician did not believe the consultation was necessary.

"It should be a physician who determines whether a specialty consultation is necessary," said Paul Wertsch, MD, a family physician and alternate delegate from Madison, Wis. "There's going to be a lot more costs generated, and it's something we need to watch."

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To-do list

Delegates agreed to take several actions on medical staff issues:

  • Oppose mandatory subspecialty consultation in hospitals.
  • Work with JCAHO to change the requirement for reappointments to medical staff from every two to every four years.
  • Support legislation guaranteeing that physicians will have full access to medical records related to any disputes.
  • Develop a third edition of the Physicians' Guide to Medical Staff Organization Bylaws.
  • Study whether medical staff bylaws should be considered a contract.
  • Look at alternatives to the forced resignation of medical staff who do not purchase or are otherwise unable to access medical liability tail coverage.

Source: AMA Annual Meeting proceedings

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External links

AMA's downloadable resources, for Physician's Guide to Medical Staff Organizational Bylaws, 2nd Edition, available to AMA members (link)

AMA's Organized Medical Staff Section (link)

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