By David Abercrombie
Are all doctors in Madison County associated with the hospital or are they allowed to visit their patients in the hospital?
Though hospitals and physicians work together to take care of hospitalized patients (and run test on outpatients), only a physician can put a patient into a hospital. This procedure is called “admitting a patient.” For the outpatient, the procedure is usually called, “ordering a test.” To be allowed to do this, the physician must have membership on that hospital’s medical staff.
All hospitals across the country have an organization within the hospital called a physician medical staff. And all of these hospitals have a similar medical staff organizational structure, though they do vary with the complexity of the hospital. Physicians (a term that in this context includes medical doctors, or MDs and osteopathic doctors, or DOs) are an independent self-governing professional group of physicians (and sometimes including mid-level practitioners) that operate within the broader hospital policy structure.
A medical membership consists of qualified physicians who have applied for membership and who meet membership criteria, and who have been granted membership through a medical staff membership vote.
These criteria for membership and how membership is granted are part of a medical staff’s governance. A medical staff governs itself through the development and implementation of its own organizational by-laws and a set of rules and regulations. Because a medical staff operates within the confines of a hospital building and because everything they do impacts every part of patient care, their by-laws and their rules and regulations are subject to the approval of that hospital’s board of directors (Board). It is exceedingly rare for this approval to be withheld. As physicians are the experts in the provision of patient care, the Board usually accepts their collective judgment as to what is best in the way of patient care standards and practices. This high level of expertise makes them essentially autonomous.
Usually each year, a medical staff will elect its own leadership. In Madison, this leadership consists of a chief of staff (chairman), a vice-chief of staff and a secretary. They meet quarterly to discuss patient care and medical staff organizational issues. MCMH supplies a medical staff coordinator (Linda Cherry) to help the medical staff schedule its meetings, to take minutes of meetings and to handle other such coordinating duties.
A MCMH Board member (Annette Johnson) and Members of the hospital senior staff (David Abercrombie and Tammy Stevens, RN), as well as the hospital pharmacist (Ted Sanders) also attend these meetings. They do not attend as members of the medical staff, but rather in a capacity to help coordinate mutual physician/hospital patient care activities.
Madison County Memorial Hospital (MCMH) does indeed employ physicians, but does not employ all of the physicians (nor all of the mid-level practitioners) that practice in Madison County.
Generally, physicians fall in one of four categories – employed by the hospital; self-employed and in private practice; physician-owned special contracted physician services; and physician practicing in Madison County but not associated with the hospital nor the hospital medical staff in any way. The first two of these are self-explanatory. The third – specially contracted physicians are actually groups of physicians who own a company that contracts with many different hospitals to provide special services. At MCMH, these include Southland EMS, a physician-owned company that provides ER coverage by physicians and mid-level practitioners; and Doctors Laboratories, a physician-owned company that provides the hospital with laboratory pathology, monitoring and directorship.
Physicians from the first three of these categories may hold MCMH medical staff memberships. Physicians from the fourth group do not.
MCMH medical staff membership allows the member to admit patients to the MCMH and to come into the hospital and take care of their patients (called “following a patient”). In doing so, they must always abide by the MCMH medical staff by-laws and rules and regulations. Physicians in that fourth category who do not have membership cannot admit a patient, nor follow a patient at MCMH, nor order outpatient tests.
For example, a MCMH medical staff physician may admit and follow a patient at MCMH. However, this same physician may not admit and follow a patient at any other hospital unless the physician has membership on both hospital medical staffs. In large cities, it isn’t unusual for physicians to be on multiple hospital staffs. However, the number of meetings a physician must attend, along with committee duties, and other associated duties, make it difficult to maintain membership on the medical staff of more than two or three hospitals.