The medical staff and the hospital historically have had a unique relationship of interdependence which has developed mostly over the last half century. In this symbiotic relationship, physicians need the technology and facilities generally available only at the hospital and the hospital cannot function without the professional services provided by members of the medical staff. Indeed, with the expansion of alternative sites for providing healthcare services, such as ambulatory surgery centers, the unique relationship between physician/healthcare provider and healthcare facilities has continued to evolve and to generate issues among those involved in the relationship.
In what began as a relationship which was often overlooked, the medical staff/healthcare entity relationship has grown into one of the most scrutinized and complex unions in the healthcare arena. Historically, most members of a healthcare entity's medical staff are not employees, or even independent contractors, of the healthcare entity. Typically, no compensation is paid by the healthcare entity to a medical staff member. (However, additional reimbursement concerns generated by adoption of the health care reform legislation has resulted in a shift toward increased employment and other relationships between physicians and healthcare entities). Rather, a medical staff member directly bills for the professional services he/she provides, and the healthcare entity directly bills for the technical/facility services it provides.
Thus, the relationship between a healthcare entity and a medical staff member is more in the nature of a limited "license" granted by the healthcare entity to the medical staff member to use its facilities to provide medical care, so long as certain requirements are met. As the healthcare industry continues to face increasing pressure from regulators and the market place, the medical staff/healthcare entity dichotomy likely will become more difficult to manage in a mutually beneficial manner. At the heart of this balancing act are the medical staff bylaws. The medical staff bylaws (i) establish the rights and responsibilities of medical staff members and the governing body and (ii) the governance structure of the medical staff. Well-drafted versions of this key governing document will assist in creating an environment where the medical staff and the healthcare entity can have a cohesive working relationship, which can enhance patient care. On the other hand, poorly drafted, piecemeal versions of governing documents likely will result in impediments to successful collaborations between medical staffs and healthcare entities.
At the beginning of the twentieth century, the American College of Surgeons ("ACS") was focused on the improvement of the quality of care provided to patients. The ACS started a movement to work on standardizing hospitals in the United States. As an organization of physicians, one of its focuses in this standardization movement was on the medical staff of hospitals. See generally, Tom Curtis, The Medical Staff, Treatise on Health Care Law, Chapter 6, § 6.01 (Michael G. McDonald, et al eds., 1995) for a detailed discussion of the historical background of medical staffs. The ACS eventually developed a program of standardization of hospitals, which required participating hospitals to submit to annual surveys. In what became the basis for the Joint Commission's Standards, the ACS standardization program was the beginning of the development and refinement of medical staff organizations.
As the standardization movement evolved, the ACS was joined in 1952 by the American Medical Association, the Canadian Medical Association, the American Hospital Association, and the American College of Physicians to found the Joint Commission for the Accreditation of Hospitals, now known as the Joint Commission ("the Joint Commission"). Id. It was the Joint Commission that established the first set of guidelines for credentialing members of the medical staff and the granting of privileges at hospitals. Since that time, the credentialing and privileging guidelines have helped guide the formal development of the modern medical staff. Id. At the opening of the twenty-first century, the Joint Commission has continued as a part of its mission to improve the organizational standards of the medical staff. Indeed, the Joint Commission is one of the driving forces in medical staff oversight.
Excerpt from Karen S. Rieger, Eric S. Fisher, Stephanie A. Russo, The Fundamentals of Medical Staff Issues: Minimizing Risks and Maximizing Collaboration, Fundamentals of Health Law (American Health Lawyers Association Nov. 2011).