A group that is often overlooked in screening medical staff members are physician employees. Hospitals and group practices may directly employ physicians in both administrative and clinical positions. Hospitals may also contract the third party groups who employ physicians to supply specific medical services, such as emergency room physician coverage. Whenever such employee physicians exercise independent medical judgment, they are engaged in the practice of medicine and must meet the same standards as members of the medical staff. The JCAH and most courts require that privileges be awarded to individual physicians only after careful screening. It should be assumed that the courts would require the same diligent investigation of physician employees that is required of independent members of the medical staff.
The hospital may want to develop a special class of privileges for employee physicians analogous to that of the consulting staff. While this would be unnecessary if the physician did not exercise medical judgment, it is important to remember that exercising independent medical judgment is not limited to direct patient care. Physician administrator exercise medical judgment whenever they supervise other physicians or nursing personnel in duties involving the rendering of medical care. They also exercise medical judgment when they establish treatment protocols. Conversely, a nonphysician administrator may enforce staff rules and bylaws approved by the medical staff, but may not make or countermand medical decisions.
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