December 01, 2001
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Hospital privileges improve patient care, raise public awareness of optometry

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Obtaining hospital privileges can often be an arduous process, in which optometrists must overcome restrictive bylaws, competition from other doctors and even political opposition. But for many optometrists, securing a place on a hospital staff is well worth the effort.

“It’s beneficial in many ways,” said Kerry Beebe, OD, a member of the privileging committee at St. Joseph’s Hospital in Brainerd, Minn. “Not only does it benefit the patients, but it also promotes greater understanding between optometrists and other physicians.”

Although the ease with which privileges can be procured varies from hospital to hospital, many optometrists agree that opportunities are greater than they once were.

“I think the climate is much better now than it was years ago,” said Barry Weiner, OD, a practitioner who previously had privileges at University of Maryland Hospitals. “I think a lot of people now realize, especially from the ophthalmological side, how important optometry is today.”

Learning the bylaws: the first step

Christopher Quinn, OD, chairs the Hospital Practices Committee for the American Optometric Association. This committee works as an advocate for members who practice within a hospital setting and also helps members who are interested in obtaining hospital privileges.

“We give them information about the process and potential benefits,” Dr. Quinn told Primary Care Optometry News. “Basically, we give them some of the tricks of the trade to guide them through the process of getting on the hospital staff.”

The first step, according to Dr. Quinn, is gaining a thorough knowledge of the bylaws of the particular hospital. “For most medical doctors, the bylaws are clear on the fact that they are eligible for hospital privileges,” he said. “They are not necessarily that clear for optometrists.”

Dr. Quinn said a practitioner should first determine whether the hospital bylaws include provisions for limited license practitioners, the category into which optometrists fall.

“This is a really big stumbling block, because often, if there is no provision specifying that optometrists are eligible for staff privileges, they may never even be given an application,” Dr. Quinn said. “Without an application, there is very little recourse for the optometrist. So it really is better to have an understanding of the bylaws before you even ask for an application.”

If an optometrist discovers that the bylaws exclude him or her from eligibility, it is possible to seek a change in bylaws, Dr. Quinn said.

“Most hospitals have a bylaw committee within their committee structures that entertains periodic requests to review and change sections of the bylaws,” Dr. Quinn said. “You then have to work politically to identify those members of the hospital board of trustees who would support such a change, and then you have to work that process through the committee structure, with the proposal to change the bylaws.”

The process of changing the bylaws can be quite lengthy, Dr. Quinn said, but it is preferable to requesting or submitting an application in ignorance.

“It is better to start on the administrative end, rather than request an application without knowing,” Dr. Quinn said. “When you do that, you may alert the physician members of the staff of your desire to become a member, and they might take a defensive posture to keep you out. Obviously, many ophthalmologists will work very hard to keep optometrists off the hospital staff.”

The application process

If it is determined that the bylaws do not exclude optometrists, the next step is the actual application, which must go through several different committees.

“It’s relatively straightforward at that point,” Dr. Quinn said. “You would request an application and submit it, and then it would go through a number of steps.”

One such step is the credentialing committee, which determines that the applicant is qualified to perform the procedures he or she has requested.

A checklist of credentialing information required by the committee is as follows:

  • personal (name, address, etc.)
  • education (highest level obtained, year/school graduated from, etc.)
  • licensure and registration (license number, expiration, DEA number if applicable, etc.)
  • malpractice insurance
  • certifications, diplomate status, areas of expertise
  • affiliations
  • certifying physician’s statement and health status assessment
  • continuing education record
  • provider activity file (publications and research articles)

According to Dr. Beebe, most hospitals check all of this information very thoroughly. “It is important to make sure everything you put down is accurate,” he said. “Hospitals really check carefully, all the way to the point of writing to your school of optometry to make sure you did graduate. They’re not going to just take your word for it.”

Because this fact-checking process is so meticulous, Dr. Beebe emphasized that it often takes a considerable amount of time. “If you put in an application, don’t expect that at the next board meeting you’ll be through,” he said. “It sometimes takes months to follow up on these things.”

Dr. Beebe added that all applicants are scrutinized in this way, making the process a fair one. “The good part is that not only are they checking every detail on you; they are also checking on every physician who is applying,” he said.

Another area that is carefully reviewed by many hospitals is that of substance abuse history, Dr. Beebe said. “We look very hard at any drug or alcohol abuse problems,” he said. “The fact is, physicians fit the same profile as the general population, and there are a number of people who do have drug and alcohol problems.”

If it is discovered that a doctor has had a history of substance abuse, it is not necessarily automatic grounds for rejection, Dr. Beebe said. “It wouldn’t necessarily be a basis for exclusion,” he said, “but you would want to have a plan in place to monitor this. If a physician has been through rehabilitation, there needs to be monitoring to make sure he or she continues to be substance free.”

Types of privileges

After the credentialing process has yielded satisfactory results, the next step is privileging. In the privileging process, a committee delineates exactly what procedures and services the applicant can perform in the hospital.

There are several categories of hospital privileges for which applicants may be eligible. According to John A. McCall Jr., OD, a private practitioner in Crockett, Texas, the most all-inclusive of these privileges is active medical staff.

“With active medical staff, you are on equal footing with any other physician,” Dr. McCall said. “You have full voting privileges, serve on committees and can be an officer.” Dr. McCall serves as an officer on the active medical staff of East Texas Medical Center in Crockett.

Slightly more restrictive are courtesy and consulting privileges, which are similar to one another, Dr. McCall said.

“The definitions vary from hospital to hospital, but they are very similar,” Dr. McCall said. “You have the rights and privileges to order tests, and in some cases you can attend the medical staff meeting, but you are a non-voting member of that medical staff.”

Dr. McCall advised that doctors who are designated courtesy or consulting staff should get a definition specifying the terms of these privileges. “You should ask for a copy of the bylaws, just to see how it is spelled out,” he said. “But in most cases, courtesy or consulting staff is not bad at all.”

Allied health category

A fourth level of privileging, allied health professional, is not necessarily the best category for optometrists, Dr. McCall said. “Depending on the definition, optometry should attempt to stay away from it,” Dr. McCall said. “It’s basically best for a non-independent licensed profession. Optometry is an independent licensed profession that makes independent judgments.”

Dr. McCall said that, in many cases, allied health professionals must be given orders from an MD before taking action. “Optometrists don’t need anyone to give them help with that,” Dr. McCall said. “That just is not where optometry should be. I think either active, consulting or courtesy is where optometrists should fall.”

Dr. Quinn agreed that allied health is not necessarily the most advantageous place for optometrists. “It is really inappropriate for optometrists, because allied health providers have to act under supervision,” he said. “Optometrists are independently licensed and provide independent patient care.”

However, Dr. Beebe maintained that, as an allied health provider, he still has been able to provide the kind of quality hospital care his patients need. “It doesn’t matter so much where you’re appointed as much as the fact that you’re there and you’re allowed to do what you want to do, independently and without supervision,” he said. “I happen to be considered allied health, and I can do absolutely everything in the hospital that I have asked to do.”

Dr. Beebe said that although under his hospital’s bylaws allied health providers do not have admitting privileges, exceptions would probably be made upon request.

“Probably the main difference between being allied health as opposed to another category is the fact that you might not be allowed to vote on hospital issues,” he said. “I think a doctor needs to decide whether to hold out for active medical status or just be there to see his or her patients. I wouldn’t necessarily consider that as a negative.”

Promoting your skills

Another crucial step for an OD seeking hospital privileges is making the hospital board aware of his or her potential contributions. Dr. McCall recommended setting up a meeting with the hospital administrator early on in the process. “This meeting will probably be extremely important as to whether he or she gets past the first barrier,” Dr. McCall said. “It is very important to appeal to administrators and let them know what you can do for them. You can’t be timid about it.”

Dr. McCall said the optometrist should cite examples of tests or procedures that he or she could be ordering with hospital privileges. “You could point out the financial benefit for the hospital to have you on staff and directly ordering these tests,” he said. “That will get the hospital administrator’s attention, because increased revenue is what keeps his or her job.”

Dr. Weiner agreed that the best way to secure privileges is to show what you can do. “You want to show that it will be advantageous for everybody,” he said. “Develop a rapport with ophthalmologists who are involved with hospital practices. Sit down, talk to them, show them what you can do. Start referring patients and have them refer patients back to you.”

An all-around benefit

Obtaining hospital privileges has obvious medical advantages in terms of ordering tests, preoperative and follow-up examinations and emergency care. Optometrists who have hospital privileges gain a greater freedom and ability to serve their patients.

Less apparent, yet equally important, is the increased awareness that is often fostered when ODs and medical doctors work together in a hospital setting.

“I think it is a good education for other practitioners,” said Sara Butterworth, OD, a practitioner who has privileges both at the University of Iowa Hospitals and Clinics and the Iowa City Veterans Administration Medical Center. “I constantly run into both patients and other health care practitioners who don’t know what optometry is all about. They know we do glasses and contact lenses, but do we treat glaucoma? Do we do minor surgical procedures or treat diabetic retinopathy? I think as more optometrists gain hospital privileges, there will be an increase in public awareness.”

Dr. Weiner recounted a situation early on in his hospital experience, which he feels represents the misunderstandings about optometrists.

“I was teaching third-year residents in a contact lens clinic at the hospital, and I had a second-year resident come up to me and ask me to see his wife who was having trouble with her contact lenses,” Dr. Weiner said. “He said, ‘She’s having problems because she got them from an optometrist.’ I told him, ‘I’m an optometrist.’”

The resident was clearly surprised, Dr. Weiner remembered. “He looked at me with disbelief, and he said, ‘That’s impossible; you can’t be an optometrist, you know too much,’” Dr. Weiner recalled. “And the funny thing is, when he got out of his residency, he asked me to go into practice with him.”

Dr. McCall agreed that it is helpful for optometrists to assert their knowledge to other doctors. “There isn’t a staff meeting that goes by where I don’t work something in about the eye that nobody else on the staff knows,” he said. “That continually reminds them that as far as the eye goes, I am the one they should be referring to. It’s an educational process, and you gain the respect of your peers.”

For Your Information:
  • Kerry Beebe, OD, is a private practitioner with privileges at St. Joseph’s Hospital in Brainerd, Minnesota. He can be reached at 506 Laurel St., Brainerd, MN 56401-3526; (218) 829-0946; fax: (218) 829-1279.
  • Barry Weiner, OD, practices in Maryland and was on staff at University of Maryland Hospitals. He can be reached at 3421 Sweet Air Road, Phoenix, MD 21131-1812; (410) 628-1510; fax: (410) 666-5244.
  • Christopher Quinn, OD, is president of the New Jersey Society of Optometric Physicians. He can be reached at 485 Route 1, Iselin, NJ 08830; (908) 750-0400; fax: (732) 750-1507.
  • John A. McCall Jr., OD, is in private practice in Crockett, Texas, and an officer on the staff of East Texas Medical Center. He can be reached at 711 East Goliad Ave., Crockett, TX 75835; (936) 544-3763; fax: (936) 544-7894.
  • Sara Butterworth, OD, practices at the University of Iowa, Department of Ophthalmology and Visual Science. She can be reached at 200 Hawkins Dr., Iowa City, IA 52242-1091; (319) 353-7044. fax: (319) 353-7699.