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Policies for General Surgeons, Surgical Specialists, and Nonsurgical Subspecialists

Gary L. Freed, MD, MPH; Kelly M. Dunham, MPP; Dianne Singer, MPH

Arch Surg. 2009;144(8):746-752.

Objectives  To better understand the relationship between board certification and credentialing policies for surgeons and nonsurgical subspecialists and to examine possible variation in use of board certification among different types of hospitals.

Design, Setting, and Participants  Telephone survey conducted from November 14, 2006, through March 16, 2007, of the privileging personnel among a random sample of 235 nonchildren's hospitals stratified by teaching status, bed size, metropolitan statistical area, system affiliation, and tax status.

Main Outcome Measures  Proportion of hospitals that require specialty board certification to gain privileges and hospital requirements for recertification.

Results  Of 235 hospitals, 11 were ineligible and 183 completed the telephone interview, resulting in an overall response rate of 82%. Approximately one-third of hospitals did not require surgeons and nonsurgical subspecialists ever to be board certified to receive hospital privileges. Among the 109 hospitals that required certification at some point, only 5 (5%) required surgeons and 3 (3%) required nonsurgical subspecialists to be board certified at the point of initial privileging. More than three-fourths of hospitals had exceptions to their certification policies for surgeons and 84 (77%) had them for nonsurgical subspecialists. Eighty-two percent of all hospitals and two-thirds of hospitals whose policies required recertification allowed surgeons and nonsurgical subspecialists to retain privileges when their board certification expired.

Conclusion  Most hospitals do not consistently use board certification to ensure physician competence at their institutions.

Author Affiliations: Child Health Evaluation and Research Unit and Division of General Pediatrics (Dr Freed and Mss Dunham and Singer), and Department of Health Management and Policy (Dr Freed), University of Michigan, Ann Arbor.

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