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Need help with APC by laws with full active staff membership


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Currently at my hospital the APCs are "affiliate staff," which is the same thing as "active staff" except that we cannot serve on the credentialing committee, cannot serve as anything other than secretary or treasurer, have "co-admit" privileges instead of admit privileges, can't be counted for quorum, and can't vote on one other thing I can't remember.

We have now formed a committee (at my recommendation, so I'm glad they seem receptive) to revamp these by-laws and adjust them so that APCs have the same active membership as the physicians. 

Does anyone have an example of how theirs is written? Based on the CMS guidelines that an APC may care for patients within their scope, is co-admit wording necessary, or can we just say admit privileges now? Of note PAs can have admit privileges in my state, nothing forbidding it. 

We do have a lot of turnover with APCs since we are so rural. We have little physician turnover by contrast, though it does happen as well. We had one physician hospitalist recently that was SOOOO terrible, everything he touched turned to garbage. Really, just a second away from killing someone. Fortunately he was not too involved in medical staff meetings and just wanted to go home early all the time. We now have an NP hospitalist who is okay, but definitely practices overkill medicine. Too many tests, too much imaging, zosyn for several days after he does a minor wound debridement. I was consider adding a clause that any new provider would have to be affiliate staff for 1-2 years before being made active staff. Thoughts?

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good luck

 

our local hospitial is affiliated with a state medical college for residents, PA and NP are considered second level medical staff

gave up a few years ago 

 

hope you can change it as it really needs to change

 

some type of tiered system so that there is senior PA/NP 

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30 minutes ago, ventana said:

good luck

 

our local hospitial is affiliated with a state medical college for residents, PA and NP are considered second level medical staff

gave up a few years ago 

 

hope you can change it as it really needs to change

 

some type of tiered system so that there is senior PA/NP 

Appreciate it! I've already spoken with the chief of staff and it's going to happen as they are 100% behind it. I just don't know exactly how to write it or if there is some pitfall I'm not seeing. I think they are willing to let it go as far as we want it to go, I just don't want some lawyer to later come back and state "well you can't do this because of X." I'm hoping to avoid any tiered system outside of time on staff. As it is, there is not enough staff to have representation of any particular group. The inpatient/ED is entirely staffed by APCs other than the one EM physician who acts as medical director. If we were ever not treated well or not hear, I would try to have senior level representation, but as it is they treat our voice the same as a physician voice. 

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3 hours ago, LT_Oneal_PAC said:

 I just don't want some lawyer to later come back and state "well you can't do this because of X."

That's where you have to go crazy with due diligence. States have regulations that directly hurt PA practice that come out of committees that have nothing to do with PAs - environmental protection, banking and insurance, etc. Might even be that the Joint Committee could jam you up somehow. Does the facility have house counsel that could look into it?

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