Medical Staff Organization / Association in a Hospital Setting

Medical Staff Organization / Association in a Hospital Setting

Reynaldo O. Joson, MD, MHA, MHA, MSc Surg

July, 2003

In a hospital, there are physicians credentialed and given privileges and benefits by the top management together with the understanding that they have certain roles and responsibilities to perform.

The physicians may organize themselves or be organized into a medical staff organization or a medical staff association.

(In the same vein, nurses and other employees of the hospitals may organize themselves or be organized into a nursing staff or employee organization or a nursing staff or employee association.)

Physicians in a hospital are under the jurisdiction of the medical director or the chief of clinics, just as nurses are under the jurisdiction of the nursing director.

At present, there are two scenes or practices that can be observed in hospitals with regards to medical staff organization or medical staff association.

Note: medical staff organization (MSO) and medical staff association (MSA) may be used interchangeably if there is only one group.  If there are two groups, then medical staff organization is the one under the medical director or chief of clinics and the medical staff association is under a medical staff other than the medical director or chief of clinics.

There are hospitals with a formal medical staff association in addition to a medical staff organization under the medical director or chief of clinics and there are hospitals without a formal medical staff association.

In hospitals without a formal medical staff association, a medical staff organization is supposed to be in place under the governance and stewardship of the medical director or chief of clinics.  The medical director or chief of clinics ensures that the physicians are performing effectively and efficiently in contributing to the hospital’s mission, goals and objectives at the same time taking care of their welfare and protecting their rights.  If the medical director or chief of clinics is doing his job well, then there may be no need for an additional medical staff association.  Committees may just be formed to take care of the special needs of the medical staff, such as socials and review of hospital benefits, which are the usual objectives of a medical staff association.

If a formal medical staff association is formed in addition to an existing medical staff organization under the medical director or chief of clinics, the reasons can include one or combination of the following: offering extra assistance to the medical director or chief of clinics and even to the hospital; enhancing social, camaraderie, and other non-medical and non-hospital activities; and serving as  watchdog or a consultative body to protect the rights of the physicians in the hospital.

A hospital may allow the formation of medical staff association in addition to the existing medical staff organization under the medical director or chief of clinics as long as it deems useful (in terms of being able to enhance or promote) in the attainment of the hospital’s mission, goals and objectives.  If it allows one, the objectives of the medical staff association should be clearly spelled out so as not to conflict and overlap with those of the medical staff organization.  If a medical staff association is allowed to be formed, it must be made explicit as to whether the hospital management is authorizing it to perform its functions or just recognizing it as an association within the hospital which is not part of the management.  If the medical staff association is allowed to serve as a watchdog or a consultative body to protect the rights of the physicians in the hospital, there must be policies or measures in place to avoid conflict of interest in the membership in either medical staff association or organization.  Example, heads of clinical department and standing committees in the medical staff organization should be disqualified from being officers in the medical staff association.

If a medical staff association is formed, the usual objectives are:

  1. To promote the welfare of the medical staff.
  2. To protect the rights of the medical staff.
  3. To promote camaraderie among the medical staff.
  4. To assist the hospital administration and medical affairs division in rendering quality medical service, training, and research.

Usual problems in the association:

  1. Payment of dues by members
  2. Participation in the activities of the association

Usual problems between medical staff organization (MSO) and medical staff association (MSA):

Conflict and overlap of leadership of medical staff and activities

Recommendations:

Delineation and constant clarification of leadership and functions

Joint activities should be spelled out.

Recommendations for medical director or chief of clinics whether there is a medical saff association or not:

Meet the entire medical staff 3 times a year (“Meeting of the Medical Staff”)

To announce

To orient

To consult

To introduce new members

Make clear to the medical staff on the following issues:

    1. consultative / recommendatory privilege
    2. extent of decision-making
    3. quorum matter

Make meeting efficient

  1. Finish within 2 hours
  2. Stick to agenda
  3. Prepare discussion of issues before meeting
  4. Medical staff submits topics before meeting
  5. Assign group to study as needed
  6. Medical staff to submit complaints and suggestions to PRO prior to meeting, not on the meeting itself
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