Credentialing issue.

In the recent issue of The Physician Executive, (Volume 23, Issue # 4) Paul Royce, MD, raised an issue we are currently grappling with, namely, the ability to properly credential or recredential physicians whose practice is primarily office-based with little-to-no-activity to demonstrate "current competence."

Dr. Royce echoes our observations that many primary care physicians tend to refer directly to specialists (we do not have "hospitalists" at this institution, yet) and, hence, at the time of reappointment especially the JCAHO mandate to determine and document continued clinical competence. The options are to ignore the mandate and potentially impact quality care (the good old boy approach) or deny appointment with its potential impact on a physician's ability to remain on HMO panels (many require staff membership and privileges) and angering physicians (who in turn may not refer their patients with obvious financial impact on the institution). A third alternative is to create a new category of membership which may not satisfy HMOs and probably be looked on as a sham.

Hence, the dilemma. If the ACPE or The Physician Executive readers can add wisdom, I would be grateful.

Richard F. Cioffi, MD, FACP 

Vice President, Medical Affairs

Holy Cross Hospital 

Silver Spring, Maryland