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Gary L. Freed, MD, MPH; Rebecca L. Uren, MHSA; Ericka J. Hudson, MHSA; Indu Lakhani, MBA, MS; John R. C. Wheeler, PhD; James A. Stockman III, MD; for the Research Advisory Committee of the American Board of Pediatrics

JAMA. 2006;295:905-912.

Context  Privileging involves the granting of permission to perform specific professional activities under the jurisdiction of a governing body's (hospital) authority. In 1951, the Joint Commission on the Accreditation of Hospitals (later renamed the Joint Commission on Accreditation of Healthcare Organizations) was formed to codify the process of hospital assessment. In the early part of the 20th century, a parallel process was being undertaken by the medical specialties to evaluate and recognize competence among physicians through the creation of specialty boards.

Objectives  To describe the use of board certification in hospital privileging policies for general pediatricians and pediatric subspecialists and to identify any variation among types of hospitals.

Design, Setting, and Participants  A telephone survey between January 1 and June 30, 2005, of privileging personnel among a random, weighted sample of 200 nonspecialty hospitals stratified by teaching status, children's vs general hospitals, freestanding children's hospital vs part of hospital system, and urban vs rural location.

Main Outcome Measures  Proportion of hospitals that require board certification at initial privileging or at some point to maintain privileges and recertification to maintain privileges.

Results  Of 200 hospitals, 7 hospitals were ineligible because they did not have at least 1 pediatrician on staff. One hundred fifty-nine hospitals completed the telephone interview, resulting in an overall response rate of 82%. A total of 124 (78%) of 159 hospitals did not require general pediatricians to be board certified at initial privileging; however, 111 (70%) did require pediatricians to become board certified at some point during their tenure. Of these 124 hospitals, 52 (42%) did not report a time frame in which certification must be achieved. Forty-nine (43%) of 113 hospitals required pediatric subspecialists to achieve subspecialty certification within a specific time frame.

Conclusions  These results raise issues regarding the manner in which board certification is used or not used by hospitals in their efforts to ensure the practice of high-quality care within their institutions. The premise for recertification is the need to assure the public of continued competence of physicians over the course of their professional careers. Increased attention by the public and regulatory agencies regarding patient safety and quality of care will likely have an impact on hospital privileging processes.

Author Affiliations: Child Health Evaluation and Research Unit, and Division of General Pediatrics, University of Michigan (Drs Freed and Wheeler, and Mss Uren, Hudson, and Lakhani), and Department of Health Management and Policy, University of Michigan, Ann Arbor (Drs Freed and Wheeler); and American Board of Pediatrics, Chapel Hill, NC (Dr Stockman).

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RELATED LETTERS

Credentialing, Recertification, and Public Accountability
F. Michael Gloth, III
JAMA. 2006;296(13):1587-1588.
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Credentialing, Recertification, and Public Accountability—Reply
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JAMA. 2006;296(13):1588.
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Credentialing, Recertification, and Public Accountability—Reply
Christine K. Cassel and Eric S. Holmboe
JAMA. 2006;296(13):1588-1589.
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