What should a hospital do with a provider who completed a fellowship in spinal surgery and is now requesting clinical privileges to perform spinal surgeries?

Hospital Credentialing Decision for Fellowship-Trained Spinal Surgeon

The hospital must assess the provider's competency through formal evaluation of demonstrated technical skills and outcomes before granting independent clinical privileges (Option D). 1

Why Competency Assessment Is Mandatory

The Joint Commission on Accreditation of Healthcare Organizations explicitly requires that granting clinical staff privileges must be based on assessment against professional criteria specified in medical staff bylaws, not simply on completion of training. 2

Fellowship completion alone does not automatically equal competence to practice independently. 1 The neurosurgical trainers at the requesting hospital must formally assess the fellow's competence and grant appropriate clinical privileges based on demonstrated technical skills and outcomes before allowing independent practice. 1

The Credentialing Process

Assessment of Competence is Multidimensional

• The assessment of competence is complex and multidimensional; isolated credentials or training completion alone are insufficient for judging overall competence. 2, 1
• Physicians are charged with identifying criteria that constitute professional competence and evaluating their peers accordingly, yet this process is often constrained by the evaluator's knowledge—a problem compounded by highly specialized procedures like spinal surgery. 2

What Must Be Evaluated

• Demonstrated technical skills and surgical outcomes from the fellowship must be reviewed by neurosurgical trainers at the credentialing hospital. 1
• Assessment should be based on actual cognitive knowledge and technical skills rather than solely on the structure of training. 1
• Evaluation should include review of the surgeon's performance on procedures similar to those for which privileges are requested. 1

Responsibility for Patient Safety

• The neurosurgical trainers at the hospital have explicit responsibility to ensure patient safety by ensuring that fully trained neurosurgeons are responsible for patient care. 1
• The trainers must decide whether the surgeon can operate independently, with direct supervision, or with assistance based on demonstrated competence. 1
• The responsibility for determining surgical competence rests with the trainers and credentialing bodies at the hospital where privileges are being requested, not with the fellow's previous training program. 1

Why Other Options Are Inappropriate

Years of Experience Alone (Option A)

• Experience alone does not guarantee competence in performing complex procedures like spinal surgery. 1
• Simply completing a certain number of procedures without proper assessment of outcomes and technique may not ensure patient safety. 1

Fellowship Completion Alone (Option B)

• Completion of a fellowship does not automatically guarantee competence. 1
• The available guidelines make clear that training completion does not automatically equal competence to practice independently. 1

Arbitrary Supervision Period (Option C)

• Imposing an arbitrary 2-year time requirement without assessment of actual competence is not evidence-based. 1
• This approach could unnecessarily delay qualified surgeons from practicing within their competence. 1

Common Pitfalls to Avoid

Do not grant privileges based solely on credentials or training completion. The credentialing body must conduct an actual assessment of the provider's demonstrated competence through review of surgical outcomes, technical proficiency, and cognitive knowledge specific to the procedures for which privileges are requested. 2, 1

When the competence of a physician requesting privileges is not clear, monitoring the candidate's performance or administration of a competency test may be appropriate. 1