QUESTION:        As Chief of Staff, I have been involved in several collegial interventions with an employed physician who is an outlier in clinical care and behavior. HR has been addressing the behavior and our Multispecialty Peer Review Committee has been reviewing his quality concerns. He is now claiming that this is double jeopardy – does he have an argument?

ANSWER:           As more physicians become employed by hospitals and their affiliates, physician leaders often collaborate with the management team (typically led by the Chief Medical Officer in these situations) to “triage” an issue and determine whether it makes sense to proceed through the medical staff process, the HR process, or a hybrid of the two. Regardless of what route is chosen, it is not “double jeopardy” (a term used in criminal law and thus not applicable). Rather, leaders assess which route makes most sense under the circumstances. There are a number of factors that may cause leaders to use one or the other – or even both – options. Information-sharing policies are increasingly being adopted to facilitate keeping both physician leaders and the management team in the loop, while maximizing peer review protection. Professionalism policies can guide leaders to use progressive steps to address behavior issues. Peer review policies (often called “Professional Practice Evaluation” policies in Joint Commission and HFAP accredited hospitals) can similarly provide steps for collegial intervention, Focused Professional Practice Evaluation and performance improvement plans.   There is no absolute right or wrong approach – if the physician is cooperative, leaders can seek to engage the physician in committing to performance improvement on both fronts based on their assessment of all the factors. The HR process may be better suited to address behavior issues and the medical staff peer review process to address clinical concerns. Both processes should develop documentation of the progressive steps. This will support the reasonableness of the steps taken.

For a discussion of these and related issues, tune into our “Employed Physician Peer Review: Maximizing Performance and Protection” audio conference on October 6, 2015 – 1:00 p.m. to 2:00 p.m. (ET). Join Phil Zarone and Charlie Chulack as they discuss the various concerns regarding hospital-employed physicians and how best to move forward so that the hospital is protected and performance is maximized.

And join Charlie Chulack, Rachel Remaley and Henry Casale for the Physician Employment Institute in Las Vegas on October 15-17 where all of our other seminars will be offered – please join us – and bring a team!