Leave of absence

March 13, 2025

Posted on by Courtney Patterson

QUESTION:
We have a physician who was granted a leave of absence (LOA) last October.  Before she went on leave, there were some concerns raised about her practice, and she signed a performance improvement plan that included extensive CME and simulation training.  When the physician asked to go on leave, she was told that before she would be reinstated, she would have to complete both the CME and the simulation training outlined in her performance improvement plan.

The problem is her current appointment term expires at the end of April.  We don’t want to reappoint her now and give her a stamp of approval especially if she hasn’t completed the CME or training. Is there a way to align the decision on her reappointment with her return from the LOA?

ANSWER FROM HORTYSPRINGER ATTORNEY SUSAN LAPENTA:
We share your concern about reappointing a physician who is on an LOA.  This case is further complicated by the fact that when the physician took the LOA there was an incomplete performance improvement plan.

Additionally, we would be reluctant to reappoint a physician about whom you had clinical concerns at least without first reviewing the most up to date information about her clinical performance.  If you reappoint this physician now, you won’t have any clinical information for at least the last six months.  And then, she won’t return from the LOA for an additional six months, at least potentially.

One suggestion would be to inform the physician that final action on her reappointment application will be held in abeyance until she seeks reinstatement from the LOA.  When she is ready to return from the LOA, she will have to update her reappointment application before any action is taken.  You will also want to make sure that your primary source verifications are current.

Simultaneously, she will have to demonstrate that she has satisfied the elements of the performance improvement plan.  Furthermore, it is not unusual, when a physician has been on an LOA for an extended period of time, for leadership to develop a focused professional practice evaluation plan to confirm competence as part of the physician’s reinstatement.

If you have a quick question about this, e-mail Susan Lapenta at slapenta@hortyspringer.com.

April 5, 2018

Posted on by hortyspringer

QUESTION:        In regard to leaves of absence, our Medical Staff Credentials Policy says that practitioners’ clinical privileges will expire at the end of their natural term.  Is that right?  Can’t a practitioner be reappointed during the LOA?  I couldn’t find anything specifically addressing that anywhere, but we have a loyal and long-standing member of the Medical Staff who is out on leave and who is up for reappointment.  Are we supposed to kick him off of the staff and make him apply as an initial applicant after his medical leave is resolved?

 

ANSWER:            It is our advice that hospitals not reappoint members of the Medical Staff, or renew clinical privileges for a practitioner, while they are out on leave.  The reason is that when they are on leave, there is something about their situation that prevents them from practicing or fulfilling the duties of Medical Staff appointment and, in turn, hospital and Medical Staff leaders would need to learn about that situation and resolve any concerns (for example, the health status of the individual) prior to making any decision about their appointment and privileges.  For this reason, it makes sense not to process any reappointments while the individual is away.

We recommend that your Bylaws or Credentials Policy language regarding leaves of absence state that if membership or privileges expire while an individual is on leave, the individual may later submit an application for “renewal,” rather than being required to apply as an initial applicant at the time of reinstatement:

If a practitioner’s current membership and/or clinical privileges are due to expire during the leave, they will expire at the end of their natural term.  The practitioner will be required to submit an application for reappointment and/or renewal of clinical privileges as part of the reinstatement process.

Note that individuals whose membership and/or privileges expire while on leave are uniquely able to apply for renewal, rather than apply as initial applicants, despite having a lapse in appointment/privileges.  The distinction can, in some situations, be important (for example, for practitioners who have been grandfathered from meeting current board certification requirements, instead having to satisfy only those requirements in place at the time of their initial appointment).

As part of the renewal application (which would be processed at the time the practitioner applies for reinstatement), the individual should be asked to explain any outstanding concerns that arose in conjunction with the leave (e.g., health status, lapse of currency).