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INTRODUCTION

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The transition from residency to staff anesthesiologist presents many challenges and having some preliminary knowledge about practice management will help ease the transition. Practice management issues are one of the most popular topics addressed by anesthesiologists and hospital administrators.

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CREDENTIALS, PRIVILEGES, AND CERTIFICATIONS

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One of the first things you will have to do as you transition from residency is to join an anesthesia group or become a solo practitioner with a hospital, ambulatory surgery center, or pain clinic/practice. If you practice within any of these institutions, you will be required to be a member of their Medical Staff and adhere to their Medical Staff Bylaws. The Medical Staff Bylaws of a hospital are focused on the delivery of quality care and practice parameters for physicians and licensed independent practitioners. The Medical Staff Bylaws address requirements for acceptable behavior, medical records protocols, credentials, privileging, impaired provider policy, the process for adverse privileging actions, medical committee membership, and Emergency Department coverage. The Medical Staff Bylaws are written by the Medical Staff Committee and are enforced by the President of the Medical Staff (a physician elected by the Medical Staff).

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To practice anesthesia in a hospital or ambulatory surgery center, a staff anesthesiologist must apply for anesthesia privileges. In order to get privileges to practice anesthesia, you must first go through the institutional credentialing process. Credentialing is the process of verifying your education, training, medical licenses, and specialty certifications. Credentialing is a time-consuming and slow process that requires an advanced commitment of approximately 3–6 months prior to your anticipated start time. The credentialing process will always include a preliminary questionnaire focused on your past and current state of health, criminal activity, medical staff issues, adverse credential and privileging action, a report of any medical malpractice suits/claims, and a query to the National Practitioner Data Bank. In addition to the extensive request for information, you will have to provide evidence of your training, medical licenses, malpractice coverage, letters of reference, and board certifications. Your credentials packet will be reviewed by a Credentials Committee made up of members of the Medical Staff and finally approved by the President of the Medical Staff.

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After the credentials verification is complete, you will be required to apply for privileges to practice. Each hospital, ambulatory surgery center, or other anesthetizing location (clinics, office based, etc.) has its own privileging requirement and the privileges are site-specific. For example, an ambulatory surgery center’s privileges may include all outpatient surgical cases, but will not include a privileging section for cardiac bypass cases.

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Privileges come in two varieties, core and supplemental privileges. Core privileges are generally defined as those sets of clinical practices that every credentialed anesthesiologist at that institution can perform, for example, basic airway support, fluid resuscitation, and cardiovascular support. Supplemental privileges are specific and usually require advance training, for example, transesophageal echocardiography. Supplemental privileges are defined ...

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