title: Conflict of credentialing: accolade or unfair trade.
abstract: The newly appointed chief of surgery at an open-staff hospital received an application for vascular privileges from a senior general surgeon who took a period of additional fellowship in vascular surgery at a nonacademic regional medical center. The fellowship does not make him board eligible in vascular surgery, but he has maintained his general surgery board certification and the pertinent bylaws do not specifically state which certification is required, only that the surgeon must be board certified and have additional training in vascular surgery. He is a member of a large politically powerful group practice that apparently wants to refer their substantial number of vascular cases internally. The chief of surgery finished vascular surgery training locally 3 years ago. The applicant has a checkered past, with multiple lawsuits and in-house investigations of cases with poor outcomes. The credentialing procedure is that the chief of service makes a recommendation to the chief of staff who makes a recommendation to the board of directors for approval. The chief of staff, who will make the final recommendation to the hospital board of directors, is a member of the applicant's group practice. What recommendation should the chief of vascular surgery make to the chief of staff?
authors: The Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Tex, USA. jwjones@bcm.tmc.edu
authors: James W
authors: JW
authors: Jones
authors: Laurence B
authors: LB
authors: McCullough
mesh_terms: D002568:Certification / Q000941:ethics; D002983:Clinical Competence; D016265:Conflict of Interest; D003406:Credentialing / Q000941:ethics*; D005257:Fellowships and Scholarships / Q000941:ethics; D006123:Group Practice / Q000941:ethics*; D006801:Humans; D008504:Medical Staff Privileges / Q000941:ethics*; D008505:Medical Staff, Hospital / Q000941:ethics*; D011787:Quality of Health Care / Q000941:ethics; D012017:Referral and Consultation; D014656:Vascular Surgical Procedures / Q000941:ethics*