How to size up a hospital

There's good news for primary care doctors who are looking for hospital privileges these days: Hospitals want you. But just because one wants you doesn't necessarily mean that you should jump aboard. First, you have to evaluate the hospital carefully. Yet readers tell us they don't really know how to do that.

How to start getting local information

One good place to start is the US News/American Hospital Association online directory, which lists more than 6,000 hospitals around the country. This website ( http://www.usnews.com/usnews/health/hospitals/hosp_home.htm) offers details on their size, facilities, staff, and services, plus links to their individual websites.

When you visit the area, plan on more than a quick weekend visit to shop for a hospital-unless everyone in the group you'll be joining works at the same one. Before you go, contact the president of the county medical society, suggests David Scroggins, a practice management consultant with Clayton L. Scroggins & Associates in Cincinnati. Ask him if you could attend one of the society's regular meetings and be introduced to local doctors in your specialty.

"Some of them may see you as a commercial threat, and won't be helpful," says Scroggins. "But some of them will be. You can then arrange to meet them later for lunch or after work to discuss the merits and drawbacks of particular hospitals." Among the topics to raise: relations between the hospital's medical staff and the administration, referral patterns, call coverage, and the quality of and access to the hospital's outpatient lab, imaging unit, ED, and surgical specialists.

What to ask the administrator

The next step is to arrange a meeting with the hospital administrator, and, if possible, with the chief of medicine or the head of your specialty department. First ask whether the hospital staff is open or closed. If it's closed, there may be no openings until someone retires or leaves town. Until then, you might be limited to courtesy privileges, which would restrict you to admitting patients only under certain conditions, and only under supervision of a mentor.

If the staff is open, ask if you'll be able to treat your own patients when they're admitted, or if hospitalists generally handle most inpatients. If you're trained in and want to do obstetrics, ask if the hospital limits obstetrical privileges to ob/gyns. If you're a general internist, ask if ICU privileges are restricted to physicians with critical care certification. Or, if you're an internist with an interest or training in cardiology and want to do cardiac stress tests or read ECGs, ask if that's possible.