One of my favourite activities is working with medical affairs leaders in hospitals managing complaints and concerns about physicians.  But when I tell people about that work – I get a few quizzical looks.

Medical affairs? What is that?

The public knows very little about the tangled web relationship between hospitals and physicians and their other professional staff members like dentists, midwives and certain nurse practitioners.  Frankly, that’s a good thing.  It is helpful for the public and most importantly, patients and their families, to experience hospital services as seamless and integrated.

Pause: Of course, hospitals employ staff who are also “professional” such as nurses, social workers, physiotherapists, medical radiation technologists, occupational therapists and lots of other regulated health professionals. In the hospital and legal communities we use the term “professional staff” to capture physicians, dentists, midwives and certain nurse practitioners and the relationship with those providers is different than other hospital staff. Use of the term is not at all a comment on the professionalism of other disciplines working in hospitals. 

Behind the scenes, there is a complicated legal relationship in Ontario (and many other jurisdictions) between hospitals and their professional staff members.

• In most hospitals, not all, professional staff members are independent contractors and not employees.
• Professional staff members have “privileges” in hospitals that are renewed on an annual basis.
• Hospitals are responsible to vet their professional staff which requires a robust system of credentialing.
• Physicians have unique rights and responsibilities unlike other independent contractors or employees in any other sector which are set out in a law called the Public Hospitals Act, which has been around since the dawn of time.
• Professional staff are usually legally responsible for their own services and care delivered independent of the hospital.

This legal separation between professional staff members and hospitals often only becomes apparent to the public when there is a  complaint or lawsuit and a lawyer explains the different parties that may be responsible.

So it makes sense that the public do not know much about the leaders in hospitals called “medical affairs”. Let me tell you a bit more about them.

Medical affairs staff are administrative leaders who address these 7 main activities:

1. Human resource planning: developing and following a strategic plan for hospital needs for physicians and other professionals. This includes an analysis of who is expected to retire and where the hospital will grow its services;
2. Recruiting: while the chiefs of department may look for the next top talent, the medical affairs personnel deals with the back-office responsibilities of bringing someone on (sending out letters, offers, contracts, enticements);
3. Credentialing: making sure that professional staff members applying to the hospital have the right skills and are able to provide the services that the patient population needs;
4. Privileging: taking the applications from the credentialing phase and bringing them forward for review by the medical advisory committee and the hospital board;
5. Managing: this is where much of the medical affairs activity occurs and is about communicating with the professional staff to ensure they are engaged in hospital issues. This could also involve orientation, training, continuing skills development, as well as making sure they understand hospital policies, any changes that happen and to receive their input in hospital planning;
6. Addressing challenging issues: dealing with and responding to complaints and concerns about individual professional staff members (for example, a complaint about a physician relating to a negative patient outcome.) This could also include dealing with staff issues such as health, parental or educational leaves; and
7. Exiting: involves retirements, resignations or when people are asked to leave the organization.

Depending on the size of a hospital there may be a dedicated department for medical affairs or the tasks above may be addressed by the Chief Executive Officer and lead physician with assistance from an administrative person.

I was recently interviewed by Advocate Daily on medical affairs leaders. You can read more about my thoughts on the role of medical affairs leaders in that article.

Free Resource:  If you want to learn more about the relationship between hospitals and their professional staff, the Ontario Hospital Association has made its Professional Staff Credentialing Toolkit free online.  I am the primary author.