Understanding Expertise vs. Specialties in the Healthcare Industry

When it comes to healthcare providers, expertise and specialties play crucial roles in their professional development and how they are promoted within organizations. In this blog post, we outline several considerations to help organizations understand the distinction between expertise and specialties, and how they relate to privileging and branding of healthcare providers.

Acquiring Expertise

Healthcare providers can acquire expertise through various means, including formal training programs, informal training, and hands-on experience. In many organizations, expertise is closely tied to a provider's desired area of practice or their aspirations for career advancement. However, when establishing criteria for privileging, medical staffs often require the completion of specialty or subspecialty training programs. It's important to note that providers may also obtain training outside of these formal programs, especially in cases where specific procedures were not yet developed at the time of their training. For example, surgeons who completed their programs before the widespread use of robotic surgery might have acquired expertise in this modality through informal training programs sponsored by technology vendors.

Additionally, providers who have completed specialty or subspecialty programs may not have expertise in all procedures due to limited experience during their training. This highlights the need for organizations to carefully consider how they promote and brand their providers to the public.

Each organization may have its own criteria for determining whether a provider can be promoted in a particular area of expertise. For instance, while there may not be unique privileges specifically associated with the care of geriatric patients that are different from those provided by internists, an organization might decide to promote only internists who have received fellowship training in geriatric care as having that specific expertise.

Ensuring Fair and Consistent Privileging Decisions

Regulatory bodies like the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission have established guidelines to ensure fair and consistent privileging decisions. CMS regulations require the governing body to consider recommendations from existing medical staffs members and base privileging decisions on criteria such as character, competence, training, experience, and judgment. They also emphasize that professional privileges should not solely depend on certification, fellowship, or membership in specialty bodies or societies. These requirements are reflected in the standards of hospital accreditors.

When developing privilege forms and criteria, organizations should keep certain considerations in mind. Privileges should be organized by specialty rather than medical staff departments to ensure clarity. Objective criteria should be established, allowing for consistent and uniform application. These criteria should include required education, training, and, when appropriate, clinical activity and outcomes. Privileges within a specialty should have similar criteria and requirements, accurately representing the majority of practitioners in that field. Detailed definitions of privileges should be provided to facilitate monitoring and prevent providers from exceeding the scope of their granted privileges.

Determining criteria for expertise requires organizations to establish requirements for the areas of emphasis or expertise they wish to promote. This may involve specific training or experience. Some organizations may focus on board certifications and training rather than highlighting areas of expertise. However, organizations must exercise caution when promoting providers with specific expertise on their websites, as they bear responsibility for verifying and endorsing that expertise.

Supporting Your Process with Software

To assist with managing specialties and expertise, platforms like CredentialStream® offer record areas within provider profiles. Specialty records interact with credential and license records, while expertise records allow organizations to maintain information on providers' areas of interest. Although expertise information stored in CredentialStream is limited and not subject to primary source verification, it can still aid in organizing and managing provider qualifications.

Understanding the distinction between expertise and specialties is vital in the healthcare industry. By establishing clear criteria, promoting transparency, and adhering to regulatory guidelines, healthcare organizations can ensure they provide accurate representation of provider qualifications, deliver high-quality care, and meet the expectations of patients and the public. If you’d like more information on managing provider qualifications in CredentialStream, we’re here to help.