Practice area 147

CLINICAL PRIVILEGE WHITE PAPER

Obstetrics and gynecology

Background

Obstetrics and gynecology (OB/GYN) is the medical specialty that involves the treatment
of clinical conditions specific to women. Obstetricians diagnose and manage all condi-
tions occurring during pregnancy from the time of conception through the postpartum
period. Gynecologists diagnose and treat diseases particular to the female reproductive
tract, which include disease conditions of the mammary glands and the urinary tract.

Historically, the OB/GYN specialty combines the two disciplines to provide comprehensive
care for women because of the large amount of overlap between them. Gynecologists,
therefore, are also trained as obstetricians, and obstetricians are trained as gynecolo-
gists. However, some doctors drop their obstetric practice, especially as they get older.
This is often due to the double burden of late hours and high rates of litigation.

Physicians who wish to specialize in OB/GYN must meet the following education and
training requirements:

 Graduation from an approved medical school

 Completion of an accredited OB/GYN residency program, which is a minimum
of four years in length and includes
- rotations divided between obstetrics, gynecology, and their subspecialties
- experience in primary and preventive care for the equivalent of at least
six months of the residency, including inpatient and ambulatory care
- increase in patient responsibility with each year of training
- serving as senior resident during final year of residency

OB/GYN practitioners can subspecialize in one of the following fields:

 Gynecologic oncology
 Maternal/fetal medicine
 Reproductive endocrinology and infertility
 Urogynecology/reconstructive pelvic surgery

Each subspecialty has its own certification exams administered by the American Board of Ob-
stetrics and Gynecology (ABOG), and physicians can become certified in one or more of them.

While there are other practitioners who request OB/GYN privileges, this White Paper is

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Obstetrics and gynecology Practice area 147

concerned with those physicians who have completed residency training in OB/GYN. For
additional information, see Clinical Privilege White Paper Family Practice, Practice Area 134 and
Clinical Privilege White Paper Nurse-midwife, Practice Area 164.

Involved specialties Obstetricians, gynecologists, family practitioners, and nurse-

midwives

Positions of societies The American College of Obstetrics and Gynecology (ACOG)

and academies is the nations leading group of professionals providing health
ACOG care for women. To become an ACOG fellow, applicants must
satisfy the following requirements:

 Be board certified in OB/GYN

 Completed an OB/GYN residency program within the geo-
graphic confines of the ACOG
 Hold an active license to practice medicine
 Show continuous limitation of training and/or professional
activities to obstetrics and/or gynecology for the five years
immediately prior to the date of application
 Show that they have practiced in the same community
from which application is made for a minimum of 12
months prior to submission of an application
 Attainment of high ethical and professional standing
 Submission of two endorsements from active fellows of the
ACOG

Positions of other The ABOG is an independent organization that certifies obste-

interested parties tricians and gynecologists in the United States. Candidates for
ABOG certification must pass both a written and an oral examination.

Candidates must meet the following requirements to be ruled admissi-

ble to take the written examination:

 Hold an MD degree, or an equivalent degree, and an unre-

stricted license. Candidates with a DO degree must have
graduated from a school of osteopathy accredited by the
American Osteopathic Association (AOA).
 Have unrestricted hospital privileges to practice as an obste-
trician-gynecologist in each of the hospitals in which the
candidate has patient care responsibilities.
 Have completed or be near completion of no less than four
years in clinical obstetrical and gynecological programs
accredited by the Accreditation Council for Graduate
Medical Education (ACGME) or no less than five years in

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Obstetrics and gynecology Practice area 147

clinical obstetrical and gynecological programs accredited by

the Council of the Royal College of Physicians and Sur-
geons of Canada.
 Submit a statement signed by the program director certify-
ing that the candidate has
- followed satisfactorily the course of instruction
designed for this program
- completed and submitted to the program director a sat-
isfactory list of obstetrical patients with medical and
obstetrical complications, as well as operative obstetri-
cal and gynecological procedures performed during all
the years of residency training
- achieved the appropriate knowledge, ability, and judg-
ment in order to provide appropriate clinical care in
obstetrics, gynecology, and womens health, as docu-
mented by ongoing evaluation during the entire resi-
dent program
- demonstrated the necessary technical skills to perform
major abdominal and vaginal surgical procedures
on the female pelvis and related structures
major surgical procedures for female urinary and
fecal incontinence and other forms of pelvic dys-
function (reconstructive pelvic surgery)
spontaneous and operative obstetric deliveries
surgical exploration of the abdomen
pelvic and abdominal endoscopic procedures
diagnostic evaluations including electronic fetal
monitoring, ultrasound, colposcopy, amniocente-
sis and urodynamic testing the diagnosis and
treatment of complications of the above

Candidates must meet the following requirements to be ruled admissi-

ble to take the oral examination

 Passing grade on the written examination prior to making

application for the oral examination
 Unrestricted license to practice medicine in any state or ter-
ritory (United States or province of Canada) in which the
candidate has held a medical license
 Actively engaged in unsupervised practice defined as inde-
pendent, continuous, unsupervised patient care in OB/GYN
for the past year
 Unrestricted hospital privileges to practice as an obstetri-
cian-gynecologist in each of the hospitals in which the can-
didate has been responsible for patient care during this time
 Submission of case lists and summary sheets of all patients

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Obstetrics and gynecology Practice area 147

dismissed from care in all hospitals during the 12 months

ending June 30 prior to the scheduled examination, as well
as a list of 40 patients from his or her office practice

AOA The AOA grants certification in OB/GYN through the

American Osteopathic Board of Obstetrics and Gynecology
(AOBOG). The certification process consists of two examina-
tions: written and clinical.

Candidates for the written examination must meet the following criteria:

 Be a graduate of an AOA-accredited college of osteopathic

medicine
 Be a resident in or a graduate of an AOA or an ACGME-
approved postdoctoral training program in OB/GYN

Candidates for the clinical examination must meet the following criteria:

 Passed the AOBOG written examination

 Completed an AOA-approved internship
 Received approval of all years of residency training from
the American College of Osteopathic Obstetricians and
Gynecologists Residency Evaluating Committee
 Received AOA approval of all ACGME residency training
 Hold a current, unrestricted medical license in the state(s)
and or territory(s) where practice is being conducted
 Are a member in good standing of the AOA or the
Canadian Osteopathic Association for a continuous period
of two years immediately prior to the date of certification
 Are able to show evidence of conformity to the standards as
set forth in the code of ethics of the AOA

JCAHO The Joint Commission on Accreditation of Healthcare Organ-

izations (JCAHO) has no formal position on the delineation of
privileges in OB/GYN. However, in its 2005 Comprehensive Ac-
creditation Manual for Hospitals, the JCAHO states (MS.4.10),
The organized medical staff has a credentialing process that is
defined in the medical staff bylaws.

In the rationale for MS.4.10, the JCAHO says credentials

review is the process of obtaining, verifying, and assessing the
qualifications of an applicant to provide patient care, treat-
ment, and services for a healthcare organization. The creden-
tials review process is the basis for making appointments to
membership of the medical staff; it also provides information
for granting clinical privileges to licensed independent

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Obstetrics and gynecology Practice area 147

practitioners (LIPs) and other practitioners credentialed and

privileged through the hospitals medical staff process.

The JCAHO further states (MS.4.20), There is a process for

granting, renewing, or revising setting-specific privileges.

In the rationale for standard MS.4.20, the JCAHO says essen-

tial information needs to be gathered in the process of granti-
ng, renewing, or revising clinical privileges. The information
will dictate the type(s) of care, treatments, and services or
procedures that a practitioner will be authorized to perform.
Privileges are setting-specific because they require considera-
tion of setting characteristics, such as adequate facilities, equip-
ment, number, and type of qualified support personnel and
resources.

Setting-specific decisions mean that privileges granted to an

applicant are based not only on the applicants qualifications,
but also on consideration of the procedures and types of care,
treatment, and services that can be performed within the pro-
posed setting. All LIPs are privileged through the medical staff
process.

The JCAHO further states (MS.4.40), At the time of renewal

of privileges, the organized staff evaluates individuals for their
continued ability to provide quality care, treatment, and serv-
ices for the privileges requested as defined in the medical staff
bylaws.

In the rationale for MS.4.40, the JCAHO says the process for
renewal of privileges involves the same steps as those outlined
under standard MS.4.20 for granting initial privileges, and it
additionally requires the medical staff to evaluate practition-
ers ability to perform the privileges requested based on their
performance during the period of time they have been prac-
ticing at the organization. A hospital reviews the performance
of each practitioner for every setting under the control of the
hospital where the individual practices. Current competence is
determined by the results of performance improvement activi-
ties and peer recommendations.

Evidence of current ability to perform privileges requested is

required of all applicants for renewal of clinical privileges.

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Obstetrics and gynecology Practice area 147

CRC draft criteria The following draft criteria are intended to serve solely as a
starting point for the development of an institutions policy
regarding this practice area.

Minimum threshold Basic education: MD or DO

criteria for requesting core
privileges in OB/GYN
Minimum formal training: Successful completion of an
ACGME/AOA-accredited residency training program in
OB/GYN.
Required previous experience: Applicants must be able to
demonstrate that they have performed at least 50 deliveries
and have performed at least 50 inpatient/outpatient gyneco-
logical procedures in the past 12 months.

References A letter of reference must come from the director of the appli-
cants OB/GYN training program. Alternatively, a letter of ref-
erence regarding competence should come from the chief of
OB/GYN at the institution where the applicant most recently
practiced.

Core privileges in Core privileges in obstetrics include admit, evaluate, diagnose,

OB/GYN treat, and provide consultation to female patients presenting
in any condition or stage of pregnancy as well as injuries and
disorders of the reproductive system. Privileges also include
but are not limited to the following:

 Perform routine prenatal and postpartum care

 Employ obstetrical diagnostic procedures, including ultra-
sonography and other relevant imaging techniques
 Manage all high-risk pregnancies, including major medical
diseases that are complicating factors in pregnancy
 Perform the following procedures:
- Vaginal deliveries, including the use of obstetric forceps
and/or the vacuum extractor
- Vaginal breech and vaginal multifetal deliveries
- Vaginal births after previous cesarean delivery
- Manual removal of placenta
- Repair of obstetric lacerations
- Cesarean deliveries and related procedures
 Care for newborns, including resuscitation and intubation

Core privileges in gynecology include admit, evaluate, diag-

nose, treat, and provide consultation to female patients of all
ages presenting with illnesses, injuries, and disorders of the
gynecological or genitourinary system. Privileges also include
but are not limited to the following:

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Obstetrics and gynecology Practice area 147

 Perform gynecology screenings, which include clinical

breast exams, pelvic exams, Pap smears, and colposcopies
with vulvar, vaginal, and cervical biopsy
 Provide the full range of commonly employed gynecologic
diagnostic procedures, including ultrasonography and other
relevant imaging techniques
 Treat vaginitis, sexually transmitted diseases, abnormal
uterine bleeding, and pelvic pain
 Perform the following procedures:
- Insert intrauterine devices
- Suction curettage for pregnancy termination and man-
agement of incomplete, missed, or inevitable abortion
- Tubal sterilization
- Adnexal surgery, including ovarian cystectomy, oophor-
ectomy, salpingectomy, and conservative procedures for
treatment of ectopic pregnancy
- Abdominal and vaginal hysterectomy
- Exploratory laparotomy, for diagnosis and treatment of
pelvic pain, pelvic mass, hemoperitoneum, endometrio-
sis, and adhesions
 Diagnose and manage pelvic floor dysfunction, including
experience with the various operations for its correction
 Provide management of urinary incontinence

Special requests for For each special request, threshold criteria must be established.
OB/GYN Special requests for OB/GYN include any of the following pro-
cedures that were not a part of the applicants residency train-
ing program:

 Use of the laser

 Surgical treatment of conditions or diseases of the mammary
glands
 Use of the laparoscope
 Transcervical balloon tuboplasty

For more information, see Clinical Privilege White Paper Gyne-

cological laparoscopic surgery, Procedure 25; Clinical Privilege White
Paper Transcervical balloon tuboplasty, Procedure 77; and Clinical
Privilege White Paper General laser surgery, Practice area 175.

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Obstetrics and gynecology Practice area 147

Reappointment Reappointment should be based on unbiased, objective results

of care according to the organizations existing quality assur-
ance mechanisms.

Applicants in OB/GYN must be able to demonstrate that they

have maintained competence by documenting that they per-
formed at least 50 deliveries and at least 50 inpatient/outpatient
gynecological procedures annually over the reappointment
cycle.

For more information In addition, continuing education related to OB/GYN should

be required.

American Board of Obstetrics and Gynecology

2915 Vine Street
Dallas, TX 75204
Telephone: 214/871-1619
Fax: 214/871-1943
Web site: www.abog.org

American College of Obstetricians and Gynecologists

P.O. Box 96920
409 12th Street, SW
Washington, DC 20090-6920
Telephone: 202/638-5577
Web site: www.acog.org

American Osteopathic Association

142 East Ontario Street
Chicago, IL 60611
Telephone: 312/202-8000
Fax: 312/202-8200
Web site: www.aoa-net.org

Joint Commission on Accreditation of Healthcare

Organizations One Renaissance Boulevard
Oakbrook Terrace, IL 60181
Telephone: 630/792-5000
Fax: 630/792-5005
Web site: www.jcaho.org

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Obstetrics and gynecology Practice area 147

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Obstetrics and gynecology Practice area 147

Privilege request form

Obstetrics and gynecology
To be eligible to request clinical privileges in OB/GYN, an applicant must meet the fol-
lowing minimum threshold criteria:

 Basic education: MD or DO

 Minimum formal training: Successful completion of an ACGME/AOA-accredited residency

training program in OB/GYN.

 Required previous experience: Applicants must be able to demonstrate that they have per-
formed at least 50 deliveries and at least 50 inpatient/outpatient gynecological procedures in
the past 12 months.

 References: A letter of reference must come from the director of the applicants OB/GYN
training program. Alternatively, a letter of reference regarding competence should come from
the chief of OB/GYN at the institution where the applicant most recently practiced.

 Core privileges in OB/GYN: Core privileges in obstetrics include admit, evaluate, diagnose,
treat, and provide consultation to female patients presenting in any condition or stage of preg-
nancy as well as injuries and disorders of the reproductive system. Privileges also include but
are not limited to the following:
- Perform routine prenatal and postpartum care
- Employ obstetrical diagnostic procedures, including ultrasonography and other relevant
imaging techniques
- Manage all high-risk pregnancies, including major medical diseases that are complicating
factors in pregnancy
- Perform the following procedures:
Vaginal deliveries, including the use of obstetric forceps and/or the vacuum extractor
Vaginal breech and vaginal multifetal deliveries
Vaginal births after previous cesarean delivery
Manual removal of placenta
Repair of obstetric lacerations
Cesarean deliveries and related procedures
- Care for newborns, including resuscitation and intubation

Core privileges in gynecology include admit, evaluate, diagnose, treat, and provide consulta-
tion to female patients of all ages presenting with illnesses, injuries, and disorders of the

10 A supplement to Briefings on Credentialing 781/639-1872 07/05

Obstetrics and gynecology Practice area 147

gynecological or genitourinary system. Privileges also include but are not limited to the following:

- Perform gynecology screenings, which include clinical breast exams, pelvic exams, Pap
smears, and colposcopies with vulvar, vaginal, and cervical biopsy
- Provide the full range of commonly employed gynecologic diagnostic procedures, including
ultrasonography and other relevant imaging techniques
- Treat vaginitis, sexually transmitted diseases, abnormal uterine bleeding, and pelvic pain
- Perform the following procedures:
Insert intrauterine devices
Suction curettage for pregnancy termination and management of incomplete, missed, or
inevitable abortion
Tubal sterilization
Adnexal surgery, including ovarian cystectomy, oophorectomy, salpingectomy, and con-
servative procedures for treatment of ectopic pregnancy
Abdominal and vaginal hysterectomy
Exploratory laparotomy, for diagnosis and treatment of pelvic pain, pelvic mass, hemo-
peritoneum, endometriosis, and adhesions
- Diagnose and manage pelvic floor dysfunction, including experience with the various opera-
tions for its correction
- Provide management of urinary incontinence

 Reappointment: Reappointment should be based on unbiased, objective results of care

according to the organization's existing quality assurance mechanisms.

Applicants in OB/GYN must be able to demonstrate that they have maintained competence by
documenting that they performed at least 50 deliveries and have performed at least 50 inpa-
tient/outpatient gynecological procedures annually over the reappointment cycle.

In addition, continuing education related to OB/GYN should be required.

I understand that by making this request I am bound by the applicable bylaws or policies of the
hospital, and hereby stipulate that I meet the minimum threshold criteria for this request.

Physicians signature: ______________________________________________

Typed or printed name: ____________________________________________

Date: __________________________________________________________

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Obstetrics and gynecology Practice area 147

Publisher/Vice President: Suzanne Perney Senior Managing Editor: Edwin B.

Clinical Privilege White Papers sperney@hcpro.com Niemeyer
Advisory Board Group Publisher: Kathryn Levesque
klevesque@hcpro.com
eniemeyer@comcast.net

James F. Callahan, DPA John E. Krettek Jr., MD, PhD Beverly Pybus
Executive vice president and CEO Neurological surgeon Senior consultant
American Society of Addiction Medicine Vice president for medical affairs The Greeley Company
Chevy Chase, MD Missouri Baptist Medical Center Marblehead, MA
St. Louis, MO
Sharon Fujikawa, PhD Richard Sheff, MD
Clinical professor, Dept. of Neurology Michael R. Milner, MMS, PA-C Chair and Executive Director
University of California, Irvine Medical Center Senior physician assistant consultant The Greeley Company,
Orange, CA Phoenix Indian Medical Center a division of HCPro, Inc.
Phoenix, AZ Marblehead, MA
John N. Kabalin, MD, FACS
Urologist/Laser surgeon
Scottsbluff Urology Associates
Scottsbluff, NE

The information contained in this document is general. It has been designed and is intended for use by hospitals and their credentials
committees in developing their own local approaches and policies for various credentialing issues. This information, including the
materials, opinions, and draft criteria set forth herein, should not be adopted for use without careful consideration, discussion, addi-
tional research by physicians and counsel in local settings, and adaptation to local needs. The Credentialing Resource Center does not
provide legal or clinical advice; for such advice, the counsel of competent individuals in these fields must be obtained.

Reproduction in any form outside the recipients institution is forbidden without prior written permission. Copyright 2005 HCPro, Inc.,
Marblehead, MA 01945.

12 A supplement to Briefings on Credentialing 781/639-1872 07/05