The doctor’s lawyer: the power of a chief of staff

PUBLISHED:     The Doctor’s Lawyer: The power of a chief of staff, Medical Post, Canadian Healthcare Network, June 24, 2024.

A Chief of Staff at any public hospital in Ontario is a position that is appointed by the Board of that hospital. They are not elected by the physicians. Yet, a physician’s privileges (and livelihood) are at the mercy of that Chief of Staff. What is a physician to do when they are on the bad side of their Chief of Staff?

What Happened?

The Chief of Staff is appointed by the Board, and it reports to the Board; that is a relationship that runs deep. While the  Public Hospitals Act (“PHA”) requires a hospital to create a Medical Advisory Committee (“MAC”), the PHA is silent on the appointment and power of a Chief of Staff. That decision is left to a hospital’s bylaw, and under which the Chief of Staff is appointed by the Board.

What Does this Mean?

A lack of procedural safeguards can lead to overbroad, disproportionate and unreasonable exercises of power in public decision making – including hospitals. Chiefs of Staff hold extraordinary decision making power, yet the exercise of their power and influence is left completely unchecked under the governing legislation, the PHA.

The same issue often arises between physicians and their Department Chiefs. The Chief of every Department sits on the MAC. If a physician is on the wrong side of their Department Chief, it is incredibly difficult for that physician to succeed at a hearing before the MAC. After all, the other Department Chiefs will defer to your Department Chief, when it comes to matters of your particular specialty;  unless, the physician has a really good case.

When a physician is impacted by a decision made by the MAC and then the Board, they have a right to a hearing before an independent tribunal; the Health Professions Appeal and Review Board (the “HPARB”). This is a lengthy, stressful, and potentially expensive process, which often deters physicians from challenging hospital leadership in the first place.

The Bottom Line

Physicians are an easy target for vengeful hospital leadership because physicians must apply for reappointment every year. Obtaining privileges at another hospital, if your privileges have been suspended or revoked somewhere else, is near impossible.

Since physicians do not have the power and protection of a union (unlike nurses), a strong, supportive and educated Medical Staff Association (“MSA”) is crucial for physicians working in a public hospital. The president of your MSA ought to be someone who is not afraid to advocate for what is right.

Not all Chiefs of Staff or Department operate this way. I have seen some genuinely strive to make reasonable and correct decisions. But in some cases, when a Chief of Staff’s power is unrestricted, a hospital’s culture can go from being just, to unjust.

Ultimately, what’s the best way you, as a physician, can protect your career? Don’t put all of your eggs in one hospital’s basket. If you start to find yourself on the wrong side of your Chief of Staff or Department, obtaining locum privileges or surgical assisting at other hospitals is a good way to ensure that you have an exit strategy.  Sad as it is to say, the time may come when you might actually need one!