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Credentials and privileges are critical for ensuring that you have access to your patients and can practice to the full extent of your desired scope.
Hospital governing boards make decisions about privileges based on the organization's medical bylaws. One way that family physicians can protect family medicine's scope of practice is by ensuring a family physician representative is on the priviling committee.
Learn how to prepare for your credentials or privileges application process and how the AAFP can support you.
In order to submit your credentialing application, you will need to gather and submit documents that verify your training, education, experience, and licensure. Review the hospital’s medical staff bylaws thoroughly before requesting an application. Once your materials have been submitted, the hospital will verify the information you submitted and medical staff will review your application. The decision to grant or deny privilege(s) is an objective, evidence-based process.
To prepare for the credentialing or privileging process gather and make copies of these documents:
Request an application package from the medical staff office. Read and follow your hospital’s application instructions carefully. Submit all requested documents, including privilege request form(s) with your application. If information is missing or the medical staff requires more clarifying information, typically they send a letter requesting information within a specific time frame. If the information is not received within the specified time frame, the credentialing committee may consider the application withdrawn.
When you sign and submit the application, you attest the application and accompanying documents are accurate and complete. Any inaccuracy, omission, or misrepresentation, even unintentional, may be grounds for terminating the process. The applicant does not have the right to a fair hearing or appeal.
You also authorize hospital and medical staff to inspect all records and documents and consult prior and current references or others about your professional competence, character, ability to perform privileges requested, ethical qualifications, and professional liability actions.
The credentialing committee and medical staff appointee determines whether you meet privileging requirements. If so, your application is processed and verified. You may be asked for an interview. If an applicant does not meet requirements, a member of the credentialing committee will notify the applicant.
Be aware that medical staff bylaws may contain language stating that certain privileges may be reserved for a contracted group with exclusive privileges (i.e., anesthesia may have exclusive services for pain management/intraoperative anesthesia, or other procedures.) Thus, a physician may meet requirements, but it does not necessarily entitle them to privileges.
Learn how one AAFP member navigated the complicated crendentialing process after taking a break from clinical work.
Privileging authorizes a physician to perform a specific scope of patient care.
Initial privileges are subject to a period of focused professional practice evaluation (FPPE). This period confirms current competence. After medical staff approval the credentialing committee will define how clinical performance is monitored and evaluated, this may use prospective, concurrent, or retrospective proctoring. Other evaluation may include:
With appropriate training, family physicians can safely provide the following procedures with high-quality outcomes at reduced costs. This list is not exhaustive, but it demonstrates the value and benefit of care provided to communities when family physicians practice at their full scope.
Note: If you are seeking privileges in a specific procedure, some hospitals may require a department other than the family medicine department to recommend and approve privileges.
The scope of family medicine includes many office- and hospital-based procedures, with many family physicians gaining advanced procedural skills during residency.1 Through this training, family physicians deliver safe and effective procedural care with patient outcomes comparable to many other specialists. When family physicians perform certain procedures, health care costs are reduced and health systems experience a return on investment.2
Therefore, maintaining the full scope of practice for family physicians is essential to ensuring access to cost-effective and quality care in rural and other areas. This is especially true for specific procedures in cardiology, dermatology, emergency care, obstetrics and pediatrics.3
1. Newman AR, Heidelbaugh JJ, Klemenhagen K, et al. Current procedural practices of family medicine teaching physicians. Fam Med. 2024;56(3):156-162.
2. Nelligan I, Montacute T, Browne M-A, et al. Impact of a family medicine minor procedure service on cost of care for a health plan. Fam Med. 2020;52(6):417-421.
3. Barreto T, Jetty A, Eden AR, et al. Distribution of physician specialties by rurality. J Rural Health. 2021;37(4):714-722.
When properly trained, family physicians can perform colonoscopies safely and competently with a high degree of patient satisfaction.4
The quality, safety and efficacy of colonoscopies performed by primary care physicians are comparable to those performed by gastroenterologists and are in accordance with expert guidelines.5-7
Family physicians perform nearly one-third of colonoscopies in rural areas.8
In one study, 99% of patients reported they would be willing to have a repeat colonoscopy performed by their primary care physician.9
Primary care physicians who performed flexible sigmoidoscopies and colonoscopies were more likely to comply with colorectal cancer screening recommendations than those who did not perform the screening.10
The AAFP supports privileging for colonoscopy based on an individual’s education, training, experience and current competence, as outlined in the AAFP's policy, Privileges, colonoscopy. Other valuable resources on the topic include the AAFP’s Colonoscopy (position paper) and the American Association of Primary Care Endoscopy’s website.
4. Newman RJ, Nichols DB, Cummings DM. Outpatient colonoscopy by rural family physicians. Ann Fam Med. 2005;3(2):122-125.
5. Wilkins T, LeClair B, Smolkin M, et al. Screening colonoscopies by primary care physicians: a meta-analysis. Ann Fam Med. 2009;7(1):56-62.
6. McClellan DA, Ojinnaka CO, Pope R, et al. Expanding access to colorectal cancer screening: benchmarking quality indicators in a primary care colonoscopy program. J Am Board Fam Med. 2015;28(6):713-721.
7. Berry E, Hostetter J, Bachtold J, et al. Evaluating colonoscopy quality by performing provider type. J Natl Cancer Inst. 2024;116(8):1264-1269.
8. Komaravolu SS, Kim JJ, Singh S, et al. Colonoscopy utilization in rural areas by general surgeons: an analysis of the National Ambulatory Medical Care Survey. Am J Surg. 2019;218(2):281-287.
9. Kolber MR, Wong CK, Fedorak RN, et al. Prospective study of the quality of colonoscopies performed by primary care physicians: the Alberta Primary Care Endoscopy (APC-Endo) Study. PLoS One. 2013;8(6):e67017.
10.Levy BT, Dawson J, Hartz AJ, et al. Colorectal cancer testing among patients cared for by Iowa family physicians. Am J Prev Med. 2006;31(3):193-201.
A variety of skin biopsies can be performed by family physicians, enabling early detection of malignant lesions.11
Incorporating dermoscopy, with adequate training, along with a clinical exam, improves the accuracy of diagnosing pigmented lesions.12
Facilities report savings and improved efficiency when general practice physicians perform minor surgery on sebaceous cysts.13
Family physicians achieved significant cost savings for health systems when performing the following procedures: drainage of skin abscesses, hematomas, bullae or cysts; biopsy and removal of skin lesions; excision of soft tissue masses; and removal of nail plates.14
11. Lin AJ, Ferris LK, Maier J, et al. Skin biopsies and diagnostic outcomes at a multisite family medicine residency network. South Med J. 2024;117(10):609-611.
12. Secker LJ, Buis PA, Bergman W, et al. Effect of a dermoscopy training course on the accuracy of primary care physicians in diagnosing pigmented lesions. Acta Derm Venereol. 2017;97(2):263-265.
13. van Dijk CE, Verheij RA, Spreeuwenberg P, et al. Minor surgery in general practice and effects on referrals to hospital care: observational study. BMC Health Serv Res. 2011;11(1):2.
14. Nelligan I, Montacute T, Browne MA, et al. Impact of a family medicine minor procedure service on cost of care for a health plan. Fam Med. 2020;52(6):417-421.
15. Arribas Blanco JM, Gil Sanz ME, Sanz Rodrigo C, et al. Effectiveness of dermatologic minor surgery in the office of the family physician and patient satisfaction in relation with ambulatory surgery. Med Clin (Barc). 1996;107(20):772-775.
The AAFP supports privileging for endoscopy based on an individual’s education, training, experience and current competence, as outlined in the AAFP’s position paper, EGD, training and credentialing of family physicians in (position paper).
Allowing family physicians to work in hospital settings ensures better continuity of care for patients, professional growth for physicians and access to better resources for communities that may not be available in traditional family physician practices.16
16. Garrison GM, Meunier MR, Boswell CL, et al. Continuity of care: a primer for family medicine residents. Fam Med. 2023;56(2):76-83.
Family physicians who perform injections around the knee (joint and bursa), shoulder (joint and bursa) and hip (trochanteric bursa) had similar patient outcomes (i.e., reduced pain and a better physical quality of life) compared with internal medicine physicians.17
Training family physicians to perform musculoskeletal injection therapy can be cost-effective for health systems.18
14. Nelligan I, Montacute T, Browne MA, et al. Impact of a family medicine minor procedure service on cost of care for a health plan. Fam Med. 2020;52(6):417-421.
17. Bhagra A, Syed H, Reed DA, et al. Efficacy of musculoskeletal injections by primary care providers in the office: a retrospective cohort study. Int J Gen Med. 2013;6:237-243.
18. Nelson RE, Battistone MJ, Ashworth WD, et al. Cost effectiveness of training rural providers to perform joint injections. Arthritis Care Res (Hoboken). 2014;66(4):559-566.
All family physicians are trained and competent to “provide care for low-risk patients who are pregnant, to include management of early pregnancy, medical problems during pregnancy, prenatal care, postpartum care and breastfeeding.”19
Many family physicians pursue additional training within residency to provide intrapartum care for low-risk pregnancies and some moderate-risk pregnancies, including vaginal deliveries. Some family physicians pursue further training to include managing high-risk pregnancies and cesarean deliveries.
Family physicians deliver safe, effective and cost-efficient pregnancy care with health outcomes comparable to obstetricians-gynecologists (OB-GYNs), especially for low-risk pregnancies and in rural settings.20,21,22,23,24,25
Self-advocacy guide: Applying for obstetrics privileges
This guide from the AAFP and ABFM provides a detailed review of the evidence, the business case and more for family physicians providing obstetrical care.
Presentation: Education on family medicine and obstetrics
Use this educational presentation in meetings with committees and health system leaders to advocate for obstetrics privileges for family physicians.
19. Society of Teachers of Family Medicine. Core outcomes, competencies, subcompetencies, and milestones. Accessed October 30, 2025. www.stfm.org/teachingresources/resources/cbme-toolkit/epascompetenciesmilestones/overview/
20. Avery DM, Graettinger KR, Waits S, et al. Comparison of delivery-related complications among obstetrician-gynecologists and family physicians practicing obstetrics. Am J Clin Med. 2014;10(1):16-19.
21. Aubrey-Bassler K, Cullen RM, Simms A, et al. Outcomes of deliveries by family physicians or obstetricians: a population-based cohort study using an instrumental variable. CMAJ. 2015;187(15):1125-1132.
22. Avery DM, Burgess K, McDonald JT, et al. Neonatal outcomes of 26,331 infants delivered by obstetrics fellowship trained family physicians and OB/GYNs. J Fam Med Dis Prev. 2015:1-3.
23. VanGompel EW, Singh L, Carlock F, et al. Family medicine presence on labor and delivery: effect on safety culture and cesarean delivery. Ann Fam Med. 2024;22(5):375-382.
24. Coffman M, Wilkinson E, Jabbarpour Y. Despite adequate training, only half of family physicians provide women's health care services. J Am Board Fam Med. 2020;33(2):186-188.
25. Walters D, Gupta A, Nam AE, et al. A cost-effectiveness analysis of low-risk deliveries: a comparison of midwives, family physicians and obstetricians. Health Policy. 2015;11(1):61-75.
26. Quinlan JD. The role of the family physician in rural maternity care. Clin Obstet Gynecol. 2022;65(4):801-807.
Point-of-care ultrasound reduces the cost of care by identifying the need for more advanced imaging.27
27. Bornemann P, Barreto T. Point-of-care ultrasonography in family medicine. Am Fam Physician. 2018;98(4):200-202.
28. Andersen CA, Holden S, Vela J, et al. Point-of-care ultrasound in general practice: a systematic review. Ann Fam Med. 2019;17(1):61-69.
29. New A, Chiles L, Bird E, et al. 1238 outcomes of vasectomies based on provider type and review of timing and sperm cell counts from post-vasectomy semen analysis. J Urol. 2013;189(4S):e507.
30. Posielski NM, Shapiro DD, Wang X, et al. Do I need to see a urologist for my vasectomy? A comparison of practice patterns between urologists and family medicine physicians. Asian J Androl. 2019;21(6):540-543.
Physicians who work in a practice that contracts with federal or private insurers must undergo credentialing. Credentialing is the process of verifying a physician’s education, training, experience, current competence, and licensure to provide services.
Hospitals and other health care employers and payers both have credentialing processes to complete. Credentialing is closely tied with privileging and is frequently a first step for physicians seeking hospital privileges.
Privileging is the process of authorizing a specific scope of practice at a healthcare organization based on credentials and performance. Hospital governing boards grant privileges based on the recommendations from a physician's department and the credentialing committee. The hospital governing board should consider all recommendations, including to deny, accept, or referral back for further consideration. At least every 24 months, or more frequently if required by state law, physicians will need ongoing professional practice evaluation (OPPE) for continued or revised hospital privileges.
Yes, typically there are active and courtesy privileges. Some hospitals may have more categories of medical staff membership that may qualify for privileges. Review the medical staff bylaws for a statement of duties and privileges in each category of medical staff.
The purpose of credentialing and privileging is to ensure that qualified, well-trained physicians are providing quality care to patients. Although the steps are clear, credentialing and privileges are unique from location to location, and challenges can arise, including stressful privilege disputes. Practices may use different services for obtaining credentials, and for privileges to be secured, you’ll need to understand your hospital’s individual bylaws. These resources can help you in the event of an anticipated or actual privileging dispute:
Medical staff bylaws stem from various regulatory sources, including state hospital licensing laws, federal conditions of hospital participation in Medicare, and rules from accrediting organizations, such as The Joint Commission. They describe a hospital’s organizational structure, the medical staff‘s organizational responsibility, rules for self-governance, and outline privileges of all licensed physicians and non-physician practitioners. They are created and approved by medical staff with final approval from the hospital governing board. Revisions to medical staff bylaws must be approved by the governing board.
Because decisions about granting privilege are made locally, it's important for family physicians to participate in the medical staff meetings at their hospital and serve on the privileging committee.
Support your pursuit of privileges with help from the AAFP. These policies were written to help you advocate for the practice scope that fits your training. They can be provided as documentation in support of your request.