Medical staff leaders have an ally in their quest to function effectively in the hospital environment-the Organized Medical Staff Section of the California Medical Association. Pro-physician model bylaws and a bylaws-analysis service also bolster medical staff leadership and ensure patient advocacy.

As a former California Medical Association staffer, I wonder how many California physicians are aware of the help that the CMA offers medical staff organizations in hospitals statewide. When I worked in-house at the CMA on medical staff issues, I could calculate that awareness in a number of ways, but the quickest, most reliable measure was the inverse proportion to the amount of sleep I got.

Now, I work as counsel for medical staffs all around the country from St. Paul, Minn., where, as my neighbor Garrison Keillor describes, "All the women are strong, all the men are good-looking, and all the children are above average." I know what my non-California medical staffs face and how envious they are of the CMA's services. Here is a quick reminder of what they are missing--what you have as a California medical staff member.

An Organized OMSS
Organized medicine has its detractors, and within organized medicine, the Organized Medical Staff Section has detractors in legions, perhaps for the same reasons. Who has time to go to meetings, write and research resolutions, and otherwise take time away from practice, patients, family and friends? Who is interested in medical staff issues?

The short answer: all physicians. If you practice in or send patients to a hospital, you have an interest in what happens there. You may have the interest sharpened suddenly, by becoming a department chair, a committee member or even an officer, as a matter of rotation, bad planning, bad luck, or good, old-fashioned guilt. Whatever the reason and without notice, "peer review," "corrective action," "clinical privilege criteria," "exclusive contracting" and "economic credentialing" are issues you are supposed to know about and make decisions on. And you may not have been exposed to any of them.

There is no shortage of help out there, but the bad news is that those people who offer ready assistance may not have physicians' interests at heart. The all-expenses-paid conference the hospital wants you to attend and the "free" legal advice from hospital counsel come at an enormous cost. That help won't help doctors.

Enter the CMA-OMSS. Physicians in the same spot, struggling with the same issues, are connected with medical staff leaders from all over California by tapping into the CMA-OMSS. Run by a dedicated council of experienced medical staff leaders, the CMA-OMSS network can save you hours and untold grief by providing information, ideas, resources and solutions that protect physicians. The CMA-OMSS meets annually, in conjunction with the CMA House of Delegates in October.

CMA-OMSS Annual Sessions include affordable medical staff-focused seminars and all-important networking opportunities, but also plug medical staff leaders into the CMA policy-making process. OMSS resolutions to the CMA spark change in state law, focus attention on medical staff crises, and bring organized medicine's resources to bear on medical staff problems. Few state medical associations have an organized OMSS--take advantage of California's. To join, check out the CMA Web site at www.cmanet.org or send an e-mail to medstaffhelp@cmanet.org.

Model Medical Staff Bylaws
I write medical staff bylaws for a living, and I know that most people--and physicians in particular--do not want to get anywhere near them. But for medical staff members and medical staff leaders, the bylaws are unavoidable. Bylaws are the roadmap to medical staff operations--how to get through to the hospital administration, who is on what committee, how to take disciplinary action, where to take this action for implementation and when to call a meeting.

Bylaws are subject to frequent changes due to shifting state and federal laws and regulations, Joint Commission standards for hospital accreditation, and the priorities within a particular medical staff and hospital. Here again, the hospital administration would be happy to help you with all sorts of ideas for changes and improvements, or to scare you with absolute mandates from above regarding bylaws amendments needed immediately.

Don't buy it.

There is a pro-medical staff, pro-physician solution--the CMA Model Medical Staff Bylaws. The CMA model is an encyclopedia on everything that should be in your bylaws and on issues peripheral to bylaws, but crucial to day-to-day medical staff operations. Not only does the model feature provisions that can be used to improve bylaws in any California hospital, it includes annotations that explain why the wording is good for doctors. And in bylaws, it is critical to maintain a pro-physician stance. Medical staff bylaws can be the best shield for or the most dangerous weapon against doctors in hospitals. Bylaws provisions can dictate who gets what privileges, when physicians have to be on call and whether you can challenge a decision that cuts off your practice. Bylaws are not just guidelines; the document is apt to be enforceable in court. Since both the hospital and medical staff have to agree to it, the document should be negotiated like any other contract.