Medical Staff Bylaws in the Heartland

Robert T. McQueeney, MD and Ralph D. Skowron, MD
Article Type: 
March/April 1999
Volume Number: 
Issue Number: 

Dear Editor,
Thank you for your outstanding effort as editor of the Medical Sentinel, especially for your courage in tackling emotionally charged issues which our other "representative organizations" ignore. Unfortunately, our aversion to the feelings these issues engender, does not negate the need to deal with them. As new members of the AAPS, we have mixed emotions discovering that our unpleasant feelings are shared by so many colleagues.

We made the choice several years ago to move to "America's Heartland," hoping to practice medicine as it was taught. "Organized" medicine was a foreign concept where we settled. Unfortunately, the tyranny of "acquisition and central control" has discovered our enclave. Our rural independent hospital (with "help" from the administration) is now under siege by several "suitors."

Seeking to maintain physician independence from the various health care merchants, we turned to AAPS for assistance. With unbelievable promptness they responded. Through Andrew L. Schlafly (AAPS General Counsel) we were introduced to José Guerra, Jr., M.D. Dr. Guerra, Chief of Staff, Wood County Hospital, Bowling Green, Ohio, graciously shared his experience and insights in dealing with this challenging issue.

Facing these issues of physician autonomy and self-determination, we recognized the need for stronger Medical Staff Bylaws. These bylaws provide not only the professional structure for medical staff operations, but also the legal structure through which the medical staff relates with the Hospital Board. If worded correctly, bylaws assure that physicians control their own affairs! If carelessly constructed, they can become worthless if hospital ownership changes.

Dr. Guerra and Mr. Schlafly assisted our implementation of bylaw changes, from language through tactics. We expect that these bylaw changes will insure that some medical control remains in physicians' hands, whether our hospital is sold or not.

Many of us realize that major non-medical forces continually disrupt the efficient provision of patient care. Few of us realize the ease with which our professional worlds can crumble. Many inefficiencies are forced upon the physicians by regulatory agencies which control hospital certifications, reimbursement, and malpractice issues. Few efforts are as worthwhile as the proper preparation of hospital Medical Staff Bylaws.

Unfortunately, we are usually too busy caring for the sick to deal with these issues. Also, most of us have no idea what we should do to protect ourselves; our "education" typically comes from the school of hard knocks. The need for further education is clear. The first step, then, is to share with our colleagues the importance of AAPS membership; no other physician organization "tells it like it is," refusing capitulation.

Further, we endorse Dr. Guerra's idea of a forum, perhaps through a regular Medical Sentinel section, or a dedicated department on to inform members (and non-members) of important medical and non-medical issues (such as bylaws development and construction) which physicians can influence locally.

Robert T. McQueeney, MD
Ralph D. Skowron, MD
Marinette, WI

[AAPS is setting up forums on various subjects including medical staff bylaws at Interested physicians can e-mail Andrew L. Schlafly, Esq. at See also Dr. Guerra's report on pages 65-66. ---Editor.]

Correspondence originally published in the Medical Sentinel 1999;4(2);41-43. Copyright©1999 Association of American Physicians and Surgeons (AAPS).

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