Question:  How should non-physician members of the medical staff be involved in peer review?

Short Answer:  The subject has not been well-studied. Best practice examples are needed.


In our national study of peer review practices, we found that Advanced Practice Nurses and/or Physician’s Assistants were credentialed as members of the medical staff to provide care at 96% of 339 facilities responding. In 76% of these, their clinical activity was subject to the same review process as physicians. Among these 243 facilities, such clinicians served on peer review committees or as reviewers in 61 (25%). (1) These findings were documented in the manuscript submitted for peer review, but were omitted from the actual publication due to space constraints.

Our study did not drill down on the associated parameters that might be associated with this asymmetry. At issue is whether they function as fully-independent practitioners. The scope of practice of non-physician clinicians is regulated by state licensing boards and hospital bylaws. In particular, there may be a requirement for a supervisory relationship with a physician.

When a supervisory relationship prevails, the ultimate responsibility for care could be seen to fall to the physician. Moreover, the non-physician clinician may have an employment relationship under a physician practice. In such cases, while their clinical practice must still be evaluated, a high degree of asymmetry is built-in and it could be reasonably questioned whether the peer review model of professional self-regulation fits.

On the other hand, Allied Health Professionals may have a strong desire, commitment and capability for participation in clinical peer review. I have personally seen this exceed that of physicians.

There is some slowly growing literature on the subject of clinical peer review that might apply specifically to Allied Health Professionals. (2-4) Otherwise, the same principles found to be of value with respect to physician peer review could serve to guide program design: The QI Model.

  1. Edwards MT, Benjamin EM. The process of peer review in US hospitals. J Clin Outcomes Manage 2009(Oct);16(10):461-467.
  2. Rout A, Roberts P. Peer review in nursing and midwifery: a literature review. J Clin Nursing. 2008;17:427-442.
  3. Briggs LA, Heath J, Kelley J. Peer review for advanced practice nurses: what does it really mean? AACN Clin Issues. 2005 Jan-Mar;16(1):3-15.
  4. Kenny KJ, Baker L, Lanzon M, Stevens LR, Yancy M. An innovative approach to peer review for the advanced practice nurse: a focus on critical incidents. Journal of the American Academy of Nurse Practitioners 2008;20:376–381