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March 23, 1984

The Battle for Hospital Privileges: III. The Antitrust Frontier

Author Affiliations

From the Office of the General Counsel, American Medical Association. For further information and reprints, write to the Office of the General Counsel, American Medical Association, 535 N Dearborn St, Chicago, IL 60610.

JAMA. 1984;251(12):1602-1605. doi:10.1001/jama.1984.03340360064034

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IN THE decade of the 1960s a coalescence of social, technological, and economic forces provided the impetus for a fundamental and ongoing transformation of the relationship between physicians and hospitals. As the modern practice of medicine became more and more technology intensive, growing demand for access to scarce but essential hospital facilities by an expanding physician population intensified pressures on hospitals and physicians alike. (JAMA 1983;249:526-527.) The process by which hospitals grant and renew admitting and clinical privileges assumed a new importance: staff selection became not only a method of ensuring quality of care, but a mechanism for the rationing of limited hospital resources.

Driven by economic necessity and a deep sense of outrage at what they perceived as the unjust curtailment of their professional opportunities, excluded physicians began to resort to litigation to secure privileges. During the 1960s and 1970s these legal battles were waged primarily on the constitutional