FPPE fever: Every radiologist deserves a 'fair, thorough' evaluation

Focused professional performance evaluations (FPPEs) are common in radiology. In fact, per CMS regulations, newly appointed radiologists are required to undergo one when they first join a hospital medical staff. But what if the evaluation goes poorly?

According to a recent article published in Current Problems in Diagnostic Radiology, if the evaluation reveals significant issues, management should attempt to work with the radiologist instead of simply firing them on the spot.

“We are strongly opposed to terminating the contract or privileges of the radiologist, as this does not facilitate any improvement and may simply allow the radiologist to move elsewhere and provide the same concerning level of patient care,” wrote authors Jonathan Kruskal, MD, PhD, and Ronald Eisenberg, MD, JD, of Beth Israel Deaconess Medical Center in Boston. “In certain circumstances, especially when matters of professionalism are concerned, it may indeed be necessary to remove privileges. This outcome should never be taken lightly, and we suggest a process that is mediated and managed by an institution’s Medical Executive Committee (MEC).”

The authors explained that when such a process is used, a group of peers comes together to evaluate the situation and make recommendations to the MEC. The MEC then meets formally and makes its own recommendations, which can be appealed by the radiologist.

When a radiologist’s FPPE does not go well, Kruskal and Eisenberg explained, there are also other options for hospital management to consider.  

“These include focused clinical training with mentoring, or even undertaking a fellowship, as in improving expertise with newer technologies such as positron emission tomography scans or magnetic resonance imaging,” the authors wrote. “For interventional radiologists, it may be necessary to repeat fellowship training or to modify or relinquish privileges for performing certain types of studies. In some situations, it may be necessary to restrict a radiologist’s privileges while all efforts at remediation and improvement are considered. Nevertheless, there may be certain instances in which violations of departmental policies, or inability to improve knowledge or skill status, make termination unavoidable.”

And in those cases when termination is unavoidable, Kruskal and Eisenberg said it’s crucial to document each step of the FPPE process in writing due to the possibility of a wrongful termination lawsuit.

Kruskal and Eisenberg concluded that since FPPEs are required, every radiologist deserves to be evaluated “in a fair, thorough, discrete, and constructive manner, with the goals of identifying and implementing improvement practices.”