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Alternative Privileges

Some of the documents below are provided in a PDF (Portable Document Format) file, which can be viewed or printed using your Web browser and a PDF Reader.  If you do not have a PDF Reader, please click here.

The recent letter concerning surgical practices was sent out mistating the contact email address; the accurate address is surgical@dca.lps.state.nj.us

Alternative privileges means permission to administer or supervise the administration of general or regional anesthesia or conscious sedation and to perform surgery or special procedures in an office setting. Hospital privileges are granted by licensed hospitals and permit practitioners to perform procedures in the hospital. Alternative privileges are granted by the State Board of Medical Examiners to practitioners who do not have hospital privileges and permit these practitioners to perform surgery and special procedures or administer anesthesia services in an office setting. The procedure to obtain alternative privileges is set forth in the regulation. Surgery, Special Procedures, and Anesthesia Services Performed In An Office Setting (pdf size 92K)

On June 29, 2005, the State Supreme Court affirmed the Appellate Division's decision upholding the Medical Board regulation governing Surgery, Special Procedures and Anesthesia Services Performed in an Office Setting, Processing of Alternative Privileges applications has resumed. Physicians and podiatrists who do not currently possess privileges at a hospital to perform the surgery (other than minor surgery) or special procedures which they intend to provide in their offices need to obtain these privileges from the Board. In addition, the rule now prohibits a physician from concurrently performing surgery or special procedures in the office and supervising the administration of general or regional anesthesia by a certified registered nurse anesthetist (C.R.N.A.). For implementation guidance, please click here. For the application for an exension, needed only by physicians who are concurrently performing surgery or special procedures in the office and supervising the administration of general or regional anesthesia by a certified registered nurse anesthetist (C.R.N.A.).Please click here for the application for an extension.

Obtaining alternative privileges is the final part of the 1998 patient safety initiative which regulates the performance of surgery and special procedures and the administration of anesthesia services in an office setting. It is the means of assuring that a practitioner who is not privileged by a hospital meets appropriate training and competency standards. The standards for alternative privileges are similar to existing standards governing provision of anesthesia services in hospitals and ambulatory care centers. This regulatory initiative addresses a number of aspects of office practice.

This regulation already requires practitioners to evaluate patients at risk in an office setting so that such patients will be referred elsewhere if necessary. In addition, the regulation requires practitioners to have in place procedures for emergencies, spelling out personnel responsibilities when transport to a hospital is necessary. Also, the existing rule mandates the use of specific equipment whenever anesthesia services are given. Notably, the rule requires the use of pulse oximeters with all anesthesia services and even more sophisticated equipment when general and regional anesthesia are used. In another contribution to patient safety, the rule requires practitioners to follow maintenance schedules for all anesthesia equipment. In addition, the rule compels practitioners to report on a Confidential Report form any complications that arise.

The alternative privileging procedure is set forth in the regulation. N.J.A.C.13:35-4A.12. Details and links to application form information can be found by clicking here. In general, the process to obtain alternative privileges requires proof of clinical experience, shown through an attestation as to the number and type of procedures performed, and evidence of the required training. The outside reviewing entity, to which the Board delegated the initial processing of applications, is the Medical Review and Accrediting Council MRAC). MRAC conducts, for the Medical Board, the initial review of the applicants' training and a sample of clinical records (with review of any specific records, involving identified complications). In some circumstances, a personal interview or an inspection of the office may be required. The regulation also requires practitioners to have certification in advanced cardiac life support (ACLS).

Practitioners who will be applying now or in the future for any alternative privileges are strongly encouraged to immediately start compiling the information necessary to complete the form for the log for surgery/special procedures and the form for the log for anesthesia services procedures (general, regional or conscious sedation) and/or the form for the log for conscious sedation (complications only). The log(s) must contain information concerning those procedures requiring alternative privileges that the practitioner has performed during the past two years. The logs must be provided with the application for alternative privileges.
Alternative Privileges Are Required for:

  • licensed physicians and podiatrists who do not have privileges in a hospital to administer or supervise the administration of anesthesia services and to perform surgery or special procedures in an office;
  • licensed physicians who do not have privileges in a hospital and, even though local anesthesia typically is used, who are performing procedures involving manipulation or removal of large amounts of tissue, such as liposuction.
    Alternative Privileges are NOT required for:
  • licensed physicians who do not have hospital privileges and who are performing:
  • surgery or special procedures without anesthesia services (which means surgery or special procedures performed without general or regional anesthesia or conscious sedation) but NOT procedures involving manipulation or removal of large amounts of tissue, such as liposuction; and
  • non-invasive special procedures or "minor surgery," such as flexible sigmoidoscopy, non-invasive ophthalmologic procedures and closed reductions of fractures.

Applications - Overview
The application for alternative privileges is in two parts. The first part is a General Section to be completed for every applicant and the second part consists of the individual Specialty Specific section. The form to be used for this section depends upon the applicant's specialty and, within the specialty, depends upon the procedure(s) the applicant wishes to perform in an office setting. Prospective applicants for alternative privileges do not hold hospital privileges for the procedures or anesthesia services they wish to perform in an office setting. Prospective applicants are encouraged to familiarize themselves with the training and competency standards that they must satisfy to obtain various alternative privileges. Click to see answers to Frequently Asked Questions.

The forms available on this site may be printed for your information but are not yet able to be electronically completed and submitted on line at this time. Application procedure information is available through the individual application forms and through the FAQs. To review the general and the specialty forms, click onto Individual Application Forms.

Continuing Medical Education: Anesthesia specific CME requirements for physicians with hospital privileges or alternative privileges who perform anesthesia services in an office setting.

General Anesthesia
By June 30, 2007, and during every consecutive three-year period thereafter, a physician credentialed by a hospital or alternatively privileged by the Board pursuant to N.J.A.C. 13:35-4A.12 to provide general anesthesia services in an office setting must complete at least sixty Category I hours of continuing medical education in anesthesia which either meet the criteria for credit towards the Physician's Recognition Award of the American Medical Association or have been approved by the American Osteopathic Association. N.J.A.C.13:35-4A.8.

Regional Anesthesia
By June 30, 2007, and during every consecutive three-year period thereafter, a physician credentialed by a hospital or alternatively privileged by the Board pursuant to N.J.A.C. 13:35-4A.12 to provide regional anesthesia in an office setting must complete at least eight Category I hours of continuing medical education in anesthesia exclusively or in anesthesia as it relates to the physician's field of practice, which either meet the criteria for credit towards the Physician's Recognition Award of the American Medical Association or have been approved by the American Osteopathic Association. N.J.A.C.13:35-4A.9.

Conscious Sedation
By June 30, 2007, and during every consecutive three-year period thereafter, a physician credentialed by a hospital or alternatively privileged by the Board pursuant to N.J.A.C.13:35-4A.12 to provide conscious sedation in an office setting must complete at least eight Category I or II hours of continuing medical education in anesthesia services, which may consist exclusively of conscious sedation, or may consist of anesthesia as related to the physician's field of practice, which either meet the criteria for credit towards the Physician's Recognition Award of the American Medical Association or have been approved by the American Osteopathic Association. N.J.A.C.13:35-4A.10.


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