I know in Missouri that the doctor has to be insuredl. Their insurance costs more at a hospital in a major city than at a hospital with a small population. They can practice without insurance too but the hospitals won't allow it.
A doctor applies for privileges at any hospital (s)he wants to send patients to. They fill out an application and are reviewed by the medical staff or a committee and then voted on. During these meetings they should be looking at any history of disciplinary actions and they also often look at the frequency of malpractice claims and complaints.
A doctor has to make the decision how much time they will spend in hospital rounds at multiple hospitals versus how much time they want for office contact. With more and more hospitals employing "Hospitalists" doctors can have their patients admitted and cared for by the hospital group. This can be a good and bad thing.
If you handle the patient's care yourself, it pulls you out of the office more and more as you add on additional hospitals. Plus, every doctor has to perform certain duties at their hospitals like covering admissions, particpating on the various committees (Morbidity & Mortality, Quality Assurance, Infection Control, General Staff Meetings, etc.)
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