Governance of Jordan’s Medical Sector: Between Specialization and Accountability

Executive Summary

This paper examines a growing governance gap in Jordan’s medical sector, specifically the weak alignment between specialist certification, clinical privileges, effective oversight, and accountability mechanisms when adverse events occur or complaints are filed.

The paper argues that the core problem lies not in the absence of institutions or legislation, but rather in an incomplete regulatory framework that does not clearly define who is authorized to perform specific medical procedures, what training and qualifications are required, in which institutional settings such procedures may be performed, and under what mechanisms of oversight and accountability.

Jordan’s medical sector has undergone substantial growth in both the scale and complexity of medical practice. The number of medical procedures listed in approved fee schedules increased from fewer than 1,500 in 2008 to approximately 4,500 in the 2024 schedule, alongside the introduction of nearly twenty new subspecialties.

This transformation has shifted medical practice from a relatively limited system to a broad and increasingly complex field in which specialties overlap, technologies evolve rapidly, and medical and cosmetic advertising advances faster than traditional oversight mechanisms can keep pace.

The paper recommends adopting a practical reform pathway based on developing national lists of certification-based clinical privileges, transforming the training registry into a live electronic registry, activating clinical privileging committees within healthcare institutions, redesigning the medical complaints process through specialized technical assessment prior to referral for criminal prosecution, and establishing a unified national platform that enables verification of physicians, healthcare facilities, clinical privileges, and medical advertising.

The aim is not to create an additional layer of bureaucracy, but rather to connect existing institutions within a clear framework that makes medical practice safer, accountability fairer, and public trust more measurable.

Introduction: Why Medical Governance Now?

Complaints involving alleged medical errors, along with recurring debate over certain cosmetic procedures, reveal a clear regulatory gap in the governance of medical practice in Jordan. This gap is not limited to isolated incidents; rather, it reflects the absence of a comprehensive institutional framework that clearly defines the relationship between specialist certification, clinical privileges, oversight of medical practice, and the accountability process when harm occurs.

This raises the central question addressed by this paper: Which authority or mechanism determines what a physician is permitted to practice, under what conditions, and within which healthcare institution?

This question has become increasingly important in light of the significant transformation that Jordan’s medical sector has undergone in recent years. The number of medical procedures listed in the approved fee schedules increased from fewer than 1,500 in 2008 to approximately 4,500 in the 2024 schedule, alongside the introduction of nearly twenty new subspecialties over the same period.

This development reflects a substantive change in the nature of medical practice, which has moved from a relatively limited range of established procedures to a broader and more interconnected field, where multiple specialties may be involved in the same procedure and where new technologies, tools, and practices have emerged that were not as clearly established in previous years.

Accordingly, the key regulatory question is whether the systems of oversight and accountability have evolved at the same pace as medical practice itself in terms of both scale and complexity.

The problem becomes more apparent in the distribution of roles among the institutions responsible for regulating the medical sector. The Jordan Medical Council oversees medical training and the awarding of specialist certifications; the Jordan Medical Association serves as the professional body and addresses matters related to complaints and professional conduct; and the Ministry of Health is responsible for licensing, inspection, and regulatory oversight. Healthcare institutions and hospitals, as well as judicial and insurance authorities, also play important roles.

The involvement of multiple entities is not, in itself, problematic, as regulating a sector of this scale necessarily requires a functional division of responsibilities. The challenge arises, however, when the relationships among these entities are not sufficiently defined and when there is no clear authoritative mechanism for resolving overlaps in jurisdiction, determining responsibility when a complaint is filed, or assessing professional practice when an adverse event occurs.

Accordingly, the challenge is not to designate a single authority with exclusive decision-making power, but rather to establish an institutional framework that connects existing entities through a clear allocation of responsibilities. If a physician holds a particular specialist certification, the issue extends beyond the certification itself to determining which procedures actually fall within the scope of that specialty, which authority is empowered to approve that scope, the role of the healthcare institution in granting the physician clinical privileges to perform the procedure within that institution, and the respective roles of the Ministry of Health, the Jordan Medical Association, and the Jordan Medical Council in oversight and accountability.

Without such coordination, the boundaries between specialty, clinical privileges, and actual medical practice remain insufficiently defined, weakening both patient protection and the fairness of accountability for physicians and healthcare institutions.

This leads directly to a fundamental distinction that is often absent from public debate: the distinction between specialty and clinical privileges. A physician’s certification in a particular specialty does not automatically mean that the physician is authorized to perform every procedure that may theoretically be associated with that specialty, under all circumstances and within every healthcare institution.

The core of Jordan’s medical governance challenge can therefore be summarized as a chain of four interconnected elements: specialty, clinical privileges, oversight, and accountability. Fair accountability cannot be achieved without a clear definition of the scope of each specialty; clinical privileges cannot be determined without establishing the physician’s level of training and demonstrated competence; compliance with those privileges cannot be ensured without effective oversight capable of identifying violations; and accountability cannot rest on a fair basis without clear technical standards that establish both individual and institutional responsibility.

Each of these elements depends on the one preceding it, and weakness in any one of them inevitably affects those that follow.

Section One: Scope of Practice and Overlap Between Specialties

The Jordan Medical Council serves as the primary authority in the first link of this chain. It is responsible for accrediting training programs and training centers, maintaining records of physicians in training, administering examinations, and awarding specialist certifications. This role places the Council at the core of the medical specialization system, as it is the body responsible for verifying that physicians have fulfilled the training and assessment requirements necessary to attain a defined level of competence.

The question, however, concerns the boundaries of this role: Does specialist certification explicitly and formally define everything that its holder is authorized to perform? In practice, implicit professional knowledge may establish, in principle, what falls within the scope of a particular specialty. Yet such implicit understanding becomes insufficient when a dispute or complaint arises, at which point there is a clear need for a written and authoritative reference against which the matter can be precisely assessed.

Against this background, a promising concept has emerged in Jordan’s institutional discussions on this issue, although it has yet to be fully developed: “certification-based privileges.” The concept is that specialist certification should not merely state the name of a specialty, but should be linked to a defined list of procedures in which the physician is expected to have received actual training and demonstrated competence. For example, a general surgery training program might be associated with a list of approximately forty procedures, with the responsible authority verifying the physician’s training and competence in those procedures through ongoing training records and assessment.

More importantly, this concept necessarily requires a distinction from another equally important concept: “practitioner privileges.” Certification-based privileges reflect the foundational qualifications that, in principle, authorize a physician to perform a defined set of procedures. Actual privileges to practice, however, are influenced by other factors that may change over time, including continuity of practice, recent experience, current competence, continuing professional development, and the nature of the healthcare institution in which the physician practices, including its capacity to manage potential complications.

Although seemingly straightforward, this distinction is a cornerstone of any fair system of medical governance. The assumption that “once certified, always qualified” is no longer sufficient in a profession whose tools, technologies, and practices are continually evolving.

The most practical tool for translating this distinction into practice is the training logbook: a record documenting the procedures that a physician observed, assisted with, or performed under supervision during training, the number of times the physician was exposed to each procedure, and the level of responsibility assumed in performing it.

However, the value of this record effectively ends at graduation unless it is transformed into a live and continuously updated tool. If a physician performed a particular procedure during training but has not practiced it for five years, should the privilege to perform that procedure automatically remain valid? There is no straightforward answer to this question without clear mechanisms for periodic reassessment, calibrated to the nature and level of risk of the procedure.

Such mechanisms must go beyond reliance on continuing professional development (CPD) hours or certificates of conference attendance, neither of which necessarily demonstrates continued practical competence in a specific procedure, particularly in surgical or high-risk interventions. Attending a conference is one thing; demonstrating the ability to perform a procedure safely before an independent assessor is quite another.

Section Two: Clinical Privileges and Oversight of Medical Practice

The second link in this chain—privileging—extends beyond the individual physician to the healthcare institution in which the physician practices, through the concept of clinical privileges. A physician’s certification in a particular specialty does not automatically authorize them to perform every procedure associated with that specialty in every institution or under all circumstances. In principle, hospitals grant specific clinical privileges based on the physician’s training, experience, and demonstrated competence. These privileges may correspond to, or be narrower than, the procedures for which the physician has been trained, but they should never extend beyond them.

Clinical privileges must also take into account the capacity of the healthcare institution itself. A medical procedure depends not only on the physician’s skills, but often also on the availability of an anesthesia team, specialized nursing staff, intensive care facilities, and the institution’s actual capacity to respond to emergencies and manage complications.

The central question, therefore, is not simply, “Does the physician know how to perform this procedure?” but rather: Are the physician, the institution, and the surrounding clinical environment, taken together, capable of providing it safely?

This distinction between specialist certification and institutional clinical privileges reflects the approach adopted by mature healthcare systems around the world. In the United States, hospitals explicitly distinguish between two separate processes: credentialing, which involves the initial verification of a physician’s qualifications, licenses, and professional record; and privileging, which determines the specific clinical services that an individual physician is authorized to provide within a particular institution.

The former is based on general standards that can be verified through standardized processes, whereas the latter is an individualized and context-specific decision made by the institution and its medical staff on the basis of demonstrated competence, actual volume of practice, clinical outcomes, and peer recommendations. Under more recent approaches within these systems, clinical privileges are also subject to ongoing monitoring rather than relying solely on periodic review.[1]

This clear distinction between what certification establishes and what an institution authorizes is precisely what Jordan’s medical sector seeks to achieve through the concepts of certification-based privileges and practitioner privileges. The difference, however, is that mature healthcare systems have formalized this distinction through binding rules and procedures, whereas in Jordan it remains closer to an implicit professional understanding that has yet to be formally documented and made mandatory.

While oversight within major hospitals benefits from the presence of medical administration, committees, records, and a documented privileging system, the situation changes fundamentally when we move to the broader landscape of centers and clinics outside hospitals, where most of the procedures that generate controversy are now performed. Cosmetic procedures, in particular, stand out as the clearest practical example of the problem of overlapping specialties. This is a field that has experienced rapid growth, in which new techniques have intersected with short training courses and intensive advertising through social media, to the point where patients may access medical services through a digital platform that provides them with no reliable means of verifying the specialty of the person providing the service.

This creates a serious gap between what the patient believes about the physician and the training and privileges that the physician actually possesses. If a particular procedure may be performed by more than one specialty, what criterion determines who is entitled to perform it? Is certification in one of these specialties sufficient? Or is additional documented training required? Is a short course sufficient to confer this right, or does this depend on the level of risk associated with the procedure itself?

These questions demonstrate that the issue is one of patient safety and clarity of responsibility. The seriousness of the problem has reached the point where cases have emerged of non-physicians opening centers that provide services of a medical or cosmetic nature with virtually no oversight, alongside cases of pharmacists administering cosmetic injections on the basis of short courses that do not meet the required level of clinical qualification.

This regulatory imbalance is not unique to Jordan; rather, it represents a local manifestation of a challenge that long-established healthcare systems have also struggled to address. In the United Kingdom, most non-surgical cosmetic procedures—from Botox injections to dermal fillers and chemical peels—are not subject to mandatory professional requirements. In theory, anyone may provide such procedures without formal training or licensing, a situation documented in a series of official and parliamentary reviews since 2013 and directly linked to documented cases of patient harm.

After more than a decade of debate, the British authorities are now moving toward a tiered licensing system that classifies procedures according to their level of risk: low-risk procedures may be provided by any licensed practitioner who meets agreed standards; medium-risk procedures require supervision by a licensed professional; and high-risk procedures—such as the injection of fillers into the breasts or buttocks—are restricted to qualified healthcare professionals operating within facilities subject to formal regulatory oversight.[2]

In the United States, medical associations are engaged in a parallel debate under the term “scope creep,” warning that the expansion of non-physician practitioners into areas in which they have not received specialized training—particularly certain cosmetic procedures—poses documented risks to patient safety. They have called for any scope of practice to be tied to the practitioner’s actual area of specialized training rather than to a broad general qualification.[3]

The common lesson from these two experiences is that delays in establishing clear boundaries for scope of practice, in any country, create a regulatory vacuum that can be filled by unregulated competition at the expense of patient safety. Addressing this gap requires, as the British experience demonstrates, a graduated approach to oversight that balances openness to innovation with protection against its risks.

However precise the definition of specialty and clinical privileges may be, it remains of little practical value unless supported by an oversight system that is genuinely capable of detecting violations. One of the most significant indicators of the scale of the challenge in Jordan is that approximately seventy percent of field inspection teams conducting visits to healthcare facilities do not include specialist physicians.

This does not mean that these teams are unable to verify the existence of a valid license or compliance with general requirements. In practice, however, it means that a substantial range of detailed technical issues—such as whether a particular procedure falls within the scope of a specific specialty and whether it was performed in accordance with appropriate clinical standards—remains beyond the current capacity of field-based assessment.

This limitation can be addressed by increasing the number of inspection visits, redesigning the composition of inspection teams themselves, and ensuring access to specialized technical expertise when required.

Paradoxically, this shortcoming in implementation does not stem, at its core, from an absence of legal provisions. As those familiar with Jordan’s medical legislative framework have noted, the problem lies less in a shortage of legislation than in an overabundance of legislation in certain areas, coupled with clear weaknesses in implementation and coordination among the relevant authorities. The laws are in place, and regulations governing individual specialties exist in principle, but the gap emerges between general legal provisions and the detailed implementing rules that govern individual cases in practice. This gap creates room for individual interpretation and can result in similar cases being handled differently from one institution to another.

Accordingly, what is required is not necessarily additional legislation, but rather the updating of existing rules and the harmonization of their interpretation and application. Jordan’s Medical and Health Liability Law No. 25 of 2018 provides, in principle, a relatively comprehensive framework: a Higher Technical Committee responsible for reviewing complaints and providing a technical opinion within a maximum period of three months; a committee responsible for reviewing professional standards for healthcare practice every three years; and the preservation of the injured party’s right to seek judicial recourse in parallel with the administrative process.[4]

The existence of this legal framework alone, however, does not resolve the length of time required to adjudicate medical cases, the challenge of standardizing the technical criteria on which experts base their assessments, or the potential for conflicts of interest in their selection. Without an effective implementation system, these challenges can render otherwise sound legislation ineffective in practice.

 Perhaps the most important implication of this gap is that the Ministry of Health, regardless of the breadth of its regulatory powers, cannot alone absorb every complaint and oversee every aspect of a sector of such scale and complexity. This is not so much an institutional failure as a structural impossibility: the number of healthcare facilities, physicians, and medical procedures continues to increase, while the human resources allocated to oversight remain relatively limited.

The logical conclusion, therefore, is to move from a model of oversight exercised by a single authority to one of collaborative governance, in which each stakeholder performs its role within an interconnected system: the Jordan Medical Council serves as the reference authority for specialization and training; the Jordan Medical Association performs its professional and disciplinary role; the Ministry of Health acts as the regulatory and oversight authority; healthcare institutions are responsible for clinical privileges and the practice environment within their facilities; and judicial authorities address the legal dimension when required.

In other words, the Jordan Medical Council is not the sole solution to all medical governance challenges. It can define specialties, training programs, and examination requirements, but it cannot, on its own, monitor every physician in every clinic, medical center, and hospital.

Section Three: Accountability and the Medical Complaints Process

This leads to a question no less important than that of regulatory authority: Who is responsible when an adverse event occurs? The obvious answer—“the physician”—fails to capture a more complex reality. The failure may result from an individual clinical decision, inadequate equipment, deficiencies in supporting staff, weaknesses in emergency procedures, the granting of privileges for which the physician was not adequately trained in the first place, or shortcomings in institutional oversight itself.

This highlights the need for two complementary levels of governance that cannot be separated from one another: clinical governance, relating to the physician’s competence, training, and privileges; and institutional governance, relating to the management of the healthcare facility, its human resources, equipment, supply chains, and quality and safety systems. If a healthcare institution permits a physician to perform an intervention for which the physician does not hold adequate privileges, that institution shares responsibility rather than merely witnessing the consequences.

One of the most significant practices requiring strict electronic controls in this context is the use of one physician’s name to cover a procedure that was actually performed by another physician—a practice that fundamentally undermines the very basis of accountability.

Given the complexity of responsibility in such cases, the medical complaints process warrants comprehensive redesign. A patient who believes that they have been subjected to a medical error needs a clear pathway through which to pursue a complaint, while the physician, in turn, needs assurance that their performance will be assessed on the basis of specialized technical expertise rather than general impressions.

The problem is that a single medical case may currently pass through several authorities—the Ministry of Health, the Jordan Medical Association, the Public Prosecution, and the courts—and may take many years before reaching a final decision. Such delays undermine trust on both sides: the patient’s trust in the seriousness and effectiveness of the system, and the physician’s trust in the fairness of the accountability process.

Moreover, conflating different types of adverse outcomes—a recognized complication of a procedure, medical error, negligence, practice beyond the scope of authorized privileges, and purely institutional failure—can result in an unfair punitive system. At times, physicians may be held responsible for failures beyond their control, while in other cases genuine violations that warrant effective sanctions may not be adequately addressed.

This underscores the importance of the proposal to establish a specialized body or court for cases involving alleged medical error, supported by technical panels composed of physicians and independent experts, as well as the proposal for a periodically reconstituted medical committee responsible for conducting an independent expert medical assessment of each case before it is referred directly for criminal prosecution. The aim is to ensure that accountability is grounded in a sound technical assessment, thereby achieving a balance between the patient’s right of access to justice and the physician’s right to a fair professional evaluation.

Another experience, geographically more distant but highly relevant in conceptual terms, merits consideration in the Jordanian debate: the no-fault compensation systems adopted in New Zealand and several Scandinavian countries. Rather than making compensation for an injured patient dependent on proving physician negligence or fault—a lengthy and costly judicial process that may take years in traditional litigation systems—these systems separate the compensation process from the disciplinary process. Compensation is provided once medical injury has been established, regardless of whether fault is proven, and, particularly in New Zealand, may be provided within weeks rather than years. Professional accountability of the physician, meanwhile, remains an entirely separate process and is not affected by the compensation decision.[5]

This separation between “who is entitled to compensation” and “who warrants disciplinary action” reduces incentives to conceal errors or resort to defensive practices, while enabling genuine institutional learning from adverse events rather than focusing solely on punishing those whose errors are detected.

Admittedly, this model is not without criticism, most notably the absence of conclusive evidence that it improves safety outcomes more effectively than traditional litigation-based systems. Nevertheless, its underlying philosophy—separating compensation from disciplinary action, accelerating the response process, and encouraging transparent reporting of adverse events—is fundamentally consistent with the logic of the “periodically reconstituted medical committee” and “independent expert medical assessment prior to criminal prosecution” currently being discussed in Jordan. However, bridging the gap between these proposals in principle and their binding institutional implementation still requires implementing legislation that clearly defines the relevant procedures and mechanisms.

This tension between compensation and disciplinary action, in turn, raises the question of sanctions themselves. Increasing penalties, however politically expedient or appealing as a quick solution, is not sufficient on its own. Genuine fairness begins with an accurate characterization of the act before responsibility is determined, followed by the imposition of a proportionate sanction.

An additional challenge may arise when a judge encounters difficulty in legally and medically characterizing a case because of the absence of a clear technical assessment. This can be addressed by ensuring access to specialized medical and technical expertise capable of clarifying the nature of the incident: Was it professional negligence, an expected complication, or a clear violation of standards of practice?

At the same time, not every unsuccessful medical outcome should automatically be classified as a “medical error.” Medicine, by its very nature, involves risks and complications that cannot be entirely eliminated, regardless of the level of professional care and precision exercised.

If medical malpractice insurance has, in this context, become a requirement imposed on physicians by certain authorities, relying on it as a comprehensive solution to the problem of medical errors is misleading. Insurance can form part of a broader system of protection, but it cannot substitute for training, oversight, governance, or the clear determination of responsibility.

Placing the burden of addressing medical errors on insurance alone effectively relieves the professional, institutional, and legal systems of their primary responsibilities and turns financial compensation after harm has occurred into a substitute for preventing that harm in the first place.

Cross-Cutting Issues: Digitalization and Regional Experience

Against this backdrop of extensive legislation and institutional complexity, digital transformation emerges as one of the most practical pathways for addressing a fundamental part of the governance challenge, rather than as a substitute for governance itself. The creation of a unified national platform containing information on physicians, healthcare facilities, and clinical privileges, linked to a QR code that enables citizens—before undergoing any procedure—to verify the physician’s name and specialty, the authority that granted the specialist certification, the physician’s declared clinical privileges, and the licensing status of the healthcare facility in which the physician practices, would transform oversight from an exclusive responsibility of the state into an active partnership with citizens themselves.

This does not mean turning patients into specialized regulatory authorities, but rather providing them with transparent tools that enable them to protect themselves and report any violations they may observe. If linked to a national electronic training registry—an advanced version of the logbook concept—such a platform could help curb dangerous practices, such as the use of one physician’s name to cover a procedure actually performed by another person, and ensure that clinical privileges are granted on the basis of documented evidence rather than certification alone.

This approach would also require parallel digital oversight of medical and cosmetic advertising on social media platforms, which can reach thousands of prospective patients at a speed far beyond the capacity of any field inspection system.

When examining regional regulatory models from which lessons may be drawn, the Saudi model features prominently in Jordanian discussions, represented by the Saudi Commission for Health Specialties (SCFHS). Established in 1992 and operating under the umbrella of the Ministry of Health, the Commission carries out a comprehensive regulatory role through two specialized councils—one responsible for the accreditation of training and assessment programs, and the other for the professional classification of practitioners and the development of standards for different professional grades. This framework links training with professional classification and ultimately with the definition of practitioners’ roles and responsibilities.[6]

The model provides a relatively independent and unified regulatory authority with the resources and specialized personnel required to oversee an expanding healthcare sector. The principal lesson from this experience, however, is not that Jordan should replicate the Saudi model in its entirety, but rather that it should examine the elements underlying its effectiveness—institutional independence, a rigorous link between training and professional classification, and sufficient specialized resources and personnel—and determine which of these elements can be adapted to Jordan’s existing legal, institutional, and medical framework.

This includes the Jordan Medical Council and the Jordan Medical Association, both of which already perform broadly comparable functions, although they require broader powers and greater resources to perform those roles with a similar level of effectiveness.

Ultimately, all of the above is not a technical debate isolated from Jordan’s broader national interests. Jordan is facing renewed regional competition over its position in medical tourism, a sector that has historically constituted one of the key pillars supporting its healthcare system as a whole. Jordan enters this competition with highly qualified physicians and expertise accumulated over decades. Yet this traditional advantage is no longer sufficient on its own in the face of regional competitors—most notably Turkey and the United Arab Emirates—that have developed integrated systems supporting patients from the moment they decide to travel for treatment until their return home. These systems encompass visas, international marketing, clearly defined treatment packages, and regulatory frameworks that provide international patients with institutional confidence extending beyond the reputation of an individual physician.

As a careful reading of this landscape demonstrates, competition is no longer simply between one hospital and another, or one physician and another, but between entire healthcare systems.[7]

This gives medical governance a significance that extends beyond protecting the individual patient to safeguarding Jordan’s overall competitive position. Every case of unregulated medical practice that receives media attention or becomes a cautionary story on social media not only damages the reputation of an individual physician or healthcare facility, but can also gradually undermine confidence in Jordan’s healthcare sector as a whole, in a regional market that has become highly sensitive to any indication of inadequate regulation.

From this perspective, the crisis of trust between patients and Jordan’s healthcare system—a genuine, though not universal, concern—does not necessarily arise from a decline in the quality of medical care itself, but rather from gaps in information and transparency: Who is the physician? What is their actual specialty? What exactly are they authorized to do? Is the healthcare facility in which they practice properly licensed? How is a complaint filed, and before which authority? And who bears responsibility when an error occurs?

Trust is built cumulatively through clear information, fair accountability, timely handling of complaints, and a clear allocation of responsibility between the physician and the healthcare institution. The clearer the answers to these questions become, the closer Jordan’s healthcare sector moves toward restoring this trust as a measurable reality.

Recommendations

Based on the foregoing, any serious effort to reform Jordan’s medical governance system should proceed on parallel rather than sequential tracks. At the legislative level, the priority should remain the updating of existing frameworks rather than increasing their number. This should include introducing clearer provisions on the scope of practice of each specialty, clarifying the legal relationship between specialist certification and clinical privileges, reviewing the framework governing medical exemptions, and ensuring that sanctions are proportionate to the nature and seriousness of the violation.

At the level of the Jordan Medical Council, the most important challenge remains the development of the concept of certification-based privileges through clear procedural lists linked to actual training programs, transforming the logbook into a live national electronic registry, and establishing mechanisms for reassessing competence, particularly in high-risk procedures. This should be undertaken in close collaboration with the Jordan Medical Association, the Ministry of Health, and healthcare institutions, rather than through isolated institutional action.

At the level of healthcare institutions, this requires the activation of genuine, rather than merely formal, clinical privileging committees that grant privileges on the basis of specialist certification and review them periodically according to the nature and level of risk of the procedure. Healthcare institutions must also assume full responsibility where failures arise from the practice environment or insufficient resources rather than from individual professional shortcomings.

At the oversight level, priority should be given to involving physicians and relevant specialists in inspection teams when necessary, strengthening digital oversight of both medical advertising and healthcare facilities operating outside hospitals, and establishing a unified database linking licensing, specialty, and clinical privileges.

At the level of complaints and the judicial process, priority should be given to establishing a specialized body or judicial pathway for cases involving alleged medical error, based on an independent expert medical assessment prior to referral for criminal prosecution, and applying clear criteria for the selection of experts that safeguard against conflicts of interest.

At the digital level, the establishment of a unified national platform, linked to an electronic verification code and a digital complaints system, stands out as a relatively low-cost investment with potentially significant impact on both transparency and public trust.

At the patient level, the priority remains to provide patients with reliable information that protects them from misleading advertising and to ensure that they have a clear pathway for filing complaints, recognizing the patient as a partner in oversight rather than merely a passive recipient of healthcare services.

In conclusion, Jordan’s medical governance challenge is neither a crisis caused by the absence of a single responsible authority nor one resulting from a lack of legislation. Rather, it is a crisis of coordination and integration: connecting institutions that already exist, legislation that is already in place, and roles that are theoretically defined but remain insufficiently integrated in practice.

The equation that captures the essence of this issue is simple in formulation but highly complex in implementation: the right person, with the right training, the right competence, and the right privileges, practicing within the right institution and under the right oversight, equals safe medical practice.

The challenge, therefore, is no longer simply to graduate a physician who holds a specialist certification, but to ensure clarity regarding what that physician has actually been trained to do, what they are competent and authorized to perform, the institutional environment in which they exercise those privileges, who oversees their practice, and how either the physician or the healthcare institution in which they practice is held accountable when an error occurs.

The question facing policymakers in Jordan today, therefore, is no longer: Do we need better governance of the medical sector? The answer to that question has become self-evident.

The real question is: How long can this sector, amid intensifying regional competition for the trust of Arab and international patients, sustain the gap between the scale of its expansion and the strength of its regulatory oversight before that gap evolves from an internal regulatory challenge into a strategic cost that will be difficult to reverse?

Policymakers have three main options for addressing the medical governance gap. These options differ in terms of cost, political feasibility, and their capacity to address the underlying causes of the problem:

This paper favors the third option as the most appropriate for the Jordanian context. Jordan does not necessarily need a new institution as much as it needs binding institutional coordination among existing entities and the translation of established professional concepts into implementable tools that can be measured and audited.

Selected Policy Recommendation

The paper recommends adopting a National Framework for the Governance of Medical Privileges, based on a simple principle: holding a specialist certification is not sufficient. There must also be documented authorization for the procedure, clear institutional authorization to perform it, effective oversight capable of verifying compliance, and an accountability mechanism that distinguishes between individual and institutional responsibility.

This framework consists of five interconnected components. The first is certification-based privilege lists, whereby the Jordan Medical Council, in cooperation with scientific and specialty committees, develops procedural lists for each specialty and subspecialty.

The second component is a national electronic registry for training and practice, documenting the procedures in which physicians have been trained, those they have actually performed, and those for which their competence requires renewal or reassessment.

The third component is the establishment of clinical privileging committees within healthcare institutions, responsible for granting and periodically reviewing clinical privileges based on competence, performance records, and the capacity of the healthcare institution.

The fourth component is tiered technical oversight, distinguishing between general administrative inspection and specialized technical assessment, particularly in relation to clinics, medical centers, and medical and cosmetic advertising.

The fifth component is a specialized medical complaints pathway, beginning with an independent expert medical assessment before proceeding to criminal prosecution and determining responsibility according to the nature of the failure rather than solely on the basis of the medical outcome.

Implementation Considerations and Risks

The success of this approach requires attention to three key risks. The first is resistance from some stakeholders to any new regulatory measures if they are perceived as restricting medical practice or narrowing the scope of professional activity. The reform should therefore be presented as a means of protecting patients, physicians, and healthcare institutions alike, rather than as a punitive instrument directed against any single stakeholder.

The second risk is that the reform could become an additional administrative burden. Lists, registries, and committees lose their value if they remain merely procedural formalities that do not change actual practice. They should therefore, be linked to licensing, privilege renewal, inspection, and the complaints process so that they become an integral part of the governance cycle rather than an isolated administrative requirement.

The third risk concerns data and transparency. The proposed national platform must protect the privacy of physicians and patients, while at the same time providing citizens with sufficient information to verify the physician, healthcare facility, and clinical privileges.

This balance should not be achieved by withholding information, but rather by establishing clearly defined levels of disclosure: public information for verification purposes, professional information accessible to regulatory authorities, and detailed information available to specialized committees when required.

Success Indicators

No policy paper is complete without indicators that allow its impact to be assessed. The success of this approach can be measured through several practical indicators, including: the number of specialties for which certification-based privilege lists have been issued; the proportion of healthcare institutions that have established documented clinical privileging committees; the proportion of complaints receiving an initial technical assessment within a specified timeframe; the number of inspection visits involving relevant specialists when required; and the number of digital verifications of physicians or healthcare facilities conducted through the national platform.

The impact on public trust can also be measured through periodic surveys assessing the clarity of the complaints process, patients’ awareness of their rights, and their ability to verify healthcare providers before undergoing a procedure.

At the level of medical tourism, governance can be linked to indicators of reputation and trust, the number of complaints involving international patients, the speed with which such complaints are addressed, and the clarity of treatment packages and institutional responsibilities within the healthcare facilities receiving these patients.

Conclusion

Jordan’s medical governance challenge is neither a crisis caused by the absence of a single responsible authority nor one resulting from a lack of legislation. Rather, it is a crisis of coordination and integration among existing institutions, established legislation, and roles that are theoretically defined but do not always function as a unified system.

The essence of reform, therefore, does not begin with the question: Who alone holds the authority? It begins with a more precise question: How can the authorities responsible for training, licensing, oversight, and accountability be integrated into a clear and binding framework?

The equation that summarizes this issue is simple in formulation but complex in implementation: the right person, with the right training, the right competence, and the right privileges, within the right institution and under the right oversight, equals safer medical practice.

What Jordan needs today is to transform this equation from a general professional principle into an implementable and measurable system.

Every delay in establishing this framework widens the gap between the scale of medical practice and the institutional capacity to regulate it. In a sector where patient safety, fairness to physicians, institutional accountability, and Jordan’s reputation as a medical destination are closely interconnected, governance is no longer merely an administrative consideration. It becomes a prerequisite for protecting public trust and safeguarding Jordan’s position as a regional healthcare destination.

[1] Relias, “Credentialing and Privileging in Healthcare — What’s the Difference?” — https://www.relias.com/blog/credentialing-and-privileging-in-healthcare

[2] House of Commons Library, “The regulation of non-surgical cosmetic procedures in England,” 2025 —  https://commonslibrary.parliament.uk/research-briefings/cbp-10331

[3] American Medical Association, “AMA steps up to fight scope creep that threatens patient safety” — https://www.ama-assn.org/practice-management/scope-practice/ama-steps-fight-scope-creep-threatens-patient-safety

[4] Jordanian Medical and Health Liability Law No. 25 of 2018, published in the Official Gazette, No. 5517, 31 May 2018.

[5] Niskanen Center, “Medical injury? Don’t call the lawyers.” — https://www.niskanencenter.org/medical-injury-dont-call-the-lawyers

[6] Saudi Commission for Health Specialties — https://en.wikipedia.org/wiki/Saudi_Commission_for_Health_Specialties

[7] الأنباط نيوز، “السياحة العلاجية في الأردن… الكفاءة موجودة، لكن المنافسة تغيرت” — https://alanbatnews.net/article/482731