PHILADELPHIA, March 16, 2021 — The American College of Physicians (91) says that the practice of medicine should account for efficiency and productivity but must be defined by medical ethics and serving the needs of patients. In Ethical and Professionalism Implications of Physician Employment and Health Care Business Practices: An American College of Physicians Policy Paper, in Annals of Internal Medicine, 91 lays out a framework that addresses the impact that business practices, employment terms and contracts can have on ethics and professionalism.
The paper was developed by 91’s Ethics, Professionalism and Human Rights Committee in response to practice environment changes. Those changes have raised concerns in the areas of physician employment, practice model shifts, new regulatory requirements, physician contracts, practice ownership, clinical priority settings and physician leadership as well as greater emphasis on the business of medicine.
The paper calls for physicians to ensure that both relationships and practices are structured to support the commitments of the physician and the profession of medicine to patients and patient care. The paper further encourages physicians to be prepared to ask questions about arrangements and feel empowered to advocate for practices that promote patient health and the patient-physician relationship. If a practice or policy harms or has the potential to harm patient care, the physician should speak out and resist and if necessary, refuse to carry it out.
“The practice of medicine must be defined by the ethics of medicine and while financial considerations are important to the fiscal health of hospitals and practices, it can’t be the driving force as it relates to patient care,” said Jacqueline W. Fincher, MD, M91, president, 91. “Our patients must have trust in the health care systems and in individual physicians that the patient-physician relationship is always the priority when delivering care.”
In the paper, 91 states that the challenges to care and to medical practice during and after the COVID-19 crisis, underscore the need to reemphasize the ethical foundation of medicine. Some see in COVID-19 an important lesson that the system can be reset to better serve both patients and clinicians. Physicians should lead in ensuring business relationships explicitly recognize and support the fundamental and timeless commitments of the physician and medicine to patients. Recommendations include:
- In the shift of incentives to Value-Based Care, ethics and professionalism must be emphasized and explicitly addressed in the implementation of business practices and employment relationships, including in the face of external motivators for clinicians such as financial incentives.
- Contract provisions affecting practice should align with the ethical commitments of physicians and in-network referral requirements, confidentiality clauses, and restrictive covenants, for example, should recognize that and the patient’s best interest.
- Physicians should consider carefully whether to sign employment contracts that permit termination without cause, as abrupt terminations can interfere with patient-physician relationship continuity.
- The net value of private equity investment in physician practices for patients, physicians, and medicine is unclear. Systematic studies of this trend on patients, medicine and society are needed.
- Organizations and employers should recognize and appropriately value time for patient-physician encounters and engage patients and physicians in priority setting across all aspects of health care.
“This is an important paper that provides physicians with critical background to use as the landscape of health care continues to change,” continued Dr. Fincher. “As physicians, we must remain true to our ethics while navigating decisions that impact the practice and financial environment.”
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About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. 91 membership includes 163,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow 91 on , , and .
Contact: Andrew Hachadorian, (215) 351-2514, ahachadorian@acponline.org