As increasing numbers of doctors forgo private practice in favor of being hospital employees, there are increasing numbers of conflict that these practitioners face when deciding how to care for patients. Those arise from the bind doctors find themselves in between providing the best care they can and for meeting the economic and performance demands of their bosses. That should not be a bind, really, and the American Medical Association rightly recognizes which of these goals ought to come first.
The AMA adopted these principles for physician employment at its November meeting and in the document makes very clear that patients are doctors’ top priority: “Doctors should always make treatment and referral decisions based on the best interests of their patients,” the guidelines say. That should be obvious, of course, but the employment relationship that more and more doctors find themselves in – as opposed to operating their own practices – sometimes compromises the clarity of those decisions.
The AMA recognizes this. “A doctor’s paramount responsibility is to his or her patients,” the policy says. “Additionally, given that an employed physician occupies a position of significant trust, he or she owes a duty of loyalty to his or her employer. This divided loyalty can create conflicts of interest, such as financial incentives to over- or undertreat patients, which employed physicians should strive to recognize and address.”
To address this potential conflict, the AMA asserts that physicians should be free to exercise their professional judgment when it comes to patient care, and that employers should support that right.
This is all relatively common sense, but bottom lines being what they are has placed physicians in a bit of a bind with respect to their hospital-employers’ priorities. While becoming a hospital employee removes much of the risk of private practice, as well as the tightening reimbursement numbers for Medicare and Medicaid patients, it also adds some constraints. Those should not compromise patient care, and AMA is right to advocate on behalf of that value – and physicians’ obligation to prioritize it.
Furthermore, patients must be part of this conversation and be made aware when their doctors are negotiating the tensions the AMA’s policy aims to address. Doctors should be clear about what is informing their recommendations and referrals, and patients must be able to trust that their doctors’ advice reflects the best options available – not what is best for hospitals’ profit-and-loss statements. That sort of openness is key for doctor-patient trust, but more importantly, for ensuring the best health outcomes possible.
This need not run at cross-purposes with hospitals’ priorities. After all, these facilities are in the business of healing people. The AMA’s policy serves as a commonsense reminder of that overarching goal for doctors and hospitals alike. The guidelines state this in terms that could not be more clear: “In any situation where the economic or other interests of the employer are in conflict with patient welfare, patient welfare must take priority.”