Medical Professionalism, Revenue Enhancement, and Self-Interest: An Ethically Ambiguous Association
Tóm tắt
This article explores the association between medical professionalism, revenue enhancement, and self-interest. Utilizing the sociological literature, I begin by characterizing professionalism generally and medical professionalism particularly. I then consider “pay for performance” mechanisms as an example of one way physicians might be incentivized to improve their professionalism and, at the same time, enhance their revenue. I suggest that the concern discussed in much of the medical professionalism literature that physicians might act on the basis of self-interest is over-generalized, and that instead we ought to argue about ways to distinguish permissible and impermissible self-interested actions. Also, I argue that financial incentives for medical professionals ought to be permissible but considered as “by-products” of doing what physicians are expected to do as professionals in any case. Nevertheless, I conclude that, even if a positive association between increasing professionalism and revenue enhancement can be established, in the long term it may not be an unambiguous good for physicians as professionals in that this association may tend to reduce their professional discretion.
Tài liệu tham khảo
Arnold, L., & Stern, D. T. (2006). That is medical professionalism? In D. T. Stern (Ed.), Measuring medical professionalism (pp. 15–37). New York: Oxford University Press.
Brody, H. (2009). The future of bioethics. New York: Oxford University Press.
Castellani, B., & Hafferty, F. W. (2006). The complexities of medical professionalism: a preliminary investigation. In D. Wear & J. M. Aultman (Eds.), Professionalism in medicine: critical perspectives (pp. 3–23). New York: Springer Science + Business Media, LLC.
Freidson, E. (2001). Professionalism, the third logic: on the practice of knowledge. Chicago: The University of Chicago Press.
Hafferty, F. (2004). Toward the operationalization of professionalism: a commentary. The American Journal of Bioethics, 4(2), 28–31.
Hendrickson, M. (2008). Pay for performance and medical professionalism. Quality Management in Health care, 17(1), 9–18.
Maister, D. H. (1997). True professionalism: the courage to care about your people, your clients, and your career. New York: Free Press.
Martimianakis, M., Maniate, J., & Hodges, B. (2009). Sociological interpretations of professionalism. Medical Education, 43, 829–837.
Qaseem, A., et al. (2010). Pay for performance through the lens of medical professionalism. Annals of Internal Medicine, 152, 366–369.
Reinders, H. (2008). Internal and external goods: a philosophical critique of the hybridization of professionalism. Journal of Intellectual Disability Research, 52(7), 634–638.
Russell, T. R. (2009). Quality and safety initiatives in the future practice of surgery: meeting patient demands for enhanced professionalism. Surgery Today, 39, 739–745.