The results of a very important survey have just been published by the
American College of
Physician Executives (ACPE). A summary of survey data is
here. The full article, entitled
"Unethical Business Practices in US Health Care Alarm Physician Leaders," is
here. An American Medical News article summarizing some aspects of the results is
here.
Basically the ACPE designed the survey to determine "how have physicians - along with other health care providers - responded to the universal seep of commercial imperatives into the modern practice of medicine." It surveyed about 1500 ACPE members (a 21% response rate). Of those responding, 10.1% were CEOs or the like, 28.8% were at the vice-president, CMO, COO, CIO level or similar, 17.9% were medical directors, 24.5% had academic leadership positions, and 18.6% were practicing physicians, consultants, or house-staff.
The results that were most striking and relevant to the issue of external threats to physicians' professionalism were as follows.
- A large majority of respondents were quite concerned about "unethical business practices affecting US health care today." (54.6% were very concerned, 35.6% were moderately concerned).
- Significant proportions of responders were concerned about unethical business practices within their own organization. (33.1% thought that there were one or more physicians in the organization "involved in unethical business practices;" 11% thought there was a board member "involved in unethical business practices;" 14.2% thought there was a non-physician administrator "involved in unethical business practices.")
- The majority, 53.8%, could identify another health care organization in their community "involved in unethical business practices."
- Although most, 70.1%, said that their organization had a written code of ethical behavior, only 59.7% of them said the code was actually enforced.
- A large majority, 80.8% agreed that "professional organizations need to promote tougher ethical standards."
- Most respondents evinced concern about a variety of unethical practices by physicians. In addition, most were concerned about board members or non-physician executives with conflicts of interest (33% very concerned, 33% moderately concerned about the former, 34% and 32%, the latter.) Most were concerned about board members or non-physician executives accepting gifts from vendors (27% and 29% re the former, 34% and 32% re the latter.)
- Finally, when asked who was responsible "for sowing the minefield through which today's physicians have to try to pick a righteous path," they named a variety of types of large health care organizations, health care plans and health insurers, pharmaceutical and device manufacturers, hospitals and health system, and malpractice attorneys.
- Finally, respondents provided some pithy comments."Our health care system is designed to encourage unethical behavior by its misplaced financial priorities." "Current medical practice on a corporate level is schizophrenic." "Ultimately, the bottom line corrupts absolutely!" "'Business ethics'... an oxymoron?"
In summary, although its small response rate is a limitation, this survey begins to quantitate the scope of some of the issues we have discussed on Health Care Renewal. It suggests that our concerns about threats to physicians' professionalism due to concentration and abuse of power are not exaggerated. If physician executives are this worried, it suggests that doctors in the trenches may be even more so.
Now the question is how can we get the folks with these concerns together, and figure out what to do about them?
