Abstract
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.
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Notes
I leave aside here the important empirical question about the truth of such claims and, as well, the counter-claims that members of the other types of medical professionalism could conceivably make against them. My concern is only to highlight the fact that such claims can be argued on the basis of a consistent set of professionally and ethically grounded values.
To be fair to these authors, they acknowledge how the term “altruism” is interpreted variously in the medical professionalism literature.
I take it as given that professional and personal values should “trump” morally impermissible self-interest.
What pay for performance mechanisms will probably not do is increase access, unless the costs saved are redirected to this end.
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Heller, J.C. Medical Professionalism, Revenue Enhancement, and Self-Interest: An Ethically Ambiguous Association. HEC Forum 24, 307–315 (2012). https://doi.org/10.1007/s10730-012-9198-5
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DOI: https://doi.org/10.1007/s10730-012-9198-5