How Employed Physicians' Contracts May Threaten Their Patients and Professionalism
Authors: Roy M. Poses, Wally R. Smith
Journal: Annals of Internal Medicine (2016)

Ideas and Opinions5 July 2016How Employed Physicians' Contracts May Threaten Their Patients and ProfessionalismRoy M. Poses, MD and Wally R. Smith, MDRoy M. Poses, MDFrom Alpert Medical School and Brown University, Providence, Rhode Island; Foundation for Integrity and Responsibility in Medicine, Warren, Rhode Island; and Virginia Commonwealth University Medical Center, Richmond, Virginia.Search for more papers by this author and Wally R. Smith, MDFrom Alpert Medical School and Brown University, Providence, Rhode Island; Foundation for Integrity and Responsibility in Medicine, Warren, Rhode Island; and Virginia Commonwealth University Medical Center, Richmond, Virginia.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-2979 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Physicians increasingly practice as employees of large organizations; therefore, they may often report to managers who are not physicians and may not share their professional values. Instead, these managers may be “managerialists” who let the demands of the “market” trump other goals and believe that practices learned in business school apply to all organizations, including hospitals (1). A recent media report that physicians may be barred from revealing problems with electronic health records, including those with health care quality or patient safety implications, because of confidentiality clauses in contracts between their hospital employers and electronic health record vendors may seem ...References1. Komesaroff PA, Kerridge IH, Isaacs D, Brooks PM. The scourge of managerialism and the Royal Australasian College of Physicians. Med J Aust. 2015;202:519-21. [PMID: 26021355] CrossrefMedlineGoogle Scholar2. Tahir D. Doctors barred from discussing safety glitches in U.S.-funded software. Politico. 11 September 2015. Accessed at www.politico.com/story/2015/09/doctors-barred-from-discussing-safety-glitches-in-us-funded-software-213553 on 25 January 2016. Google Scholar3. Neely TRC. Selling to a corporation poses challenges. Medical Economics. 25 April 2011. Accessed at http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modern-medicine-feature-articles/selling-corporation-poses-cha on 9 December 2015. Google Scholar4. Poses RM. The Corporate Physicians' Dilemma - Three Hospital Systems Settle Cases Alleging Pressure on Employed Physicians to Refer Patients Within the System. Health Care Renewal. 27 October 2015. Accessed at http://hcrenewal.blogspot.com/2015/10/the-corporate-physicians-dilemma-three.html on 9 December 2015. Google Scholar5. Meyer H. Can You Speak Out Without Getting Fired or Being Labeled a Troublemaker? Medscape. 17 April 2013. Accessed at www.medscape.com/viewarticle/781964 on 25 January 2016. Google Scholar6. Page L. 10 Potential Time Bombs in Your Employment Contract. Medscape. 22 October 2015. Accessed at www.medscape.com/viewarticle/848973 on 25 January 2016. Google Scholar7. Chesanow N. Are Disruptive Physicians a Real Problem – or Scapegoats? Medscape. 20 October 2015. Accessed at www.medscape.com/viewarticle/851013 on 25 January 2016. Google Scholar8. Mandrola J. The Wrongness of a Doctor Being in Two Places at Once. Medscape. 29 October 2015. Accessed at www.medscape.com/viewarticle/853447 on 25 January 2016. Google Scholar9. Poses RM. You Can Check Out Any Time You Like, But You Can Never Leave–Duke and UNC Allegedly Agreed Not to Hire Each Other's Faculty. Health Care Renewal; 2015. Accessed at http://hcrenewal.blogspot.com/2015/8/you-can-check-out-any-time-you-likebut.html on 9 December 2015. Google Scholar10. Relman AS. Medical professionalism in a commercialized health care market. JAMA. 2007;298:2668-70. [PMID: 18073363] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Alpert Medical School and Brown University, Providence, Rhode Island; Foundation for Integrity and Responsibility in Medicine, Warren, Rhode Island; and Virginia Commonwealth University Medical Center, Richmond, Virginia.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2979.Corresponding Author: Roy M. Poses, MD, Foundation for Integrity and Responsibility in Medicine, 16 Cutler Street, Suite 104, Warren, RI 02885; e-mail, [email protected]edu.Current Author Addresses: Dr. Poses: Foundation for Integrity and Responsibility in Medicine, 16 Cutler Street, Suite 104, Warren, RI 02885.Dr. Smith: Virginia Commonwealth University Medical Center, Box 980306, 730 East Broad Street, Suite 430, Richmond, VA 23298-0306.Author Contributions: Conception and design: R.M. Poses, W.R. Smith.Analysis and interpretation of the data: R.M. Poses, W.R. Smith.Drafting of the article: R.M. Poses, W.R. Smith.Critical revision for important intellectual content: R.M. Poses, W.R. Smith.Final approval of the article: R.M. Poses, W.R. Smith.Administrative, technical, or logistic support: R.M. Poses.Collection and assembly of data: R.M. Poses.This article was published at www.annals.org on 1 March 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byEthical and Professionalism Implications of Physician Employment and Health Care Business Practices: A Policy Paper From the American College of PhysiciansMatthew DeCamp, MD, PhD and Lois Snyder Sulmasy, JD, for the American College of Physicians Ethics, Professionalism and Human Rights Committee*How to Evaluate a Letter of Offer or ContractDirect Primary Care and Concierge Practice 5 July 2016Volume 165, Issue 1Page: 55-56KeywordsBehaviorDisclosureElectronic medical recordsHealth care qualityMotivationNursesPatientsSafetySurgeonsSurgery ePublished: 1 March 2016 Issue Published: 5 July 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...