4 Top Complaints of Employed Doctors

Kenneth J. Terry, MA

Disclosures

May 08, 2013

In This Article

Is a Change Coming?

In his experience, Cain says, hospital administrators don't challenge any doctor's advocacy for patients. But in the future, as Accountable Care Organizations grow, employed doctors may be compelled to hew more closely to practice guidelines. "In some cases, physician autonomy may have to be balanced against cost and quality."

The AMA recently issued guidelines for physician employment stating that "a physician's paramount responsibility is to his or her patients." Employers should not retaliate against physicians for asserting their patients' interests, according to these guidelines. "In any situation where the economic or other interests of the employer are in conflict with patient welfare, patient welfare must take priority," the AMA says.

The guidelines also call for employers and employed physicians to disclose to patients any agreements or understandings they have that restrict, discourage, or encourage particular treatment or referral options.

Nevertheless, employed physicians are often expected to refer patients within their own groups and send tests to a hospital laboratory or imaging center. Hospitals may tell employed surgeons which kinds of joint implants to use, and according to a New York Times article[1] even whether to implant defibrillators in Medicaid patients. It's unclear how often any of this is disclosed to patients.

"What we doctors say is that we're ethically bound to our patients because we took an oath, and that's what our license is based on," says Linda Brodsky. "But many hospitals say, 'No, you're employed here, and what we say goes.'"

David L. Bronson, MD, President of the American College of Physicians, disputes Brodsky's assertion that hospitals tend to squelch doctors who criticize leadership for policies that they believe harm patient care. In fact, he says, healthcare organizations may identify outspoken physicians as potential leaders, "as long as they're collaborative and trying to solve problems, and not just be a thorn in the side of everyone they know. Organizations are looking for physician leaders, and physicians who can collaborate and not just be adversarial can go far inside organizations."

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