Professionalism In Industry Relations

Now that the majority of physicians work in paid positions of regular employment of large medical centers, healthcare corporations, and payer-owned companies, the ongoing professional obligation either directly or indirectly to patients is at risk of being obscured by other social contracts built on traditional business models rather than a traditional doctor-patient relationship.

The aim of each physician should continue to be the care for and protection of the interests and wellbeing of patients to the best of that physician’s abilities, irrespective of business obligations. Whether organized as a for-profit or not-for-profit business, all health-related businesses need to remain economically sustainable, and healthcare company leaders have fiduciary responsibilities to maintain their financial bottom line.

There is something different about medicine, however. While healthcare business may focus on shareholders and profit because that is how companies are thought to contribute most to overall social welfare, physicians’ responsibilities originate not from broader social welfare but from a commitment to the individual patient. Fiduciary duty is an obligation to act in the best interest of another person or party. The fiduciary is entrusted with the care of another person and must ensure that the person’s interests take precedence over the fiduciary’s own interests.

Fiduciary duty for physicians is embedded in their relationship to patients. In business, executives have a fiduciary duty to the shareholders of the corporation. Can physicians maintain two fiduciary duties simultaneously, to both patients and a business interest? Broader medical professionalism that expands fiduciary duty to symbiotically design and organize around efficiency, profit, advancing medical science, and patient care can be built on cultures and processes that acknowledge the tensions between medical and business approaches while maintaining a trustee relationship to in all fiduciary obligations.

Physicians must ensure that they continue to lead continuous process improvement to improve quality and enhance innovation as new discoveries and healthcare delivery systems evolve. Physician relations with industry are important to advancing science and the development of new services and interventions for patient care. However, physician leaders must monitor relations for themselves, their organizations, and the broader physician community to ensure that four objectives are met:

1. Ensuring ethical conduct.

2. Prohibiting fraud.

3. Properly handing remuneration.

4. Avoiding conflicts of interest.

Regardless of whether it is a small physician group practice, integrated health system, radiology center, clinically integrated network, or a public health program, each organization places physicians squarely in contact with other stakeholders across the industry. Within the broader healthcare ecosystem, patterns of relationships are established, and some fuel sustainability of programs and organizations while others may lead to the self-organization of new entities.

In 1994, Dr. David Blumenthal noted three key elements to strengthen professionalism: altruism, self-improvement, and peer review. When focused on with the proper resources and effort, each of these elements can help ensure the accomplishment of the four objectives in their impact on relations with industry.

Physicians have interactions with industry in several different sectors, including biotechnology, health policy development, health information technology, managed care, and medical device manufacturers. The vendors and organizations that provide services and products across these sectors need physicians in development, validation, and testing stages to advance and introduce new interventions across markets. Physician executives and practicing physicians must manage all of these relations with the utmost scrutiny. The Stark Law provides physicians with rules that govern self-referral patterns and relationships, while the Anti-kickback Statute put in place guardrails to deter the occurrence of fraud and abuse that impacts patients and federal health programs negatively.

As physician leaders address emergent health reforms, these statutory frameworks provide guidance that reinforces the importance of professionalism in physician-to-industry relations. Physicians’ role on advisory boards and recruitment of patients for new pharmaceutical/biotechnology trials is important to the advancement of medical innovation. Whether physicians play a role in leadership and governance, the importance of meeting the four objectives is part of professional responsibility.

Excerpt from Reframing Contemporary Physician Leadership: We Started as Heroes by Grace E. Terrell, MD, MMM,CPE, FACP, FACPE.