Roy M. Poses, MD; Wally R. Smith, MD
This article was published at www.annals.org on 1 March 2016.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2979.
Requests for Single Reprints: Roy M. Poses, MD, Foundation for Integrity and Responsibility in Medicine, 16 Cutler Street, Suite 104, Warren, RI 02885; e-mail, email@example.com.
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.
Poses R., Smith W.; How Employed Physicians' Contracts May Threaten Their Patients and Professionalism. Ann Intern Med. 2016;165:55-56. doi: 10.7326/M15-2979
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Published: Ann Intern Med. 2016;165(1):55-56.
Published at www.annals.org on 1 March 2016
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 startling (2). In fact, such clauses in the contracts that physicians sign with their employers or that their employers sign with third parties may be part of a growing class of subtle but protean and pernicious restrictions on employed physicians' professionalism and autonomy. These provisions may financially benefit employers and their management. No clear arguments that they benefit patients or support physicians' professionalism have been made. Because these contractual provisions are not well-studied or well-reported, physicians may start working for these organizations under the naive delusion of unthreatened professionalism.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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