Table 1 Curricular priorities for business ethics in medical practice
Topic | Consensus for MS Curriculum | Mean for MS Curriculum | Consensus for PG Curriculum | Mean for PG Curriculum |
|---|---|---|---|---|
Problems that can arise from conflicts of interest | YES (10/12) | 4.4 | YES (9/12) | 4.6 |
- Biased prescribing, advising on formularies, or selection of devices | ||||
- Harm to patient trust | ||||
- Bias operates unconsciously and unintentionally, making it difficult to manage | ||||
General healthcare organization and systems | YES (8/12) | 4.1 | YES (11/12) | 4.4 |
- Medicaid/Medicare and private insurance industry | ||||
- Drivers of cost increases, gaps in system, and other challenges | ||||
- Alternative models, including international models | ||||
Fostering patient care quality and safety | YES (9/12) | 4.1 | YES (10/12) | 4.3 |
The cost of medical errors | ||||
- Strategies for improving patient care quality | ||||
- Strategies for addressing medical errors | ||||
Medical professionalism, the goals of medicine, and their relationship to medical ethics | YES (7/12) | 3.9 | YES (8/12) | 4.0 |
- Primacy of patient well-being in physician-patient relationship; fiduciary obligations | ||||
- Balancing secondary gains (to finances, career, or life-work balance) with obligations to patients | ||||
- Physicians as advocates for system change | ||||
The structure and ethical issues surrounding reimbursement systems for physicians | YES (7/12) | 3.8 | YES (10/12) | 4.5 |
- Pay for performance | ||||
- Fee for service | ||||
- Managed care and capitated payment systems | ||||
Conflicts of interest arising from physician relationships with pharmaceutical and device industries | NO (6/12) | 3.8 | YES (8/12) | 4.2 |
- Free samples as marketing | ||||
- Consulting relationships and speakers bureaus | ||||
- Sponsoring CME | ||||
The legal framework for the business of medicine | YES (7/12) | 3.7 | YES (9/12) | 4.2 |
- False claims act, anti-kick back statute, Stark self-referral law | ||||
- Possible penalties and sanctions | ||||
- How law influences behavior | ||||
Good stewardship in resource utilization | NO (6/12) | 3.6 | YES (9/12) | 4.2 |
- Exploring costs of competing treatment options | ||||
- Rationing strategies | ||||
- Value of stewardship when resources are limited | ||||
Oversight of the practice of medicine | NO (5/12) | 3.1 | NO (6/12) | 3.5 |
- Self-regulation vs. government regulation | ||||
- Whistleblowing—mechanics, risks, protections, responsibilities | ||||
The business relationships of academic medical centers - Influence of educational and research mission on patient care | NO (3/12) | 2.9 | NO (5/12) | 3.5 |
- Financial pressures on academic medical centers and influence on medical practice | ||||
- Advantages and disadvantages of specific business relationships of academic medical centers | ||||
Disclosure rules and strategies for managing conflicts of interest | NO (2/12) | 2.8 | NO (5/12) | 3.6 |
- Disclosure rules such as the Physician Payments Sunshine Act and institutional policies | ||||
- Strategies such as divestment or increased oversight | ||||
Resources physicians can consult on matters of business ethics and compliance | NO (2/12) | 2.7 | NO (5/12) | 3.4 |
- Institutional resources, including compliance officers | ||||
- External resources, including Bar Association, health lawyers, CMS medical directors | ||||
- Educational materials, including Officer of Inspector General and Institute of Medicine publications | ||||
Mechanics of documentation, coding, billing and audits | NO (2/12) | 2.6 | NO (5/12) | 3.6 |
- Accurate billing vs. upcoding | ||||
- Documentation—the need and best practices | ||||
Physician ownership of practices and facilities | NO (2/12) | 2.6 | NO (5/12) | 3.7 |
- Advantages and disadvantages of ownership | ||||
- Avoiding violations of self-referral and kick back laws | ||||
Conflicting interests arising from ownership vs from working as employee or consultant |