ACP releases new ethics policy on physician employment, business practices

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The policy paper lays out a plan to address the impact business practices and employment terms can have on ethics and professionalism.

The American College of Physicians (ACP) has released a policy paper which seeks to address the ethical and professional implications of healthcare business practices and physician employment.

According to a news release, Ethical and Professionalism Implications of Physician Employment and Health Care Business Practices:An American College of Physicians Policy Paper was published in Annals of Internal Medicine. It was developed by ACP’s Ethics, Professionalism and Human Rights in response to changes to practice environments which raised concerns about physician employment, practice model shifts, new regulatory requirements, physician contracts, practice ownership, clinical priority setting, physician leadership, and the greater emphasis on the business of medicine.

The policy paper says physicians should ensure both relationships and practices are supportive of the commitment to patients and patient care. They should also be prepared to ask questions about arrangements and feel empowered to advocate for practices that promote patient health and the patient-physician relationship, according to the release.


Physicians should speak out, resist, and, if necessary, refuse to carry out any practice or policy that harms or has the potential to harm patient care, the release says.

“The practice of medicine must be defined by the ethics of medicine and while financial considerations are important to the fiscal health of hospitals and practices, it can’t be the driving force as it relates to patient care,” Jacqueline W. Fincher, MD, MACP, president of ACP, says in the release.“Our patients must have trust in the health care systems and in individual physicians that the patient-physician relationship is always the priority when delivering care.”

The COVID-19 pandemic has underscored the need to reassert the ethical foundation of medicine and physicians should lead an industry-wide reset that better serves both patients and clinicians, according to the release.

Recommendations in the paper include:

  • Ethics and professionalism must be emphasized in the shift to Value-Based Care and must be explicitly addressed in business practices and employment relationships when faced with external motivators.
  • Contract provisions should align with ethical commitments of physicians and the best interest of patients.
  • Physicians should consider the impact abrupt terminations could have on patient care before signing an employment contract that permits them to be fired without cause.
  • Systematic studies are needed to study the net value of private equity investments in physician practices for patient, physicians, and medicine.
  • Practice leaders and organizations should recognize and value time for patient-physician encounters and engage in priority setting across all aspects of health care.