Does Hospitals Ownership Of Primary Care Practices Create A Dual Agency Problem?
The dual agency problem is simply the way ethicists have defined the old saying "No man can serve two masters..." When a hospital owns a patient population through the ownership of general medical practices, the doctors whose practices are owned are put in a tough position. The hospital expects that doctor to refer to other doctors who are in that system, because the "bottom line" of the hospital or hospital system is increased when patients are kept within that system. Whatever cosmetic face hospitals try to put on their administrations, they are nearly always run by businessmen, and to businessmen, the bottom line is everything.
When a doctor must treat a patient, and his or her practice is owned by a hospital or hospital system, then he or she is in an ethical pickle. Most doctors know in their hearts that all medical care is not equal. They and their family members frequently go to doctors outside their own hospital system. One reason for this could be the protection of and respect for privacy. But I don't think this is the primary reasons physicians go outside their own medical systems for care. I believe it is because they know where the best care is available in the area, and that is where physicians in the know send themselves and their families.
So if I were a patient, the next time a doctor in a hospital owned practice, suggests hospitalization or even evaluation for further testing, I would just ask him or her this simple question, "Is this where you would go or send your family?" If the answer is unhesitatingly "yes", then it's probably a good referral. If there is any hesitation whatsoever in the answer to that simple question, then that patient needs to seek a second opinion.
Doctors are generally truthful people. To them truth is more important than money. The exceptions are so rare that they receive as much press as the Al Qaeda Christmas bomber when they occur. Trying to create a TSA for doctors is certainly a jobs program, but is hardly necessary. Doctors really do try to live by the maxim "first, do no harm," and they try to give their patients the best care they can. Hospitals on the other hand are businesses run by businessmen. Just like insurance companies.
So the next time your doctor wants you to undergo tests or be admitted for surgery, just ask him or her that simple little question: "Is that what you would do? Is that where you would send your family?" You'll find out a lot about your doctor, and you'll help him or her solve the dual agency problem very quickly.
by Vernon Rowe, MD