Show me the money: the ethics of physicians' income

Outpatient before inpatient—the good, the bad and the ugly

Background

In January 2019 the Swiss Federal Department of Home Affairs defined a group of six selected surgical interventions to be performed on an outpatient basis. The aim of this paper is to assess surgeons’ opinions on patient safety, costs and treatment based on this new regulation.

Methods

An online survey was sent electronically to all 942 members of the Swiss Society of Surgery between August and October 2019.

Results

About half of the participants think the new regulation could harm patients (52%) and will lead to lower patient satisfaction (49%). Whereas half of the participants expect a reduction in health care costs (52%), most expect surgeons to earn less due to the new regulation (82%). About three quarters (73%) of the participants expect the new regulation to negatively affect surgical resident education. More than half (62%) of the participants assume that diagnoses allowing reimbursement for inpatient treatment (such as, e.g., bilateral instead of unilateral inguinal hernia) could be made more generously. Accordingly, 70% assume that the new regulation may result in not necessarily indispensable or possibly unnecessarily extended interventions (such as, e.g., bilateral inguinal hernia repair). Furthermore, most (86%) participants fear that the new regulation could possibly lead to hospitals/surgeons rejecting patients.

Conclusion

Whereas about half of the participants expect a reduction in health care costs, about two thirds fear that more generous diagnoses and not necessarily indispensable or possibly unnecessarily extended interventions could be performed due to the new regulation demanding outpatient care for said surgical interventions.

Medicine and money: friends or foe?

The relationship between medicine and money is a delicate one that all people involved need to handle responsibly. If one becomes a physician for the mere fact of pursuing money, s/he may soon find that another profession or activity may have fulfilled such a need in a better way. While in the practice of medicine the interest of the patient is paramount, this does not suggest that the welfare of the physician should be neglected at all. It is much about a balance of priorities between the legal and ethical pursuit of money and the promotion of the health of society. Physicians are not called to a life of self-denial, poverty and destitution, as others may be tempted to suggest. The service of patients and the honest reward from one's labour are not incompatible. Where conflict of interest arises, it is prudent for a physician to always remember never to harm oneself, the profession and the patient more than what can be gained.