Articles
From the President: Keeping patient welfare ahead of corporate interests
In November, it was my honor and privilege to be sworn in as NCMB’s 123rd Board President. As I reflect on the opportunity to serve the people of North Carolina and the medical profession in this role, I find myself gravitating towards NCMB’s vision statement, which signals our organization’s desire and intent to be a “proactive and progressive” leader in medicine.
What exactly does that mean in the context of medical regulation? Board Members and staff often talk internally about the need to “stay in our lane”. This can be somewhat limiting when considering ways to positively impact some of the most pressing challenges facing our profession, since we must always remember that NCMB is an impartial regulatory body and not an advocacy group. Even so, I have been pleased that NCMB frequently finds opportunities to be thoughtful and creative in how it approaches its licensing and regulatory work, keeping the vision top of mind.
One of the most recent examples of how NCMB practices “proactive and progressive” regulation relates to the increasing “corporatization” of medicine.
For a variety of reasons, which many licensees are no doubt familiar with, more and more of NCMB’s licensees are working as employees or contractors. Licensees in such employment arrangements typically are subject to policies and business practices determined by administrators or owners, who may or may not be medical professionals themselves.
While it is certainly possible for physicians, PAs and other medical professionals to deliver high quality care under such terms, it is also true that NCMB has noted an increase in enforcement cases where problems arise primarily due to policies or decisions made by someone other than the licensee.
We have seen cases where licensees discharge patients home from the hospital against their own clinical judgment because the patient did not meet criteria for admission or continued inpatient treatment, as established by their employer. We have also seen cases where it is obvious that profits are put before patient care, such as a recent situation where licensees were dismissed from employment not because care was below standard but because they were not bringing in enough revenue. In these instances, it can be challenging to decide how best to hold a licensee accountable for substandard practice or other misconduct because it is obvious that the licensee is not in full control of the situation.
NCMB does not have jurisdiction over non-licensees. That means the medical board cannot control the decisions or policies put in place by hospitals, health systems, or other owners and employers. However, NCMB cannot simply overlook substandard practice because it emerges amid convoluted circumstances. Ultimately, as our mission mandates, we must protect the public. Therefore, despite the increasingly complex environment in which medicine is practiced, we believe that professional ethics demand that a physician or PA take responsibility for the quality of the care they provide.
So what is proactive and progressive about this directive? Well, through NCMB’s Policy Committee, we are seeking to proactively educate licensees about the potential pitfalls we think employed physicians and PA’s may face. The committee is in the process of finalizing a new position statement that highlights some of the issues I have touched on in this short article. You can read the proposed position statement here.
In the upcoming months, NCMB is planning to send licensees an anonymous survey that will include questions about how workplace issues have impacted patient care.
I urge licensees to do their homework and go into any employment situation with their eyes open about who has the final say in clinical decisions. It is also important to consider how the employer’s policies may negatively impact patient welfare. Ideally, informed licensees will be able to avoid putting themselves in situations where their professional knowledge and ethics regularly chafe with company policy.
In closing, I invite you to share your thoughts about the challenges of practicing as an employed physician or PA by emailing forum@ncmedboard.org. We are always interested in perspectives from ground level.
Thank you for the opportunity to serve.
What exactly does that mean in the context of medical regulation? Board Members and staff often talk internally about the need to “stay in our lane”. This can be somewhat limiting when considering ways to positively impact some of the most pressing challenges facing our profession, since we must always remember that NCMB is an impartial regulatory body and not an advocacy group. Even so, I have been pleased that NCMB frequently finds opportunities to be thoughtful and creative in how it approaches its licensing and regulatory work, keeping the vision top of mind.
One of the most recent examples of how NCMB practices “proactive and progressive” regulation relates to the increasing “corporatization” of medicine.
For a variety of reasons, which many licensees are no doubt familiar with, more and more of NCMB’s licensees are working as employees or contractors. Licensees in such employment arrangements typically are subject to policies and business practices determined by administrators or owners, who may or may not be medical professionals themselves.
While it is certainly possible for physicians, PAs and other medical professionals to deliver high quality care under such terms, it is also true that NCMB has noted an increase in enforcement cases where problems arise primarily due to policies or decisions made by someone other than the licensee.
We have seen cases where licensees discharge patients home from the hospital against their own clinical judgment because the patient did not meet criteria for admission or continued inpatient treatment, as established by their employer. We have also seen cases where it is obvious that profits are put before patient care, such as a recent situation where licensees were dismissed from employment not because care was below standard but because they were not bringing in enough revenue. In these instances, it can be challenging to decide how best to hold a licensee accountable for substandard practice or other misconduct because it is obvious that the licensee is not in full control of the situation.
NCMB does not have jurisdiction over non-licensees. That means the medical board cannot control the decisions or policies put in place by hospitals, health systems, or other owners and employers. However, NCMB cannot simply overlook substandard practice because it emerges amid convoluted circumstances. Ultimately, as our mission mandates, we must protect the public. Therefore, despite the increasingly complex environment in which medicine is practiced, we believe that professional ethics demand that a physician or PA take responsibility for the quality of the care they provide.
So what is proactive and progressive about this directive? Well, through NCMB’s Policy Committee, we are seeking to proactively educate licensees about the potential pitfalls we think employed physicians and PA’s may face. The committee is in the process of finalizing a new position statement that highlights some of the issues I have touched on in this short article. You can read the proposed position statement here.
In the upcoming months, NCMB is planning to send licensees an anonymous survey that will include questions about how workplace issues have impacted patient care.
I urge licensees to do their homework and go into any employment situation with their eyes open about who has the final say in clinical decisions. It is also important to consider how the employer’s policies may negatively impact patient welfare. Ideally, informed licensees will be able to avoid putting themselves in situations where their professional knowledge and ethics regularly chafe with company policy.
In closing, I invite you to share your thoughts about the challenges of practicing as an employed physician or PA by emailing forum@ncmedboard.org. We are always interested in perspectives from ground level.
Thank you for the opportunity to serve.