Financial Pressures Spur Physician Entrepreneurialism

Pham, Hoangmai H.; Devers, Kelly J.; May, Jessica H.; Berenson, Robert A.

doi:10.1377/hlthaff.23.2.70

Cited by 83 publications

(50 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As a result, physicians are seeking new channels within the context of their practices to augment their incomes (Pham, Devers, May, & Berenson, 2004). These emerging revenue streams range from selling patients/clients "nutraceuticals," such as vitamins and herbal supplements, to offering cosmetic procedures, such as facial peels and Botox injections.…”

Section: Clinical Trials As An Emerging Medical Specialtymentioning

confidence: 99%

Practicing research ethics: Private-sector physicians & pharmaceutical clinical trials

Fisher

2008

Social Science & Medicine

View full text Add to dashboard Cite

This paper focuses on constructions of research ethics by primary care physicians in the USA as they engage in contract research for the pharmaceutical industry. Drawing first upon historical studies of physicians as investigators and then upon 12 months of qualitative fieldwork in the South Western US, this paper analyzes the shifting, contextualized ethics that shape physicians' relationships with patients/subjects and pharmaceutical companies. Just as physicians followed professional codes of ethics prior to the codification of acceptable research conduct in the 1980s, physicians today continue to develop tacit systems of research ethics. This paper argues that private-sector physicians primarily conceptualize their ethical conduct in relation to the pharmaceutical companies hiring them, not to human subjects they enroll in clinical trials. This is not to say that these physicians do not follow the formal U.S. regulation to protect human subjects, but rather that their financial relationships with the pharmaceutical industry have a greater influence on their identities as researchers and on their constructions of their ethical responsibilities.

show abstract

Section: Clinical Trials As An Emerging Medical Specialtymentioning

confidence: 99%

Practicing research ethics: Private-sector physicians & pharmaceutical clinical trials

Fisher

2008

Social Science & Medicine

View full text Add to dashboard Cite

show abstract

“…These economic pressures have intensified providers' interest in nontraditional revenue sources, such as surgicenter investment, as a means of generating extra income. 4 Regardless of the reason for increasing investment in them, it is important to note that surgicenter ownership creates a potential conflict of interest for physicians. Ownership entitles physicians to collect a share of the facility's profits from referrals in addition to their professional fees.…”

mentioning

confidence: 99%

Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries

et al. 2010

View full text Add to dashboard Cite

Many physicians confronting declining reimbursement from insurers have invested in ambulatory surgery centers, where they perform outpatient surgical and diagnostic procedures. An ownership stake entitles physicians to a share of the facility's profits from self-referrals. This arrangement can create a potential conflict of interest between physicians' financial incentives and patients' clinical needs. Our analysis of Florida data for five common procedures revealed a significant association between physician-ownership and higher surgical volume. Possible remedies include revising federal law to require disclosure of investment arrangements; reducing facility payments to dilute ownership incentives; and reforms (such as accountable care organizations) that discourage an excessive rate of procedures.

show abstract

“…In markets with increased malpractice liability this disincentive manifested itself as an increased reluctance to provide unscheduled acute care. In these markets both PCPs and specialists avoided providing acute care in their offices by sending patients to the ED, and physicians associated a higher liability risk with low-income patients (Pham et al, 2004). Because of increasing specialization and shifts toward group practice, it has become less common that a patient will depend solely on a single PCP for his or her care (Liebhaber & Grossman, 2007;Goldstein, 2008).…”

Section: Physiciansmentioning

confidence: 99%

The Influence of Patient-Reported Provider Availability Factors on Nonurgent Emergency Department Use

DeWood¹

View full text Add to dashboard Cite

DEDICATIONThis work is dedicated to my family. My husband, Gary DeWood, has provided far more encouragement and support throughout the duration of this project than either of us thought would be necessary, and has done so with grace and forbearance. My children, Patricia, Dale, and Kathryn, made many sacrifices and contributions that were material to my being able to be in school, for which I am more grateful than I can express. While it may be impossible to quantify the benefits of prayer, I am certain that the maximum of those benefits have been bestowed on me due to the fact that my mother, Alice Davis, has made countless petitions heavenward on my behalf. (Any answering of prayers that has occurred is because my mother deserves to have her prayers answered, not because I do. In any case, because of the probable reduction in requests for help, I dare say even God is relieved that my dissertation is finally complete.) The example set by my late father, Dr. Dale Davis, whose work as an adult PhD candidate I remember, exhorted me to sustain my efforts during times when it seemed that this enterprise was ill-advised for anyone who could be otherwise gainfully employed. iv ACKNOWLEDGEMENTSFirst and foremost, I thank Dr. James Vaden for being my advocate, providing encouragement, and for being a mentor without peer. I do not know by what luck it is that I was able to find such a friend.I would also like to thank all the faculty members who gave me instruction and guidance. In particular I appreciate the efforts of my committee members, Drs. Lawrence Brown, Cyril Chang, Joy Clay, Doug Imig, and Junling Wang, but most especially for those of Dr. Lawrence Brown, who had the unenviable task of assuming chairmanship of my dissertation committee late in the game. No one knows better than I do that accomplishing all that is required to obtain a Ph.D. cannot be done alone.v ABSTRACT Purpose. The purpose of this study is to examine the influence of patientperceived provider availability on nonurgent emergency department use (NUEDU). The study population consists of a nationally-representative population of non-elderly adults who were continuously privately insured (CPI) for at least a year before an emergency department visit that was determined to be nonurgent, and who reported having a regular source of care (RSC).Methods. Data were obtained from a nationally-representative longitudinal survey, the Medical Expenditure Panel Survey (MEPS). The classification of ED visits as nonurgent was based on patient report using a method developed for this study. Patient-perceived provider availability was based on patient report of how difficult it was to contact their RSC by phone for medical advice during office hours (Regular Hours Contact), how difficult it was to reach their RSC after hours in case of an urgent problem (After Hours Contact), and whether their RSC had office hours at night or on weekends (Night or Weekend Hours). Multiple logistic regression analysis was used to determine whether the patient-reported provider ava...

show abstract

Financial Pressures Spur Physician Entrepreneurialism

Cited by 83 publications

References 9 publications

Practicing research ethics: Private-sector physicians & pharmaceutical clinical trials

Practicing research ethics: Private-sector physicians & pharmaceutical clinical trials

Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries

The Influence of Patient-Reported Provider Availability Factors on Nonurgent Emergency Department Use

Contact Info

Product

Resources

About