Impact of financially driven health care models on tenets of medical professionalism including workforce equity, diversity, and inclusion

Abstract

We read with great interest the article entitled "Ethics in contemporary health care management and medical education" by Balak et al which discusses the ethical challenges associated with an increasing trend towards prioritization of fiduciary interests and their potential impact on patient outcomes and trainee education. 1 We agree that systems which are focused on productivity and profitability dilute the focus on the mission of medicine and its tenets of professionalism. At a minimum, institutions need to give equal consideration to professionalism and education priorities that are not fiscally driven.How does an institution formalize the adoption of professionalism values? Tenets of professionalism can be prioritized through the thoughtful creation of a mission statement. The Charter on Professionalism for Healthcare Organizations states that mission statements should not focus on financial aims, 2 but instead, detail the critical components of high-quality patient care and patient satisfaction.beliefs of an organization's leadership are aligned with the institution's mission, performance improves. 4 Therefore, a narrow focus on financial performance not only undermines the core competencies of medical education, but also the practice of medicine.As Balak et al describe, there are many potential adverse outcomes of prioritizing financial imperatives over those related to professionalism. 1 First, the disconnect between institutional mission and professionalism may have unintended negative consequences on efforts to enhance diversity, equity, and inclusion. For example, a financially focused business model does not serve to bridge the gender wage gap that has been well-documented in the literature, even after adjusting for potentially confounding factors. 5-7 Efforts to correct such inequities are the moral and ethical imperative of health care institutions. 8 Also, the wage gap, among other drivers, further perpetuates inequities in the hiring and retention of a diverse workforce. As a consequence, the recruitment and inclusiveness of a diverse group of physicians, a new ACGME core program requirement, would be adversely affected. As described in the Charter, a "healing environment can best be achieved when all of those in the organization are afforded the same value and respect". 2 Finally, narrowing the scope of patient selection in order to improve financial metrics is yet another example of a breach in the ethical standard of professionalism in regard to diversity, equity, and inclusion.In conclusion, we are in agreement with the authors that a purely profit-oriented focus has great potential to be in conflict with the vital tenets of professionalism. We recommend that institutions thoughtfully reassess their mission statement to prioritize professionalism and its inherent implications for diversity, equity, and inclusion.