Virtual Mentor

Bander Essay Contest in Medical Business Ethics

The Bander Essay Contest is supported by the Saint Louis University Bander Center for Medical Business Ethics. The contest is meant to encourage scholarly inquiry into business ethics within the practice of medicine or the conduct of medical research.

Medical students, resident physicians, fellows, and physicians in practice are eligible to submit essays for consideration. Essays must be 2,000 words or fewer, typed, and double-spaced. The author’s name, address, telephone number, e-mail address, and medical school class should appear on the cover sheet only—not on the essay pages. Entries must be received as e-mail attachments by midnight CST, January 15, 2012. Submit essays to Faith.Lagay@ama-assn.org.

A peer-review committee established by the Virtual Mentor editorial staff will select contest winners. Essays will be judged on understanding of the topic, applicability of the proposed policy to medical practice and patient care, clarity of writing and argumentation, and integration of relevant scholarly literature and data if appropriate.

The author of the best essay will be awarded $5,000. If more than one exceptional entry is received, the author of the runner-up essay will be awarded $1,000. Winning essays will be published in Virtual Mentor.

2011 Contest Scenario

Delta Health was one of three large health insurers that shared a mid-West multistate market. Recently all individual and group practices and clinics that were among Delta’s preferred provider organizations (PPOs) received letters from the company informing them that Delta was about to perform a quality audit on a select number of providers.

The letter explained that Delta employees would be calling for appointments, showing up at the appointed times, and going through with the physician visit. They would then report to Delta on their success at getting a timely appointment, the helpfulness of the telephone and office staff, the physician’s attentiveness and response to their reasons for the visit, and the physician’s recommended treatment.

The Delta Health letter concluded by saying that the company intended to share the results concerning each specific physician and clinic with that physician or clinic only, in the hope that the objectively acquired and reported information would help the physicians maintain or improve quality care.

Reaction to the Delta Health letter at one PPO, Mid-West Internal Medicine Clinic, was like that at many other letter recipient locations. At a specially called meeting, 12 of the clinic’s 15 physicians met to discuss what steps they should take to prepare for Delta audits if, indeed, they were among the “providers” visited.

“This is a secret shopper attack,” said the first speaker, “and we’re not Wal-Mart and our patients aren’t customers. We have difficulty seeing everyone who really needs care in a timely manner. Now that patient is going to have to wait while we see a secret shopper who’s not even sick. It makes no sense.”

“I’m not worried in the least,” said a second physician. “It’s a one-time thing. They’re not going to send these fake patients in week after week. And we could get some observations that would really help. I don’t have a clue what patients expect when they first walk into the waiting room.”

But others feared that what Delta Health called “information to help maintain or improve quality care” was really going to be economic profiling—discovering which physicians ordered more costly tests and hospital admissions. A physician whose husband had been getting treated at the Faculty Practice Organization associated with the academic health center in the neighboring state said that Delta had recently dropped that organization as one of its PPOs. She and her husband reasoned that patients in the Faculty Practice Organization were probably costing Delta too much money.

Should physicians accommodate or oppose secret shopper visits? Why or why not?

2009 Winning Essay

2010 Winning Essay