Virtual Mentor

The 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 one e-mail attachment with the file named as your last name only, by 5 p.m. CDT, February 15, 2013. Submit essays to Kelly Shaw at kelly.shaw@ama-assn.org.

A peer-review committee established by the Virtual Mentor editorial staff will rate contest entries and select the 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.

2012 Contest Scenario

Midstate Internal Medicine, an LLC of 12 physician equity partners, has been incorporated for 15 years. Each partner has equal ownership of physical assets and shares overhead expenses in a leased building. Serving an area of about 120,000, their urban and suburban practice has been financially solvent for the last 10 years. Though the group is incorporated, each physician has his or her own patient panel and works, essentially, as a solo practitioner, arranging patient cross coverage when necessary.

Over the past few years, the partners have met frequently to discuss the uncertain and rapidly changing health care market in their community. Since passage of the Patient Protection and Accountable Care Act of 2010, and especially since the Supreme Court’s upholding of the act’s constitutionality, Midstate physicians have been considering the possibility of collaborating with a local hospital and other practices to form an accountable care organization (ACO) because of concerns about the future economic viability of their stand-alone practice. They stalled at the point of creating a payment scheme and accountability structure for the ACO’s many physicians; successful physician-led models were still hard to find.

At this juncture, Midstate received an unsolicited offer from Roosevelt Hospital, the largest hospital system in the state. Roosevelt wanted to buy the entire equity stake (physical assets, accounts receivable, and good will) of the practice. This arrangement, Roosevelt’s senior management explained, would solve Midstate’s concerns about forming an ACO, inasmuch as Roosevelt had purchased several physician practices in recent years and functioned as an extended ACO itself. Midstate was told that becoming part of the Roosevelt system would reduce its continuing overhead expenses. In the long run, Roosevelt’s executives explained, the consolidation would lower costs to patients and insurers, as continuity of care was enhanced, fewer unnecessary tests were preformed, and complications and hospital stays were reduced through the integration of hospital and physician services.

When Midstate Medical Group physicians met to consider the offer, all 12 acknowledged that they had seen a decline in patient visits as Roosevelt acquired practices and kept its referrals within its system, a trend that was likely to continue. However, Midstate physicians who had been their own bosses for over 25 years were skeptical about life as salaried employees. Stories were already circulating at specialty meetings that physicians in the Roosevelt system had to meet admissions quotas, for example.

What ethics issues should Midstate physicians address in responding to Roosevelt’s bid?