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    4 ethical dilemmas facing physicians

    Why ACA, malpractice, hospital consolidation and patient demands pose new ethical pressures for U.S. physicians

    asking a patient Today’s physicians are subject to numerous competing pressures, rooted in both time and money, perhaps to an extent they’ve never experienced before. Medical Economics consulted doctors and healthcare experts to explore the push-pull of four ethical, financial, and logistical dilemmas that doctors must navigate in 2014--and beyond.

    Read: Top 10 challenges facing physicians in 2014

    Consider the trends. Patients newly insured through the Affordable Care Act (ACA), some with long-ignored medical needs, will be flooding the system, with slightly more than eight million people signed up by late April, according to federal officials. Medicaid eligibility also expanded in 26 states. Meanwhile, the U.S. health system is rapidly evolving. Hospitals are consolidating and building networks, many doctors are moving away from independent practice, and everyone from federal officials to the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign are targeting ever-rising treatment costs.

    Add to that mix the perpetual edginess about malpractice lawsuits and patients who walk into the exam room with an iPad stocked with medical studies and their own game plan, says Terry McGeeney MD, a visiting scholar at the Brookings Institution and chief medical officer for VillageMD, a Chicago-based practice acquisition and management company that works with primary care practices. Doctors somehow have to keep their practice solvent amid shifting economic incentives, he says.

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    “Even though a lot of physicians are living in fee-for-service and RVU (relative value unit) worlds, the reality is that there’s an end date on all of those things,” he says. “Physician compensation is going to be moving more toward total cost of care, quality, following protocols for whatever the process or disease might be. But we’re caught in this sort of transition time right now.”

    Even before the influx of newly-insured patients, doctors felt as though they were practicing a form of triage to best meet patients’ medical needs. A primary care doctor would have to work nearly 22 hours each day to meet all of the guidelines for preventive care and chronic disease management for a typical patient panel of 2,500, according to an analysis published in 2009.

    “People who already feel like they are doing a ton of work, are going to say, 'I can’t do anything more. There’s nothing more to squeeze out of me,’ ” says Marc Tunzi, MD, a family practitioner at Natividad Medical Center in Salinas, California. “You want me to do more work, but then you want me to be empathetic. So I need to deal with my own wellness. I need to get some exercise. There’s only 24 hours in the day.”

    Medical Economics explored four ethical dilemmas that many doctors face on a regular basis.

    Next: Dilemma No. 1

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