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Ann Thorac Surg 2001;72:3-5
© 2001 The Society of Thoracic Surgeons

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Editorial

Ethical and legal concerns in relationships with cardiologists

Address reprint requests to Dr Sanderson, 5540 Circulo Terra, Tucson, AZ 85750
e-mail: rgsanderson@compuserve.com

During the past year, the Standards and Ethics Committee has received a variety of pertinent and thought-provoking communications from STS members about ethical concerns regarding their relationships with referring cardiologists. This editorial reflects the committee’s deliberations on these issues.

The most common concern is the invitation by a large group of cardiologists for one or more cardiac surgeons to join their practice, many times under the expressed or implied threat of withholding surgical referrals if the invitation is not accepted. Thoughtful members asked a number of questions related to the conflict of interest raised by this practice: Is retaining and distributing a portion of the surgeons’ fees to the associate cardiologists the equivalent of fee splitting? Is trading the security of a referral base for negotiated compensation ethically acceptable? Does the employment arrangement cause surgeons to lose their perspective as practitioners and patient advocates? Does the arrangement adversely affect the surgeons’ decision-making process?

A second ethical concern is the practice of the cardiologists’ taking over the care of postoperative patients for financial reimbursement purposes, whether the involved cardiac surgeons are employed by cardiologists or are independent practitioners. Finally, great concern was expressed about situations in which cardiologists from all over the country directly ask cardiac surgeons to share income in exchange for continued referrals.

These aforementioned scenarios are just three current examples of problematic intraprofessional relations; undoubtedly others will surface in the future. They raise ethical concerns as well as questions of legality under applicable federal or state statutes.

Background

In today’s medical marketplace, there is a growing number of employment and reimbursement arrangements. The current trend is to shift away from independent private practice to group practice, frequently in a multispecialty setting in which surgeons are salaried from shared revenues. In academic university practice, a surgeon is often a full-time . . . [Full Text of this Article]

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