ACP Issues Revised Ethics Manual

"It goes both ways," she says. "As people are employed and paid in a lump sum for a job they do, it may take away some of the incentives that the current payment system has to encourage more procedures than maybe are necessary. All of the incentives in the system support volume rather than value. Having people employed may take away some of those incentives."

"On the other hand it brings up other issues, such as the institution making demands on how physicians treat patients or what tests or medications they are allowed to use, or pressures to get people out of the hospital sooner because it's better for the institution's bottom line," she says. "There are institutional pressures that can be pressed on employed physicians that we have to be concerned about. It is a growing trend and there might be more about that depending upon how healthcare is paid for."

As medical resources become more expensive or scarce, Hood says physicians may find themselves caught between the demands of patients and the greater society.

"The ethics of professionalism revolve around doing good, doing no harm, allowing patient autonomy and social justice—the equitable distribution of limited resources so everybody has the same chance to get what is needed," Hood says. "These are the principles one has to balance and the decision to do things that may cost more when you can do something that costs less just because a patient saw something on television. We are obligated as physicians not just to try to make the right decisions but to help patients make the right decisions."