Ethical questions often sit at the intersection of financial incentives, ownership of medically related businesses and patient care decisions. A controversial new practice structure, the “company model of anesthesia,” exemplifies the dilemmas that can occur when physicians are either pressured or incentivized by economic factors as they try to decide what is in their patients’ best interests.
The company model is a very problematic development that threatens the independent nature of the specialty of anesthesiology. This practice paradigm separates the reimbursement for professional services from the providers of those services and in doing so creates a number of ethical conflicts. Its typical arrangement involves fixed-salaried, employed anesthesiologists and nurse anesthetists who work for, not with, the proceduralists bringing patients to them. This occurs to the benefit of the referring physicians who profit from the difference between the anesthesia revenues and salaries, a spread that in many situations involves significant dollars....
