Physicians should not engage in fundraising efforts that directly solicit patients for donations — a practice known as grateful patient fundraising — due to ethical concerns, according to a position paper from the American College of Physicians (ACP).
Major ethical concerns can arise when physicians engage in fundraising activities, such as direct solicitation or misuse of patients’ confidential medical records, which can damage trust between patients and their physicians, noted Lois Snyder Sulmasy, JD, of the ACP, and colleagues in the Annals of Internal Medicine.
The authors highlighted three key positions that physicians — and healthcare administrators — should follow, including:
- Any participation by physicians in healthcare fundraising should be guided by the best interest and needs of their patients
- Physicians are responsible for protecting patient privacy and confidentiality and should never use that information for fundraising efforts
- Physicians should not be asked to solicit their patients during fundraising efforts and fundraising should never be a condition of employment for physicians
They also highlight the ways that the patient-physician relationship can become strained when physicians seek contributions from patients for their healthcare institutions, noting that pressure on patients to donate can lead to potential expectations of preferential care, the misuse of confidential patient information, and conflicts of interest for physicians.
“Over the past two to three decades … we have even seen private equity get into the healthcare space, so that a majority of the physicians now are part of healthcare systems,” Omar Atiq, MD, the president of the ACP, told MedPage Today. “Therefore, we wanted to make sure that we don’t lose sight of the fact that whenever a physician sees a patient, that relationship remains paramount, and no other consideration supersedes that.”
Atiq noted that there has been an increasing sense that healthcare administrators want to use the positive relationships that physicians have with their patients — especially those who have the financial means to donate — to request philanthropic donations for their institutions.
He said that the position paper is not a direct response to any specific trends in medicine; the ACP just wants to make the ethical implications of physician fundraising practices “crystal clear” to all physicians.
“We don’t want them to feel that they are alone in this and that the largest specialty organization of physicians in the country is totally behind them,” he added. “[ACP] is encouraging them to preserve that patient-physician relationship, despite potential pressures from administrators and corporate executives and the like.”
Atiq also noted that the ethical concerns around physician fundraising can be an issue both ways. If patients are providing funds to the healthcare system, then those patients may develop an expectation that their physician should start to give them priority over other patients.
“We think all patients have priority, and there should be a level playing field once they become our patients,” he said. “The other circumstances should not matter in provision of care.”
The goal of the paper, which was developed by the ACP’s Ethics, Professionalism and Human Rights Committee, was to provide physicians with clear outlines of the potential methods that physicians might be recruited for fundraising efforts, as well as the specific ethical implications of engaging in those efforts.
For example, the physician’s knowledge of the patient’s medical history and clinical status, personal information, and financial circumstances could be reasons why administrative officials might believe physicians are strong potential fundraisers.
Snyder Sulmasy and team also detailed how physicians should engage with patients, their families, and healthcare administrators when questions about fundraising arise.
They suggested that physicians direct patients and their families to healthcare administrators when asked about charitable donations, and should highlight considerations that extend beyond financial payments. For example, they noted that participating in activities such as speaking at events, attending galas, or giving public talks can be “ethically acceptable” ways for physicians to engage in fundraising efforts.
The authors also stressed that physicians should always maintain confidentiality of their patients’ privacy. “ACP opposes the use and disclosure of [protected health information] for fundraising purposes,” they wrote, even when its use is allowed by HIPAA.
Finally, Snyder Sulmasy and colleagues emphasized that fundraising from patients or their families should not be a condition of employment or a part of an incentive program for physicians.
“Philanthropy is, of course, very important for the healthcare system,” Atiq said. “But philanthropy that has the potential to jeopardize patient-physician relationships is counterproductive to what that relationship ought to be.”
The development of this paper was financially supported by the American College of Physicians (ACP) operating budget.
Snyder Sulmasy reported being an employee of ACP. A co-author reported receiving support for travel from Kansas University Medical Center and the ACP; serving on the boards for the ACP, the ACP services PAC, GEHA, and the Kansas City Medical Society Foundation; and owning stock in Intercept Pharma.
Annals of Internal Medicine
Source Reference: Snyder Sulmasy L, et al “Ethical guidance for physicians and health care institutions on grateful patient fundraising: a position paper from the American College of Physicians” Ann Intern Med 2023; DOI: 10.7326/M23-1691.