Physician employment adds a practice management stakeholder to the patient-physician encounter, a stakeholder whose financial interests differ from those of physicians in solo or group practice.
Publicizing physician ordering information as a way of peer-pressuring hospital employees into cutting costs is likely to have unintended consequences.
Deciding whether to recommend Avastin or Lucentis raises ethical issues. Should the public health consequences of using a far more expensive drug trump what the doctor thinks is best for the individual patient?
Good ethics and good business don’t have to be in conflict. Ophthalmologists shouldn’t resort to requiring their patients to buy contact lenses in-house; instead, they should focus on expanding their skill set and providing personalized service.