title: The ethics of administrative credentialing.
abstract: A vascular surgeon has practiced in the same community for more than 20 years, holding privileges at the two largest local general hospitals. She is widely respected and admired by patients and fellow physicians in all specialties, and her results are consistently good. Recently, the board of directors at the hospital that has been the source of 80% of her case referrals hired a notorious slash-and-burn management firm to improve the balance sheet. The new chief executive officer (CEO) installed an information technology system that can provide management with physician-specific figures on costs and reimbursements. The management consultants identified the 10% of physicians with the worst cost/reimbursement ratios over the preceding 5 years and persuaded the board of directors to order their clinical privileges withdrawn. Our seasoned surgeon learns that she is among the targeted group. Is there an ethical issue here, and, if so, how should she respond?
authors.affiliation: The Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston 77030, USA. jwjones@bcm.tmc.edu <jwjones@bcm.tmc.edu>
authors.forename: James W
authors.initials: JW
authors.lastname: Jones
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Crigger
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Richman
mesh_terms: D003406:Credentialing / Q000941:ethics*; D005377:Financial Management, Hospital / Q000941:ethics*; D006801:Humans; D008504:Medical Staff Privileges / Q000941:ethics*; D012051:Reimbursement Mechanisms / Q000191:economics*