• Am. J. Obstet. Gynecol. · Dec 2018

    Guild interests: an insidious threat to professionalism in obstetrics and gynecology.

    • Frank A Chervenak, Laurence B McCullough, and Ralph W Hale.
    • Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, New York, NY.
    • Am. J. Obstet. Gynecol. 2018 Dec 1; 219 (6): 581-584.

    AbstractPowerful incentives now exist that could subordinate professionalism to guild self-interest. How obstetrician-gynecologists respond to these insidious incentives will determine whether guild self-interests will define our specialty. We provide ethically justified, practical guidance to obstetrician-gynecologists to prevent this ethically unacceptable outcome. We describe and illustrate 2 major incentives to subordinating professionalism to guild self-interest: demands for productivity; and compliance and regulatory pressures. We then set out the professional responsibility model of ethics in obstetrics and gynecology to guide obstetrician-gynecologists in responding to these incentives so that they preserve professionalism. Obstetrician-gynecologists should identify guild interests affecting their group practices, set ethically justified limits on self-sacrifice, and prevent incremental drift toward dominance of guild self-interests over professionalism. Guild self-interests could succeed in undermining professionalism, but only if obstetrician-gynecologists allow this to happen. When guild self-interest becomes the deciding factor in patient care, professionalism withers and insidious incentives flourish.Copyright © 2018 Elsevier Inc. All rights reserved.

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