Ethicists were recently negotiating an hourly rate for consultation services at Corewell Health Beaumont Hospital in Michigan. However, the group realized there were no reliable compensation benchmarks.
“We had asked various colleagues about their rates. But this didn’t give us systematic evidence about what would constitute fair compensation,” says Jason Adam Wasserman, PhD, HEC-C, clinical ethicist at the hospital..
Wasserman and colleagues searched for data or guidelines on compensation for ethics consults, but found no relevant resources. The ethicists decided to conduct their own research, surveying 133 clinical ethics consultants on how they are compensated for their work.1
Participants described compensation levels that varied widely. “This is a window into the professionalization trajectory of the field of clinical ethics,” Wasserman asserts.
Clinical ethics has made some recent strides toward standardization, such as the establishment of a credentialling process — the American Society for Bioethics and Humanities’ Healthcare Ethics Consultant Certified (HEC-C) program.
“However, in terms of establishing norms around employment models and compensation levels, clinical ethics remains very underdeveloped relative to other professions,” Wasserman says.
According to the survey, the average full-time salary is $188,310 for respondents with a clinical doctorate, $146,134 for respondents with a nonclinical doctorate, and $113,625 for respondents with a master’s degree. For every additional year of experience, respondents reported an average increase in salary of $2,707.
The survey also revealed a wide array of employment models. Most respondents were full-time clinical ethicists; pay differences by degree type within this cohort were not significant. But in another cohort, 9.8% of respondents were working other jobs in the hospital, with a portion of their time carved out for clinical ethics consultation work. These individuals were paid for a 1.0 full-time equivalent (FTE) position, and some explicit percentage of that was allotted to ethics work.
For 6.8% of respondents, ethics consults also were considered part of the duties of another position they held, but there was no explicit portion of their salary allotted for ethics work. This cohort was expected to handle ethics consults on an as-needed basis, but could not specify what portion of their non-ethics job was allotted to ethics work. “It’s hard to tease those two things apart, and even harder to quantify how that time is compensated,” Wasserman says.
Some respondents worked under a part-time model, where someone is paid separately for a certain portion of an FTE position. Those individuals received separate, additional compensation for ethics work, in addition to their regular FTE salary.
Others said they worked hourly (ranging from one to 25 hours a week, for an average of 7.3 hours). One respondent charged a flat fee of $325 per consult.
Certain respondents said they work on retainer (monthly, quarterly, or annually), and billed hourly or by the case over and above an agreed-upon workload. Adjusted to a monthly rate, the average retainer was $3,260, with a range from $83 to $11,666.
About one-quarter of respondents said they receive no pay for ethics work, spending an average of 3.9 hours a week (with a range of one to 12 hours a week) handling ethics work on a volunteer basis. For example, physicians who provided clinical ethics services often did so on a volunteer basis as a supplement to their primary role as a clinician. Fifty-six percent of respondents with a clinical doctorate were uncompensated. Of those with a nonclinical doctorate, only 13% were uncompensated.
Wasserman and colleagues learned training of individuals who performed clinical ethics work varied widely, too. Eight of 30 respondents with clinical doctorates had earned any degree that was focused on clinical ethics. Eight others had received (or were currently working on earning) other advanced clinical ethics training, such as short-term intensive courses.
Respondents with nonclinical doctorates tended to have taken more formal curricula in ethics, such as bioethics-focused degrees or clinical ethics fellowships. “This led to one of our key recommendations: That the development of new training opportunities in clinical ethics ought to consider ways to accommodate the needs of those already in clinical professions,” Wasserman says.
Of those who had taken or intended to take the HEC-C exam, 89.7% reported they were reimbursed or would receive reimbursement.
Most (65%) respondents were “slightly” to “extremely” satisfied with their compensation. However, some respondents used the open-ended comments portion of the survey to vent frustration about the overall lack of support for ethics work.
One physician-ethicist commented, “We provide this service out of a sense of professional obligation. But lack of pay sends a message of undervaluing the resource by hospital administration.” Another noted that lack of financial incentives clearly affects hospital leaders’ interest in funding clinical ethics work.
“The field, as a whole, needs to do more work to establish, validate, and promote its value within the healthcare system,” Wasserman offers.
Wasserman notes that although nearly all hospitals have established ethics committees and/or ethics consultation services, that was not the case until the 1990s. Not long ago, there was no such role as a “clinical ethicist” in the hospital setting. Thus, early hospital ethics committees were staffed by people whose only qualification was their interest in ethics. “But as it developed into its own field, you now have specialists entering the landscape. The result is that it’s currently a very mixed field with respect to employment models, qualifications, compensation, and the like,” Wasserman explains.
The wide variation in compensation and training stems in part from a lack of evidence establishing the fact that trained ethicists experience better outcomes compared to their untrained counterparts. “The first step would be to identify where we would expect them to differ,” Wasserman says.
For instance, researchers could determine if the notes of trained ethicists reference best practices and national consensus standards more often than the notes of untrained ethicists. Such data would allow people to make reasonable, evidence-based arguments that paid professionals experience better outcomes than those without formal training. “Otherwise, people will continue to think they can get the milk for free, instead of buying the cow,” Wasserman says.
REFERENCE
1. Wasserman JA, Brummett A, Navin MC. It’s worth what you can sell it for: A survey of employment and compensation models for clinical ethicists. HEC Forum 2023; Aug 5. doi: 10.1007/s10730-023-09509-y. [Online ahead of print].
The disparities stem in part from a lack of evidence establishing the fact that trained ethicists experience better outcomes compared to their untrained counterparts. Researchers could determine if the notes of trained ethicists reference best practices and national consensus standards more often than the notes of untrained ethicists. Gathering tangible data allows ethicists to make reasonable, evidence-based arguments.
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