Some hospitals and health systems are pressuring doctors to provide names of likely donors or to solicit donations directly from the patient.
Doctors are increasingly being pressured to engage in this type of “grateful patient” fundraising, as a result of increasing corporatization of medicine, reports Omar T. Atiq, MD, MACP, president of the American College of Physicians (ACP). “We’ve been hearing from our members they are being asked, or told, to participate in grateful patient fundraising in this changing healthcare environment,” says Atiq.
In response, the ACP issued an ethical guidance on grateful patient fundraising.1 Physicians should not engage in fundraising solicitation of patients or patient families; and hospitals should not ask physicians to do so — not as a condition of employment, and not as part of any incentive system or performance metric, according to the position paper. The ACP paper outlines these ethical concerns about grateful patient fundraising:
- The patient/physician relationship may be undermined.
- If patients or families do donate money, they may expect preferential care. This raises justice and fairness concerns.
- Doctors may be pressured to disclose confidential patient information, raising concerns about patient privacy.
Hospital administrators see doctors as having strong potential as fundraisers specifically because of what they know — patients’ medical history, personal information, or financial circumstances. If a surgeon saves a patient’s life and knows that patient lives in a wealthy neighborhood, it’s highly possible that the patient would be willing and able to donate a large amount of money to the hospital. However, this conflicts with the physician’s core ethical obligation to respect patient privacy and confidentiality.
Doctors may be less willing to push back if they are employed or contracted by the hospital or health system than if they are independent contractors. If pressured to participate, Atiq says that physicians should remind hospital administrators of the need for physicians to put patients first, and the ethical obligation to preserve the patient-physician relationship.
“Philanthropy can be accomplished without the blurring of the boundaries of clinician and fundraisers,” underscores Atiq. Institutions should have policies and procedures on fundraising that align with the ethical obligations of physicians outlined in the ACP position paper, adds Atiq.
The way in which physicians are involved in grateful patient fundraising ranges from subtle to overt. In some cases, physicians are asked directly to solicit donations from patients. Other doctors participate indirectly by “data mining” of clinical notes to assess patients’ financial circumstances. Some organizations use physicians’ photographs for patient outreach campaigns.
Some physicians are getting financial incentives in exchange for soliciting donations from patients, according to the ACP position paper. Some examples:
- One hospital created a “grateful patient referral metric” to reward physicians based on the number of patients referred to development officers.
- Development officers, or consulting firms, are coaching physicians on how to approach donors, and encouraging them to notify the office of potential donors.
- Promotions or research funding can be used to incentivize physicians.
Some patients or family might ask doctors about charitable donations without any prompting. “Patients and families who want to show their appreciation for their care and help to advance science are expressing noble sentiments,” acknowledges Atiq. However, the doctor is not the right person to have the conversation. Instead, ACP recommends doctors direct people to administrators. “This provides the appropriate venue and firewall for the discussion,” explains Atiq.
Fundraising typically is not within the purview of ethicists in the hospital setting. However, since there are ethical concerns involved, ethicists can and should play a role, says Atiq. The first step is for ethicists to ask administrators if grateful patient fundraising is happening at their institution. If it is, says Atiq, “Ethicists should advise administrators and development staff on why grateful patient fundraising is ethically problematic and should not be done.”
- Snyder Sulmasy L, Callister TB, Opole IO, 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;176:1392-1395.
