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J Thorac Cardiovasc Surg 2002;123:403-405
© 2002 The American Association for Thoracic Surgery

Editorials

Profits and professionalism

From the Division of Cardiothoracic Surgery and the Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, SC.

Received for publication Oct 23, 2001; accepted for publication Oct 31, 2001. Address for reprints: Robert M. Sade, MD, Department of Surgery, 96 Jonathan Lucas St, Suite 409, Box 250612, Charleston, SC 29425 (E-mail: sader@musc.edu).

	Introduction

 
Innovation is the lifeblood of contemporary surgery, especially cardiothoracic surgery. Our most revered mentors and exemplars of excellence achieved their greatness in large measure through their innovative contributions to our surgical art and science. Their contributions were made in the spirit of advancing the care of surgical patients. In earlier times, the possibility of profit was not an important incentive for innovation.

But times are changing. In the past several decades, the business side of medicine, which has always been present, has risen to a new prominence among the concerns of surgeons. In part, this has been related to environmental change: efforts to control costs through managed care have resulted in substantially lower incomes, and younger surgeons now start their practices with high levels of indebtedness. Both factors provide incentives for surgeons to seek additional sources of income. Another impetus toward increased focus on business is the development of new surgical technologies. As technologies have become more sophisticated, the potential for profiting from them has grown substantially; often, millions of dollars will be made from new inventions and techniques. For many surgeons, business ethics has overtaken, and in some cases, supplanted professional ethics.

I do not speak pejoratively of business ethics. I have little patience with those who reduce business ethics to caveat emptor and then easily knock down that straw man to demonstrate the superiority of professional ethics. In my view, we should respect business ethics in its best expression, much as we view our own professional ethics as an aspirational ideal. ¹

Business has a central goal, a characteristic that distinguishes it from charities, governments, country clubs, and all other human activities: to maximize the value of the business to the owners over the long term by trading goods and services. Achieving that goal requires businessmen to act in . . . [Full Text of this Article]

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