Letter to the Editor
Conflict of Interest between Hedge Funds and Groups?
I have a question about physician groups and residency teaching responsibilities. After reading this article by Thomas Cook, MD, in March (EMN 2017;39:1; http://bit.ly/2odLEwl) about a hedge fund taking over physician groups and benefiting financially from physicians (or residents-in-training), is there an inherent conflict of interest? Physician groups, especially those who do their own billing, have financial gain if residents are not properly trained and order any test or treatment they want because of the fee-for-service health care system that we have. How do physician groups (and now a hedge fund) maintain a high level of training for residents while avoiding this conflict of interest?
Marcus Ma, MD
Dr. Cook responds: Thanks to Dr. Ma for his question. Many organizations, including the American Academy of Emergency Medicine, have expressed serious concerns regarding conflict-of-interest issues with contract management companies, but I am not sure this applies to resident training. Resident physicians are inefficient regardless of where they train because they are learning, and an element of this process is trial and error that involves expensive testing. Of course, the attending guides resident decisions, and it could be argued that a given attending might be “encouraged” to advise residents with an eye on finances. But my experience is that residency training generally use more testing than experienced physicians working alone. If you add to this that most residency programs are in medical centers with high acuity, my impression is that you will find the average cost of patient care in the ED to be higher when residents are involved regardless of the business structure of the supervising attendings.Wolters Kluwer Health, Inc. All rights reserved.