Not too long ago, in an online discussion in a physicians’ group on Facebook, the topic of discussion was should doctors engage in side gigs? And what if those side gigs include consulting in the medical realm, e.g. pharmaceutical industry, start-ups, selling products etc.
On the face of it, doctors seem to be split in two camps, both yes and no. And there are good reasons put forth by both sides. So as long as there are two camps we have an opportunity to clarify this issue in order to offer some consensus position.
I have been thinking about this issue on and off for months now. And after much thought decided that rather than make it drawn out it would serve the discussion better by keeping it as simple as feasible.
The most common reason presented by the ‘nay’ corner is that being a physician is a noble profession, and one that is imbued by honor and trust. The patient who comes to a doctor in need is vulnerable, and as a societal value we aim to place human life above all material wealth. Whether it be true or not, it is being suggested that a physician who is involved in material ventures may be compromised as an objective provider of care to a patient.
The most common reason presented by the ‘yay’ corner is that becoming a physician should not disallow one from wanting to pursue other activities, opportunities, and prosperity in general. Whereas a couple of decades ago a full-time physician could make a tidy income doing their day job, the work-life balance of physicians has taken a substantial hit, and the cost of healthcare increase is often unfairly placed at the feet of the doctors. This is why many physicians seek alternative sources of income, not just to feel professionally fulfilled but to supplement the dwindling primary income and job security. With the recent Covid pandemic it has been eye opening to see many institutions and practices furlough doctors, in the middle of high demand.
The human condition is such that often people are skeptical of the honesty of doctors, lawyers, professionals but they never seem to understand if someone is skeptical of their loyalty. This behavior lends itself readily to be manipulated by market forces and people with agendas who want to make physicians look bad. But most doctors actually became doctors because they enjoy the science and care in medicine to some extent.
There is a middle ground here. We must all judge people on a case by case basis rather than lumping them all together; one could say the golden rule of professionalism applies. It should be acceptable for physicians to engage on fee-based services that are elective, such as aesthetic medicine, or not always covered by health insurance, such as functional medicine. At the same time, we must assess the validity of the services offered to ensure against the rare physician who is abusing the system by offering less than optimal services in the name of non-standard are.
For physicians who wish to engage in side gigs, here are some suggestions:
1. Create a social media outlet where your patients and public at large can clearly see exactly what service if offered by you.
2. Ensure that your side gig is discreetly different in time and space than your medical clinic hours. Give ample guidance to patients who may avail themselves to your side gigs as to where the medical care stops and the side gig begins.
3. If you are serving in a clinical/consultant role but are not offering any patient-facing services, provide clear explanation of your involvement with industry, e.g. pharmaceuticals, and why you are choosing to follow this route. Many major institutions already ask for conflict of interest disclosures. This social media outlet may be a physician to patient interface to explain your activities.
4. Be cognizant of potential for conflicts in your medical practice and side gigs. Should you encounter a conflict, work proactively to address the situation before it may harm a patient or your professional reputation.
5. Avoid discussing your side gigs in your daily practice environment, unless solicited formally by your leadership, or unless necessary for professional reasons. The less you allow crossover between the two part of your professional identities, the less likely you will be to have an unforced error.
Medicine is a fulfilling but difficult profession. With the increasing demands on our time, pursuing side gigs is very attritive for professional and financial success. But we must also be mindful of the first dictum ‘do no harm’ and lookout for both our patients and the collective reputation of our profession.
As discussed in a previous post, authenticity is a combination of authority and integrity. We must respect and preserve our authenticity in order to remain effective.
Some relevant literature content that may be of interest follows:
https://www.medicaleconomics.com/view/eroding-trust-between-patients-and-physicians
Patient experience surveys: reflections on rating a sacred trust. Ferguson CC.BMJ Qual Saf. 2019 Oct;28(10):843-845.
Trust, Distrust and Trustworthiness- Lessons from the Field. Susan Dorr Goold, MD, MHSA, MA J Gen Intern Med. 2000 Jul; 15(7): 509–513.
Patients' Trust in Physicians: Many Theories, Few Measures, and Little Data. Steven D Pearson, MD, MSc and Lisa H Raeke, MA