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JAMA 100 Years Ago
February 22/29, 2012


JAMA. 2012;307(8):758. doi:10.1001/jama.2012.77

The question of the secret division of fees for medical or surgical services, which has agitated physicians in various parts of the country for some time past, has reached such a point in New York that it is being discussed by laymen and by newspapers. A little over a year ago, the Erie County (N. Y.) Medical Society appointed a committee to investigate the causes and extent of this evil. The report of this committee appeared in THE JOURNAL,1 and we then pointed out that, unless this question was promptly settled by physicians themselves, it would be taken up by the public. This prediction has come true. At a recent meeting of the Board of Regents of the University of New York, Mr. Draper, the State Commissioner of Education, in his report abstracted on another page,2 discussed the subject and recommended a law forbidding the secret payment of commissions, and empowering the Board of Regents to revoke the licenses of any physicians or surgeons found guilty of such practices. The Brooklyn Eagle , in a lengthy editorial on Mr. Draper's report, demands that physicians institute a radical reform, and, if this be not done speedily, that the state put an end to secret commissions. THE JOURNAL has repeatedly condemned this practice. It has repeatedly warned physicians that, unless they themselves put a stop to this evil, the public would do it. Under the present plan of organization, the discipline of members and the enforcement of ethical conduct lies with the county society, which alone can call its members to account for wrong-doing. It is the duty of each county society in which such practices are suspected, publicly to declare, in no uncertain terms, where it stands on this question and then to apply its principles to its members, No amount of sophistry or of discussion of the “rights of the family physician” is going to obscure the plain fact that the secret payment of commissions for referred cases, or the secret division of fees among physicians—division, that is, without the knowledge of the patient—is a moral offense which every self-respecting physician or surgeon should consider beneath him. Financial arrangements between patient and physician are, to an extent, necessarily commercial. When fees are secretly divided, however, the issue ceases to be commercial and becomes a moral one.

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