In exchange for prestige, respect, trust, autonomy, self-regulation, and other rewards, physicians and other healthcare professionals agree to be altruistic, self-regulate well, be trustworthy, and prioritize patient’s best interests. This is the social contract for healthcare, and it is fraying, challenged by changes in the organization and financing of health care, and by the commoditization of the professional workforce.
The 2013 report by the National Academy of Engineering and the Institute of Medicine highlighted that clinicians routinely must make heroic efforts to do the right thing for patients because clinical design or policies make it difficult to do so. A recent New York Times article made a related accusation that health systems “exploit professionalism”. That health systems count on professionalism as a default for system failures is a recipe for burnout. When clinicians are burned out it affects their health, when they progress to callousness, it affects patients’ health. The National Academy of Medicine is emphatic that burnout and callousness require system solutions and we believe that the bigger problems of de-professionalizing the healthcare workforce and salvaging the social contract, do too.
Key Aims of the Center for Professionalism & Value in Health Care are to investigate current understanding and value for the social contract and to promote practice and policy solutions to support professionalism. We fundamentally aim to align the values of the professions with the way the professions are valued.