Ethical issues in the managed care setting: a new curriculum for primary care physicians

Several challenging ethical issues have been associated with the shift to m anaged healthcare in the United States. Our objective was to develop, imple ment, and evaluate a curriculum designed to help physicians identify and ex amine ethical issues encountered in the managed care setting. The curriculu m teas developed during a year-long workshop at Johns Hopkins Bayview Medic al Center The content of the curriculum was established through literature review, focus group discussions with physicians, and a needs assessment of targeted learners (primary care physicians practicing in managed care setti ngs). Some of the key issues addressed in the curriculum include: changing professional responsibilities of physicians; fair use of resources; and thr eats to the doctor-patient relationship as a consequence of the new healthc are delivery system. The 7.5-h curriculum was taught over five sessions usi ng varied teaching methods. Evaluations demonstrated that the curriculum wa s successful in increasing learner awareness of ethical issues confronted i n the managed care environment and improved learner knowledge in these area s. The physician-learners reported that this educational experience would c hange their teaching of medical students and residents. After completing th e curriculum, learners felt that they were at least somewhat better able to cope with ethical challenges encountered in the managed care setting. Futu re research might examine whether such a curriculum could positively affect physician behavior or enhance physician satisfaction with the managed care setting.