It is really the fault of the profession if people do not (Part 6)
The Fellows of the American College of Surgeons are to use the title F. A. C. S., and this will be an honorable title, provided that the president and censors are chosen with the deep feeling of responsibility which has accompanied the first movement and election of officers. A Fellow of the American College of Surgeons is supposed to be a man who has been recognized by his peers as a man competent to engage in surgical work.
<Callout type="important" title="Professional Integrity">The underlying motive in formation of this College was altruistic, and for the purpose of protecting the public. The prime movers were entirely above the need for using any such means for enhancing their personal interests.</Callout>
Tremendous impact of pressure will be brought to bear against it by the thousands who feel themselves competent to engage in surgical work but who are not recognized in the profession as being quite well enough prepared. The corrective influence will not only tend to the exclusion of unqualified men from fellowship in the College, but it carries a sword of Damocles which may fall at any time upon a Fellow who takes part in such unprofessional methods as fee-splitting.
Now that the subject has been agitated, doctors are looking about in a wide-awake manner and asking, "Which ones among us are the crafters?" Whenever any one specialist is found to belong in this class, the names of general practitioners who are associated with him and known to be his friends are smirched, and they are made to feel it: One of the best features of the American College of Surgeons was the sending about of this circular to all applicants:
AMERICAN COLLEGE OF SURGEONS At the meeting in Washington when the American College of Surgeons was founded, the question was asked whether the College should positively exclude surgeons who were suspected of fee-splitting or paying commissions in any form whatsoever. The President declared that no one should be admitted who was suspected of being guilty of this pernicious practice.
This declaration was received with universal and most enthusiastic applause. It does not seem possible that many men who would otherwise be eligible can belong to the class of fee-splitters, but the fact that the matter was so much emphasized has induced the Committee on Credentials to prepare the following positive declaration, which will be filed in connection with the credentials of each Fellow.
If the College succeeds in eliminating this evil, the public will be enormously benefited. Very respectfully, COMMITTEE ON CREDENTIALS. TO-MORROWS TOPICS DECLARATION 1 t I will 1 I hereby promise upon my honor as a gentleman that not, so long as I am a Fellow of the American College of Surgeons, practice division of fees in any form; neither will I collect fees from others referring patients to me ; nor will I permit them to collect my fees for me; nor will I make joint fees with physicians or surgeons referring patients to me for operation or consultation; neither will I in any way, directly or indirectly, compensate any one referring patients to me; nor will I utilize any man as an assistant, as a subterfuge for this purpose. Signed . Date
The intent of the college is to establish this standard, to begin with by recognizing those men now in practice whose training, experience, and character entitle them to be considered specialists in surgery or in the strictly surgical specialties.
If the best American surgery is the best of all surgery, but the most of it below a reasonable average in character, we may assume that the foundation of a college for correcting the situation in surgery will be followed by the establishment of a similar college by the internists for raising their own standards of efficiency. The ophthalmologists were perhaps the first specialists. They have demonstrated in many ways the dangers of specialization, which separates men from the spirit of the central profession.
<Callout type="warning" title="Fee-Splitting Risks">Honorable physicians explained to the committee the altruistic motives which took them to Albany. Sinclair, however, was fortified with documents to uphold his contention that doctors were in business for the money to be gotten out of the business.</Callout>
Not all ophthalmologists accepted commissions. The ones who were instinctively superior to that fault were commonly those who had been engaged in general medical practice at some time in their lives and had caught the true professional spirit. Specialists who have not enjoyed general practice first, lose much beside professional spirit.
Centuries before Christ a Hindoo physician, Sasruta, said, "He who knows but one branch of his art is like a bird with one wing." Little things which are perfectly well known to one part of the profession may not be known at all to another part. For instance, the ophthalmologists in general do not realize that plain water is corrosive because of its action in taking water out of the body cells by osmosis.
Ringer's solution or even plain saline solution as a basis for eye-medicaments would avoid this corrosive effect. Surgeons know this principle very well, but the specialist in the eye has not as yet appreciated it.
Key Takeaways
- The American College of Surgeons was established to maintain high professional standards and exclude unqualified practitioners.
- Fee-splitting is a significant ethical issue that can lead to the expulsion of Fellows from the college.
- General medical practice provides a broader perspective necessary for specialization.
Practical Tips
- Maintain transparency in billing practices to avoid accusations of fee-splitting or unethical behavior.
- Engage in continuous education across various medical fields to maintain comprehensive knowledge and professional integrity.
Warnings & Risks
- Participating in unprofessional methods such as fee-splitting can result in the loss of prestigious titles like F. A. C. S.
- Specialists who lack general practice experience may overlook fundamental principles critical for patient care.
Modern Application
While the specific context and terminology have evolved, the core ethical principles outlined here remain relevant today. Ensuring professional integrity through transparent practices and rigorous standards is crucial in maintaining public trust and delivering high-quality medical care.
Frequently Asked Questions
Q: What was the primary motive behind forming the American College of Surgeons?
The underlying motive for forming the American College of Surgeons was altruistic, aimed at protecting the public by establishing a standard that excludes unqualified practitioners and maintains professional integrity.
Q: How does the college address unethical practices such as fee-splitting among its members?
The college addresses fee-splitting through a declaration signed by Fellows promising not to engage in division of fees or any form of compensation for referrals, ensuring transparency and ethical conduct.
Q: Why is general medical practice important before specializing?
General medical practice provides a broader perspective necessary for specialization. Specialists without this background may overlook fundamental principles critical for patient care.