Physicians, healthcare costs, and society: who's responsible for what?

Physicians play a key role in the utilization of healthcare financial resources. The unsustainable rise in the cost of healthcare in the US implies physicians should be part of addressing rising costs to make them more sustainable. But how can they do so with integrity? Ancient vows of medicine require fidelity to individual best interests. Modern norms of social contract require attention to just distribution of societal resources. Both are important. If and when these responsibilities conflict how can they be reconciled? This talk will describe the problem of dual agency, the challenges it poses to contemporary US medical practice, and common solutions to address the challenge. These challenges will be illustrated with empirical data from recent research with doctors, and will outline empirical, normative, and policy opportunities to clarify and define what kind of role physicians can and should play in addressing healthcare costs with integrity.