Dual-Loyalty: The Wicked Problem of Corporatization in Health Professions

. Increasingly, for-profit corporations are delivering a greater portion of healthcare services. While this may enhance operational efficiency and organizational effectiveness, it may raise questions about safeguarding of patients’ interests and supporting the autonomy and professional judgement of individual professionals who may work as employees. In such corporate healthcare settings, there may often be leaders who themselves are licensed professionals. These individuals may not personally provide care to patients but direct the work of other professionals or establish corporate policies, practices, and cultures that shape the practice of others. In such situations, the problem of “dual loyalties” may arise, in which licensed healthcare professionals must simultaneously reconcile a professional/ethical and fiduciary responsibility to act in the best interests of patients with a corporate responsibility to maximize shareholder value. While many different agencies—including governments, accreditation bodies, and industry agencies—participate in the regulation of corporatized healthcare, the specific responsibilities and opportunities for licensing bodies to ensure appropriate management of dual loyalties has not been widely discussed. The multi-faceted and highly interconnected nature of this wicked problem opens opportunities for discussion and reflection within licensing bodies regarding how best to use mechanisms such as Codes of Ethics, Standards of Practice, and complaints/investigation systems in the context of dual loyalties in corporatized practice settings.