Appendix to Ethical Guidelines for the Delivery of Health Services by ...

physicians to control or sanction one another and some evidence that
physicians with similar behavioral tendencies associate with one
another. 2 Although physicians may withhold referrals to and employment
from colleagues whose ethical behavior they question, such exclusion
does not limit or affect in any significant way the continuation of
ethical violations. Moreover, the effectiveness of long medical training
as a screening device is an illusion. While medical schools attract
applicants with a high level of academic competence, retention rates are
extraordinarily high compared with most other types of graduate or
postgraduate training and insure little "weeding out" of undesirable
candidates. Similarly, although supervision and negative appraisal
during internship or residency may affect the ability of the candidate
to obtain the most desirable positions, such supervision and evaluation
almost never exclude the candidate from medical employment. In short,
the image of a highly selective screening process that insures quality
and ethicality is a mirage, protecting the autonomy of the profession
more than the public.
Regulation of autonomous and prestigeful professionals is extraordinarily
difficult to achieve without producing undesirable side effects.
Moreover, in regulating the segment of the profession most likely to
engage in violations, burdens are placed inevitably on those who practice
a high standard of quality and ethicality in a way that detracts from
their performance. These facts support the argument that regulatory
mechanisms are needed that provide checks on professional abuses without
being too intrusive.
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