**The Tension Between Medical Ethics and MBA Practices: A Call for Physician Stewardship**

As an emergency physician contemplating the convergence of business and medicine, I find myself reflecting on a significant contrast that underpins our roles as healthcare providers. My father envisioned me obtaining an MBA from Harvard Business School, but I took a different path to become a physician. Throughout my career, however, I’ve learned to value the merits of MBA practices while also identifying where they crucially differ from the ethical principles that are the essence of medicine.

One of the most significant differences is central to our vocation: the concepts of **beneficence** (acting in the patient’s best interest) and **nonmaleficence** (avoiding harm). These principles, originating over 2,500 years ago with the Hippocratic Oath, form the foundation that separates patients from mere consumers and medicine from a straightforward business operation. Regrettably, these principles are increasingly compromised as MBA-educated administrators slowly redefine the practice of medicine. We are witnessing a concerning transformation in how healthcare delivery is understood—and how patients are viewed—in this corporate landscape. Without action, this trend threatens to undermine the esteemed role that physicians have historically occupied.

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### Patients Are Not Clients: A Core Distinction

Although MBA graduates bring valuable skills in strategy, financial management, and operational effectiveness, applying a business-oriented “client” mindset to patient care leads to ethical challenges. Businesses, including non-profits, are primarily driven by the goal of maximizing returns—whether for shareholders or institutional objectives. Patients, however, do not neatly fit into this paradigm. Treating them as “clients” diminishes the fiduciary responsibility that physicians hold—one that is based on care, trust, and ethical duty.

An illustrative instance of this conflict arises during the medical billing process. When a patient’s account falls behind, MBA-trained administrators may view it as acceptable to hand it over to collections agencies. This practice, common in the business realm, can cause irreparable harm to patients—both financially and emotionally. From a business efficiency standpoint, aggressively pursuing overdue accounts is sensible, yet such practices do not align with the ethical commitments physicians hold towards their patients. When we, as healthcare providers, remain passive while patients face financial jeopardy due to a system designed to assist their recovery, we neglect a pivotal aspect of our professional responsibilities.

This situation is poignantly exemplified by data from my home state of West Virginia, where 15 percent of residents are burdened by medical debt, and an astonishing 25 percent of these debts are in collections. These figures expose a troubling ethical failing. The financial damage—bankruptcy, loss of credit, or stress-induced health issues—should never be an unintended consequence of receiving medical care.

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### The Perils of Blending Business with Medicine

The fundamental conflict between MBA principles and medical ethics extends beyond theoretical discussions; it poses a direct threat to the integrity of our profession. Physicians have a unique dual obligation to safeguard both the patient’s physical well-being and their dignity. Traditionally, this ethical framework has secured the medical profession a revered position, likened only to that of clergy. However, allowing administrative processes to treat our patients as overdue accounts instead of human beings deserving of empathy risks dehumanizing the very individuals who entrust us with their care. This troubling trajectory could diminish public respect for the medical field and reduce physicians to little more than well-compensated technicians.

The implications extend past societal perception. Physicians are also susceptible to the emotional strain of navigating a system that contradicts their ethical values. The dissonance between beliefs and actions can lead to burnout, a widespread issue among healthcare professionals. Being compelled to witness or engage in decisions that negatively impact patients—financially or otherwise—alienates us from the profound sense of purpose that fuels us in this challenging profession.

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### A Way Forward: Redefining Physician Stewardship

Recognizing the increasing corporate influence in medicine is a sobering realization. The U.S. healthcare system is propelled by over $4.3 trillion each year, much of which is governed by entities that prioritize profits over patient well-being. While completely overturning these economic forces may be beyond physicians’ control, there are proactive measures we can—and should—implement to protect our ethical foundations.

To begin with, **medical debt oversight must involve physicians**. Physicians cannot afford to disregard billing practices. Instead, we must insist that any accounts earmarked for collections undergo a comprehensive medical review beforehand. As the frontline caregivers, we can assess the contextual factors that administrators frequently overlook: Was the treatment warranted? Did the patient encounter financial or systemic barriers to payment? Were there billing discrepancies? By taking this kind of oversight, physicians can help alleviate unnecessary harm and fulfill their obligation to advocate for patients.

Additionally, fostering a workplace culture aimed at reversing the commodification of care could be beneficial. Physician-led discussions regarding ethical practices should be integral to institutional decision-making. Medical professionals must act as a counterbalance to administrative policies that place revenue above humanity. Ultimately, the notion of “patients as clients” needs to be reconsidered.