The Society of Thoracic Surgeons (STS) is committed to patients' unimpeded access to quality care. That concept is currently being placed in jeopardy by the practice of groups of cardiologists hiring cardiac surgeons.

Conflicts of interest are inherent when a referral process takes place within an employer-employee arrangement. Such conflicts threaten the integrity of the patient-surgeon relationship. The independent judgment of surgeons may be compromised when the referring doctors are the surgeons' employers.

The STS firmly opposes business affiliations that negatively affect the surgeons' capacity for independent decision-making in patients' best interests. Specific areas of concern include the use of referral leverage to restrict treatment options and surgeon selection, unwarranted regulation of surgical services, and remuneration schemes that do not reflect the services provided.

Surgeons contemplating contracting with cardiology groups as salaried employees should be aware that influences on surgical judgment by employers may be overt or may be difficult to recognize and they should be prepared to resolve such conflicts of interest in favor of what is best for the patients rather than the practice.

Adopted by the Board of Directors of The Society of Thoracic Surgeons: January 25, 2004