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Kenneth M. Ludmerer, MD

JAMA. 1999;282:881-882.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Professions have long been recognized to consist of 3 essential characteristics: expert knowledge (as distinguished from a practical skill), self-regulation, and a fiduciary responsibility to place the needs of the client ahead of the self-interest of the practitioner.¹ In recent years there has been renewed recognition among medical leaders of the particular importance of the third, or altruistic, characteristic in medical professionalism.^2-4 For instance, in 1994 the American Board of Internal Medicine defined the "core of professionalism" as "constituting those attitudes and behaviors that serve to maintain patient interest above physician self-interest."⁴

In recent years, market forces have posed an unprecedented threat to medical professionalism—particularly the physician's obligation to serve the needs of patients. For all its defects, the fee-for-service system that long dominated medicine had one great advantage: it allowed physicians easily to do what was necessary for patients. In contrast, today's managed care environment . . . [Full Text of this Article]

Author Affiliation: Department of Medicine, Washington University, St Louis, Mo.

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