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- Anthony N. DeMaria, MD, MACC, Editor-in-Chief, Journal of the American College of Cardiology⁎ ()
- ↵⁎Address correspondence to:
Dr. Anthony N. DeMaria, Editor-in-Chief, Journal of the American College of Cardiology, 3655 Nobel Drive, Suite 400, San Diego, California 92122.
It is generally acknowledged that the financial support for medical programs can be drawn from four sources: state or institutional resources, collections for clinical care, research grants and/or industrial contracts, and philanthropy. Of these, philanthropy has usually been mentioned last and been pursued with the least vigor. However, as state funds remain stagnant, reimbursement for clinical care decreases, and research support is ratcheted down, philanthropy has received more attention and effort. In fact, judging by the size, prominence, and influence of the Development Departments appearing in many hospitals and institutions, philanthropy has moved to center stage. As expressed in one recent article, philanthropy has gone from “nice to have, to need to have” (1).
Perhaps the greatest source of philanthropy is the grateful patient. Good health is of irreplaceable value, so the gratitude engendered by restoring it is the strongest stimulus to making donations. Therefore, physicians play a major, and often the primary, role in generating philanthropy. However, a number of issues exist that I believe often influence our enthusiasm and effectiveness in acquiring philanthropic donations.
The new drive for philanthropy can sometimes lead to circumstances with the potential to make physicians uncomfortable. One of my neighbors related to me that he received a solicitation for a contribution from a hospital less than two weeks after a single visit for a consultation. I am aware of requests made by Development personnel for physicians to screen the list of their patients so as to identify possible donors. We are all accustomed to being solicited for contributions for a variety of causes, and the foregoing is not inconsistent with this accepted behavior. Nevertheless, the concept that seeking medical care may automatically trigger a request for a donation does seem to straddle the fine line between appropriate and unseemly.
It is said that physicians, as a group, are not very adept at obtaining philanthropy. I can certainly identify with the fact that physicians find it difficult to ask for contributions. We are an independent lot who have worked very hard to achieve our goals and do not feel that we should be in a position of requesting donations. Moreover, physicians typically lack knowledge about the process of development. We are accustomed to seeing relatively short-term results from our patient encounters. Philanthropy, on the other hand, is usually a protracted process during which it is necessary to cultivate knowledge of and interest in a project by the donor, build a compelling story and relationship, and help motivate the donor to take action. Physicians often lack the patience for this process.
I believe that the greatest difficulty physicians have with soliciting philanthropy is concern that it may inappropriately play upon the physician/patient relationship. Patients are clearly in a dependent position relative to the physician who delivers care. It is difficult for most physicians to solicit a donation without worrying that the patient may feel that their care will be adversely affected if they do not contribute. This factor has made it brutally difficult for me to make direct philanthropic requests to my patients, a situation in which I know I am not alone. If a patient inquires about our needs or about ways in which they can help, I certainly will seize that opportunity. On occasion, I may bring up activities ongoing at the University or Medical Center in which the patient may have some interest. But I always go to great lengths to make it clear that I will give the patient the best care of which I am capable regardless of whether they contribute or not. The dependency in the physician/patient relationship is sufficiently unique and strong as to present a major issue in physician participation to obtain philanthropy
Another issue worthy of consideration with regard to philanthropy is the role that we as physicians play in setting an example as donors. Although not usually accumulating great amounts of personal wealth, physicians are nevertheless among the highest paid members of society. It seems appropriate, therefore, that we make philanthropic contributions ourselves if we are soliciting others to do so. In this regard, our actions with respect to the uninsured and underinsured speak volumes. By donating our services to those without adequate finances we demonstrate a generosity and willingness to share for all to see. Conversely, we cannot expect strong support from others when we avoid caring for those who cannot fully reimburse us or continuously complaining about inadequate payments for care of the Medicaid population. It just seems logical that the more we physicians set an example as philanthropists, the more we will likely receive in the same way.
On a tangential note, one recent philanthropic development about which I have concern is the action taken by Warren Buffet to have Bill and Melinda Gates distribute his personal wealth. The Bill and Melinda Gates Foundation, already overseeing $30 billion in assets, saw that sum doubled to $60 billion by the contribution of Buffet. This staggering amount of money dwarfs the second largest charity, the Ford Foundation, with assets of “only” $11 billion. This concentration of money is unprecedented and may never occur again.
The thing that bothers me about this situation is the concentration of so many resources in the hands of so few individuals. Buffet’s rationale for doing this was that effective application and disbursement of philanthropic funds requires expertise, and that the Gates have such qualifications. In this he is probably correct. However, a great many worthy causes exist in this world. Typically, individuals choose to support causes in which they have a personal interest. The greater the number of philanthropists involved in distributing wealth, the better the chances that multiple diverse causes will receive support. It is only appropriate that the Gates have charities of personal interest. Nevertheless, I believe that it would be unfortunate if all, or the vast majority, of the combined funds are directed just to those causes of interest to themselves. Most would consider it inappropriate if the Gates were opera fanatics and disbursed the majority of funds to this art and little to world health and high-school education, which they favor.
There can be little question that philanthropy has contributed greatly to a large number of important medical programs. It is a legitimate source of support whose importance is sure to grow in coming years. Moreover, it is likely that grateful patients will continue to be the major driving force behind medical donations. Therefore, it behooves all of us as physicians to become familiar with and participate in the process of development. However, in the rush to compete with other worthy causes for philanthropy, it must be remembered that medicine differs in some important respects. In particular, the nature of the physician–patient interaction must be recognized. The patient must never be put in a position to wonder if their continued care is dependent upon making a contribution. I am convinced that, if we deliver clinical care to the best of our ability to whoever needs it, that our pressing needs will be recognized and met. As in so many things in life, our best chance of receiving support is to be supportive of others.
- American College of Cardiology Foundation