Retainer Practices

Physicians are free to enter into contracts to provide special non-medical services and amenities with individual patients who are willing and able to pay additional costs out of pocket for such services. While such retainer contracts are one among many diverse models for delivering and paying for health care, they can also raise ethical concerns about access, quality, and continuity of care.

1. Present the terms of the retainer arrangement clearly to patients, including implications for the patient’s current health care insurance, if known, and take care not to imply that more or better medical services will be provided under a retainer contract.
2. Ensure that patient decisions to accept retainer contracts are voluntary and that patients are free to opt-out of entering into a retainer agreement.
3. Facilitate transfer of care for any patient who chooses not to participate in a retainer practice. If it is not feasible to transfer a patient’s care to another local physician, the physician should continue to provide care under the terms of the patient’s existing health care insurance until other appropriate arrangements for ongoing care can be made.
4. Ensure that treatment recommendations for all patients are based on scientific evidence, relevant professional guidelines, sound professional judgment, and prudent stewardship.
5. Uphold standards of honesty and transparency in billing and clearly distinguish charges for special services or amenities provided under a retainer contract from medical services reimbursable by the patient’s health care insurance or third-party payer.
6. Uphold professional obligations to promote access to health care and to provide care to those in need regardless of ability to pay, in keeping with ethics guidance.

Council Reports

Related Opinions

Patient-Physician Relationships

At the heart of medicine lie relationships founded in a “covenant of trust” between patient and physician in which physicians commit themselves to responding to the needs and promoting the welfare of patients.

Disparities in Health Care

Differences in treatment that are not directly related to differences in individual patients’ clinical needs or preferences constitute inappropriate variations in health care. Such variations may contribute to health outcomes that are considerably worse in marginalized populations. Physicians ethically are called on to provide the same quality of care to all patients without regard to medically irrelevant personal characteristics.

Financial Barriers to Health Care Access

Physicians individually and collectively have an ethical responsibility to ensure that all persons have access to needed care regardless of their economic means.

Professionalism in Health Care Systems

Physicians should hold leaders accountable to meeting conditions for professionalism in health care systems. This includes advocating for changes in health care payment and delivery models to promote access to high quality care for all patients, recognizing that over-reliance on financial incentives may undermine physician professionalism.

Transparency in Health Care

Physicians have an obligation to inform patients about all appropriate treatment options, the risks and benefits of alternatives, and other information that may be pertinent, including the existence of payment models, financial incentives, formularies, guidelines, or other tools that influence treatment recommendations and care.