American Speech-Language-Hearing Association

Ethics Roundtable: Are Sales Quotas Appropriate in Clinical Settings?

Response by David Hawkins

David Hawkins, Ph.D.
Head, Audiology Section
Mayo Clinic Jacksonville
Jacksonville, FL

Mr. Allen has been placed in a difficult ethical situation. By having a quota to dispense five hearing aids each week, he may be placed in a potential conflict of interest. This is not to say that Allen will dispense hearing aids to those who do not need them, in order to keep his job and benefit financially, but the situation could definitely give the appearance of a conflict of interest to patients. When dealing with ethical issues involving conflict of interest, the "appearance of a conflict" is just as important an issue as unethical behavior itself.

While the concept of sales quotas is certainly common in the business arena, quotas are inappropriate for health professions that dispense prostheses. To make an analogy, consider that you visit your dentist and he/she recommends that you have a $1500 bridge. You would certainly like to assume that this recommendation is based solely upon your dental needs. Would your confidence in the dentist's decision be affected if you discovered that the dentist had a quota for six bridges each week and his/her salary could be affected if you did or did not obtain the bridge?

Allen's performance should be judged by the quality and appropriateness of his clinical decisions. If his employer thinks that he fails to recommend hearing aids to patients who needed them, then a variety of actions could and should be taken. However, a straight sales quota with financial and/or employment consequences is not appropriate and could put Allen in a conflict of interest in the eyes of the patients he serves.

To submit cases or to be added to the list of respondents please contact: Helen Sharp Department of Speech Pathology and Audiology, 307 WJSHC University of Iowa, Iowa City, IA 52242. Phone: 319-335-6596, fax 319-335-8851, e-mail: helen-sharp@uiowa.edu

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