Journal of Research in Medical Education & Ethics

Among Indian medical practitioners, the unethical practices of fee splitting for investigations, seems to be increasing exponentially. Therefore, it would be useful to identify factors that promote or impede this practice of accepting commissions.

A mixed method study was conducted among a group of 140 first year medical students. A before-after study design was used to assess the change in perception of students about the practice of accepting commissions after the session on Medical Council of India code. Analysis was done for only 132 students who responded both before and after the session. Focus group discussions were conducted to identify the factors that influenced their perception. Institutional Ethics Committee clearance was obtained.

The number of students who refused to take commissions in the beginning (n = 46) had doubled after the session (n = 96). Monetary supremacy, high living costs and vying with others were the reasons for accepting commissions. Reasons for refusing commissions were conscience and parental education. Fear of punishment was the main reason for their change in decision from accept to refuse commissions.

The key internal factor that promoted ethical behaviour was conscience, whereas the supremacy awarded to money was the main reason for the opposite.