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ACP Conflict of Interest: Policy and Procedures

American College of Physicians Board of Regents Approved January 24, 2009

Policy Title: Conflict of Interest: Policy and Procedures

Rationale: The American College of Physicians (“ACP” or “College”) is a medical professional society organized for charitable, educational, and scientific purposes. It is the mission of the College to “enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.” In carrying out that mission, the College depends on the excellence and professionalism of all who represent it or who are associated with the College or its name.

Policy:

Regents, Governors, Officers, Insurance Trust Trustees, members of all types of committees, faculty, authors, anyone in a position to control or influence the content or who is involved in the planning or execution of an educational activity, College staff, and others, while acting on behalf of the ACP, must be aware of and seek to avoid conflicts of interest or even the appearance of a conflict of interest. All decisions and actions should be based on the best interests of the College, in accord with College policy and applicable state and federal law regulations. College staff shall be accountable to the Executive Vice President/Chief Executive Officer and Deputy Executive Vice President/Chief Operating Officer.

No ACP salaried staff member shall serve on the College’s Board of Regents with the exception of the Executive Vice President/Chief Executive Officer, who shall serve as a non-voting member of the Board of Regents.

A current or former ACP leader shall not use his or her affiliation or the ACP name for personal or commercial gain. A former ACP leader shall not use that prior affiliation or the ACP name in any manner that may imply ACP support or endorsement.

The overall impact of any trends in financial or other relationships based on the review of individual disclosures should be assessed by the College on a yearly basis.

This policy shall be posted on acponline.org.

What Is a Conflict of Interest? A conflict of interest can exist when a person (or his or her immediate family, business partner, employer, or institution) has a relevant direct or indirect interest or relationship that is or may be inconsistent with, conflicts with, or prevents the person from carrying out or otherwise fulfilling the responsibilities, duties, loyalty, or exercise of independent judgment, in a matter involving the College. These relationships are often, but not always, financial. ACP requires disclosures of these relationships over the past 3 years.

For faculty, authors and anyone in a position to control or influence content or who is involved in the planning or execution of an educational activity, the Accreditation Council for Continuing Medical Education (ACCME) requires disclosures of direct or indirect financial relationships in any amount with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

Not all relationships pose a conflict of interest or automatically exclude the person from service on behalf of the College or involvement in a specific matter, although it may be that participation should be avoided, limited, or qualified by disclosure of the competing interest. If there is any uncertainty about whether or not there is a potential conflict, the individual should err on the side of full disclosure.

The electronic ACP Conflict of Interest Disclosure System shall include categories of required disclosures, time frames and dollar thresholds for reporting.

Administration: Executive Office, Membership, Medical Education and Publishing, Division of Governmental Affairs and Public Policy, Annals of Internal Medicine, Legal Affairs

Divisions Affected: All

Procedure:

Disclosure of a Conflict of Interest or Potential Conflict of Interest:

Board of Regents, Officers, Governors, Insurance Trust Trustees, Committee and Council Members, Staff, nonstaff, policy developers, all College researchers, faculty, authors, anyone in a position to control or influence the content or who is involved in the planning or execution of an educational activity and persons who otherwise serve in an appointee capacity.

On election and/or appointment of a College position, all Regents, Governors, Officers, ACP appointees, and members of all types of committees shall be required to complete the disclosure process and shall provide updates for any changes in circumstances (such as development of a conflict not previously reported or a change in position that raises a conflict). College staff vice presidents and above, all College researchers and all other staff identified as being in a decision-making position within the College shall be required to complete the disclosure process on appointment to a College position, annually thereafter and as needed as circumstances change. Other staff shall be required to complete the disclosure process as needed.

In the context of a particular matter before a deliberative body, such as a Board or committee, a conflict of interest should be disclosed to the full body. The person should not participate in and/or not vote on the matter at issue, as appropriate and determined by the Chair. The reporting of conflicts, the discussion of any conflicts, and the resolution of conflicts must be reflected in the minutes of meeting, including any abstention and the reason for the abstention. If the person’s presence will inhibit open discussion of the issue, the person should also not be present for that discussion, at the option of the Chair. If the Chair is the person with the conflict, the group shall decide on the Chair’s level of participation, or the matter can be referred to the Chair of the committee to which he or she reports.

Outside of the deliberative body process, a conflict of interest that has not been previously recorded on a disclosure statement should immediately be disclosed to the Deputy Executive Vice President/Chief Operating Officer. The next steps, if any, will be assessed by the Deputy Executive Vice President/Chief Operating Officer and will include consideration of disclosure and/or limitation of activities and a recommendation on how to proceed. The Deputy Executive Vice President/Chief Operating Officer and the Executive Vice President/Chief Executive Officer shall consult with the Chair of the Board of Regents on any conflict or potential conflict either might have.

Non-staff policy developers, researchers, faculty, authors, anyone in a position to control the content or who is involved in the planning or execution of an educational activity, and persons who otherwise serve in a representative capacity shall report any conflicts of interest to the College staff person who oversees their work or appointment. In the context of a particular matter before a deliberative body, such as a Board or committee, a conflict of interest should be disclosed to the full body.

Disclosure of a Conflict of Interest or Potential Conflict of Interest: For faculty, authors, and anyone in a position to control or influence the content of an educational activity, disclosure is the principal mechanism for determining conflict of interest and minimizing bias or the effect of bias in the College’s education programs and publications. Faculty, authors, and anyone in a position to control or influence the content or who is involved in the planning or execution of an educational activity must disclose conflicts of interest and potential conflicts of interest. Committees, course directors or staff will be responsible for maintaining balance in programs and content and, on occasion, it may be necessary to exclude a particular individual with a conflict of interest.

ACP will identify and resolve conflicts of interest and provide disclosure information to users (attendees, subscribers, etc.) of ACP educational programs and products early enough to allow the user to evaluate the nature of any conflict or bias and make an informed judgment as to whether the user should participate in the educational activity.

Notification

Prior to engaging in any activity for or on behalf of the College, all individuals must be provided this policy and required to complete the conflict of interest disclosure process. This policy and information about the disclosure process shall be distributed yearly. Updates for any changes in circumstances (such as development of a conflict not previously reported or a change in position that raises a conflict) should be reported as they arise if outside of the disclosure reporting cycle. Disclosures of any conflicts or potential conflicts will be forwarded by the relevant committee staff liaisons to the committee’s Chair and Vice Chair prior to the committee’s next meeting.

All staff orientation packets shall contain the conflict of interest policy, and it shall be incorporated into the ACP Policy and Procedures Compendium. College staff Vice Presidents and above, all College researchers, and all other staff identified as being in a decision-making position within the College shall be required to complete the disclosure process on appointment to a College position, annually thereafter and as needed as circumstances change. Other staff shall be required to complete the disclosure process as needed. Faculty, authors, anyone in a position to control or influence the content or who is involved in the planning or execution of an educational activity, and others outside the College shall be advised by College staff of this general policy and specific policy, as appropriate. Failure to comply with College policy could result in disciplinary actions that may include loss of position.

All College meeting agenda books shall include a standing agenda item for conflicts of interest review at the start of the meeting, the discussion of which is recorded in the minutes, and shall contain the following reminder on its own separate page following the agenda page:

Members of the committee are reminded that they shall abide by the College’s conflict of interest policy and shall disclose any relevant conflict of interest to the full body, as the matter arises. The member should not participate in discussion of and/or not vote on the matter at issue, as determined by the Chair, and the disclosure of the conflict, any abstention, and the reason for the abstention should be recorded in the meeting minutes. If the person’s presence will inhibit open discussion of the issue, the person should also not be present for that discussion, at the option of the Chair. If the Chair is the person with the conflict, the group shall decide on the Chair’s level of participation, or the matter can be referred to the Chair of the committee to which he or she reports.

Disclosure and review of specific conflicts should be recorded in the minutes as above. There should also be documentation at the end of the meeting minutes that any conflicts were considered and addressed.

Examples and Core Responsibilities: Conflicts are often, but not always, financial. Individuals with conflicts of interest include the following:

  • A staff member who engages outside services on behalf of the College for personal reasons.
  • A staff committee liaison who, for personal gain, influences the selection of a consultant by a committee.
  • Industry support of an author or of CME faculty.
  • A committee member who advocates a project because it will bring him or her financial gain.
  • A Clinical Efficacy Assessment Subcommittee member who has a leadership position or is closely involved with an advocacy group that has a vested interest in a particular guideline, or who holds a position in guideline development with another organization. Intellectual bias or academic conflict of interest may be additional concerns if they would result in intangible personal gains.
  • A former Governor who uses the College name to imply an endorsement of a product or service.
  • A Regent who personally utilizes proprietary College information.

Your core procedural responsibilities:

  • Read and understand College policy.
  • Be aware of conflicts and potential conflicts of interest; check if you are uncertain about whether something is a conflict.
  • Disclose and otherwise comply with College policy.

When in doubt, err on the side of disclosure.

Conflict of Interest Disclosure System

Ethics & Professionalism

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