The Phenomenon of the Fee Splitting Between Physicians and Pharmacists and Its Impacts on Healthcare Delivery

Abstract

Background: Financial agreements between physicians and pharmacies have raised concerns about ethical implications and potential impacts on patient care. Objectives: This study assessed physicians' attitudes toward these agreements and their perceived effects on healthcare delivery. Methods: This cross-sectional survey was conducted in Rasht, Iran, among 69 licensed general practitioners (GPs) and specialists working in public and private healthcare centers. Participants completed a 17-item questionnaire. All data were analyzed using SPSS version 26, and the significance level was set at less than 0.05. Data were analyzed using descriptive statistics and MANOVA to compare attitudes by educational degree, workplace, and gender. Results: Of the 69 participants, 34 were GPs and 35 were specialists; 33 worked in public and 36 in private centers. Most agreed on the need for guidelines regulating financial agreements, with significant differences in attitudes by educational degree (P < 0.01), workplace (P = 0.006), and gender (P = 0.048). Conclusions: While consensus exists on the need for regulation, opinions on practical impacts vary. As a single-city, cross-sectional study relying on self-reported data, potential selection and response biases may limit the generalizability of these findings.