Although ethics dictate that physicians must act in their patients' best interests at all times, a physician's independent judgment and loyalty can be compromised by business interests and contractual commitments with insurers. When physicians limit patient care and services to comply with an insurer's goal of generating profit, they act unethically [1]. The potential for conflicts of interest has become more prevalent as physician employment by and affiliation with managed care organizations have increased.

Physician deselection, a method by which third-party payers, such as managed care organizations, terminate or fail to renew physicians' contracts, is sometimes used by insurers to control physicians whose statistics show them to be unprofitable or who advocate strongly for patients' rights. Courts indirectly support deselection by limiting deselected physicians to the review mechanisms contained in the contracts and the insurers' own rules and bylaws [2].

To counteract deselection, any-willing-provider statutes have been enacted in more than half of the states in the United States [3]. Any-willing-provider laws restrict a managed care organization's ability to terminate physicians without cause from participation in a particular insurance plan by requiring the organization to admit to the provider network all providers who meet the organization's objective criteria [4]. Proponents of any-willing-provider laws stress the need to protect patients' rights and the need to prevent managed care organizations from arbitrarily limiting participation in particular plans. Opponents maintain that these laws interfere with the managed care organization's ability to contract with providers of their choosing, thereby preventing favorable pricing and increasing administrative costs related to credentialing and monitoring provider networks.

Without the benefit of any-willing-provider laws, some physicians may restrict needed services for fear of deselection by a managed care organization, which leaves them no recourse and, ultimately, no patients to treat [5]. Only with the continued proliferation of any-willing-provider laws will providers be able to discharge their duties to their patients fully and within the confines of their code of ethics.