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Take an Aspirin and I’ll Send You a Bill in the Morning!

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People often complain about doctors, not because they sometimes give them bad news, but because they charge them too much. People are rightfully incensed if their doctors charge them thousands of dollars for a simple medical procedure that takes only about a half an hour of their doctor's time and may not even be necessary. A doctor billed the insurance company of one of my friends nearly $400 for just asking my friend to come to his office and fill out the routine forms prior to his surgery which was scheduled for the next day. Much to his chagrin, in response to his grousing inquiry, my friend's insurance company told him that the billing is justified and doctors can charge their patients just for filling out forms! In other words, the insurance company acted as if it was the agent of the doctor and not the insured. The inability to pay expensive medical charges is one of the contributors to bankruptcy for many American households today. According to an MSNBC report entitled "Medical Bills Are the Biggest Cause of U.S. Bankruptcies," this reality affected nearly two million households in 2013 (see http://www.cnbc.com/id/100840148).

Physicians earn a total of $540 billion annually, nearly 20% of the total healthcare expenditures in the United States. A June 18, 2013, article in Forbes Magazine listed the average compensation of the highest paid doctors. The list included: Orthopedic Surgeon, $464,500; Cardiology, $461,364; Gastroenterology, $441,421; Urology, $424,091; Hematology/Oncology, $396,000; Dermatology, $370,952; Radiology, $368,250; Pulmonology, $351,125; and General Surgery, $336,375. As a related aside and unbelievably, even the highest paid doctors make less than the CEO of a typical hospital. Becker's Hospital Review, on October 21, 2013, reported that an independent health system CEO's annual salary was more than $874,000. Just about "21.5% of physicians are in households whose income places them in the top 1% of income" according to a report in Forbes Magazine, May, 28, 2013.

Specialists earn four times as much as primary-care doctors despite the fact that the number of specialists is much higher than that of primary-care doctors. According to a January 18, 2014, New York Times article, "Only an estimated 25% of new physicians end up in primary care." Given the amount of time they spend with patients, the services rendered by primary-care doctors are not any less valuable than those provided by surgeons. Surgeons often do not deal with complicated problems related to patients such as medication issues and bedside matters. In my opinion, there are significant flaws in the system by which doctors are reimbursed for their services. Primary-care providers should be properly compensated since they do the actual job of keeping patients out of hospitals where the most expensive treatments are delivered. According to the same NYT article, evidence shows that with the increasing number of specialists, the number of surgeries performed has also increased "400% in a little over a decade," implying that demand may have been influenced by these specialists, particularly for non-urgent procedures like cosmetic surgeries.  

Unique to the healthcare market is the absence of choices for consumers as well as the flexibility ordinary consumers of other services enjoy. A broken leg must be promptly set and an infected ear must be treated by a specialist. Patients have to accept the doctor's diagnosis and recommendations, and it is not customary for patients to question his or her opinion, search for alternatives, or negotiate the pending charges. A January 18, 2014, New York Times article provided an example of fluctuating cost; for a standard Mohs surgery, the cost to patients ranged from $7,594 to $747,000, a hefty difference of $739,000! There is no shortage of such stories about the astronomical charges levied by doctors, especially by specialists; however, consumers seem to be powerless when it comes to the pricing of medical care. As a result, it is natural for some of us to complain instead of being grateful for the work doctors do and prevent the undue biases toward doctors, most of whom are honest and save lives.

No doubt, many people may pursue healthcare careers because of the lucrative salary. If the salaries for doctors were decreased, there would not be as many people interested in pursuing that career. There are, of course, many research doctors whose motivations are not monetary. They are more interested in patient care than their pocketbook. However, some doctors have turned more entrepreneurial in recent years. They have learned how to diversify the sources of their income. For example, in addition to their income from normal practice, they earn additional income by investing in medical equipment, labs, or by offering ancillary services to their patients. It is also interesting to know that health professionals are represented by more than 750 powerful lobbyists in Washington, DC. These medical practitioners spend nearly $80 million annually to make sure that laws and regulations passed by the U.S. Congress do not undermine their interests.

As we know, under the free-enterprise system, people, including doctors, are motivated by monetary incentives; they always do whatever it takes to maximize their gain or to elevate their living standard. That should not give us the right to judge healthcare professionals solely on the basis that they make more money than we do.   We are supposed to be able to trust our doctors because they are expected to do what is best for us, especially when we encounter serious illnesses. It is not out of the ordinary for doctors to earn high salaries, but they should be doing so honestly and by providing proper care for their patients. I believe ethical and moral values should take precedence over compensation. If physicians would place moral and ethical values first, they would realize that it is better to live on a comfortable salary and save more lives than to be a millionaire saving only those who can afford their exorbitant charges.

The medical profession is somewhat unique in that it is one of the professions that espouse the values of valor and integrity.   Needless to say, doctors take an oath promising to put the welfare of their patients above their own profit. However, the examination of the steady growth of doctors' earnings may give us an anecdotal impression that some of them may use their patients as ATM machines. They are transformed from idols of compassion and angles of mercy to business-minded profiteers. Such words may sound judgmental and punitive, but unfortunately, that's what many think of as reality. If medical practitioners consider their profession only as a moneymaking career, they are stripping this noble profession of all of its credibility.

To be fair and balanced, according to experts, preventative medicine, which is often over-prescribed, is one of the major contributors to the escalation of healthcare costs in the U.S., this as well as the financial investment needed to meet complicated regulations and requirements for maintaining high standards of practices. Compliance with state and federal laws and regulations has added an additional financial burden to medical practices. Given the high cost of university education as well as the length of time, dedication, and training the profession requires, not to mention the exorbitant cost of malpractice insurance, doctors may well deserve the high compensation they seek. On the other hand, there are other professions that entail just as much training and education, but these professions are rewarded nowhere near the level of compensation demanded by medical practitioners. Doctors may be entitled to high compensation, but as previously stated, this should not come before the welfare of the patients they serve. Doctors should be paid well for their efforts, but dishonest business practices aimed at increasing prices and revenues may raise public skepticism about the integrity of their profession. It is obvious that doctors have worked hard and invested a lot of money to get to where they are; however, this should not give them license to nickel and dime patients to death, or bleed them of their financial savings.

I have no doubt that most doctors have their patients' best interests at heart, but the underlying fact is that some of them have their own monetary self-interest on their minds more than the patient's interest. With so much at stake, such as the lives and wellbeing of those needing medical attention as well as their financial security, it seems selfish and self-seeking for some in the medical field to focus so intently on trying to charge more when they could be trying to help more. In addition, put increasingly astronomical medical bills and medical-insurance premiums alongside the ordinary person's decreasing ability to pay, and this country has the makings of a ticking economic time bomb. Unfortunately, disreputable doctors and greedy insurance companies will not only survive, they will thrive, while the rest of us will suffer the ill effects of not being able to access needed medical care and scramble to creatively figure out how to make ends meet.

A few bad apples should not be allowed to blemish a time-honored profession, and unbridled medical malpractice monetary awards and consequently, escalating insurance premiums should not be allowed to drive dedicated doctors of integrity into leaving the profession.

 

Reza Varjavand (Ph.D., University of Oklahoma) is associate professor of economics and finance at the Graham School of management, Saint Xavier University, of Chicago. He has been an avid participant in many professional organizations and active in (more...)
 
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As noted above,   about 20% of medical ... by sesquiculus on Saturday, Mar 8, 2014 at 8:33:14 PM