Billing the Doc

Bye-bye to that Christmas bird

Faced with a hefty bill from a physician, many people may turn to a young son or daughter and say: "Become a doctor. Then we won't have medical bills to worry about." That may soon be poor advice. Though physicians have long ministered to colleagues and their families free of charge, such professional courtesy, as it is euphemistically called, is now fast dying out. By the time Junior gets an M.D., the practice may in fact be as rare as the house call.

As with so much else in contemporary medicine, the issue is largely economic. No longer are the time-honored Christmas gifts of turkeys, bottles of bourbon and frivolous gadgetry that doctors give one another for professional courtesy enough to make up for the dent in income. Complains Hollywood, Fla., Pediatrician Edward J. Saltzman: "We are giving away $40,000 or $50,000 worth of care a year." Indeed, to cover the deficits, doctors may simply charge other patients more. As Pittsburgh Pediatrician Jerome Wolfson explains, "Paying patients are carrying the nonpaying patients."

Doctors concede that this kind of fraternal "charity" hardly seems appropriate any longer for a group with such high incomes. But a more telling criticism of professional courtesy is that it can be a barrier to good medical care. For one thing, the donor physician often feels exploited and overburdened. Says Pediatrician Lee Bass, Wolfson's partner: "There is a subtle difference in how you feel about people who get free care in your office and those who pay." Also, doctors and their families frequently have misgivings about taking up another doctor's time. The result: quick, inadequate "curbside consultations" in hospital corridors or at parties, or dangerous delays in seeking medical treatment for a serious illness.

Some traditionalists are distressed by all the talk of abandoning professional courtesy. After Wolfson and Bass denounced the no-fee practice as a relic in an article in the New England Journal of Medicine, it received a spate of critical letters. Gastroenterologist William Haubrich of La Jolla, Calif., protested that proffering a bill to a fellow doctor smacks of commercialism and erodes the strong feelings of fraternalism in the medical community. Oklahoma City Internist Ernest Warner Jr. added: "One of the greatest honors one can receive is to be asked by a fellow physician to care for his or her family."

The trend, though, is toward charging. Psychiatrists long ago decided to bill all patients, including fellow doctors. Hospitals too have largely given up the practice of free care, as have many surgeons, especially since most doctors have health insurance to cover the bills. Thus, as Boston Pediatric Radiologist John Leonidas points out, "with all these third-party payers, professional courtesy is ultimately going to be obsolete anyway."

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