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A response to the backlash following last month’s op/ed “Life Cycle of a Parasitic Specialist”

Following the publication of Dr. Mallon’s opinion piece last month, EPM was flooded with comments, mostly from radiologists, but a few emergency physicians. It would be disingenuous to suggest that the editorial staff was surprised by the firestorm of responses. But the level of violence and profanity spewing from these “professionals” was truly shocking, and largely unprintable. Letters calling for Dr. Mallon and/or the editor who allowed his opinion to be printed to be fired or for EPM to be “wiped out of existence” were some of the more tame responses. Normally, we would allow an opinion piece to stand as just what it is, an opinion. After all this is America and we still have free speech. However, in this case, the vitriol and vulgarity of the responses to an opinion piece demanded an explanation from the editors who published it.

First, we recognized that Dr. Mallon’s parasite metaphor was over the top and intended to insult. We debated whether to censor this portion of his opinion. But we knew that this was Dr. Mallon’s voice, one well known in emergency medicine for his aggressive, provocative, and unfiltered style. This was simply Billy being Billy.

Second, while one can possibly make the legitimate criticism that Dr Mallon’s tone is unprofessional, it is also understandable. Professional, collegial communication with the radiology community on this topic has been attempted repeatedly, and has been coldly rebuffed (See the letter from Dr. Myles Riner on the opposite page). So, after knocking on a door for years without answer, it is understandable that someone would finally heave a brick through the window.

The real issue for me as executive editor was that it appeared that Billy Mallon’s insulting diatribe against radiologists contained a rather large nugget of truth. While every other specialty must make themselves available around the clock, diagnostic radiologists have somehow skirted that responsibility while continuing to bill as if they were. Dr. Mallon was shining a light on a very uncomfortable reality. EPs covering nights, weekends, and holidays at many hospitals do a great part of the work and risk of diagnostic radiologists, but get none of the compensation.

Whether Dr. Mallon’s assertion that the billing practices of radiologists for delayed readings constitutes a fraud is indeed debatable since an element of fraud is willful deception. Radiologists have been billing in this manner for years with the tacit approval of Medicare despite clear language that would prohibit such. So whether this behavior represents willful deception or simply accepted practice is a matter of opinion. Dr. Mallon is, however, entitled to his opinion. And maybe CMS should clear it up for us once and for all.

Dr. Mallon’s further assertion that emergency physicians should be entitled to bill for diagnostic readings when the radiologists are prevented from doing so, is debatable as well. It is clear that the readings EPs provide are, under most circumstances, temporary and not intended to be complete or final. It is not to say that we couldn’t perform this complete service. It is just that under current circumstances, we simply don’t.

The real concern that we have with Dr. Mallon’s opinion was that it sparked a fight that could prevent real conversation. And for this, the publisher and editors of Emergency Physicians Monthly issue a sincere apology.

Dr. Mark Plaster is the founder and executive editor of Emergency Physicians Monthly


 

 

Comments   

# Hueydoc 2011-11-08 11:34
I've always found it astounding that I read the xray, treat the patient and yet a radiologist waltzes in at 8 AM Monday, reads the xray, gets paid more then me for my entire treatment of the patient.
I call BS
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# MDDN 2012-05-17 09:25
I love the defense of the article "this was simply Billy being Billy." That's like saying, "You guys just don't understand him the way we do; this was just Hitler being Hitler. You should have seen the violent and unprintable reponses of the Jews in response the Hitler's campaign." Blame the victim.

The total disregard by the editors for the origianl unprofessional tone and the lack of accountability in the editorial response above is embarrasing.

And to the above note: The Medicare reimbursement rate for a single chest x-ray is about $10. You make significantly more than $10 to see a patient (the ER is the most expensive department in every hospital - and perhaps necessarily so). I call BS on your BS.
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# TW 2013-10-23 02:38
"Hitler being hitler"? A bit much, don't you think? You compare a man who has worked his whole career as a physician to a genocidal maniac. Your hyperbole undermines your argument.
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# MDMario Riega 2014-09-12 14:07
WOW, as a chilean MD, i see clearly why are you fighting about. Its about money and how it compensate the time wasted in your work at the hospital.

The MD physician must be the best-payed of the hospital, because the crytical work depends on him, and also, the they have to work when others are sleeping or in vacation. It`s just not fair.

Greetings from Chile!!! (third world democracy, it´s incredible and disappointing, that in the US, the model for our country, you still have this type of conduct´s
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