WhiteCoat

Fair Payment?

This story is making the rounds on the internet recently.

A plastic surgeon is being sued by California State because she charges patients fees in excess of what insurance pays for her services. California’s lawsuit alleges that the doctor poses a “substantial, irreparable, and unjustified threat to the financial livelihood” of her patients.

In addition, the California Medical Board is attempting to revoke her medical license because she is allegedly engaging in “unprofessional conduct” by requiring patients visiting emergency rooms to sign agreements to pay her costs if their insurance companies didn’t.

I’m not going to try to justify the fees that the doctor charges. More than $12,000 to repair a fingertip is a lot of money.

However, with one caveat, I think that the actions taken by the state and the medical board are way out of line.

Suing a doctor and trying to revoke her license because she wants to get paid the asking price for her services? If people don’t want to pay her price, then don’t use her. Go see another “professional.”

You go to work at a new job where you agreed that you would be paid $50/hour. You work 40 hours, and expect to get a check for $2,000 at the end of the week. As you leave work Friday, your boss gives you a check for $200.
“Sorry,” he says, “if you don’t like it, you’ll have to go take it up with the company CEO. That’s all I’m paying you for your work.” The company CEO tells you “we pay other workers $5/hour, therefore we can pay you that much, also.”
You try to sue to get your money, but a court says it is against the law for you to demand to be fully reimbursed for your work because the corporation that reimburses your boss pays $5/hour, therefore it is legally entitled to pay you that same amount. Since you’ve already completed the work, you try to sue the company for your back wages. Then the state files a lawsuit against you because you filed a lawsuit against your employer.

Or imagine going into a lawyer’s office, agreeing to pay the lawyer his fee, receiving the services, then sending the lawyer a check for 10% of the total fee as payment in full. You’d be back in court so fast it would make your head swim.

That is the position this doctor is being put in. She performed the work at the patients’ request, the patients signed a form stating that they would pay her full price for her services, then, when she tried to collect the money from the patient after performing her services, the state stepped in and said that the doctor must agree to the amount a third party wanted to pay her.

The caveat in this whole mess is that the patients should know what they could end up paying the plastic surgeon before she renders her services. If that occurs, the patients get to decide whether or not the costs are worth the perceived benefits. If the patients agree to such costs, then they should be held responsible for paying the agreed-upon price.

The patients refused to have the emergency physician repair their wounds and demanded that they be treated by a “professional”. Now they’re accepting the “professional’s” services without planning on paying her the price that she asked?

Wonder why there are so many specialists who aren’t providing care to emergency department patients?

I also wonder whether specialists would be considered “unprofessional” if they required retainer fees before providing services. Would the state take action against them then? Lawyers do it all the time. No money, no representation.

Looks like a lot of patients are going to be stuck with us all of us sub-“professional” emergency docs for their emergency department treatment in California.

I wonder if this whole “we’ll pay you what WE think is fair” line of reasoning would work when the doctor went to pay her California state taxes …

46 Responses to “Fair Payment?”

  1. Matt says:

    Don’t the physicians sign a contract agreeing to this reimbursement scheme?

    If WC’s sentiment is typical of most physicians, then you guys have some terrible lobbyists, and regulatory bodies. You’re your own worst enemies.

  2. Ardosa says:

    If this was simply an ED visit/physician its one thing. If the patient specifically said, “No, I want a plastic surgeon” then its his fault.
    Most people who are ‘smart’ enough to ask for a plastics specialist, are probably versed enough to know many times plastic/reconstructive surgery isn’t covered. Pay her.

    Do I think she is charging a lot, yea, I do. If I cut off a fingertip would I ask for a plastics person, probably not… if it was part of my face (and it wasn’t life threatening) – Maybe. Maybe not. Depends… but I still would have to understand, that there is a chance that it isn’t covered properly and in full and if i sign i’ll pay the remainder, then well, i should. If i don’t agree, don’t sign. I’m sure another plastics specialist on staff may not ask for the form and is just as qualified.

    Then again, if I were her, i’d spend my time doing plastic/reconstruction on people who want it and willing to pay for it and not do ER rotations/on call if i could help it…
    then again, that limits her to not being on staff except for a surgi suite, correct? I’d assume to be on medical staff there has to be some agreement to an on call rotation for specialists…

  3. Yes, the patient may have asked for a plastic surgeon and may have signed a document agreeing to pay. However, is there any evidence that a price of >$12,000 was quoted by the plastic surgeon before the work was done?

    It’s more than just “a lot of money.” It outrageous for a fingertip. The plastic surgeon has a pattern of this type of billing practice.

    I do not see how this doctor’s behavior can be justified. These are the kinds of stories that make people resent all of us in the medical profession.

    • WhiteCoat says:

      I agree with you that the $12k was expensive. What if it was for re-implantation of the fingertip with repair of the lacerated tendons on the dominant hand? All follow up care included. Still unreasonable? Maybe.
      I got billed $70,000 for repair of a blown disk in my neck. Should we just take the surgeon out and hang him now?

      The issue really comes down to a freedom in this society to contract. If you think that a car or a lawyer or a head of lettuce is too expensive, then you can go and find a better price somewhere else.

      If you’re aware of the surgeon’s price and agree to it, then you need to pay it – even if you think the price is unacceptable in retrospect.

      • Seth Trueger says:

        The concept of freedom to contract breaks down in medicine a lot — there’s asymmetry of information (hidden costs, medical expertise) and the coercion of acute disease. A nasty finger lac is not a head of lettuce — driving to another hospital may result in delayed repair and a higher risk of worse outcome and complications.

      • As I said, there is no evidence that the patient was aware of what the fee would be. He was possibly not in a position to argue about the “contract” or shop around. If it was lacerated tendons on the dominant hand, insurance would have paid more.

        Using your logic, what if the surgeon had charged $50,000.00 for the fingertip repair? Do you think that she should still be entitled to take the patient’s house?

        Were you aware that your neck surgery was going to cost you $70,000.00? Was your surgeon paid that much or did he accept what your insurance paid?

  4. Tarl says:

    Interesting. A plastic surgeon *and* a lawyer. Maybe she needs the money to pay off her student loans.

    Her tactics (as described in the article) do seem over the top – having lost in small claims court, filing liens for the amount the court refused to allow her to collect seems vindictive (and futile).

    In principle, I don’t object to a doctor saying “I bill xyz, your insurance is going to cover only about 50% of that, you owe me the rest.” My dentist did that for a while, back when my insurance was particularly obnoxious. We had a discussion about it when he dropped his contract with that insurer.

    But we don’t know if she was stating what she was going to charge before starting procedures. I also question the wisdom of the hospital having someone with those practices even walk into an ER. The court does have a point that someone in an ER is in a uniquely vulnerable position, and consent given while seconds are ticking off the clock of tissue viability is of dubious validity – even if the patient was being obnoxious by saying “I want a real surgeon, now”.

    Gray areas indeed.

  5. DensityDuck says:

    I think that this blog post is the most dishonest thing I’ve ever seen you write.

  6. ThorMD says:

    I’m just the messenger here – don’t blame me for what you are about to read

    We don’t have plastic surgeons on call for our ER because none of them want the hassle of call and/or non-payment for their services. When I have a patient request a plastic surgeon, I’m forced to have the secretary go through the Rolodex to try to find “someone”. They can’t come to the ED though as they are not on the medical staff. Instead, if they agree to take the patient, the patient is discharged and goes to their office -thereby skirting the balance billing issue. If it’s M-F from 9-3 I can’t find someone about 1/2 the time. If I can’t find a plastic surgeon to help, and the patient is still insisting, they get transferred to the county hospital where plastic surgery is on call and in-house. Granted it’s an intern on the plastic surgery service who sews them up…

    The same thing happens for oral surgeons – they’re not on the medical staff so they are not obligated to take call. Because they got sick of getting woken up at 2am for belligerent drunk people with jaw fractures – and then not getting paid to take care of them.

    I’ve been practicing for 15 years and see a patient who “needs” a plastic surgeon about once every 2-3 years. Most of the time is a simple lac on the chin that Mom wants to have “a real doctor” sew up. Once they realize they will have to pay, suddenly, I’m good enough.

    • WhiteCoat says:

      You have illustrated the point I was trying to make quite well.
      Thanks.

    • Dina says:

      I would even go a step further: If they insist on “a real doctor,” I don’t see why the ED should extend its scant resources (ie the ED secretary, you) to find them one, when there is a “good enough” doc right there. Explain the situation, hand them a list with office phone numbers, and let them make the calls.

  7. Nurse K says:

    This chick put liens on peoples’ houses and wrecked credit for acutely-injured patients after she was unhappy with what the insurance companies paid her. She charges 4x more than normal for already-expensive procedures done on bloody, fingerless individuals and then balance bills the f*ck out of people, including taking their property and houses? Really? You think that’s cool?

    What if you pay a credit card bill of $2 one day late and they tack on a $1000 late fee and then ruin your credit for not paying up? Would that be cool too? There’s a concept called predatory billing, and this sounds like the ultimate in predatory billing.

    Incidentally, if you’re uninsured, you do pay a “retainer” which is generally referred to as a “deposit” before a specialist or non-charity clinic will see you. These deposits might be $100-$500 or more, depending on what is to be done.

    • WhiteCoat says:

      K, you’re missing the point. If your hospital paid you less than you agreed upon, you know darn well that you’d go and wreck the hospital’s reputation to get the money that you earned.

      Do I think the prices that she charges are acceptable? Not really. Let’s say that she put a lien on the patient’s homes for $3,000. Is that acceptable? How about $250? Or should specialists with advanced training just get minimum wage for their efforts? Maybe we can stiff them all and pay them nothing. They’re rich. Then you’ll get into the situation that ThorMD described above. No specialists. Come to the emergency department with a mangled finger and your finger is going to stay mangled.

      Who gets to decide what are “acceptable” costs for medical care?

      Credit cards already do charge large late fees and jack up the interest rates if you’re late on your payments, regardless of how small the payments are. That’s the whole issue. If you accept the terms of service with the credit card provider, you *agree* to let that happen. If you don’t like the terms, then you get rid of the credit card.

      Regarding retainers, would be OK for specialists to charge a retainer before providing non-emergency services in the emergency department which is what the doctor is alleging happened here?

      • Nurse K says:

        I think for anything done in an emergency department that is due to an acute injury or illness, one should never be charged above what is “customary” for that procedure (average of what is billed for that in that state by a person of equal training) in a similar circumstance because all patients in a hospital are considered vulnerable adults by law, and trying to use your position as physician in a circumstance where your patients don’t have time to call insurance companies or consider other options to overcharge and then put liens on their dwellings is unethical.

        So, if you are doing a non-emergency procedure for convenience in the ER, you should charge what you would charge at an outpatient clinic.

        Also, just in general, if you have a contract for reimbursement with a person’s insurance company, you need to be fighting with the insurance company about your reimbursement, not the patient. It’s not the patient’s fault that insurance that you had a contract with didn’t pay you what you wanted.

        I think it was certainly appropriate to take away her medical license until she agrees to not harass and intimidate patients for money like a freakin’ crack dealer. F her.

  8. Matt says:

    WC is right, it’s about freedom to contract, yet by the same token so many of you have CONTRACTED much of your freedom away. And what you didn’t willingly contract away, you’ve allowed to be legislated away why your lobbyists sat mute, or worse cheered it on, and you guys were playing liability carrier stooges. It’s crazy.

    Your reimbursement model is ridiculous, and were I a physician, it would be the #1 area for reform in my mind.

    Why your profession does so little about it is beyond me.

    • DensityDuck says:

      The problem is that this wasn’t a contract. Physicians did not enter into contract with the state of California and negotiate these working conditions; they were forced on them by legislative action.

      Unless you’re taking a hard-line states’-rights position, and saying that if doctors don’t like the legislative environment in California then they can jolly well move to another state. But that sounds pretty libertarian, and I find that unlikely coming from you.

      • Matt says:

        I don’t know why you would find that unlikely. I’m about as libertarian as you can get. I find it funny a tort reformer would accuse others of being unlikely libertarians. And I would agree – if docs don’t like the legislative environment in CA they should move – although it’s the original tort reform Mecca so I don’t know why you would. After all, they apparently already agree that you can’t “sue your way to better health care” and other silly lobbying lines that physicians spout.

        Back to the point, though, it’s hard to tell from the article but is the doctor subject to the managed care plan through her contract with the hospital and its contract with the health insurer?

  9. BirdStrike says:

    Fingertip repair by plastic surgeon: $12,000

    Nike Lebron Sneakers: $300

    Life saved by ER doctor: $120
    (Medicare CPT 31500, emergent intubation)

    Which is more valuable?

    http://online.wsj.com/article/SB10000872396390444233104577593623581068492.html?mod=googlenews_wsj

    http://www.trailblazerhealth.com/Tools/Fee%20Schedule/Downloads/Medicare/FS29CO12.pdf

  10. Lee Wood says:

    I do not live in the USA and have never worked in your system so I don’t know your system. I am wondering if you can legally sign to cover the difference without being given a fully itemised quote stating the actual price you would need to pay and secondly how legally binding is it when you have been given opiods? Also Selesnic quoted in the article sems to be generalising not talking specifically about the finger repair patient requesting a plastic surgeon.

  11. [...] in CA who is being sued by the state for having excessive fees. Follow this link to read what one of my favorite bloggers has to say about it and then check out the  link to the original news story. I fear this becoming widespread and hope [...]

  12. Ivan Ilyich says:

    If you look into this a little deeper, you will find that the news item does not report that the patient with the damaged finger selected this surgeon, and that the assertion that the patients requested this surgeon was made by her attorney.

    There are sites which go into more detail about Dr. Martello’s practices, and indicate that there may be a pattern worth investigating. I will give the California Medical Board the benefit of the doubt on that point, allow them to do their job without prejudging it, and see how it turns out.

  13. Vladimir von Winkelstien says:

    WC, I have to agree with a previous commenter: your post is dishonest. What’s worse is that it’s acutely unconvincing.

    (1) You make two analogies. In both of them, you (a) compare an emergency procedure to a non-emergency procedure, and (b) compare situations where the payor agrees to pay a specific fee, with a situation where the payor has no idea what the fee is.

    Your little “caveat” tacked onto the end of a strident argument is one of the crucial details that changes the entire argument. Your argument boils down to, “He agreed to pay $12,000! With the caveat that he didn’t agree to pay $12,000!”. See? Unconvincing.

    So. Enough about you and your argument. On to the situation:

    (1) This was an emergency situation, yes? He was sitting in the ED? Could the guy have taken a week to shop around plastic surgeons and get quotes? In an emergency situation, emergency responders have a duty to provide reasonable care at reasonable prices. Who decides what’s reasonable? That’s a grey area, hopefully reasonable people can work it out, and if not, take it to a judge and then abide by the judge’s decision. In this case, $12K was unreasonable, the doctor was way out of line, preying on her patients, and she deserved to get smacked down.

    (2) Your point about doctors refusing to be on call due to underpayment is a good one, and worrisome. We should pay doctors enough that they are willing to work. But it’s very difficult for me to believe that your average doctor would turn down an opportunity to make $3500 for 2-3 hours work. (Is that a reasonable estimate of the time it takes to drive in, do the repair, and drive home? I estimate the drive would be under half an hour, round trip.) Indeed, even the reduced amount of $3500 seems excessive, if that’s just the surgeon’s fee and doesn’t include hospital fees.

    • WhiteCoat says:

      My argument with the payments parallels what is sometimes known as the “prostitute’s theorem”: services are worth much more to the purchaser before the services are performed than after the services are performed.

      My argument with the policy still remains. Once we start down the slippery slope of stating that specialists shouldn’t be paid the fee they request in an emergency, then were does the sliding stop? If insurers and/or legislators say that an emergency surgery for repair of a fingertip is only going to be paid at $2.27 including follow up care, are doctors supposed to just take the insurers to court over every low payment? They’d spend a large majority of time in court chasing bills.
      Doctors *don’t* have a duty to provide care in emergency departments. Some hospitals try to force the issue, but fewer specialists are willing to provide emergency care. If you live in a rural area, call around and see where the closest neurosurgeon with privileges for brain surgery or hand surgeon or emergency dentist is located. Good luck with that last one.
      In many cases, surgeons’ fees are for “global” care, meaning that the fees also cover all care and office visits provided by the surgeon for 30 days after the surgery. Surgeons out there correct me if I’m wrong (I don’t have in-depth experience with surgical billing) but if the patients in these cases need revisions, then the surgeons may not be paid any extra.
      And let’s not forget the malpractice insurance premiums and all of the other fixed costs of running a surgical office.

      I’m just pointing out that in the long run, the way this California case is being handled is going to cause more problems than it solves for the patients. A state and a professional licensing group threaten a private entity’s license and livelihood because of the prices that entity charges? What is this, the Twilight Zone?
      You don’t see DAs filing criminal charges against Nike for its $300 sneakers or against BP for the damn gas prices and the oil industry’s record profits year after year.
      Think about how these disincentives will affect the willingness of physicians to perform emergency services in California.

      If that’s dishonest, then maybe I’ll take up a career in politics instead.

      • Vladimir von Winkelstien says:

        (1) Patients generally don’t know the price of services before the services are performed. So I don’t see how your “prostitute’s theorem” applies.

        (2) I’m not arguing that the current system is a good one. I agree that it’s not very sustainable. I’m arguing that having reasonable people agree on a reasonable fee (with a reasonable judge to back them up) is better than your proposal of simply paying specialists whatever they decide to charge. I would much prefer a system where fees are agreed upon in advance, but we can’t have that, at least not right away.

        Have you even thought about what might happen if you needed medical care, and the doctor who provided it was allowed to charge you any unreasonable amount he wanted, and sue you for any amount you couldn’t pay? You could be in debt for the rest of your life. you would avoid going to the ED unless you were truly convinced that you were dying. Does that sound like a good way to run a society?

        (3) I didn’t say _doctors_ have a duty to provide care, I said _emergency responders_. As in, the people who sign up in advance to make themselves available to respond to emergencies.

        (4) In the California case in question,the doctor is not getting prosecuted because of what she billed. She’s getting prosecuted because her subsequent actions violated the law. Doctors who simply provide care and accept the $1700 per hour that this lady got paid have nothing to fear.

        (5) Your reference to Nike sneakers and BP gas are irrelevant, because they are not emergency situations. Do you truly not understand the difference between an emergency situation and a non-emergency? I think you do. Quit wasting my time.

    • WhiteCoat says:

      First, at least according to the attorney in the article, they weren’t emergency situations. The patients were stable. If you define every patient coming to the emergency department as having an “emergency situation” until they get whatever treatment they want, then you’re being naive.
      And what if this plastic surgeon wasn’t on call? Many plastic surgeons won’t take emergency department call. What if the emergency physician just called her because the patient wanted a “professional” to repair the injuries – just to see if she would come in? The physician may have had no “duty” to respond to the emergency department request. Then what?

      Second, the attorney in the article also stated that the patients signed an agreement to “pay her costs if the insurance companies didn’t.” If her fee was disclosed, I don’t see how you can argue that the patients shouldn’t have to pay it. The prostitute’s theorem applies. If not, then it is an entirely different issue. That’s a disclaimer that I have made from the beginning.

      In your system, what if patients didn’t agree with prices in advance? That’s what is happening now between insurers and doctors in California. Insurers lowball the prices that they pay for services, doctors drop out of the insurance plans, then, when so many doctors stopped contracting with the insurance plans because their reimbursement was too low, the California Supreme Court stepped in and *required* doctors to accept insurance plan prices even if they aren’t under contract with the insurance company.

      You going to just start forcing specialists to work for whatever amount of money you feel like paying them? Then when specialists just drop emergency department call altogether – except for the university programs where residents take care of many of the cases – what’s next? Force them to take call?

      Do I think about the issues? All the time. I’m involved on state and national levels with similar issues right now. That’s one of the reasons I keep writing the blog – to vet issues like this. I could just go on about silly things that happen at work, but to me these discussions are more important.

      Want examples of “emergencies”?
      How about the state suing a plumber who charges too much to fix an emergency sewage backup into a house?
      How about the state revoking the business license of a pharmaceutical company because it charges too much for emergency medications or cancer treatments?
      How about suing ambulance companies because they charge too much for transport?
      How about suing the county and throwing the board members in jail because I think the property taxes I pay to fund emergency fire and police protection are too high?

      How are you going to distinguish these from medical emergencies so you can advance your argument? They aren’t big enough “emergencies”? Medical emergencies are “different”? How?

      What the doctor did was smarmy. But you are focusing on her actions rather than the precedent that the state and medical society are setting. Every person in this country has the right to go to court and to initiate collection actions against anyone who owes them money. Because people don’t like the amount of money the surgeon charged, now everyone wants to establish a precedent that doctors should be sued by the state and should lose their licenses if they charge too much and then try to collect their bills. States are taking away the rights of citizens. If we try to apply that same logic to any other profession or situation, we’re being “dishonest” or “irrelevant.” In the future, though, the state can use the case as precedent in other areas.

      From your comments on this issue, it is apparent that you believe retrospective price controls should be in place for any care provided in the emergency department. Doctors should be forced to provide the care and should be required to take whatever money the insurance companies pay them after the fact (the insurers generally don’t tell doctors what they’re going to be paid, either – especially if the doctors aren’t contracted with the insurers).
      On an outpatient “non-emergency” basis, then I assume you still believe that the usual “freedom to contract” thing kicks in and the state should allow doctors to charge whatever prices they want? If so, think about what incentives that will create for medical providers. If not, then you need to review the thirteenth amendment.

      I could walk you through other policy considerations that you should consider based upon this decision, but I’d obviously be wrong … because the plastic surgeon charged too much.

      If you want to pound your chest and declare yourself victorious in this argument because what this surgeon did was smarmy, congratulations. You win.

      I just hope all the patients in California can accept the potential consequences of this victory.

      Be careful what you ask for.

      • Vladimir von Winkelstien says:

        (1) Maybe things are different in the Great Pacific Northwest. Maybe your proximity to Canada has driven a little sense of fairness into your brains that is lacking in the Southern part of the country. I have had medical care on both coasts, and even once right in the middle. And EVERY SINGLE TIME, before I receive care I am asked to sign a form agreeing to pay whatever the doctor decides to charge. There is no amount quoted on the form. If I ask the receptionist how much the cost is, she says she doesn’t know. If I ask the doctor, she says I should talk to billing, who will be in on Monday.

        So I hope you’ll understand when I think that this form of yours, which clearly spells out the cost of a procedure and asks for my informed agreement, exists only in your head.

        (2) The doctor’s attorney says that it wasn’t an emergency? Really? Well, he wouldn’t have any incentive to lie. He must be telling the truth. I’m sure that finger repair could be delayed days, weeks even.

        (3) “In your system…” Buddy, I don’t have a system. If I did have a system, it would look a lot like Canada. Or the UK. Or France even. But I can’t have that, so I take what I can get. Given what we have now, I think that it’s much better that insurance companies and doctors fight out their reimbursement amounts, with some doctors refusing to work when the payments are too low, than to have doctors bankrupting patients by charging sky’s-the-limit.

        (4) I told you before, I’m not going to play games with your weak analogies comparing a situation where someone gets maimed to a situation where someone’s basement smells like poo for a few days. You know the difference. Quit wasting my time.

      • Matt says:

        It’s a well known fact that doctor’s attorneys, and doctors themselves, don’t say things in their own interest – just the unvarnished truth. Only their opponents lie. Frequently and without remorse.

      • Birdstrike says:

        Matt: “It’s a well known fact that doctor’s attorneys, and doctors themselves, don’t say things in their own interest – just the unvarnished truth. Only their opponents lie. Frequently and without remorse.”

        Matt, it warms my heart to know you are finally catching on. Please, keep on reading.

      • Matt says:

        I never miss a post. The unintentional comedy levels can’t be matched!

      • WhiteCoat says:

        1. The form doesn’t belong to me. Advance beneficiary notices require that the cost of services be included. I already stated that if the price wasn’t disclosed, it shouldn’t be enforceable.
        2. Finger repairs can be delayed. It depends upon the injury. And I’m sure that no one with an interest in the situation has an incentive to present facts that most favor their position. Why is it that you believe the patient more than the attorney?
        3. Make that “in your proposed system …” So your proposed system would allow people receiving services just not to pay for those services if they thought the services were too expensive?
        4. You didn’t answer the question about lifesaving medications or about lifesaving ambulance transports. Pretty much it appears you are advocating that emergency medical care – whatever the definition that best suits your purposes – is a legal right and that the government should be able to force private citizens to perform emergency medical services at their own expense regardless of how much the private citizens will be paid. That will go over real well.

        You’ve effectively sidestepped any of the substantive discussion on topics you raised.

        While you were in the middle US for that one instance of medical care, you must have stocked up on a bunch of straw for all those strawman arguments you’re making.

  14. Johnathan Blaze says:

    Good, it’s about time that these greedy doctors get smacked down for being the financial rapists that they are.

    Medicine in this country is the biggest, most destructive SCAM going on today. Doctors think they are entitled to RIDICULOUS amounts of money for simple routine procedures.

    Dr. Martello is a CRIMINAL and needs to be treated as so.

    Do no harm? Give me a freakin break. Time for the medical SCAM in this country to come to an end.

    • Misplaced Priorities says:

      Absolutely! Doctors become multi-millionaires after spending just a few months completing online degrees in their basements. Can you imagine the nerve of a doctor charging someone who would spend $3000 on a cell phone contract or $4000 on a engine for their car $12,000 to fix a finger? That’s ridiculous! Free health care now!

      • Johnathan Blaze says:

        Oh please. Doctors make good salaries w/ their residencies. Usually over 50k. Yes, they go through medical school. Of course doctors should be well compensated.

        But right now their salaries are absolutely ridiculous compared to other Americans. Meanwhile doctors also fund lobbying groups to keep the supply down so they can financially RAPE people further.

        All specialists need to have their salaries slashed by 35% NOW. It is gotten out of control how much we pay these people to do simple routine things. Surgery is not some miracle anymore. America is going broke trying to pay these doctors. They ALL scam the system. CROOKS.

      • WhiteCoat says:

        Doctors borrow money to go to college. Say $30,000/year x 4 years.
        Doctors borrow money to go to medical school. Say $50,000/year x 4 years plus living expenses.
        Doctors get paid a relatively slim hourly wage in residency while interest on the loans from college and medical school accumulates.
        Then, when they graduate residency 12 years or so behind in earnings from those who went into a trade out of high school and they have to pay tens or hundreds of thousands of dollars per year in malpractice insurance, plus pay back all their student loans, plus in many cases set up and run a business, people who have little idea of the sacrifices they make state that they aren’t allowed to earn as much as a plumber?

        Who’s getting raped?

      • Matt says:

        WC, welcome to virtually every business. The main difference is you make more than 95% of them once your career starts. By a large margin.

      • Johnathan Blaze says:

        Give me a break WC.

        First of all, most people go to college, so those fees aren’t just being felt by doctors. Secondly most smart kids can get into state schools for little to no tuition. If you choose to pay 30k+/yr for undergrad, that is your choice.

        Yes, medical school is expensive. This is the one extra thing doctors have to pay for. But 300k worth of loans is NOTHING when you’re guaranteed to be making 250k+ for the rest of your life. It is only because medical salaries are so absurdly overinflated that medical schools can charge so much. If we lowered doctor salaries, then the med school tutions would fall as well.

        Residents usually get paid 50k+ which is above the average American salary. Not bad for a TRAINING PROGRAM. Yes, the hourly wage is sometimes low, but remember, it’s a TRAINING PROGRAM. Residents are also coddled, wined and dined, and given a strong social network. There are lots of perks to residents that other jobs don’t have.

        There is also a huge psychological difference when you know you will be paid 200k-600k+ after residency It’s a lot easier to deal with “low paying” work when you know it’s just a stepping stone to a guaranteed huge payoff (albeit one built off of financially raping the sick).

        Doctors in training also have chances to make money “moonlightling”, in which they are paid $50-$100 an HOUR to SLEEP all night at a hospital (and occasionally have to do a little bit of work). Yes, lets pity these poor doctors and the absurd money they make.

        Malpractice insurance is a complete red herring. Most doctors never pay a penny out of pocket. It is handled by the hospital/practice they work for. Doctors still take home hundreds of thousands of dollars.

        $200k should be the maximum salary for ALL DOCTORS. The only ones who should get more are the ones who actually INNOVATE and contribute to the overall practice of medicine. However 95% of doctors are simply mechanics and should be paid as such.

      • Matt says:

        While I don’t agree with Mr. Blaze, I can’t say that physicians haven’t brought this sentiment on themselves.

  15. One of the frustrating things about this article, and the way it was written, is that it implies that ER physicians are not professionals, or at least that this patient held this belief. The language in the article only reinforces this fallacy. Another frustrating aspect is that emergency physicians often get tarred with the reputation of being ‘expensive’ because of the behavior of some of the specialists we consult in the ED. That is one of the main reasons why the DMHC proposed regulations to prohibit balance billing of HMO claims (most PPO claims in CA can still be balance-billed). Often cited during this regulatory process were examples of the exorbitant claims of on-call specialists, and the huge balance bills that resulted from these out-of-network claims. In comparison, ER physician claims are typically much smaller, but this regulation, and the Prospect Supreme Court case that upheld it, landed on all emergency care providers.
    This regulatory and legislative ‘contamination’ reached an extreme level when a consumer advocacy group pushed through legislation that limited what emergency physicians could charge the uninsured in California when these patients met certain income thresholds and requested a charity care discount. Note that other physicians were excluded from this charge limit, even if providing emergency care. This came about because the California Medical Association decided to remove their opposition to this legislation (AB 1503 2010) in exchange for the author’s willingness to apply this limit only to emergency physician services.
    In the face of this recent plastic surgery case, I can’t help but wonder what this consumer advocacy group now thinks about their legislative ‘deal’ with the CMA.

  16. Vladimir von Winkelstien says:

    “In your system…”
    “You going to just start forcing specialists to work for whatever amount of money you feel like paying them?”
    “From your comments on this issue, it is apparent that you believe…”
    “On an outpatient “non-emergency” basis, then I assume you still believe…”
    “If you want to pound your chest and declare yourself victorious in this argument…”
    (After I say, “I don’t have a system”) “So your proposed system would allow…”
    “Pretty much it appears you are advocating…”

    Please stop trying to put words into my mouth. It’s extremely annoying.

  17. [...] physician-blogger “Birdstrike, MD” wrote a post in response to an earlier blog comment by a “Johnathan Blaze.” While I believe Blaze’s comments where wholly off the mark, I find Birdstrike’s [...]

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